ADHD and other letters: on forgiveness

I think one of the hardest things about having ADHD – especially prior to diagnosis – is that you lose faith in yourself. This applies to any condition that includes “executive dysfunction” as a symptom, but throw in the ADHD brain’s inability to perceive or estimate time, and it’s a real doozy.

Because you know what you need to do to change.

You just don’t do it.

In reality, you can’t do it, but it doesn’t feel that way a lot of the time because there is no visible, physical, insurmountable barrier.

I know what I need to do – to be productive, accomplished, punctual – but I just don’t do it. I know the decisions I have to make. I just don’t make them. I know the actions I have to take. I just… don’t take them.

It’s made so much worse – so much worse, indescribably worse – by the fact that executive dysfunction is almost impossible to explain. The transition from “thought” to “action” is so intangible, so steeped in lionised notions of willpower and determination, that people who don’t have this particular problem can’t wrap their heads around it.

Almost a poetic irony, since executive dysfunction is profoundly neurobiological in nature.

But every time you come up with new plans, new information, new ideas, all bubbling enthusiastically around the problem, and this time, it will be different –

And then it’s not.

It’s not different at all.

It’s the same failure. The same disappointment. Every. Fucking. Day.

And a chorus of imagined voices asking why, why, why, a deafening mental roar of judgement and anger –

And then one day you lose faith.

You stop believing you can fix it.

Sometimes other people will say wonderful things about you, about what you’ve done, and you realise that the rest of the world sees you in a profoundly different way than you see yourself – and that the empty hours when you’re stuck and trying and horrified at yourself, well, somehow you manage to squeeze the things that matter into the other hours.

Maybe it’s not as much as you think you could, or should do. Maybe it’s not as much as other people do – people who understand time, people who can focus, people who can simply decide to do something.

It’s so strange that there are people who think you’ve achieved something. They see what you do, and for them, it’s enough. They funnel their vision back to you, and even if that’s not everyone, even if there are still people who matter that judge you for having so much trouble, it matters that there’s a dissenting voice, something to break the consensus of whispers in your head.

For the people who think it’s enough, the people who see your slow crawl and cheer like it’s a rocket launch, for them, you can keep going. Even if it’s just one person, that’s enough. You might think you’re constantly disappointing them. You might have lost faith in yourself.

But they haven’t. Not everyone. I think you can borrow that faith for a while, use it in place of your own, like borrowing a car while yours is in the shop.

I don’t know how to believe in myself sometimes, but I know how to borrow the belief of others. They don’t seem to mind.

Thank you, to everyone who lets me borrow their belief in me. I hope you know who you are.

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On Penelope

Sometimes, I think nothing is real until I write about it.

I’ve been avoiding this, as though if I don’t write about it – if I don’t let the feelings and thoughts come out the way they need to – then it didn’t happen.

If I don’t write about it, I can still believe that nothing has changed. If I go to that little townhouse in Newmarket, and lean heavily on the doorknob (because it got stuck, and even though her dad fixed it, we’d all been shoving it so hard for so many years that it was muscle memory), I’ll see Penelope sitting on the couch with an enormous tapestry frame resting across her lap, copper-brown hair fuzzing around her head. Behind the ever-present glasses, her eyes are quiet and focused, and her face is almost stern, an expression of an unflinching rationality that has been mistaken for coldness, for aloofness.

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Just Keep Swimming

I could look at my current pile of blog post drafts, or the three notebook pages filled with concepts I want to write about and untangle, the stories I want to tell – but the tight mass in my stomach says no.

It’s a thick, heavy knot of anxiety.

And fear.

And grief.

And anger.

And sheer misery.

[Edited: removed about 650 words explaining all the shit that’s going on right now, because I don’t want to read over this in the future and feel like I was wallowing in self pity]

I went to my GP for a prescription renewal, updated her on some of what’s happening, and she asked if I was okay.

“No,” I said bluntly, as tears started running down my face. “No, I am not okay. I am one hundred percent, absolutely not even remotely okay.”

I’m sorry, guys. This is the only post you’re getting this week. Maybe next week I’ll be able to knock something else up, but the truth is that severe depression and personal horror are actually really bad for creativity, because you can’t do shit. You can’t focus. You can’t think.

