Posted on 2009-09-17
As many people know, I have Attention Deficit and Hyperactivity Disorder, also known as ADHD. What very few people know, is what this actually means. Most people relate it to problematic kids, and it's difficult to understand the extent of how much ADHD affects those of us who live with it.
Since this affects me greatly, and I'm going through a period right now that's fairly challenging (I'll get back to that), I figure it's time I write a little bit about it from my perspective. However this is a complicated subject, both because it's a complicated disorder that, by its very nature, is hard to understand, but maybe more importantly because I'm essentially writing about myself and parts of me that has taken me decades to come to terms with. You'll have to forgive me if I don't do the subject justice.
Wikipedia has a reasonably good definition on ADHD:
Attention-deficit/hyperactivity disorder (ADHD or AD/HD) is a neurobehavioral developmental disorder. ADHD is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone." While signs may appear to be innocent and merely annoying nuisances to observers, "if left untreated, the persistent and pervasive effects of ADHD signs can insidiously and severely interfere with one's ability to get the most out of education, fulfill one's potential in the workplace, establish and maintain interpersonal relationships, and maintain a generally positive sense of self."
I want you to focus on the second part of this sentence, which is the real problem. It barely scratches the surface, but it's a good start. Everyone faces difficulties in their life, and I'm pretty sure everyone can identify with one or several of the typical symptoms displayed when you have ADHD. And that's great part of what makes it hard to write about this. And talk about. And most of all: live with.
However, some parts are far easier to explain than others. Hyperactivity, while often misunderstood, doesn't really have to be all that bad when you're an adult. For me, the main symptom of hyperactivity is that I have to keep active constantly, both mentally and physically. Working with a computer, the keyboard does the trick. In a meeting, pens, balls, or whatever happens to be in front of me. Annoying, but not really a show-stopper for a social life. Mentally it means getting to sleep is difficult and my mind is going non-stop regardless of what I'm doing or how tired I am. So far, this is fairly easy to deal with. This was a far bigger problem when I was a kid where the physical manifestation was far more extreme. Because all of this is fairly easy to grasp, this seems to be what most people consider the symptoms of ADHD. If only that was the case.
If we take hyperactivity out of the picture, it gets far more difficult to understand. In all fairness, the two are related, but it's still the attention deficit that's hard to explain, understand and live with. At least to me.
Without medication, I can go through an entire day switching constantly between tasks without actually getting a single thing done. And that would be a reasonably normal day. However, I am still very much able to focus on things that interest me. That's how I got where I am today. Or to put it an other way: whatever I work on has to constantly distract me from all the OTHER distractions. And anything will do, as far as distractions go. Boredom too. This means that I can stare at a problem for an hour, not really do anything else, but still not make any progress, because I'm constantly shifting my thoughts around. It's not a matter of "just concentrate" or "trying harder". I can't control whether or not I'm distracted. Imagine working on something in the middle of a circus - that's how my mind works, roughly. And we are still talking short-term.
The distractions above only represent one part of the problem, but is at the core of the issue. Imagine for a moment that you need to make a somewhat difficult call, but every time you let your mind wander in that direction, an elephant whines. Or a lion chews on your leg. Extrapolate that to bills, appointments, registering work hours (which reminds me....), or just about any task that you either don't look forward to or find boring. While the result is the same, I don't really delay these tasks, I'm just constantly distracted. Is that an excuse? No, it's an explanation. Just like someone in a wheel chair can't climb stairs - they are not using it as an excuse to not get to the post office.
This is an other reason it is very hard to talk seriously about ADHD - I do not wish to use it as an excuse, however, I can't deny that it affects me. I do not want to burden my surroundings. The cruel fact of this situation is that my struggle is invisible. If you saw a person without feet crawling up stairs day after day, you'd understand the effort involved, but it's not possible to see the struggle it takes to live with ADHD. Does that mean I want pity? No - I just want to live my life. Do I want help? Yes, and no. I do not want to be carried, but I'd appreciate an elevator, to continue the wheel-chair analogy.
As I have lived 25 years with ADHD, I've gotten fairly good at it. I am now able to, at great effort, get through the day and be a productive member of society without medication. The problem is that I'm still not sure I can get through my life that way, because life consists of more than just days. And since I'm fairly fond of life, that's a bit disturbing. It worries me greatly, in fact, it scares me to death, but all I can do is live on. The most obvious example of how this affects my life is my eternally delayed studies, despite the actual subjects being relatively trivial, the constantly growing amount of over-due bills, the difficulty I have keeping in contact with friends... The latter problem is something I've suppressed for the longest time, and continue to suppress if I don't pay attention. Because it's very difficult to distinguish this from what one would easily qualify as "loser behavior". As I hope the reader can understand, this is extremely difficult to write about too..
Too use a bit of humor, although there's really nothing funny about this... Imagine being a social fun-loving person, wanting to go out or do something, but there's an elephant on your phone.
And unlike cancer, this isn't something that ends quickly. Because 5 years, 10 years, 15 years... would be quick. I will have ADHD my entire life.
