Fake ADHD Isn’t Real (Part 1 of 7)

ADHD is a story we tell ourselves about a pattern of behavior.  As such, it isn’t real.  It’s not real in the sense that all the stories we tell ourselves aren’t real; they are mere interpretations/representations/translations of reality.  In the strictest sense, nothing is real other than reality itself. In this sense, ADHD is not any more real than democracy, love, God, and fantasy football.  To quote a cheesy movie, “There’s no such thing as an ass.”

The philosophical sense of “real” is not what people use when they question whether ADHD is a real thing or not.  I hope you’ll forgive my rhetorical trick in the title and keep reading.  The best search engine hits on my blog come from “fake” and “ADHD.”

Aristotle, a 4th-century-BCE philosopher, port...

Aristotle is the father of rhetoric.  His name is Latin for funky hat.

I get a little flash of anger when someone says that ADHD, anxiety, or depression isn’t real because these things affect me, the same way I get defensive when people assert that online classes aren’t real classes because I teach a lot of online classes, and people who make those assertions don’t know what the fuck they’re talking about.

Putting anger aside, though, I ask why would a person need to make such a denial?  People who use the term “real,” aren’t usually interested in metaphysics.

Consider Andrea Yates.  She’s the woman who drowned her five children, one a time, whose lawyer used postpartum depression as a defense.  She was found not guilty by reason of insanity.

I teach a class called “Justice in Literature,” which is a general education class for criminal justice majors.  I’ve used an essay about this case in class to talk about culpability and mental illness.

Most of my students are young enough not to have heard of this case, but knowing only a few basic details of the case, more than a few students have responses that condemn Yates.  They say things which seem cruel, like “she didn’t want to be a mother any more and used depression to get away with murder,” or “everyone is depressed sometimes, but only lazy people use it as an excuse.”

I don’t condemn such points of view in class, but explore them further, trying to use a factual approach as much as possible.  One detail I provide is the fact that by “winning” the case, a now-treated Andrea Yates spends her time in an institution with perhaps a fuller consciousness of her loss.  At the time of the murders, she was denied treatment despite warnings from her doctor and kept confined to the home by her strongly religious husband, and was convinced that by drowning her children she was saving them from eternal damnation.  People take many things from the Andrea Yates story; I’ve heard people blame religion, patriarchy, a too-weak medical system, a too-strong medial establishment. As a teacher I think it is more important to explore the reasons for one’s honest responses to texts rather than pretend to adopt the “correct” reading.  The former instance is called “learning” and the latter is called “coercion.”

(Next: Who said ADHD is fake?  Uh . . . I did.)

All my posts on ADHD “fakeness.”

What’s ADHD Like?

I’ve been following the ADHD subreddit lately:  http://www.reddit.com/r/ADHD/.  If you have ADHD, you should join it. (Because you need something else to follow.)  Anyway, one discussion I particularly like today is here:

http://www.reddit.com/r/ADHD/comments/1na6lz/i_need_help_explaining_adhd_to_someone/

Brainscan of brains with and without ADHD

Purple fire shoots out of my brain.

Taking the A Train, Part I

Two months since my last post, whaaaat?

Summer time is always busy, but geez. Being Cancer Dad will sap your time.  At the moment, I’m staying in the hospital with my son (we’re on day 5 now) so I’ve got to write or risk climbing the walls.

On the AD(H)D front, I went to see an ADHD specialist about six weeks ago.  He’s a physician who specializes in ADHD treatment.  I had a recommendation from a friend about a year ago to see this guy, but, ahem, ADHD.

I went to see him on a Thursday morning his office is in East Grand Rapids, a tony part of town (there’s a yacht club, for Pete’s sake!).   EGR is about an hour from my house, and I had taught a class the night before in Grand Rapids and decided to stay over with my brother who lives downtown GR.  I did not sleep well, unfortunately, and was quite tired that morning.