You just try to keep swimming, because it’s either that or drown.

You do have a choice. It’s just not a good one.

 

ADHD and other letters: Adjusting and Unlearning

The first response to an ADHD diagnosis is often relief, excitement, even delight. Having answers, feeling that you might not actually be “lazy, crazy or stupid”, finding out that medication might give you the ability to restructure your life – all that is wonderful. This is especially true for people like me, who are born problem-solvers. We like answers and explanations and solutions.

It’s less clear after that. I’ve read that some experts liken it to a grief process (although I’m not sure where bargaining comes in).

What I did find was that, after the initial excitement and euphoria wore off, I was intensely frustrated and disappointed. Continue Reading

Declarations and Commitments

Hello from the distant ends of when-the-fuck-do-I-update-this-thing:

As it says in the “About” section (which I really should update), my brain is churning out a lot of narrative and monologue and opinion and reaction, more or less constantly (turns out: that might be an ADHD thing). I have a lot of opinions and plans and thoughts, and I think I explain things well (regardless, people have told me I do, and even if that sounds like “MY MUMMY SAYS…” from Matilda the Musical*, let’s roll with it).

I sometimes feel that the reason I explain things well is that I take the time to come up with context, and angles, and metaphors, and what that means is that my posts get very long. Settle in with a cuppa when I update this marvellous platform for sarcasm, swears and communication.

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“A Normal Body” And Other Fairy Tales

When I go and see my personal trainer (also an exercise physiologist), or my physiotherapist, or my podiatrist, I inevitably end up apologising for and explaining my body, and how it’s put together.

These people have been treating me for a while, and it’s also literally their job to observe how I move. They know how my body is put together. Their job is to help me move more efficiently, with less pain.

I really don’t have to awkwardly, anxiously explain that my single-leg squat is super wobbly because my right leg has quite noticeable internal rotation and the leg is permanently twisted because years of bad motor habits mean that the bone and muscle have just grown that way. It isn’t possible to correct it – merely compensate for it.

So many exercises look awful when I do them, because my leg rotates inwards. I wobble. My back arches and hyperextends unless I’m looking in a mirror (or having a really good proprioception day. I do have those. They’re amazing, and everything feels easy).

I don’t have to feel awkward and anxious, but I often do.

I keep falling into this trap.

If I do these exercises, my body will move properly.

If I keep working at it, it will work as it is supposed to.

Everything will come together as it should.

I only recently caught myself doing this, and realised how incredibly misguided this thought pattern is. I can’t blame this on my support team – they never speak to me like this or imply that they’re trying to change my body. At some point or other, every one of them has made it clear that the goal is to try and get to the point where my body can do what I need it to do, in the most efficient and least painful way that it can, given that it has a few quirks.

I’ve been unconsciously thinking (up until recently) that there’s one perfect way for my body to move and function, some ideal system that I can get closer and closer to, like the Platonic bone structure and muscle activity that will mean I’m effectively not hypermobile anymore.

Not only will that never happen, but it doesn’t even make sense to think that way.

I have multiple chronic illnesses, and treating them results in conflict between the affected systems.

Core muscle activation is an excellent example.

Strengthening core muscles is a crucial part of managing Ehlers-Danlos / Hypermobility Syndrome. This is the area where most people are a bit weak, leading to back problems and other joint overcompensations – and for bendy people, it’s much, much worse. The collagen connecting our vertebrae is just as stretchy and unstable as the rest of the collagen in our bodies and we are terribly prone to our spines moving in ways that they just aren’t supposed to (not in terms of a Platonic ideal, but in terms of load bearing function).

I also have Crohn’s Disease, and visceral hyperalgesia stemming from that Crohn’s. Hyperalgesia means “too much pain” – basically, my intestines think they’re in pain all the time, even when there’s not necessarily a proximal cause. They’ve become sensitised to pain signals because of the long term effect of the Crohn’s.

My intestines are either inflamed most of the time, or they think they’re inflamed and behave accordingly (massive oversimplification, but work with me here).

It is not recommended that you compress your core if you have Crohn’s Disease, because it will hurt like a motherfucker, and also if you have visceral hyperalgesia, that will feed the sensitisation occurring in that region.

