Wednesday, March 20, 2019

ADHD + Medicine from the Inside (TMI Digression 2)

I was diagnosed with ADHD just before my 50th birthday. I was a little shocked at first, and even more so when medication was recommended soon thereafter.




Six months later, the honeymoon is over, medication-wise, but I cannot deny that my life has changed in wonderful ways. I still bounce between grief over half-a-century of unnecessary self-loathing, judgment, and shame, and tremendous gratitude that the page seems to have turned, at last. I am also grateful that the things I managed to learn, as an adult, to survive and thrive with undiagnosed ADHD, have made me so valuable to my students, who are getting something I did not get, and the healing in that for me is impossible to overstate.




My students’ experience with ADHD medicine has always been hard to glean--I’m either told it “helps” or not told anything at all--just as their individual experiences of ADHD itself are pretty inscrutable. It is very difficult for them to describe, because they know no other way of being: it is the water they swim in. It has also been, I now know, the water that I swim in. But I think I might be more able to describe the contrast, in my own life. It has clearly impacted my personal interactions, as well as approaches to tasks, and productivity in general, in pretty profound ways, explained hereafter.




The primary difference between my experience and what I thought my students were experiencing--and what educators are often told they are experiencing--is that my distractibility is primarily internal. That is, external distractions do make it harder to focus, sometimes intensely so, but this really doesn’t touch on the key debilitating and emotionally crushing piece, which is that often I could not tell my brain what to think about. Productive focus has always meant that a huge, invisible mental effort was dedicated solely to batting away intrusive thoughts, and when the executive part of my brain doing that got tired and took a breath for a second, the intrusive thoughts¹ immediately pounced and filled that exposed bandwidth with associations and worries and musings, until something environmental or internal randomly happened to redirect me to the task at hand. When I’ve asked students about this, they generally identify with the experience.




So, what follows is my before and after experience with medicine. After several months trying a few different combinations, I have been on the same regimen for about three months now. I say “the honeymoon is over” because it is clearly up to me to make the most of what the medication gives me. I can still fall into compulsive behavior; I still have emotional ups and downs; I still struggle to eat right and exercise. The medicine gives me precious, new executive control of my own mind--I can aim it where I want, keep it there, and utilize far more bandwidth for the area of focus than I have ever known. This is a revelation. But it is also ALL the medicine does for me. Which is, actually, a good thing, in the long run. Lastly, I need to say that this is a snapshot of today--it may continue to change for better or worse, and if you are reading this after March 2019, you might check for updates!

Right now, today, much has changed:

Interactions

I noted in the previous blog post how shocking it was to be able to listen to folks’ entire verbal contributions in meetings, without associations from things they say constantly carrying me away into my thoughts without asking my permission. Now, a rising mental association is simply an opportunity to reflect, not a slippery slope into oblivion, and to my amazement I can reflect with focus, while maintaining focus on what is being said, simultaneously, because I have so much more mental bandwidth to work with now. It is like switching from trying to function while running through a dastardly funhouse to doing it while moseying through a quiet meadow.




I have long considered myself an introvert, and I think that is true, but not nearly so much as I had thought. The accumulated anxiety from years of randomly not hearing what people say, or not remembering key details that I did hear, because they went in and out of my head so quickly that nothing stuck, has made me interaction-avoidant. The message people get is often that I don’t care enough to listen, or to note, things they say, and it is off-putting. I’m sure I have seemed self-involved, uncaring, disinterested, or worse, at times when I actually felt the polar opposite of these. In fact, the anxiety that grows around this dynamic makes it self-perpetuating and self-reinforcing.

The flip side is the hyperfocus that comes with really caring, which makes me notice and remark upon details and subtleties of the conversation and environment that the other person whom I care about so much may not have noticed at all, and I can sound super-nerdy, quirky or random, and when I see that familiar bemused expression on their face, I retreat. These are things that echo in my adulthood more than they are actually present--I have learned to be me and be OK, for the most part--but I think the cumulative experience has shaped me a great deal. Very early in my experience with medicine, I began to find social situations less overwhelming, and less worrisome. I seemed to have the bandwidth to calibrate my interactions casually to the people around me, and I was no longer so afraid of missing what people said, and being off-putting in that way. I care a lot about people, and now that doesn’t express itself in hyperfocus or anxiety as much as a genuine happiness to see and interact with them. We meet in the meadow instead of the funhouse.





I have had the same umbrella for this entire rainy season. That has never, ever happened before. It is a bigger deal than it sounds.


Sequential Tasks

In the mornings I make breakfast and lunches for my two daughters, as well as myself, get them up, and dressed, and try to exercise and finish up whatever dishes need to be done. A year ago, I had learned that this took me 60 minutes to do without exercise and dishes, 90-120 minutes with. I would decide how ambitious to make each morning based upon how much time I managed to give myself by waking up early enough. Once in the kitchen, that room became the boundary that kept me on task. Whatever direction I looked, there was something to do within this set of tasks, and I did whatever I saw until I was done. This meant I was doing everything at once, darting across the kitchen countless times, and opening and closing cabinets as well as the refrigerator and freezer over and over again. If anyone tried to talk to me I would probably forget what I was doing, be unable to restart where I had stopped, and fall behind schedule incrementally. This meant that anyone saying anything more than good morning to me would be greeted with a sigh at best, exasperated frustration at worst. That is not a nice greeting, but it is very hard to maintain a cheery demeanor when being productive always feels like juggling fine china. I am grateful that Emily has endured me for a decade.




