We Need To Stop Judging ADHD Patients By Their Expected Cover
So much ADHD is unseen. Why does society expect it to be otherwise?
When ADHD patients finally feel ready to share their diagnosis with their friends and family — if indeed they ever do — then one of the most discouraging reactions can be the following (Note: I’m pretty sure I got every single one of these. Like, actually):
“Trust me, Dan, you DON’T have ADHD!”
“You’re one of the most productive people that I know! You can’t have ADHD”
“But you write stuff. How can you have ADHD if you can write stuff?”
“Stop worrying about problems that you don’t have. You don’t have ADHD”
“But …. you’re not hyperactive”
Truism: People Generally Don’t Invest Too Much Time Thinking About Problems They Don’t Have
There are a few problems with the way society perceives ADHD.
The first is that society’s conception of what ADHD should look like is stuck where science was several decades ago.
To throw a little less judgment about, I would actually contend that this is perfectly reasonable.
To the best of my knowledge, I don’t suffer from multiple sclerosis. Hence, I know relatively little about the disease. I assume that all MS patients fit a certain picture. I’m unaware of what research is being done about MS or what its drug pipeline looks like.
If I were diagnosed with MS — G-d forbid — or someone I loved was, then that would likely change. But for the moment I make do with my elementary knowledge of the illness. I don’t need more than that to get through life.
And so I imagine it is for many people and ADHD.
We think that ADHD is a children’s disease. We think that ADHD is a monolithic clinical entity and that there are no subtypes to it.
That every ADHD patient is a five year old restless toddler running around a classroom. Even though many ADHD patients are predominantly inattentive and the condition commonly persists into adulthood.
Many ADHD Patients Don’t Fit The Stereotype
I have a friend who is what could be described as hyperactive. Let’s call him Dave. He talks at a million words a minute. He fidgets. His brain jumps from topic to topic as he talks animatedly.
People — including me a year ago — might assume that he is a classic undiagnosed case of ADHD. Some might even use the term colloquially “oh, he’s very ADHD.” (By the way, this trivializes the condition and is something that I do not support.)
But put Dave in a library — or an office — and he can switch in a moment’s notice from Gregarious Dave and into Studying Dave or Working Dave.
He might emanate a restless social energy that fits the ADHD stereotype much better than I, but his focus is nevertheless very much under his control.
He doesn’t need stimulant medication to get into that mindframe. It just happens naturally for him because his brain is producing, endogenously, enough dopamine and norepinephrine. Dave make look hyperactive, but he doesn’t have ADHD.
Now take me.
I emanate a much lower key social energy than Dave. People would probably describe me as quite or even shy. I have my moments, but I’m often the thinking, pensive, retiring type. Which is why I assume I pick up the “you can’t have ADHD comments.” But the difference between Dave and I is that I can’t shift gears so easily. In fact changing gears from “I’m awake” to “here’s that complicated white paper you ordered” used to take me hours of effort.
Put me in that same library or office without medication (previously self-medicated caffeine, now Vyvanse) and I’ll sit there procrastinating or fidgeting for 20 minutes. Or daydreaming. Or looking out a window. Or browsing Twitter.
It’s not that I don’t want to focus and get through my workday. It’s that I can’t.
But put a stimulant into my bloodstream and — hey presto! — within 20 minutes I’ll be right up there with Dave studying or working. I might even outpace him. The difference between un-stimulated me and stimulated me is night and day. Most people enjoy a cup of coffee in the morning. But I’m pretty sure that they’re not getting quite the same thing I do out of it.
Many Facets Of ADHD Are Invisible — For Many, Most
The final reason why judging any ADHD patient’s condition without walking a day in their shoes — or an hour in their brain — is that frankly you’re going to miss out on virtually everything that makes this condition a challenge to live with. In fact, unless you’re overtly hyperactive, almost the totality of your symptoms — what makes ADHD a challenge to live with — might go unseen.
Here’s some of the ways ADHD affects me for instance:
- Before I take stimulant medication, I have a hard time “getting going” in the morning. But because I realize that people who show up late to work habitually tend to get fired, I have developed a careful ritual of preparing my morning’s Vyvanse (previously caffeine) the night before. Hence, I’ve never been fired. But I’ve also had to go through this routine every morning for about the last 15 years.
- I am overly sensitive to noise and (to a lesser degrees) smells. They compete with my focus and make it hard to pay attention to whatever I’m trying to do. In fact, even the air conditioning in my apartment — which is set slightly too low — is making it 5% harder to finish this post because my brain keeps jumping in every five seconds to say “hey, it’s slightly too cold here, what’s the thermostat set at?”. I once lived in a studio apartment that was barely big enough to accommodate me and my belongings. The sound of the fridge compressor drove me crazy. My solution? I lived fridge-less for a year and subsisted on street food. The only people who know how intolerant I am to sound when trying to work are my family and former coworkers. A mildly loud conversation in the next room — or a TV or radio playing — can make it so hard for me to focus that I need to put on headphones or earplugs. Even an open plan office with all glass windows presents a lot of visual stimuli that I need to filter out.