Whenever you tighten your abdominal muscles, particularly the deeper set that wraps around your spine, you are compressing your core.

So. Whenever I try to prevent back pain, I facilitate stomach pain. Whenever I slack off on core compression to ease the pressure on my stomach, I move so awkwardly and the angle of force on my joints is such that I get back pain, hip pain and so on, and simply moving is very tiring because the whole system is just incredibly inefficient in a mechanical sense.

(I’m aware that I’m implying here that I’m fainting away from constant agony. That’s absolutely not the case! My abdominal pain is very well managed these days, and I get plenty of low-level warnings from my joints before it gets unmanageable, so I have time to get my backside into gear and start working out properly – or take a break, if that’s what is needed. It’s really not that bad. I’m just trying to highlight the conflict between the two systems)

This also happens regarding my low blood pressure. I’m supposed to wear compression garments to help with the fact that the large blood vessels in my abdomen are just a bit crap (again, due to those gosh darned stretchy proteins). Compression helps blood move back up my body from my legs, up to my heart and brain when otherwise I’d just end up with exhaustion, light-headedness and brain fog.

Mind you – and you’ve probably figured out the catch – as stated above, deliberately compressing your abdomen when you have inflammatory bowel disease can be uncomfortable. It can also hurt like a motherfucker.

So. I pace myself with the compression garments.

The human body (actually, any complex multicellular organism) is a marvel of interconnected systems and patterns. We marvel at it all the time, in awe of how the hip bone connects to the thigh bone and the thigh bone connects to the shin bone, and it’s led to a bit of a hippy-dippy idea that all these systems will strive to work in harmony with one another, if only we can find that one perfect piece of health advice.

Unfortunately, that’s bullshit.

Body parts do what body parts do, physically, in response to chemical changes and application of force. It’s physics. My spine doesn’t give a crap about my intestinal tract, and my small bowel has no sodding interest in the pain in my hips.

What is right and appropriate for one system is a stupid idea and maybe actively harmful for another.

I could feel defeated by this. I could feel that I’m just fucked coming and going. I could use it as a cover to give up, to say “Well, damned if you do and damned if you don’t, so I don’t even care anymore.” And to be honest, I don’t know that I’d judge anyone else for that response. It’s fair, and it’s human.

Instead, I had this realisation, and I found it empowering.

Because, if that’s true – if there isn’t an answer that will untwist my leg and support my spine and heal my small intestine – then here’s no perfectly healthy, functional body. There’s no perfect ideal in which every part of me will work without rubbing up against the world in some difficult way. There’s no one secret plan to make all the systems work together. You just do the best you can, and work with the systems you can. Your body will do what it can in response to stimulus that it gets from the outside world, or from internal systems; and a lot of that’s not up to you.

What you can do is try to make some of it a little smoother, a little more manageable, a little less painful and awkward.

And suddenly: that little bit that I can do feels even more significant. It’s not one small step on the road to perfection: it’s me exerting some level of control over a difficult situation and experiencing victories that are, relative to what is possible, pretty damn magnificent.

You know what, it takes the fucking pressure off.

I can stop trying – however unconsciously – to make my body normal and just make it work.

 

ADHD Coping Mechanisms and “Masking” Behaviour

Getting a diagnosis of ADHD at age 36 with a PhD and two degrees under my belt has thrown me for a loop, and no mistake. Of course, I increased the intensity of my reading, trying to understand what my brain is doing, why it makes life hard, and how the hell I got this far before I fell apart (i.e.: the past three years have been a disaster from an ADHD perspective).

It turns out that there are a lot of ways that people with ADHD can cope with their problems, mask the symptoms (and I’m still ashamed and embarrassed by a bunch of them, which I need to work through), and generally delay diagnosis. Even qualified psychiatrists can be fooled by these coping mechanisms, thinking that a person is coping a lot better than they are.

Or, to put it bluntly, some of us are very good at putting a brave face on our difficulties, and we don’t even realise that’s what we’re doing. My psychologist didn’t pick up on my ADHD at all, even though a good number of my sessions were about feeling overwhelmed and miserable and adrift because I couldn’t get anything done. She’s been great for me in many areas, but she just didn’t know much about ADHD.