I found my way to the Sundance Grill for breakfast, had some fabulous breakfast tacos, but felt weird dining alone at a place with table service. I kept eavesdropping on all the business meetings going on all around me.  The best conversation was at the next table; a business man from Ecuador was being entertained by a local guy.  At first, I thought the local guy was being kind of rude, all he had to go on was stereotypes.   You like soccer down there, right?  But it turned out Mr. Ecuadorian returned those stereotypes right back. You all play baseball up here, yes? Mr. Grand Rapids said he actually didn’t like baseball all that much.

I got to Gaslight Village early, found the doctor’s office, then hit the Starbucks down the street to wait. My nerves were getting the better of me.  As I said, EGR is a tony part of town, and I was surrounded by very successful looking people in sailing, tennis, or yoga outfits, with the occasional hipster thrown in for seasoning.  I’m more at home in the university crowd with a bit of earthiness thrown in by going to my local Biggby’s in a college town, where someone wearing Carhartts might have just arrived from a construction site or an art history class (or both).  In all honesty, the pending appointment probably kicked up my hyperawareness a notch; my first meeting with a psychologist many years ago I started to question the choice of magazines and muzak in the waiting room.

I forced myself to wait long enough not to arrive too early, and then walked into the door of the doctor’s second-floor office at five minutes before my appointment.  The office was empty, not even a receptionist.  Knowing that this doctor himself has ADHD, I wondered if he forgot my appointment.

Instead, he appeared at the door and said “You’re early!  Remarkable!”  I guess not too many of us ADHDer’s show up on time.

I took a seat and he got ready for me.  I went in a few minutes later and we started the consultation.  I had very thorough testing before, so he didn’t see the need to re-test me, and instead we talked about why I had come.

I talked about being on Ritalin and that it was sort-of working sometimes.  I got about two hours of benefit from each 10mg pill and then felt terrible when it wore off.  I had filled out extensive paperwork ahead of time with medical history and self-reporting of symptoms and we went over that. (Another sign that they were used to dealing with ADHDer’s: the staff would not schedule an appointment for me until after I had filled out and returned the paperwork.)  I also talked about my son having cancer and my needing to have more executive function so as to be more reliable and available to support him and my family.

We talked about my issues, such as not being able to get things done on time, not being able to stop doing things that I get involved in, my unreliable performance, etc.  I also talked about how I couldn’t understand why Concerta didn’t work for me.  On straight Ritalin, about 40mg a day seemed right (four 10mg pills) but the constant roller coaster was exhausting.  I felt constantly fatigued and downright hopeless most of the time.  On Concerta, I never got the full feeling of benefit even though I was taking 54mg (Concerta is Ritalin with a time-release mechanism).  And I had been working with my GP who basically let me decide what to try (“sounds like the wrong person is driving that bus,” he said).

The doctor had the simple answer to this confusing problem: “Some people respond more to the slope than the level.”  Ritalin has a sharp up and down level in the bloodstream.  The dose of Concerta I took had had a higher overall level, but a relatively weak up slope.

Oh.

We talked through various other things and then he said I had sat long enough for my blood pressure to calm down.  My blood pressure always measures as borderline, but I was just the high end of normal, even though I had been nervous.  “Perfectly normal for a stressed-out dad.” At my GP’s office, they take my BP as soon as I get there, so I always measured higher than when I measured at home.  He also took my weight and height and, demonstrating his ADHD, forgot what my weight was in the time it took to walk over to his computer to record it.

He went through a lot of PowerPoint slides on his computer, showing me the different slopes of different drugs and talking about brain scan studies.  He was careful to say that the brain scan stuff is easy to oversimplify and overdetermine, but (putting it simply and deterministic) my brain is inefficient because it tries to use emotional motivation for almost everything instead of more logical motivation when it is appropriate. (And that everyone is always a mix of emotional and logical motivation.)