- I am famous for going through phases — being extremely passionate about hobbies. This is a common ADHD trait known as hyperfocus. We have a hard time staying focused on things we’re not interested in. But when we find something that captures our attention — it’s all there, but on overdrive. People who know me get a kick out of this — I’ve always picked up my latest ‘thing’ (the low point: flags). But sometimes I wish my attention was a bit more consistent and I didn’t feel the need to jump into every new passion project 110% and was just mildly interested in a few things across the board. For the most part, I know a little about a lot. This has had a big impact on what I do professionally.
- I have a very hard time getting to bed at night and have been on various degrees of a terrible sleep schedule for large stretches of my adult life. My brain often simply refuses to turn off and I lie in bed too restless to sleep but also exhausted at the same time. I drive myself crazy by overthinking things. Even by fidgeting when unsuccessfully trying to get to sleep (it happens subconsciously). Hyperactivity can be entirely mental — on the inside. Unless you can get inside the brain of the person you’re sure “couldn’t” have ADHD, you probably shouldn’t make assumptions.
- There are times when I would love to be able to enjoy a book or a TV show, but my brain literally won’t allow me to. I can’t pay attention long enough to follow the plot development unless I find the show totally riveting (see: hyperfocus). And so I give up and do something else. But if I find a show really engrossing — I can watch it for hours.
- I’ve been misplacing things and losing belongings for as long as I can remember — wallets, phones, you name it. Because my brain doesn’t do a particularly good job at paying attention to things it doesn’t find stimulating. When you put your wallet somewhere you’re supposed to briefly think “here’s where I left my wallet” so that you can remember it the next time you need it. I often don’t do that. I’ve made a lifelong habit of buying “backup” extras of things I really need — like headphones. I haven’t invested in a high quality smartphone for years — even though I’d dearly love to— because I’m worried that I’ll loose it somewhere. The good news is that if I’m diligent about taking stimulants I can mostly avoid this. But I have residual losing-things anxiety and constantly worry, when I’m out of the house, that I’ll misplace something.
- Sometimes, I’m irritable. But never more so than when my focus is interrupted. When I’m writing and “in the zone” … I’m doing that. Something as simple as background music at a restaurant — while I’m trying to focus on a conversation and my thoughts — can ruin the experience for me and even put me in a bad mood. Cigarette smoke is another pet peeve. Beyond asthma (research suggests the conditions might be linked) it’s an olfactory distraction. By the way: I detest background music.
- Here’s a slightly weird one. I make no secret of the fact that I’m partial to beer, but (almost) never have even one beer while I’m working. The reason? Alcohol is a CNS depressant and will counteract whatever is helping me stay focused which, in turn, will make it harder for me to finish whatever I’m working on. I leave that until I’ve wrapped up all my day’s activities. I drive a fairly strict line between work and pleasure.
- Time management can be an issue for me because I tend to get into hyperfocus periods and loose all sense of time in the process. Because it’s hard for me to get “in the zone,” I tend to feel a strong desire to take care of whatever needs to get done right now. The reason? Sometimes I’m worried that my focus won’t be on par tomorrow. Again, now that I’m discovering an effective treatment regime that isn’t taking caffeine pills, this is also in good measure simple anxiety.
In short:
ADHD patients — including me — don’t all look the way society expects them to. We don’t all jump about with arms flailing running around classrooms.
Some of us look out the window when we should be looking at the blackboard, loose our wallets repeatedly, and undergo silent struggles whenever it’s time to get to bed on time and prepare for the next day.
Those around us might think that we’re crazy because we can’t focus on a writing project because there’s a TV in our field of vision with presenters doing distracting things. But that’s how our brains work for many of us.
But guess what?
Depressed patients also don’t constantly walk around with a big frown on their faces.
Anxiety patients aren’t constantly shaking with tremors.
Schizophrenics under treatment aren’t constantly chasing after imaginary people on the street.
We’re all different. And most mental health patients become very good at finding ways to hide our conditions from the world and put up the masks we need to in order to get by and succeed — as best as we can.
ADHD is a truly multifaceted condition. Society will learn more about its many manifestations as time moves on.
If you’re reading this and are trying to support an ADHD patient, please remember that a lot of our struggles are unseen.
Leave the judgments aside and trust that the psychiatrists and medical professionals who have diagnosed us know what they’re talking about more than you do. It’s a tough condition. But with the right support many of us can manage.