What I’m going to do here is list out the coping mechanisms that I have used to deal with my (undiagnosed) symptoms and get through a PhD in science, and also my own daily life. And… some of those mechanisms were also about hiding how messy and disorganised I was underneath it all, so no-one would see.

The other thing is that most of these coping mechanisms are really hard for someone who has an ADHD brain in the first place, and they have a price.

Without further ado: How Doctor Kate Gets By

1. Redundancy! Backup Plans!

I forget things. Lots of things. All the time. Keys, glasses, phone charge cable, actual phone, wallet, medications and so on. If I’m in the lab, I’ll walk all the way across the building from my desk only to realise I’ve forgotten (a) my new set of samples or (b) my lab book or (c) my headphones (essential for lab work).

Hey, maybe I could “just try harder” to remember things. I could “just pay attention” or “just be more careful” or any of the crap that gets said to forgetful people. Except I literally cannot do that.

Nope. Better to just accept I’m going to forget things, and plan for it.

So I need to set up situations where forgetting things isn’t catastrophic. I can always walk back to get my samples and my lab book. I can get home without my keys (albeit not comfortably). It’s frustrating that I sometimes leave the home three times without what I need for the day (sometimes getting halfway down the road before I have to drive back – like forgetting my gym bag when going to the gym).

I now have two pairs of glasses, one of which lives in my backpack whenever I’m not wearing them (see #2), the other which stays at home or comes out with me when I don’t take my backpack.

For medications I might need to take during the day, I have a set in both my handbag and my backpack, a pharmacopoeia ranging from Telfast to high dose codeine.

I have – I am not exaggerating – five lightning cables. That’s right. I have five phone charger cables, not counting Husband’s, which I could borrow in a pinch. One lives by the end. One in each car. One plugged into my desktop. And one in my backpack at all times.

2. Put things back

This one is really hard for ADHDers, but I’ve basically branded it into my brain. When I have finished with something, if it has a place, I put it back. Keys in the key bowl. Shoes on the shoe rack. Dishes get rinsed and left in the sink because I can’t deal with dirty dish smell. Shopping gets unpacked. Shopping bags either get put back in the car or in the hall cupboard.

I think being a laboratory scientist helped with this – you have to put things away in a lab, or not only will you make mistakes and a mess and slow yourself down, but your co-workers will actually murder you.

The problem with this is that it’s not something that comes naturally to me. It takes time. I’ll forget what I’m doing halfway to the hall cupboard, holding the bag, or stare blindly at the shopping trying to work out what to put away first. I might unpack my suitcase as soon as I get home from a trip – very organised, Kate, very good! – but I do it in an immensely disorganised and slightly manic way. I’ll start putting some things in the laundry and then I’ll see something that has to go in the kitchen and then when I get to the kitchen I’ll see that there’s a bill on the table I need to pay and- then I’ll get back to the bedroom and see the other stuff I was doing, and go on with that. And I’ll be doing this at top speed, too, whirling around the house like a determined tidying tornado.

Things that other people do easily and calmly are hard for me. There’s a lot of standing still and waiting for the thought or the plan to come back to your brain (medication definitely helps with this in a fairly huge way, but it is not magical).

The problem is that I have to do this, to stop the chaos piling up around me. I dread that chaos. It’s horrific and shameful. And there’s another reason to keep it down: see #3.

3. Reduce distractions in your environment

ADHDers naturally tend towards chaotic environments. That mess and disorganisation takes over our lives. Some can find a sort of peace with it, and just accept it, but I have real trouble. I am so much happier in an uncluttered environment. I can’t make be at home with the ADHD chaos. Part of that is that I find all that mess inherently distracting.

Objects and paperwork catch my eye, interrupting my thoughts and reducing everything else to white noise. Books I haven’t put away cause me to stop and think about them instead. Dirty dishes and mugs are just gross and set off some of my aspie sensibilities.

I hate the physical sensation of mess. I hate if I have to move things or step over things to do what I need to do. I want to be able to spread out my arms without bumping into crap. Most of all, ADHDers also tend to be very uncoordinated and clumsy. We bump into things and drop things. Navigating mess is a lot harder than navigating a clear space, and it’s mentally exhausting. It’s why I want to keep my backpack organised and my desk space as clear as possible. The odds of me knocking a coffee onto my keyboard will be greatly reduced, or fumbling around trying to pick something up that’s under something else. I hate dropping stuffs, and I hate that I do it so much when everyone else seems to be able to pull stuff out of their backpack without it going everywhere.

