I had a nice conversation recently, and went through a list of questions that was both very familiar and yet unique. Prior to my first official appointment for Adult ADHD, I had a phone evaluation, just a basic "who are you and where do you think you are with this issue?" kind of thing. It's interesting going through this process as an adult, where I'm the one initiating the conversation rather than my parents/another physician. When I was a kid, I was dragged in to get evaluated and get treated, and I didn't really want to be. Now, however, I am both curious and strongly invested. It makes all the difference.
Many of the questions were the same pat ones I remembered; "Do you have trouble concentrating"? "Do you have a high energy level"? Well, yeah, or I wouldn't be having this discussion. Sorry, pat snarky answers there, too, but we have to start somewhere. Then we shifted gears a bit. Tell me about your sleep patterns. How do you deal with anxiety and frustration? Do you own firearms? Have you ever had thoughts of suicide? I get the need to ask these questions, because it could determine where on the spectrum I am. It definitely felt strange answering some of these. Even though I knew them, it felt very different telling them to someone else.
One part of the story that, as we were discussing things and how I'd "behaviorally coped" without medication, and if I had any external habits or if I used any illicit drugs, led me to an interesting realization. While I did stop taking the pills when I was younger, I replaced them, not intentionally, with something else… caffeine. More specifically, black coffee. Yes, those of you who know about my religious upbringing and heritage may be raising an eyebrow or two about now. It's true, I was inactive in my faith for several years, and this shift coincided with this time. For several years, I drank the equivalent of a full pot of the stuff a day, or about a gram of caffeine daily. My productivity during this time period was phenomenal, and in many ways, I'd considered that I'd beaten ADHD. Not true, I'd just replaced one medication with another, and one not particularly well suited to that purpose.
Around the end of 1993, I decided I wanted to go back to church, and embrace the life I'd not lived for many years. With it, I made a commitment to get off coffee, completely. It took me a full three months to detox from it, and afterwards, I felt radically different, but during that time, I felt many of the old hallmarks creeping back in. The lack of attention, the restlessness, the erratic sleep patterns, etc. Thus, I settled into a strange little "cycle" that I would repeat over the next nearly two decades. I would treat my distract-ability with caffeine (albeit this time with sodas or caffeine pills directly), until I felt myself reaching that "hypocrite" point, and then I'd stop, and I'd wind down, and when my distract-ability level would get to me again, I'd start the whole process all over again.
There are other tell-tale signs in there as well. Generally speaking, I've been with most of my work gigs for about two years. Usually within those two years, I would either find some other focus within a company, or I'd find another company. Some times those decisions were internally motivated, sometimes they were externally motivated. For years, I blamed the problems on me getting bored, or me doing the rote things over and over and losing interest. I love innovation, I thrive on new challenges, but I find that, often, there's just a solid level of yeoman's work that has to be done, and it has to be done a certain way, whether I liked it or not.
That's been my biggest struggle lately, and quite possibly why I often feel the need to agree to any volunteer initiative that comes along. Those are great, and what you can learn is tremendous, but it is hugely detrimental when your volunteer efforts start to invade on your thoughts to a point where you can't effectively do your day job. Walking through "The Hours" helped confirm this for me. It also showed how hard it is to block out fresh and new thoughts and the desire to tackle new challenges when there are plenty of old challenges that need my attention (and are not getting it).
Wednesday is the day. I will go in and I will lay all my cards on the table, holding nothing back. I don't want to take medication, but I'm open to it if it will help. If there are behavioral things I need to do, then I will commit to doing them and tracking them (and I may discuss some of them here). More to the point, it's possible that my commitments and involvements in some areas will have to, for now, be curtailed. To borrow a little from Steven Covey, too often I've been dealing with too many things that are Urgent but Not Important, and neglecting those things that are Important but Not Urgent, to the point where many Important things have now become Urgent.
Another "Coveyism" that I like a lot, and was reminded of this weekend as I was talking to a few people about my decision, is the value of a paradigm change. In "Seven Habits of Highly Effective People", Stephen wrote:
"if we want to make relative minor changes changes in our lives, we can perhaps appropriately focus our attitudes and behaviors. But if we want to make significant, quantum change, we need to work on our basic paradigms. [...] We can only achieve quantum improvements in our lives as we quit hacking at the leaves of attitude and behavior and get to work on the root, the paradigms from which our attitudes and behaviors flow."
In other words, I need to change the very mental map that I use. Behavioral changes are difficult enough in themselves. Paradigm changes are much harder, but they have one solid benefit on their side. They are all encompassing. There's no back-sliding with a paradigm change; you are either in it or you're not. I've decided to stop dealing with the leaves, and start attacking the root, even if that second path is less comfortable, more fraught with risk, and more terrifying to my Lizard Brain.
I've talked a lot about the Lizard Brain in previous posts, not because I fully understand it or because I have mastery over it, but because I realize how little mastery over it I really have. The Lizard Brain can undermine behavioral modifications. It has much less control when you undergo a paradigm shift; because it's so sweeping, it doesn't know where to find safety. My getting treated is a genuine paradigm shift in my life. Frankly, I don't know where it will end up. That's frightening, and really cool at the same time :).
Fantastic write up Michael. This kind of stuff is difficult to write or talk about as an adult, because you're just expected to be in proper working order (at least in the professional world).
I've had a lot of the same difficulties and empathize a great deal with your struggle. I have no desire to take medication and stopped about 2 years ago myself. (I was on Concerta then Focalin for quite a while) But I feel the same coffee/caffeine habits creeping back up. Maybe I need to follow your example.
I had a good chat on Wednesday. Of course, that chat was to set up yet another appointment (of course ;) ). Still, there was some interesting stuff that came out of this meeting, and I learned a few new tricks. It'll be two more weeks before I know if this will be medically treated or behaviorally treated. I'll be sure to let y'all know :).
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