I find myself asking why I'm writing this. Do I want your sympathy? No. I can only hope for understanding. And my life isn't bad, I'm actually quite happy. I don't want anyone thinking otherwise. But it's difficult.
Enough with the whiny Kristian, it's time to bring out some more facts.
Luckily for me, there are medications to help with the symptoms. Mainly Ritalin. I've been using it somewhat off-and-on for the last 15 years. When working properly, Ritalin is a blessing. While some people claim it's wrong to "drug down" people with ADHD and whatnot, I like to say, in the most kind words that I have, that those people are fucking idiots. First of all, Ritalin is NOT a sedative. In fact, it's the opposite. I am no medical expert, but I know quite well - and first hand - what Ritalin CAN do for someone with ADHD. And one thing it doesn't do is sedate me. When working properly, it does not give me the ability to ignore distractions, but it allows me to never see them. And I'm not talking about not being able to notice if somebody talks to me, I'm talking about the random impulses to think about something else, like that interesting dot on the wall. They are virtually gone. It has made, and continues to make my day a better day. It does not, however, cure ADHD, and it comes at a high price. It also has several somewhat ironic flaws. Due to this, Ritalin is never an easy choice, nor do I think it's right for everyone.
If we begin with the flaws, Ritalin is a class A narcotic substance in Norway. As such, getting and picking up a prescription requires more paperwork, phone calls and visits to a doctor. All of those tasks are naturally challenging to someone living with ADHD. This means that, from time to time, I'll find myself without medication. Additionally, Ritalin has to be taken regularly. The pills I take have a duration from 2 to 4 hours or so (more on that later), timing it wrong can lead to periods without medication, which means that the circus is back, but this time it brought friends. More than the reduction in productivity, it's the unstable mental condition that is troublesome when this happens. This is part of why I have been reluctant to use Ritalin over the last decade and a half, but found myself having to to get something done. It also means that when I wake up, I don't have any medication in me, which means that I can easily spend 3 hours to get out the door if I'm not careful. It also means that it's easy to forget.
Some of the medical side effects of Ritalin are also fairly scary. Depression, disturbed sleeping pattern/ability and loss of appetite. Over the years, I've had all of these to great extent. That I choose to still use Ritalin should tell you something about the seriousness of the condition.
One of the tougher drawbacks is the fact that I have to live with the knowledge that without medication, I wouldn't function mentally. Knowing that does something to you.
So, to wind back a little bit. The reason I bring all of this up now is that I recently visited a private psychiatrist, since the only follow up I've gotten from the public sector has been what I can only describe as insulting forms to fill out, asking me how frequently I feel like someone else is controlling my mind, if I often hear voices others don't and how often I want to smash things. During the consultation, I learned several new things about Ritalin, among other, its duration. I have not been happy with my medication for many years, and it was a relief to hear that it is likely just due to incorrect dosages. I've been using this dosage for at least 10-13 years, but in a life-time, that's not really too much. I also learned that there are now capsules that have a far greater duration. I also debunked some of what I thought I knew about Ritalin, mainly about the negativity over over-medicating. In consultation with my psychiatrist, I'm now experimenting to find the right dosage. It's tricky, but interesting. I've been doing that since Monday this week. When I've figured out the dosage, I'll try using capsules, which should make it easer.
The results were immediate, though I'm not done. So far I've increased the daily dosage with about 250%. The main difference is the frequency. I'll be experimenting like this for a month, smaller dosages one day, adjusting the frequency an other day and so on. And let me tell you, it's tiring but worthwhile.
So far the results have been what I can only describe as a tremendous increase in productivity at work. It's not like I was sitting on my ass doing nothing to begin with, but it's far easier now. I have yet to experience the most alarming danger sign of over medication, which is a "speedy" feeling. A high, basically. However, since I'm also experimenting with the dosages affecting me while I'm going to sleep, I've also suffered from sleep loss. I've also noticed a change in appetite, not anything alarming, but noticeable. And this afternoon I also felt the typical and strange feeling of "chemical" depression. And I couldn't be more thrilled. A month with sleep loss and variable amounts of depression is something I gladly pay if that's what it takes to suppress some of the symptoms of ADHD.
During the weeks to come, I'll try to find the right dosage so I can actually sleep at night and still functional optimally. One thing that's important to remember, however, is that while it is far easier to measure the effect of Ritalin in the workplace, it's also necessary to be medicated in the evenings. The difference is that if I go without medication at work, it's the work that's neglected and I drag other people down with me, so to speak. If I'm without medication at home, I'm only dragging myself down. This is something that's somewhat difficult for me to accept, but it's also fairly obvious. This means that I actually need to make sure that my medication works for as large a part of the day as possible, which means I might have to risk some more sleepless nights.
I could go on, but I think I've driven the point home, and while there are other challenges, there is little point in enumerating them all. It should also be noted that people experience ADHD differently, and this turned out to be more personal than I had initially intended. Maybe it was more for myself than for you.
So, if you work with me and notice I'm a bit different, strange or tired these days, now you know why. If you read through this, I hope you learned something.....