Me? Nope. There’s no dignity at all in how I navigate a space.

So: I put things away. And it’s hard. And it takes way longer than it should. But I do it, because if I don’t: chaos and frustration.

Mind you, because it’s so exhausting and frustrating…

4. Organised “well enough”

In Delivered to Distraction, Hallowell and Ratey recommend that ADHDers ease back on trying so hard to be organised. We can’t do everything. It’s going to be too hard and it’ll exhaust us – but we don’t need to everything. We don’t have anything to prove, here. We just need to be functional. Get organised well enough to do what you need to do.

Turns out I’ve been following this advice for years. I’ll make sure my working desk space is clear, but shove everything into drawers (because it doesn’t have an actual “place” to go and I’m too tired and cranky to figure one out. I find that overwhelming). My lab book (which is supposed to be written out so clearly that everyone knows exactly what you’re doing) has all the information that I need, and that’s it. I store samples in such a way that I know roughly where they are, because I don’t have the mental energy to organise them precisely.

Maybe once a year or so, I’ll go through those drawers and sort them out. Otherwise, I have a pretty rough idea what’s in there, so it should be okay.

5. Muttering to myself

Welcome to my most annoying and yet second-most-effective coping mechanism: I’m an irredeemable mutterer.

My working (short-term) memory is for absolute shit. I’ll forget what I’m doing in the middle of an action. Happens all the damn time.

As it turns out, my auditory memory is… pretty functional. I remember sounds, not actual thoughts or intentions. If I get interrupted by a thought in the middle of an action, but I’m describing what I’m doing to myself, I can use the sound of the words I’ve just spoken to pull me back.

If I repeat a phrase or a number over and over and concentrate, I’m much more likely to remember it. I’ll say the names of my samples when I add them to a PCR, or the coordinate of the well I’ve just loaded, because then if I can’t remember if I loaded it, I’ll remember the sound of B6.

I provide constant running commentary of what I’m doing, or odds are pretty good I’ll forget what I’m doing. So there’s a lot of Oh yeah I need to change the bin as I walk into the kitchen to change the bin because otherwise I’ll walk into the kitchen, forget what I was doing, and get a snack, and then go do something else, and forget the bin entirely.

This can make me a very annoying person to be around!

I try to keep my muttering minimal while there is someone nearby, and I can keep it way under my breath when I’m an office, but without it, I just can’t remember what I’m doing. I was quite flattered and chuffed when my PhD lab mates said they missed me in the lab when I was away, because it was too quiet. I thought they were having a gentle dig and apologised, and then one said, “No, actually, your muttering is kind of soothing, like that’s how the lab is supposed to sound.” Which is a situation I was very lucky to enjoy!

Because if I don’t do this, I’ll go into the bathroom with the intent of moving the wet laundry into the dryer, and instead I’ll scoop out the kitty litter, because I’m in the bathroom now and that was probably what I meant to do, and I won’t remember the washing until the machine beeps again, long after I’ve walked away.

The other advantage (that I have just recently realised) is that for me it’s a kind of verbal stimming, which I find very soothing and comforting. When I’m in an environment where it’s not okay for me to mutter much or I don’t get an opportunity to sing aloud, I find my urge to make weird noises is overwhelming. It’s almost a tic.

6. ROUTINE IS THE BEST THING AND ALSO THE WORST

This is the absolute number one most important coping strategy. It’s basically like a hack for the ADHD brain. Stack a number of habits and tasks together to form a routine, and after a little while it becomes natural. I have a routine at home, just a little one. After breakfast, I go clean my teeth (including flossing and also doing skincare stuff). Get clothes on. Then make the bed and tidy the bedroom.

It is the silliest, tiny thing, but it restores an important space, reduces distraction, and makes sure I floss (and also that I don’t get toothpaste on my clothes for the day, because I brush my teeth in my pyjamas). I find this routine – this particular order of tasks – incredibly soothing. It makes me happy. I get a dopamine hit. I feel like I’ve exerted some small control over my environment. It helps me get out of the house.

