The Road Trip
Imagine life as a road trip. Your consciousness is the driver of this vehicle. As we grow up, we each are learning to drive. The vast majority of people learn successfully enough to navigate on their own. Everyone has differences in skill and style, and various breakdowns and accidents occur along the way. Nevertheless, it’s very much the norm to move through life.
Now, imagine that you seem to have a tougher time than most people. There’s nothing obviously unique about your car. It has a motor and pedals, body panels and seats, tires, etc. etc. And you’re sorta moving along with the rest of the crowd. Some of the time. Frequently, though, you seem to just be less skilled than others. You seem to stall out at stop signs. You make wrong turns. You can’t seem to keep your eyes on the road.
For your whole life, you’ve been trying to drive this thing. Frequently, people behind and all around you keep honking at you. They sometimes yell at you to GO!!! Or they insult and mock you for being a bad driver. “Learn how to drive!” “Watch where you’re going!” “Idiot!” So-called helpful people lecture you. “You’ve got a much more powerful engine than many people. There’s nothing standing in your way except your willingness to concentrate on the rules of the road. Everybody has these bad days. You’re not special in that. But you just need to learn to keep going.”
Life is passing you by. Long past the childhood learning age, you keep trying. You’ve been told countless times that you just need to put the pedal down and GO. This seems to work for other people who drive smoothly through life, passing you by every day. So it must be true. You just suck as a driver. Too bad driving is how you do life.
Every day, for decades, you start the engine and floor the pedal. Your RPMs are usually in the red zone, so why can’t you go anywhere? You wonder why you set out every day not knowing whether you’ll be able to get out of the driveway, whether you’ll end up in a ditch, or whether you’ll maybe be able to putt along in a way that at least keeps other people from noticing that you can’t drive–an inexcusable, pathetic flaw that you should have outgrown so many years ago.
ADHD in Real Life
A feature question of this blog (and my life) is, “What the hell is wrong with me?” This blog post jumps ahead about 3 years from previous posts to provide a big answer. Previously, I had self-diagnosed with CPTSD. I still stand by this.
But I’m also in the growing cohort of people who received a late-in-life ADHD diagnosis. In my case, in my early 50s. The sheer number of different problems, issues in life, and symptoms this explains is astonishing, and so much of my life makes so much sense now that I’ve had this diagnosis.
There are still so many healing modalities and strategies that I employ and that I’m still learning about. But the ADHD diagnosis led to one therapy that cuts right through so many of my struggles. That therapy is the use of stimulant medications. After a couple of months of careful dosage adjustments, I’m seeing huge benefits. It’s like this is the ingredient my brain has been missing my whole life, and now new worlds of possibility are opening up.
It’s not quite affecting me the way I expected, after reading some others’ descriptions. Often these descriptions are along the lines of “Adderall helps me focus, and I’m more calm.” I didn’t notice this, at least as a direct effect of Adderall. What I noticed was a boost of energy. But more to the point, I suddenly had agency. The most impairing symptom of my ADHD was a daily drowning in the hellhole of what is sometimes called ADHD paralysis, or task paralysis. It’s a state of helpless procrastination characterized by intense, panic-attack-level anxiety on the inside, coupled with an inexplicable inability to initiate action on anything on my to-do list.
For me, this doesn’t look like what some people think of when they hear about procrastination. As in, “Oh, I totally know what that’s like, my closet is a MESS and I’ve been meaning to organize it for months!” That type of response is the one that lets me know that there are plenty of people who think they relate, but who really don’t get it at all.
For me, procrastination meant a daily battle to do the most mundane things. Get out of bed. Take a shower. Get to work on time. Focus once I got there. The effect was a crushingly, miserably burnout level of effort only to reach a very small level of basic functioning. This life is characterized by shame and frustration and self-loathing. Outwardly, it’s characterized by chronic underachievement in my career, my personal goals, my development as a person. Most of my energy has been spent trying to keep myself above the baseline survival level of self-sufficiency.