That trend in my brain is both inefficient and exhausting.  It means I have to be “in the mood” for everything, even routine things that should not have an emotional investment, and that I spend my life trying to generate mood and feelings to motivate my work. I felt that was an apt description of what I feel going on in my head.  I told him that when I need to write, one trick I use is to Google Image search for writers, writing desks, writer’s studio, etc. Looking at those pictures gets me in the mood to do the work a lot of the time. He thought it was a great example of using creativity to work the problem.  One of the biggest problems I have is switching gears.

So I left with a prescription for Adderall XR and Wellbutrin. He had noted I was reporting depression symptoms and asked me to rate my depression on a scale of 1 to 10. My answer was 8.5, hence the Wellbutrin.  I was to start the Adderall first for four days, then start on a low dose of Wellbutrin.

I also had an appointment in a few weeks and a fat bill I had to pay up front.  This office does not bill insurance.  That’s something that made me put off getting my first appointment, until I read this in Jennifer Koretsky’s Odd One Out:

In the United States, most insurance companies reimburse health care providers so little that they are forced to see 4–5 patients an hour just to make a living. This is unfortunate. And it’s particularly dangerous when a healthcare provider who sees you for 10 minutes a visit is your psychiatrist, or other doctor prescribing your ADD medication! I always recommend that my clients see a psychiatrist for their ADD medication. And, due to the current state of the U.S. health insurance industry, it’s not uncommon for a psychiatrist to stop taking insurance once they have established a practice.

While this doctor is not a psychiatrist, the insurance bit seems to apply.  I have good insurance, so it will be paid for, but I have bad follow-through and may not get around to submitting my claims.

Next installment: All Aboard!

You must take the "A" Train ...

You must take the “A” Train … (Photo credit: keithcarver)

Review of _Square Peg_ by L. Todd Rose

squarepeg-8-8-VER-8-198x300Square Peg

L. Todd Rose

with Katherine Ellison

Hyperion

http://www.amazon.com/Square-Peg-Visionaries-Out-Box/dp/1401324274/ref=tmm_hrd_title_0

Book drawing here.

 

ADHDer’s have trouble fitting into an executive functioning world. L. Todd Rose makes this point throughout his book Square Peg: My Story and What it Means for Raising Innovators, Visionaries, & Out-of-the-Box Thinkers. Readers of this blog will know my own experience in illfittedness. But, being it’s my blog and all, I shall explicate.

How about a top ten list? Too many? Five, then.

1. I grade papers well sitting down with a student. On my own: procrastination followed by panicked overwork.

2. Bills never get paid on time if I have to write a check and mail something.  Even when there’s plenty of money.

3. I am good at developing basic competence in many new endeavors.  I am terrible at actually accomplishing anything with said competence.

4. I am extremely good at finding time to work, performing maintenance, and managing money and possessions . . . in a video game. My executive function is legion in Borderlands. (Photo below)

5. Being successful in the line of work and life I’ve chosen requires steady effort over the long term.  My work habits are cyclical, intensive, and frequently abortive.

Rose’s book is framed around his story of a rise from a near-dropout to a Harvard professor. Yep, Harvard, it’s true: http://www.gse.harvard.edu/directory/faculty/faculty-detail/?fc=81464&flt=r&sub=all.  I had to check, I’ve been duped before, like that one time with that job offer from Havrad Univresity (Nigerian emails are so creative).

Like many people who work in the ADHD field, Rose has lived with it himself (even his ghostwriter/cowriter Katherine Ellison has ADHD; I can only imagine the Hyperion editors pulling their hair out [it’s really hard to write a book when you have ADHD; I’ve tried at least a dozen times]).  I used to wonder about ADHD coaches who themselves live with ADHD, but then I remembered my own writing practice;  I am good at helping students with writing processes, with talking through different strategies, with coaching them, so to speak.  My own practice? See #5 above.