At the time of writing (or drafting) this, I’m in Perth for work. The place I’m staying is great, I have everything I need, and it’s a short walk from my work site and there’s even a café on the way to pick up a coffee, but I have terrible trouble leaving for work in the morning. It’s so damn hard. The order of putting on the kettle, making breakfast, laying out clothes, taking medication, all those things, it’s all up in the air. I can stare at my clothes in confusion wondering where to start (in spite of the obvious logic). I should put the charge cables in my bag. I should put the kettle on. I should make my lunch for the day. And I should do this all at the same time.

*head explodes*

I get stressed, so I open up my phone and check my social media. Yeah. That’s a top idea when you have a tendency to get distracted from what you’re meant to be doing. I’ll find a conversation I need to respond to right now, and everything from clothes to breakfast gets forgotten.

I lie awake at night, consciously planning what order I’ll do things in the next day. First, take meds. Wait, no. Refill water bottle. Then take meds. Wash face. Then put kettle on. Then get clothes out. Don’t forget to pack your gym bag.

Over and over, trying to impress it into my memory. And it… does not work well.

Outside of my routine, my coping mechanisms start to fray around the edges.

And I have to acknowledge here: my brain wants to rebel against routine. Often I love it and it’s soothing, I get a sense of control and achievement and I can function almost normally – but then I’ll just get frustrated and angry at the sameness of it all and I’ll desperately want to break away from the structure that I need to function.

But without that routine, without that structure, I’m a semi-functional teenager again, wading through a mid-calf high pile of crap in my bedroom, wondering where my maths textbook is.

7. I drink a lot of coffee

ADHDers are known to self-medicate. Caffeine and energy drinks feature heavily, and I’m no exception. It’s just a good thing I didn’t end up using alcohol, or dope, or cocaine, or any of a number of things I might have turned to. Instead, I drank a shitload of coffee and a bunch of sugarfree V. I had to, because my brain only lets me do a lot of things at the last minute, and I needed to stay awake. I used it in a desperate attempt to clear out the brain fog that made it impossible for me to focus on anything. It helped a little bit. Some of the time. Oddly, I find I’m drinking a lot less coffee now that I’m on medication…

8. Leave things out so you don’t forget- no, wait – deal with it NOW

I try to leave out papers I want to read, or bills that need to be paid, or essentially anything that needs to be dealt with soon. This isn’t too bad now – I have better strategies for ensuring things get done – but basically what I end up with is giant piles of things I mean to deal with and don’t. The fear is that if I put them away neatly, I’ll forget about them – and I will. When they’re not in view, they don’t exist in my brain. Then eventually the mess distresses me more than that concern, and I give up and put them away.

As a note: this is why I pay bills as soon as they arrive. I walk in the door, get out my phone, open my banking app, and pay them right then. I can afford to, so I do it, I write the BPay receipt and the date at the top, and they go on the “to be filed” pile (although, ha, guess how often the filing gets done).

9. Skim Reading and Note Taking

Without note-taking, I’d have been useless in my undergraduate lectures. I need the physical movement of the pen to get me through it. I skim read papers, searching for the key phrases of interest, noting the abstract, the results and then searching for the relevant parts of the discussion. As I’ve discussed elsewhere, reading papers is actually hell for me, so I have to employ a strategy to make sure I get what I need from them.

10. Exercise

So. Apparently exercise is superbly good for ADHD people. It releases a bunch of brain chemicals that help us focus. I didn’t know that at the time, but I suspect this was also one of my coping mechanisms throughout the ol’ PhD. Having the executive function to get myself out of the house and down to the gym was a challenge when I was overwhelmed and distressed, but it was worth it when I could manage it.

When it comes down to it, these strategies mostly work for me, but they are exhausting. They are draining. I feel like I live in this rigid framework of reminders and calendars and plans and lists. Unpacking and tidying takes so long. A lot of mental effort goes into maintaining all this. I resent the hell out of it.

But if I don’t do it, the whole structure just falls apart.

P.S. Yes, this post is way too long. No, I don’t have the energy to edit it. I’ve been meaning to write it all week and if I don’t put it up now, it’s not going to happen. ADHD in action!