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.

I'm Coming Back

After more than a year's hiatus, I am back. This year has been difficult and remarkable, and I want to share parts of that, because I wish I had had someone else whose experiences reflected mine. The two postcards here are from Post Secret. I don't know who wrote them, but they will be my jumping off point, my raison d'etre for coming back to this blog.

Every once and a while, I see a secret on the Web site that reminds me of myself, but these two so closely encapsulated my most recent decision to return to grappling with ADD, that I gasped. I am sharing them here and will refer back to them in the near future.

I hope that I can develop this Web site into a real resource for others. Again, please e-mail me at addblog@gmail.com or leave a comment if there is anything you would like to see.

With a year break, I will have to do some promotion to get readers, but I am also going to change the focus of this blog a bit.

Lots more to come.

Stereotypes, Ignorance, and Britney Spears

I have not posted in ages, and I promise to write a substantive post soon. But for now, I just wanted to comment on something that I found ridiculous, offensive, and factually incorrect.

Last week's US Weekly, which granted is not the authoritative source on anything other than photographs of and gossip about celebrities, wrote (emphasis mine):

Days after a judge ruled that Britney Spears could only spend three days a week with her children, she reacted by leaving her two kids in a parked car with a court-appointed monitor (whose job description does not include babysitting) as she shopped for $18,200 worth of chandeliers at the Crystal Place design shop near L.A. November 4.

Why does Spears, 25 — even after having physical custody of her kids taken away — keep exhibiting such questionable parenting skills?

Sources say the troubled pop star does not seem to grasp the gravity of her custody case, and they blame her bizarre public behavior (swapping clothes with a stranger, among her recent moves) on psychological issues, not drugs.

“It’s not substance abuse — it’s mental!” a confidante tells Us."Pals suspect adult-onset ADD or depression, with one friend saying, “Postpartum has always been a problem” after giving birth to Sean Preston, 2, and Jayden James, 1."

This is problematic for a number of reasons.

First, it might be true that Spears is dealing with mental illness, but it is unlikely that all of her bad judgment, or even most of it can be attributed to mental illness. The article implies that people with mental illness, people with ADD or depression would be unable to take care of children, or that an imbalance of serotonin or norepinephirine would cause someone to think it was O.K. to trade Halloween costumes with the bartender. I am not a doctor -- and it should be noted that Spears' friends and US Weekly sources are not doctors either--but I am pretty sure that that's pretty unlikely.

Secondly, and this is what caught my eye in the first place, there isn't really such a thing as "adult-onset ADD".

According to the DSM It is essential that "some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. As Doctors Glenn Brynes Carol Watkins, of Northern County Psychiatric Associates in Baltimore wrote, "By definition, AD/HD is a condition that has its onset in childhood."

It's great that Spears' friends -- or so called friends since they are dishing to magazines instead of getting her help--are concerned, but US Weekly perpetuates all sorts of falsehoods and stereotypes by printing these guesses. All that would have been needed to fix it was one line from a doctor explaining what was and what was not possible. Maybe this week's cover story on Spears' childhood will reveal a long-time struggle with ADD. Maybe. I am not holding my breath.

I am all for celebrities with ADD or any other disorder talking about it to raise awareness and to educate people. But spreading ignorance and perpetuating stereotypes? It doesn't make dealing and living with ADD any easier for those who have it. Even US Weekly should do better than that. Or for a magazine as widely read as US, maybe I should say especially US Weekly.

News For Thought

This New York Times Magazine article, "Self Non-Medication," is one of the best examples of science journalism I have seen in quite some time. It is a personal story of a man trying to go off of depression medicine, which I should note is not at all necessarily reflective of ADD medicine. What is great is the mix of personal and science. It is an interesting look at the quesiton of taking medicine, though admittedly for a different disorder.

It's a bit long but well worth the read.

Enjoy.

A Preliminary, Personal Decision

Part 1 in a series on medicine and the thought processes that go into deciding to take it.

It's been a while since I wrote a post here and even longer since I wrote a post of substance. So here goes. A lot of the books I have been using are sitting in a box in my parents' house, so I am going to try my best to write about medicine without the books and will write an updated or new post when I unpack that box. Because it seems I have a lot to say, this post will just be about deciding whether or not to take medication and later posts will cover the options. I'm trying out this bolding key sentences style as a way of breaking up huge blocks of text.

First off, there is a lot of bad information on the Internet. By bad I mean either patently false or very biased. There are people who don't believe in taking medication ever, there are those who don't believe that Attention Deficit Disorder is in fact a disorder and therefore don't believe in treating it, and there are people who are paid by drug companies to promote specific drugs. Know that and do not self medicate. It's not worth the risks, and even with the medicine that says there are "no side effects" there can still be side effects because each person reacts to medication differently (I had horrible side effects with a med I tried, even after being assured by a top doctor that side effects with that medicine were extremely rare) and there are ALWAYS risks if you are self-medicating.

I firmly believe that the decision about taking medication for ADD is an extremely personal decision, one that should be made with your doctor and whoever else you choose to consult. No one else, not even if you are still on your parents' health insurance, should be allowed to weigh in without your consent. (Keep in mind, this is a blog directed at adults with ADD, it might be different when the person in question is a small child, but I am not commenting at all here about medicating children. That's a whole different discussion that does not have a place on this blog). For that reason, I will not write here anything about whether or not I am currently taking medicine or which ones, if any, I am taking.

When I first considered whether or not to take medicine, my primary concern was that my personality would change. I didn't want to lose the speed at which I talk, the sharpness of my sarcasm, my ability to be interested in multiple conversations and topics at once, or my creativity. That's not to say that there is any medicine for ADD or ADHD out there that does that, but there were things I was worried about. I had heard descriptions of high-schoolers complaining that their friends were so much more fun -- funny, loud, all around goofy and more active--when they didn't take their medication. And I didn't want that to be me, even though I had been told by more than one doctor that those effects were common in people who have the hyperactive subset and in children, neither of which I was, I was still nervous. But this quote of a mother describing her child on medication : "She's still my dreamer, but now it's on purpose that she dreams" (Hallowell, 40). In short, the medication didn't stop her ability to dream, only let her choose when to do it.

When I considered taking medication, I decided that I would tell a few very close friends, friends who knew me very well and would see me in varying situations. These would be the only people I would tell at first--three or four people total--and I would let them know that I expected them to be honest with me. Did I seem less distracted? Was the change noticeable? Was the change positive? Were there personality differences? Were there things that were missing, and if so were those things that they were glad to see go (like, walking into the middle of the street with out looking, temper bursts, too much anxiety) or quirks that were part of who I am?

Pay attention to things that irk other people. Are those things that you want to change about yourself? Are those things that medicine could help you change?

One more thing to think about: You should be able to tell if the medicine is having an effect, so with people with more mild forms of ADD or ADHD, you might want to take your environment into account. About to leave school and start a job? Switching from one job to another? About to go on vacation? Do you want the extra boost (and I mean this in an entirely positive, way. Taking ADD medicine is not cheating or giving you an unfair leg up. It's leveling the playing field) as you start a new job, or are the demands on your attention so different that you need to be able to see what lack of attention feels like before you can decide if it needs to be remedied? In other words, are you going to be able to tell what changes are caused by medicine and what are caused by a new environment? Is that something that you are concerned about?

This post is full of questions, many of which people might want to bring to the doctor who is prescribing the medicine, but they are also questions to ask yourself, because as I said before and will say again, taking medicine should be an informed, safe, and intensely personal decision.

NEXT: On the different medicines. What is out there? What are the differences?