Rose’s research, practice, and theory stem from the idea of “complex systems.”  When applied to behavior, the theory is that “all behavior emerges from the constant interaction between a person’s biology, past experiences, and the immediate environment, or context.”  His advice (for parents and/or adults dealing with ADHD) echoes my own concept about the disorder, which goes like this:  if a person is languishing and can’t perform, there are three things that can be altered: change the person, change the task, or change the environment.  They can be altered in combination, of course. In fact, I think that a good program of therapy addresses all of them.

My own plan of attack, for example, is

  • Medication, supplements, and nutrition
  • Yoga, meditation, and exercise
  • Picking projects that increase the chances of my success (lots of face time and accountability)
  • Creative outlet (defined broadly: can be anything from poetry to gaming)

When I can get all these things going and when the creative output happens to coincide with something that I honestly feel is productive, especially in a professional sense, I perform very well and have peace of mind and fulfillment.  When some things start to slip, then my life tends to get stuck. I completely agree with Rose’s position on medication—used carefully it can be a tool to help. Ritalin has helped me in many regards, but without the other pieces of my plan, I might as well be downing Tic Tacs.  The surest sign of a downward trend is when I get preoccupied (okay, obsessed) with my “creative outlet” of the moment (which has included guitar playing, woodworking, cartooning, blogging, writing, gaming, running, bike-building, reading, photography, job hunting) and start to neglect basic responsibilities (sleeping, eating, email, being a father in any sense beyond legal).  To use Buddhist terms, I start to “take refuge” in my hobby of the moment because all the regular stuff of life is either too boring or too stressful.

Rose heavily emphasizes context.  I’ve seen it in my own work and could never understand why I could work brilliantly and with ease one day and like a drooling inebriated cowering fool the next.  But it’s easy to understand with my own “plank” example (I really should write about the book more in a book review . . . sigh).

Take a plank of wood.  Say it is twelve feet long and a foot wide.  Put it on the ground.  Walk from one end to the other, without stepping off.  Easy, right?  Now, string that plank between two adjacent buildings, say, fifty stories up.  I’ll even give you a nice, calm day.  Okay, now walk. Go ahead, just toodle across there.  What’s wrong with you?  You did the same exact task down there on the ground!  You’re just not trying hard enough.

Back to the book, another key concept from Rose is “variability,” meaning the many variations in human brains.  A prime example: the relationship between stress and learning: “A little stress can help someone learn, while too much stress prevents it. The optimal amount of stress varies from person to person.”

It’s a simple idea, but what great insight!  In my many years as a college professor (yes, I managed to hang on to this job, despite my significant deficits) I have seen this in action.  Many students respond well to the “stress” of the traditional classroom: due dates, having to show up and explain yourself if you don’t perform, the pressure of grades and such.  But by “many” I’m not even sure I mean “most.”  I’ve often taught people on the fringes.  I started by teaching “remedial” writing at a time when our institution was flagging and we had open admissions.  Most of my students were struggling, not just as writers, but as college students.  As such, they had widely varied responses to stress: ignore it, resent it, negotiate, panic.  I had bad advice from a former colleague: you’ve got to show them who’s boss and lay down the law. After two months of trying that and meeting chaos in return, I started just to listen and talk honestly.  World of difference!  Even though they all struggled, they all struggled differently.  Understanding them as individuals helped enormously.

Likewise, today I teach a literature class for students whose primary interest is definitely not literature.  After trying many things, the simple solution was to learn about them, take their concerns and points of view seriously, and help them figure out how to meet the course goals in their own way.

Through all my trials of different ways of going about teaching (mostly because I was never satisfied with my own performance) I’ve seen students respond to varying policies.  Hard and fast due dates with severe penalties makes some students successful, some resentful, and some doomed from the start.  Extremely flexible or even self-made due dates makes, well, some students successful, some resentful, and some doomed from the start, just different students in each model.  A successful learning environment strikes a balance between what students want and what they need.  It’s different for everybody, which is why I like doing as much one-on-one teaching as possible.