Now, I can actually do these things one after another. I open the fridge and take out all the things I need, and I put back things all at once at the end. If I have time, I do dishes, then lunches, then breakfasts, then wake up the girls and instead of running away to finish the chores, I can actually visit with the girls while supporting them to stay on task (which is strangely hard for them...) on many mornings. These things take about half the time that they used to, and rather than juggling china mentally, it is like hiking up a familiar trail; if I get stopped it is obvious where to go when I start again, and though there is exertion, there is usually not much stress.




On my way out the door in the morning, not only am I able to think through whether or not I have everything for my day, but I remember to do that. Of course, remembering was not really the problem before as much as simply having either no ability to muster an idea of the day ahead and the necessary supplies for that day, or not being able to spare the considerable time it would take to do so. I think we sometimes remind kids to “think through” what they need, not realizing that remembering to do so doesn’t mean it is something they can actually do.

Productivity

As addictive as screens and video games seem to be for so many, I think people like me probably experience an additional layer of compulsion. This has been greatly reduced for me, if not stripped away, by the medicine. My primary compulsion of this sort–my Fortnite, if you will–is pinball. For years, I have known where all the machines are near any workplace, school, or other place I regularly spent time.




The interactive, high-speed, kinetic nature of the game, combined with the patterns of shots that one strategizes while playing, make for an immersive in-the-moment diversion that completely removes me from other cares and concerns. By contrast, the electrified tightrope of perpetual mental exertion to focus, produce, navigate, and interact in the world of work and people is desperately tiring and simply doesn’t turn off by itself. In the past, I am embarrassed to admit, I have regularly driven 45 minutes in order to play pinball for 15 minutes during an hour break. There was a desperation to it; the moment my hands moved to the flipper buttons, the relief was palpable... Simply put, I don’t need that the way I did before. I find myself with a 90 minute break and a start instinctively to pack up to go play, but then realize I’d rather get some in-depth analytical work done for a client. Making that choice used to mean enduring that tightrope for hours longer. Now, it means, getting that work done, and feeling the satisfaction of a job well done, before maybe taking a little walk and continuing my work day refreshed.

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New Challenges

There are times, now, when I find myself wondering if the medicine is still working, because I am already so accustomed to it. But I have a built in reminder system–all I need to do is miss a good night’s sleep, and its effects are greatly reduced. I’m reintroduced to the Mike I knew for five decades, who works so very hard to muster hyperfocus when he needs to get things done,² and who has learned myriad self-supports to function (relatively) effectively in the world, and I am again grateful for the medicine’s support.



When I first started the current medicine, I had no appetite until the end of the day, and struggled not to overeat in the evenings after starving all day. But I adjusted, and then my appetite actually returned, for good and ill.




I am bone-tired at the end of the day, and it is sometimes sad that my family gets that version of me, while the world gets a much sharper one. But in the past caffeine did the very same thing, frankly, just much more acutely and erratically, with far less benefit (nowadays I drink about 3-4oz in the morning, and that’s all—it’s pretty clear I was self-medicating with caffeine all my life). The good news is that I now have the resources to notice and act on this, to learn to bring my whole self into my day, and then into my home as well. It was just too much before.


All of these things may change, of course, and I may have to go back to an unmedicated version of myself in the long run, but at least I will be armed with the knowledge of what efficient cognition can be like; perhaps I will learn to meditate after all, knowing better the benefits I am after.



And I do hope that many others, too, who may not yet realize what is possible for them, because their struggles are the water they swim in, will find the tools to step out of the storm, out of the funhouse, out of the swamp, out of the pit, and into a place of calm and light, of clarity and joy.
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1. Anyone who meditates probably recognizes the “intrusive thoughts” idea, and I do believe meditation is likely very helpful–I have really tried it, repeatedly, and will surely do so again. I also think that people without ADHD who assert that meditation is “the answer” are a little like healthy people who prescribe positive thinking for the terminally ill. Frankly, I am excited to try meditation again, with medication, because it feels like it may actually be possible for the first time.

With or without medication or meditation, as a wise colleague reminded me back in December, best practices for overcoming ADHD will be integrated approaches, using combined methods to combat a complex problem: things like therapy, direct instruction, nutrition/exercise, medication, meditation, etc. Not one, but many.

2. It is clear that the incredibly attentive, nuanced work about which I care so much– one-on-one academic help for students –has been an ideal, naturally-occurring hyper-focus environment for me, for years. I’m assessing, planning, translating, observing, communicating, suggesting, inviting, calibrating, and improvising moment-to-moment, and it feels like my most perfect niche, as a human and a professional



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