Shortly after trialling Adderall, my life started to look very different. Let’s return to the driving analogy.
The Road Trip Continued
At some point, you finally get this car-that-won’t-go to a shop with a mechanic who correctly diagnoses the problem. “I see what your problem is. Somehow, your vehicle rolled off the assembly line without a clutch or a steering belt. I’ve done some aftermarket installments that should help.”
In many ways, you know that this news might otherwise be extremely upsetting. Your car is completely defective. But you’ve endured so much that all you feel is vindication. You KNEW something was wrong all along. And that something was, in fact, a very big deal. No amount of “Just GO!” advice was ever going to fix it. But now you’ve got the right diagnosis. There are repairs in place, and you realize that your car requires a special type of maintenance. At long last. You’re relieved and elated.
Now you have a car that operates like it was supposed to. You hit the gas, getting a huge rush out of the instant acceleration. You notice that when you turn the wheel, your car reliably follows. “Holy shit,” you think, “is this what driving has like for everyone else this WHOLE TIME?” For the first time, you look forward to starting this baby up and heading out each day.
Yet, for a while, you start making a completely new set of errors. You floor the pedal the way you’ve been doing every day. And you find yourself speeding out of control. You turn the wheel hard, and overcorrect and wind up driving the wrong way. You’re astounded at the ease of getting moving. On the other hand, you realize something you hadn’t thought of. Although you long ago passed the written test and have a license, you’ve never actually driven a functional car before! You were going through the motions, but how do you get experience driving when you don’t have a functional vehicle? You need to start a new learning curve, teaching yourself how to drive this suddenly operational machine.
The Stimulant Effect
My experience on Adderall involves some jerky motion. Only my very first day on my very first dose actually resulted in an effect of calm and focus that I have heard about. The discordant, multi-voice and sound noise that has always made up my mental space suddenly quieted down. I felt calm yet alert, able to relax and focus.
But after that, once my pill kicked in, it didn’t automatically result in that calm, focused effect. In fact, wherever I was mentally at the time when the medication took effect, became amplified. That was as true for a distracted, emotionally dysregulated state as it was for a focused state. However, the important thing is that if I remembered to be conscious of this state, I could control it. If I was mindful and present, I could start driving this energy, and choose what to focus on, rather than being hijacked by distraction or emotions.
I think perhaps what is happening is that I’m getting a boost of some of the right chemicals. But I have to consciously drive it.
Maybe this is just what agency or free will or the ability to push through feels like, and I am struggling to describe it because it’s completely novel to me. But, for the first time, I CAN drive this thing. It’s not just the occasional fluke, or burst of unusual energy, that allows me to achieve something. With medication, these days of just getting through a basic to-do list happen more often than other days. That may not sound like much, but to me it’s a glimpse of a completely different life.
I’m now dealing with a lack of any practice and a lot of learned helplessness. Because I still have that issue where if I’m caught up in rumination or distractedly in my head going in multiple directions at once, that is simply ramped up by stimulant meds. But when I can get a mindful moment, I start to get a little control and I can drive this thing. I have been able to be productive in things where there is no external accountability. Looking back at my planner for the past month or so, there are a hell of a lot more check marks and a lot fewer crossouts.
It’s early days yet. I’m only weeks in to my personal “Adderall diaries”. I’m still adjusting dosages, noting side effects, and getting used to things. I’m trying to navigate learning about what is a placebo effect and what is the actual effect. The biggest potential issue is that the novelty hasn’t yet worn off. That leaves me very prone to biases and misreadings of the medication effects. Novelty can be everything to an ADHD brain: it’s a dopamine jackpot.
Then again, I don’t know if I’ll ever be able to describe to a more normal person what it’s like to be able to simply decide to do something, and then to do it. This is so much a part of what it means to be human, that the shame and panic of knowing I’m lacking in this crucial function has been so damaging to my own sense of efficacy. That’s on top of the more basic impairment. And if this medication can alleviate the hell of “ADHD paralysis” to any degree, then there is no question in my mind that this is the right treatment for me.