In the book I especially like the epilogue, where Rose explores the changing role of technology in education and advocates for using such technology in a meaningful, individualized way, and not for more standardization and cost savings.

Overall, though, I have to admit feeling lukewarm about this book.  Usually I can plow through a book in a day or two, but this one has been sitting around for awhile.  I think it’s that much of this I’ve encountered before.  Had I read it not knowing anything about my ADHD, though, I would have probably read it in a single sitting.

It’s also part of this genre of self help/memoir mashup.  Again, probably my standards are too high on the memoir side being a teacher of writing (and having read thousands of personal essays over the years).  The help part is good, and each chapter ends with a summary both of main points and action items, which seems a plus.

I guess my personal issue is with the subtitle.  I feel like a square peg in a round hole world, but I do not want to be a visionary, out-of-the-box thinker.  I have plenty of visions.  My thinking could benefit from some containment in a box or box-like container.  I just want to settle down and get my work done.

hunter

Professor Pain: master of marksmanship and falconry.
“If I had email, I’d kick its arse.”

Dispatch from The Molehill Mountainization Department

MEMORANDUM

TO: Cerebellum in latudine

FROM: Frontal Cortex

RE: Committee for Project Timeline Expansion implementing GO Policy

DATE: February 13, 2013

Given the recent decrease of inflow of methylphenidate and other raw materials re: executive function (i.e. cobalamin, monolaurin, and levels of serotonin/dopamine declining due to excessive couch sitting and absence of sunlight), the Committee for Project Timeline Expansion has implicitly been given leave to convene and begin deliberation regarding the appropriate course of action on necessary tasks.

Heretofore the committee’s responsibility and attendant area of expertise has been the organization and reorganization of tasks in response to changing inputs from the Working Office of Reprioritization Management.

However, the mixed messages and conflicting instructions from WORM has stymied real task completion and given us no choice but to implement Double Manual Gluteus Maximus Obsfucation (widely known, thanks to the ad hoc Humorous Crudification Defense League as “covering our ass with both hands”; though we are not sure if our organization indeed has a collective singular “ass” and therefore suggest instead we all use the simplified policy term “Gluteal Obsfucation” [or simply “GO” {this is no joke, people!}]).

As a reminder, the CPTE’s GO policy is as follows:

1.  All incoming mail will be marked “Important!” “ASAP!!” or “DO THIS NOW DUMB ASS!!!”  with the number of exclamation marks used in direct proportion to the height of the pile of existing mail.

2. Work hours will be assigned on a sliding bifurcating scale, split (at first) equally between the Panic-Intensive Task Purge Team and the Avoidance Tactics Work Group.

3. The Avoidance Group’s main assignment will be the making of lists and writing of sticky notes in lieu of actual task completion.  In addition, brighter colored notes and larger lettering count double towards task completion substitution.

4. The consumption of caffeine and sugar will immediately double.

5. In the event that policy item #3 proves ineffective for the Avoidance Group, the secondary assignment of neatly organizing mail into thematic piles utilizing binder clips and rubber bands will suffice. This policy step can be repeated as needed (i.e. organizing first by sender and then reorganizing by pay/non pay and then reorganizing the pay pile by days past due and then once again by amount due [lowest to highest and then reverse]). Adding sticky notes to said piles again increases task substitution. This policy is particularly effective for sustaining the Avoidance Group’s work and can continue indefinitely.

6. Upon the occurrence of negative external events (e.g., the flooding of basements, illnesses of children, or turning off of electricity), Avoidance will be given longer shifts, and some hours will be outsourced to the Bureau of Existential Insomnia.  However, the activation of the BEI ensures more overall waking hours are available for our committee, and thus BEI hours do not detract from, and often result in the increased availability of, overall Avoidance hours, as fewer overall resources are available for the Panic Team.

7. Communication with other human beings will be severely restricted, and when required, non-task topics such as the weather, politicians behaving badly, the relative merits of wine/food pairings vs. beer/food pairings, and current postings on Facebook which include cat pictures (or anything from George Takei) will receive highest priority.

