News For Thought: Science and Pagents

Or, Getting Things Done: Update

My white board has had the same to do list on it for days: Get up, shower, eat breakfast, get bag together, pack lunch.
Which is not to say I have not done those things, nor is it to say that I have done those things consistently every day.

It's just to say, that pure drive isn't cutting it. I have a hard time ending my day (i.e. getting done whatever I need to get done before going to bed) and I have a hard time starting my day, or getting out of the house in the morning, a white board and some organizational tools and sheer will power are somehow not enough to change that.

Which, I suspect I knew. Still it was calming to see this article in the Washington Post, highlighting a study about the biology of ADHD. Sometimes, it's nice to see that reasserted.

The JAMA study said that, compared with a group of healthy subjects, brain scans of 53 adults with ADHD revealed a flaw in the way they process dopamine, which among other things, alerts people to new information and helps them anticipate pleasure and rewards. Swanson speculated that people with ADHD may even have a net deficit of dopamine.

The findings offer support for a long-held theory about why people with ADHD tend to be so easily distracted and bored -- so hard to teach in school, so prone to end up in high-stimulus jobs such as in sales or the media, and so susceptible to gambling and drug abuse. According to the theory, the trouble is a lack of motivation as well as a deficit of attention: People with the disorder can't generate the same degree of enthusiasm as other people for activities they don't automatically find appealing.

I don't highlight this to say that motivation or Getting Things Done is a lost cause, only that there are issues that might not be able to be solved with a white board, or a program that shuts down my computer at midnight, or a fifth alarm clock or a ... . Note, that here lack of motivation is not a "well if only you wanted it more" kind of lack, it's an actual difference in the way that the brain processes cause and effect.

But that also doesn't mean that I am ready or willing to chalk up distraction, procrastination and the rest to ADD and shrug my shoulders. ADD doesn't need to be an excuse. Making it one just degrades the disorder and diagnosis.

I once had a camper whose mother told me "oh, he's not going to remember anything unless you pin it to his shirt. He has ADD. I guess it was good that she recognized that ADD affects all parts of life and not just his homework during the school year, but I think the positive in that recognition was far outweighed by the message she conveyed. You can give up on my kid. He has ADD. That's a message that is unfair to her son, to his counselors (who managed to get him to learn his lines without pinning anything to his shirt) and to everyone else who has ADD.

Don't even get me started on the people who randomly decide their kid has ADD because it's easier than actually getting tested, or saying my kid is acting up because she's annoyed.

(video from Jezebel).

Given things like this video (throughout the episode of Toddlers and Tiaras, it's clear that more than anything this woman's daughter is unhappy. Notice how the woman used "undiagnosed ADD" and "bratty" as synonyms. Ugh), it's hard to say straight up, "yes. ADHD is a biological disorder, so stop saying it's an excuse," because people are still using the term as an excuse. Still, I wish the Washington Post didn't frame the issue as an open-ended debate:

For decades, attention-deficit hyperactivity disorder has sparked debate. Is it a biological illness, the dangerous legacy of genes or environmental toxins, or a mere alibi for bratty kids, incompetent parents and a fraying social fabric?

Is it over-diagnosed? Maybe. Is it hard to understand? Yes. Is it real? Believe me, it is.

Getting Things Done: Day One

Purchases: A white board for day to day agendas. A notepad of weekly calendars for weekly goals. A binder, for a reason I forgot, but seemed important at the time. I think, among other things, I will keep track of bedtimes in there. I am going to try to make sure this blog does not turn in to only a log, maybe I will look into putting a widget on the side instead.

A New Try

I have four alarm clocks in my room not counting my cell phone. I have a clip with an outdated to-do list. I have a coffee maker. I have three lamps. I have a desk and two other places to sit that are not my bed. I am taking ADD meds (yes, I decided to take this piece of information public, more on that to come). I still do not feel like I am Getting Things Done.

So starting today, I am going to try a new strategy. Forget about the technology. I am going old school.

Today I am buying binders and a white board or two. I am making lists that are easily changeable, and I think the one technology thing I am going to do is set an alarm (maybe on my computer) to go off at bed time. I am going to try to forget about the panic that these goals make me feel and focus on this problem like a scientific experiment. I am going to try to post on this here, costs and all.

It IS Personal

I long avoided writing anything personal here, the thought being that this was going to offer the facts, and other places could offer feelings.

The problem is, it doesn't work like that. At the end of the day ADHD is a whole lot more than some misfiring synapses in the brain and questions about which medicines work and how.

It is almost entirely about how it effects ones life; if it had no effect, if it were only about the synapses, than it wouldn't matter at all if anyone had ADD. It would be a quirk like red hair or left-handedness.

