Last week I received a fascinating email from long-time reader Dr. Heather Brannon, a family medicine physician who has been treating Attention Deficit Hyperactivity Disorder (aka AD/HD) exclusively since the beginning of 2013. The gist of her email was surprising: had I considered getting diagnosed for AD/HD?
She explained further:
[…] When I was practicing family medicine I stumbled upon the discovery that many of my patients had AD/HD and I found that treating it well was life-changing for them (no exaggeration here at all) because AD/HD impairs every aspect of an adult’s life.
I just wanted to send you this email to encourage you to be evaluated for AD/HD and get it treated. The thing is people don’t realize that AD/HD is caused by a deficiency of dopamine in the brain and we all need dopamine to be interested in things. AD/HD should really be called Interest Deficit Disorder. Because it’s a chemical deficiency (like Type 1 Diabetes, hypothyroidism, low testosterone, and menopause) the treatment of choice is medication. That’s why we use the stimulants but they should really be called “Dopamine Replacement Therapy”.
I hope I haven’t offended you by sending this email. Please understand it is not a criticism or judgement. I actually recommend several of your tools to my patients. I just know that angst you feel isn’t necessary. […]
As this was coming from someone who has been following my blog for quite some time, I was highly intrigued. I’d known for a while that some of my tools were very appealing to people who described themselves as AD/HD, as I design them to require minimal focusing, computation, and memorization skills. I thought of this merely as good design / common sense, and didn’t think that I had AD/HD from the Wikipedia article I’d read long ago. I was intrigued enough to look through it again, and noticed I did notice a handful of related disorders that did ring true for me:
- Anhedonia – “a loss in the ability to experience pleasure from activities usually found enjoyable”; in my case, I don’t even feel like doing these things because I’m feeling burdened by numerous goals. Expressed as a lack of desire to go and do “fun things” because I perceive that as a delay in “getting my stuff moving for the future”.
- Insomnia – Not so much an issue right now, but I do tend to stay up late because I don’t want to “miss” anything.
- Difficulty in exercising attentional control; which I had thought of as just being “bored by mundane tasks” instead of an issue. But I am entertaining the possibility.
- Low tolerance for stress – This despite not having many external stresses; they’re all the kind that comes from my own ambition and the number of goals that I have.
- Tire easily – These days I find that I need to take a lot of naps. I thought this was due to the amount of energy it takes to be creative and forge new paths for myself, and I am not convinced that this is not the case.
I can think of a lot of causes for these symptoms…stress and depression seemed like likely causes, after all. However, I am not a doctor, and Heather provided a link to a video she had made for her patients, Life History of Someone with AD/HD that was eerily descriptive of how I often feel.
I’ve written a lot about the quest to be more productive and proactive over the years. My process has been to look for recurring patterns in my behavior and then hypothesize ways to work around them. I’ve taken inspiration from books like The Alchemist, The War of Art and The Creative Habit, incorporating their wisdom into my belief system: I believe that the great big ball of resistance is part of the creative act. If it was easy, then it wasn’t worth doing.
It never occurred to me that my resistance itself might be due to unbalanced brain chemistry. I reckoned my experience was pretty normal for people with curious minds regulated by high standards and finite resources. I also figured that that everyone had some form of resistance in them somewhere in one form or another. But that isn’t to say that there is ALSO the possibility that there might be something to investigate along the lines of low dopamine production.
My gut reaction: I’m not severely handicapped by my resistance. Personally, I hate the idea of altering my brain chemistry because it makes me who I am; the use of drugs to increase creativity, or reduce fear, or otherwise change my emotional reactions is highly distasteful to me. I have never used drugs recreationally and avoid drinking alcoholic beverages. I don’t even like taking aspirin when I have a headache, if I think a nap will take care of it. My resistance to the idea is tied to the idea that a flexible mind can overcome any obstacle that it faces; one of my favorite movies is Star Trek: The Wrath of Khan‘: I don’t believe in the no-win scenario! I believe in routing around difficulties and outflanking the problems!
So I wrote back:
[…] I don’t really feel impaired, though, probably because I’ve created a comfortable bubble for myself that I’m starting to outgrow. If I wasn’t ambitious or liked to settle, I probably would be existing quite happily and uneventfully like everyone else around me; I see these as the frustrations of anyone who wants things to get done and doesn’t like delays. Since I don’t have a team I’m working with or working FOR me, I see the main barrier as myself, so I write a lot about that. In the interest of emotional transparency, which is one of my values, I identify what I think is the source trigger, and then proceed from there. Maybe that’s a description of AD/HD? I don’t really know what AD/HD is, but what I’m describing doesn’t seem like something holding me back. I do know there’s a lot of users of my productivity tools that identify as or are AD/HD, people who are looking for answers while working in challenging environments. I think relatively speaking, I’m pretty focused, but I don’t like dealing with the unfocus of people around me, and I don’t like inconvenient activities. Is this something that really needs to be ameliorated?
And a little later, I added the following:
[…] I have tended to think of my challenges in terms of a mismatch in my innate desires and unmet needs versus the need for self sufficiency; everybody has stuff they don’t like to do , right? I think an AD/HD diagnostician would have to be able to convince me that a treatment isn’t about altering brain chemistry to make difficult life decisions easier to make, though I’m not sure exactly what I mean by that. […]
In her email followup, Dr. Brannon made these points:
It’s funny that you say you don’t want to make difficult decisions easier for many reasons. The most interesting to me is that is what most people with AD/HD say. Because they have had to put forth so much effort all their lives, not only do they think that’s normal, but they also consider it a badge of honor. While many of them think of themselves as lazy (or maybe significant others and parents think of them that way), they’re actually very industrious and hard-working. It’s just they have much less to show for all their hard work.
DOH! While I hadn’t thought of it as a “badge of honor”, I had thought of it being an indicator of “worthy challenges”. Which then proceeded to bum me out when I couldn’t overcome them right away.
The good doctor continued with:
I recently had to write a letter to the LPGA for one of my patients who is a professional golfer. In the letter I explained that treating AD/HD doesn’t create an unfair advantage. On the contrary, because treating AD/HD effectively just means correcting brain chemistry levels, it really just levels the playing field. That dopamine deficiency I talked about earlier is like the insulin deficiency in Type 1 Diabetes, testosterone deficiency in men with low T, and estrogen deficiency in women who are menopausal. Nobody in their right mind would tell a post-menopausal woman to “just try harder” to make the hot flashes go away. Hehe!
An excellent point. There are two other beliefs that I sensed, which I’ve dragged out of the shadowy muck and defined as follows:
- I don’t want to be “normalized” through drug therapy. I kind of enjoy my weird creative hurdles. It’s irritating at times, but the struggle to overcome them is challenging. Somewhere in the back of my mind is that my struggle is what has made me who I am.
I’m not sure that I want to lose my resistance because I’m USING it. I don’t think it’s possible to eliminate resistance to all things that are challenging; I use it (I think) to identify opportunity. Certain goals are hard, time-consuming, and difficult to track down. Perhaps my attitude toward them can be improved…but what would that mean? I’m a little bit scared of being happy, maybe, without conflict. The writer in me distrusts lack of conflict.
While that’s how I feel, I don’t know for sure how “true” my sentiments really are. Does struggle have to define me? Is this the badge of honor I am making for myself? Am I really using my resistance, or have I fallen victim to Stockholm Syndrome and have become the Patty Hearst of Resistance?
I must admit my ignorance and acquire more data!