Those who have ADHD were born with it. You learn everything with an ADHD brain and never know what learning, living or executing a plan are like for folks without ADHD. When you figure out that others have better emotional and executive self-control than you, you can’t really imagine what it’s like to be them. Imagining better self-control is about as easy as imagining living on the other side of the world. You can guess dozens of details, but thousands never occur to you, till you get there.
When I held the very first ADHD pill I took in my hand, I tried to imagine what I would be feeling in an hour. An hour later, the answer was ‘nothing’. By the end of the day, the answer was still ‘nothing’. I felt no joy, no elation, no energy, no buzz, no euphoria, no calm, no peace and no different. But looking back on the day, there were a thousand differences from the patterns of the previous forty years that were all small, but collectively stunning.
I learned a lot about ADHD in the first few days after I started medication for it by what changed and what stayed the same. I found myself able to do things that I had never been able to do before. It was far more exciting for me in some ways, than for my wife.
“Guess what I can do?” I prodded her excitedly. “I can simultaneously talk to patients AND keep mental track of the time!” This was very new and different. I could think of a world of useful things that could be done with such a super-power. Not get an hour behind my schedule every day for example.
Her response couldn’t have been more deflating. “Yeah, hon, everybody can do that.” She didn’t even look up from the book she was reading.
“Well I couldn’t before the meds, and I can now,” I replied.
She looked at me with utter incredulity, like I had just told her I’m Martian and need to catch a shuttle back there now. Her concept of ADHD was changing just as fast as mine. The surprise in her eyes relaxed, and she grew more reflective.
“I never imagined you couldn’t do that,” she said. “I thought you were choosing not to.”
We had been married almost 20 years, and she had never known this stunningly basic fact about me. She assumed that I wanted to come home late every night more than I wanted to be with the family. There were plenty more surprises those first few days.
I drove home from work one night (an hour earlier than usual) in crowded, but fast-moving traffic. The driver in front of me was very erratic and irritating. I felt the manly impulse to drive right up her rusty tailpipe, flashing my lights and generally intimidating her into driving less erratically. (“Great plan with a high chance of success!” you’re probably thinking.) The thought of arriving home safely and calmly also flashed through my mind, and I backed off a couple car lengths.
“Does this pill make me a driving whimp?” crossed my mind. The only answer I could think of to my own question was “No, given the choice, I’d rather relax and think my own thoughts than to be a butt-head.” Once again, it was a brand new thought for me that I had a choice of reactions to this annoyance, and the simplest choice was to relax and not be obnoxious.
The most remarkable thing, though–and it occurred time and time again–was how simple small work tasks became. I could look at several necessary jobs, pick the top priority and start working on it with less effort than it takes to read this sentence. People who don’t have ADHD probably never imagine how much effort goes into the smallest task, the simplest morning routine, nor do they know how frustrating it is to spend that much effort and still do it badly.
With ADHD, the amount of internal wrestling you go through to start a mundane task is many times the work of the task itself. If you’ve ever spent 10 minutes getting your teenager to spend 2 minutes taking out the trash, you know what I mean. People with ADHD cajole and plead with their inner teenager to finish every item of the morning routine, to start every simple task of the work day, to pick up every piece of clutter.
Experts refer to this as “motivational impairment”, but it really deserves a much more descriptive name, such as “the soul-wrenching effort to shame yourself into doing small, mundane tasks, by imagining that God and your ancestors will hate and disown you if you don’t”. “Motivational impairment” is the short-cut the experts use to save time in their busy research labs.
The need to start a task occurs hundreds of times in a day. People who do hundreds of tasks in a day deserve to feel tired, and they deserve their rest at the end of the day. People with ADHD may only accomplish dozens of tasks, because of the exhausting inefficiency of wrestling our minds from task to task. We may be working harder than anyone knows behind the scenes, but only get credit for the work accomplished. There is no credit for the motivational “pre-work”.
Being able to do a full day of simple work is the most amazing thing I experienced after starting medication. It’s like waking up and taking a deep, delicious breath of the morning air, and realizing that—as far back as you can remember—all you’ve ever known is breathing through a straw.
oren – great post! answers a lot of questions and misconceptions people have about using meds. I will link it.