But it's not. I recently read an interesting kids' book The Lightning Thief. Broadly, it and the other books in the series answer the question "what if there were children of the Greek gods among us mere mortals today." The answer, in it's unfairly abbreviated form, is those children would all be dyslexic (hard wired to read Greek not English) and have ADHD (hard wired for battle not modern-attention spans).

The thing I liked about it, is it didn't glorify ADHD. When the kids are in the special camp for "half bloods" (half god, half mortal) they are in their element, but they are nowhere close to godliness in the world everyone else exists in. They have real problems in school and in making and keeping friends. They suffer realistically with severe cases of dyslexia and ADHD.

It is a great read for middle school students because it is an intersection between literature and mythology, and--perhaps more importantly-- it creates a platform for thinking about what kids who are different have to offer (that probably takes a teacher's prompting, since kids are generally not threatened by titans in their day to day lives).

But for me, it also gave another message, one that I've been avoiding: this is something I have. It's the way I am. For better or for worse. Period.

So when my mom asked why a three page essay was taking me so long to write, I said "that's the way I'm wired" and moved on to talking about the importance of research and the idea that "the dignity of movement of an iceberg is due to only one-eighth of it being above water."

But being able to say "that's the way I'm wired" is the result of months and thousands of dollars in therapy. Which is to say that therapy is expensive and, I think for people diagnosed with AD(H)D in their adulthood, often necessary.

I still get massively frustrated with how long it takes me to get things done and the anxiety that the lost time and the frustration produces. But even as I am annoyed at myself, being able to say "that's the way I'm wired" without it feeling like a lame excuse, rather an explanation of how I will inevitably approach the world and the tools I will need to find and develop, is something that is important enough for me to share with others.

Important for me to post on this blog. So maybe others in similar positions will mull it over themselves.

News For Thought: Broader Mental Health, Learning To Swim

Internet troubles have slowed a bunch of pending posts, but in the meantime, I want to post an incredible project the Columbia Daily Spectator has been printing for a month or so: Mind Matters.

It's about mental illness and mental health in general, not just about ADD, but certainly worth the read.

And, for an incredible, personal account, read the editor's column, the first paragraphs (and last) of which are published below:

To the tenured, highly esteemed anthropology professor who failed me last spring:
“Why are you even here?”

This was the first thing you said to me a year ago when I sat down in your office before you explained that I would not be passing your class.

It was understandable. I barely attended any lectures or discussion sections, let alone turned in any of the assignments. I earned what Columbia students have to work extremely hard to receive: an F.

I left Schermerhorn, bawling as I walked back to Watt, where I hid for the entirety of my junior year. I thought about Richard Ng, a student who committed suicide by jumping into the East River two years prior. I didn’t know how to swim. It could work!

I ended the semester with an impressive 1.8 GPA. I felt mostly dead. But looking back, I realize I was living, and that was the point.

“Why are you even here?”

I didn’t come to Columbia to be depressed, mind you. I came here to take my high school valediction and press onward, to become editor-in-chief of this paper, to meet the man of my dreams. None of these things happened.

After a tremendous freshman year, things spiraled. I teetered on the edge of my 20th floor window in EC and looked down.

Over the next year, I would accumulate a number of diagnoses: major depression, recurrent, without full inter-episode recovery (DSM-IV 296.32), and borderline personality disorder (DSM-IV 301.83). One psychiatrist told me I actually had bipolar disorder. My mom told me I wasn’t practicing Islam enough. A professor actually told me I was a liar. My friend told me I was just being 20.

You could say this period constituted a Profound Experience, the one often criticized in other senior columns. I know I’m a cliché, and I laugh about it often. (See headline.) But, it is my experience, and it is all that I have....

I am painfully aware that I might have another depressive episode in the future.

But this time, I can handle it.

I wish you could see me now, professor. I got a 4.0 last semester. I live on the 20th floor of EC again, two doors down from a previous site of trauma. I am learning how to swim.

The Devil You Know

Part 2 in a series on medicine and the thought processes that go into deciding to take it. Read part one here.

Before I start this post I need to stress: I have no training scientific or medical and I cannot stress enough how important it is to consult with a doctor before making any decisions about medicine or treatment. End disclaimer.

In the year this blog lay dormant, I thought a lot about medicine for mental illness. I have seen my friends-- and, frankly, myself--struggle with a bevvy of diagnosed and undiagnosed problems and then struggle with the question of whether or not to take medicine.

What is it about taking medicine for mental illness that makes people balk? We take medicine for all sorts of things. For allergies, for colds, for muscle aches, for cramps, there's a pill for every ailment and we take them and praise modern medicine.