This policy will continue until such time our services are no longer needed.

Français : cortex frontal

Français : cortex frontal (Photo credit: Wikipedia)

A great post from a college student’s perspective. I struggled with college and what pulled me out of it was a creative writing teacher who took lots of extra time to work with me and talk about direction in life. Many ADHD coaches recommend college students have a mentor, especially the first year.

Living and Learning Under Pressure

Dear Teachers,

Here is what might help a student with ADD and ADHD from the student’s perspective.  I know that it might be difficult and hard to deal with us but bear with it. I had really good luck with teachers who knew how to help me as well as directing me toward resources that might help me further down the line.

If you can help a student towards what they love to do get them involved in something. The best thing that happen to me in my school carrier was when a family friend and also one of the best teachers I ever had told me to go try technical theater. It turned everything around for me. I had a reason to do well in school and started to do a little better.

Also if they are like me they might not have the easiest social life. It took…

View original post 35 more words

Where the magic happens

One of my hobbies (distractions) is looking at pictures of writers’ desks.  One of my favorite books is The Writer’s Desk by Jill Krementz.  See also my last post.

In that vein, I decided to post some photos of my own office.  My home office, tucked away in the basement where pretty much no one but me dares venture.  My work office is public enough for me to keep on display, but not the home office. I was tempted to clean and stage the room, as I imagine at least some of the writers in Krementz’s book did. But in the spirit of honesty and full disclosure I decided to photograph it as-is.

This is my office at its full productive state; this was its condition on the day that I finished my semester grades, which is when I’m the busiest.  (Since I’m teaching only online this summer, I’ve taken to working at home.)

Here ye be:

When I was a kid, my mom tried to motivate me to clean my room with money.  I had a $10 a week allowance, and she took deductions a dime at a time if we talked back or didn’t do something she asked.  My younger brother was on the same plan, but a $5/nickel rate.  Part of this system was daily room  inspections.  After we got home from school, there would be a report card on our desks listing the infractions and deductions.  Yes, my mother was nickel and diming us.

However, after awhile, I found it was easier just to go out and get a job as a paper boy rather than try to keep my room clean.  My brother, on the other hand, is a perfectionist and often got extra money for his extra-good housekeeping.

Probably my office today would wipe out the entire roll of dimes in one day.

Here’s a second view:

Have I mentioned that I have a little reading habit?

So, what do I see when I look here?  First, I like Post-it notes.  Bright colors, the super sticky kind, written on with a Sharpie.  In the first photo are some 4×4 sheets of plywood that were supposed to be kitchen trim that I decided to put up on the wall (the notes don’t stick to the cinder block wall too well).  That act started the room’s devolution; you can see the corner of my lovely Frank Lloyd Wright print sticking out behind one of the sheets of plywood.

The white table in the foreground was supposed to be “temporary” when I put it there last June.  I needed to sort through weeks of mail and filing and needed more desktop space.  When the Tour de France started, I stuck a TV on there so I could watch while I work.  The Tour was over last month, and there sits the telly.  On the table.

I’m also struck by how orderly my post-its look on the board. I like to see everything when I work.  I like piles, but not disorder.   For example, this:

would drive me crazy, but this:

looks completely awesome to me.

What else is in my office?  I have several guitars, which I have touched exactly twice since the novelty of my “blues experiment” wore off.  In the corner that I didn’t photograph is a work bench and a small portion of my tools, along with a sink and some countertop from the bathroom remodel I insisted I would finish within a week last June and haven’t done any work on since.

But even though it seems cluttered, my office is not disorganized.  The stacks of books are usually on related topics.  There’s a teaching pile, and a writing pile, and a I-started-rereading-but-got-bored-and-haven’t-put-away-yet pile.  My various manuscripts in various stages of unfinshedness are in a box.  When the piles start to overlap, that seems disorganized to me.