Thanks, Doug. I’m not going to believe it next time you say you aren’t techno-savvy!
This article could not be more true. Thanks for your insight and explaining me better than I could ever do myself.
Thank you thank you thank you. Our son is, as I say, OFF-THE-CHARTS ADHD, and I have trouble getting people to just lay off him, and give him some credit. Sometimes that person is myself, on a bad day. I will share this ad nauseum. So excited.
yes this is good post and reflecting what I tell in my practice.
In order to define the end of effect I rather look out for the disturbances rising again then for the effects themselves as they are more visible in retrospective.
Where I am not yet very sure about is when I should rise the methylphenidate doses to unusual high ranges and when to switch to dexamphetamin or add or switch to atomoxetin.
You spoke about the courage needed by the patients, but the courage needed by the unexperienced physicians is another topic and could explain why this disorder is so severely underdiagnosed and undertreated in adults, at least in many european countries as mine: Switzerland.
Thank you and have a nice day!
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Thank you for your comments, Dr. Kaufmann. I personally favor the addition of atomoxetine over high doses of stimulants. My definition of ‘high dose’ is >1.5 mg/kg/d methylphenidate or >0.8 mg/kg/d amphetamine. Honestly, I ask most patients on one stimulant to do a second trial of the other stimulant to see which works better in the individual case. There is no clinical algorithm that predicts whether an individual will respond to a trial of any ADHD medication.
Finally, I believe your comments on courage are correct. The under-diagnosis and under-treatment of ADHD in Europe is quite tragic. Physicians who wish to do right must strike out “against the crowd” to diagnose and treat ADHD outside the US.
Thank you so much for this article. It explains a lot to me about my 11-year-old daughter who was diagnosed with ADD in December 2013. She can’t fully tell me what it’s like to live with ADD but your article gave me a new understanding. I was very wary of giving her medication for it because of a lot of bad things I heard about Ritalin. She has a very good doctor who went over everything with me and listened to my concerns. She happens to have personal family experience (nieces and nephews) who live with ADHD and how it affected the ones who haven’t been on medication. My daughter is taking medication and it’s really helping her. Your article gave me a little more insight to what my daughter is going through and I thank you for that.
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And thus anxiety builds as I worry about what tasks to do next and dreading starting anything. So exhausting. Thank you for explaining how overwhelming ADHD can be and explaining to me the link to my almost life long struggle with anxiety… my weapon of choice to motivate my sluggish self.
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dale – there may be better ways, strategies, organizing, makes life easier
A perfect explanation. Being diagnosed myself last year this was EXACTLY my experience. It’s the little tasks – starting them is the hardest thing I do and the pleading and reasoning that goes on with my “inner teenager” takes up so much time and is the source of so much shame, guilt and frustration. The meds are helping, but finishing this PhD is going to be a long hard journey…. Thank you for reminding me that there are others in my tribe…
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Yep, and finishing your PhD is also going to be the most awesome triumph over chaos and inertia!
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Thank you very much . I have adhd since i was a kid. Now im 33 just been trying to find happiness my whole life and ive had it in bits and pieces and always had to fight for every piece. Living with adhd without proper medical treatment is a monumental task for me.. countless frustrations, disappointments,embarrassments, bullying, rejections, isolation but im still alive in 2014 an amazing thing happened after having prozac coupled with omega 3 for few months continually i started feel how a normal person would feel and think and do things it was to me kind a godly feeling. I even came to believe i was kundalini awaken thats how the spiritual people feel after years n years of meditation.
The feelings stayed with me for 5 – 6 months i was having a time of my life meeting people making new friends people just loved me i start to talk with lot of energy and tone. did good in business too wow that feeling. And then it started to fade away even though i continued the medication .—- emptiness numbness started to take me over again… now im again to my old self. Living day by day no hopes. Am still alive coz i have two young brothers i live far away from them i dont want to be a bad example for them by killing myself.. Most people in this world are gifted with healthy brains nobody takes this in to count the fact how valuable is to be able to feel all the feelings staying focus naturally. completing tasks without wrestling with your heads….
Sorry for my English im not a native speaker.