And then, we face mental illness. For many mental illnesses or disorders there are even physical symptoms. I don't think there are any direct physical manifestations of ADD, but the possibility of anxiety that comes with unchecked ADD certainly has physical effects, as does depression, which also can stem from unchecked ADD.

But its not the physical symptoms--of any mental illness--or not only the physical symptoms. Emotionally and mentally, medicine can be life changing and, in some cases, life saving.

Why the fear? Why the worry about taking medicine that can change a chemical makeup on the brain? That can address the biological basis of something as confusing and often as intangible as mental illness and disorders?

I don't have all the answers. I wouldn't even presume to have a single fully formed answer, and I can't speak for other people's fears; this is a question that plagues even some of the most accomplished psychiatrists and psychologists. But I've been thinking about it a lot and I have a theory.

I think that this idea works best when applied to adult mental disorders, which is the focus of this blog. I think it is particularly applicable to ADD, because unlike some other disorders that are treatable with medicine, ADD is something that doesn't just show up. You might get diagnosed later in life, but once you're diagnosed, you know that you've had it for a while.

Not to resort to cliches, but I think that the question of treating adult ADD is a question of the devil you know versus the devil you don't. Someone who gets an ADD diagnosis in adulthood had already found some coping mechanisms. Even though the coping mechanisms likely will have failed enough to start thinking about treatment in the first place, ADD is the way that you have lived . However effective or ineffective those coping mechanisms were the whole package of struggle and coping become part of your personality; you know what it feels like, you know what it looks like.

Medicine, however, is not known. Additionally, it's the failures of medicine that get more attention that success. Breakthrough technology gets coverage, but the day to day stories of people taking pills and feeling better are not news, are not talked about, and are not fretted about. A brief look at just some of the articles that have caught my attention, indicate how scary the Internet can be when you are looking for guidance.

In recent weeks the Supreme Court ruled that patients could directly sue drug companies, which then lead up to several other cases, where people who committed suicide while taking different antidepressants. It's in the news, and its frightening.

And then, there was a mystery diagnosis that the New York Times Magazine printed which featured some scary stuff about Concerta, one of the ADD meds. (That article, I think deserves its own, nuanced blog post, because Concerta is safe and was used in an extremely unusual situation that became unsafe). And there is news of over-diagnosis and over-medication. And then, this article about Paxil resurfaced on Slate. I suspect that it resurfaced because of the renewed interest in the legal ramifications of misusing, or mis-prescribing drugs, and because of the settlement of a case regarding poorly-made pills.

So there's the news, and the fear that the medicine will change your personality (whether that's the coping mechanisms or something larger), and the fact that at the end of the day, the only way you can tell if medicine is working out is by trying it and seeing how you feel. That trial and error process can be both scary and frustrating. And then there's the stigma, which to be perfectly honest should be lifted, but its not. It's still going strong, which is why this blog was anonymous.

So then you choose.

The devil you know: ADD and everything that comes with it: all the crap that comes with it, all the personality quirks that might be part of it, and all the coping mechanisms that you've sorted out over the years.

And then the devil you don't: medicine, all its uncertainty, and all the frightening stories that float around.

It's hard to get past that fog and see the positives, the possible assets among all the uncertainties.

That's one theory at least.

Adult Manifested ADD

Once I committed to coming back to this, it was hard to actually do so. First, I started this blog while on Spring break in college. And, second even after that, I had more time -- and more personal need -- to write this blog.

But, recently, now that I'm no longer in college and am now in the real world -- whatever that means--I've been thinking a lot about ADD again. Particularly about the warped, incorrect term "adult onset ADD."

The DSM standards mandate that symptoms manifest themselves before the age of seven. That much is clear. But then, there is the fact that this is a blog about adult ADD. As I understand it, there are two types of adult ADD. There are the people who had child ADD which turned into adolescent ADD, which turned into teen ADD, which turned into adult ADD.

And then, there are the people, who were diagnosed with ADD as adults.

In my case, it was the latter, though it came as a surprise to no one, including -- well, hypothetically--my first grade teacher who administered the hearing and listening test I failed.

But I would suggest the term "adult manifested ADD." A psychiatrist I recently spoke to said that for many people, ADD surfaces at different times in different people's lives: for some it's high school, for some it's college, for some it's medical school, and for some it's a first job, or a marriage, or what have you.

Different changes trigger different types of symptoms, different manifestations, and that's when the diagnoses come in, offering help in the wake of changes in a person's life that can be big enough, or different enough to allow the ADD to manifest itself.