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January 13, 2006

Just stop being lazy

ADD.jpg It's been a month now since I started taking Wellbutrin. The effects on my ADD are subtle, or at least they seem that way to me. But I'm happier, in general, and somewhat more able to focus for long periods of time. Becky has observed that I'm not only taking more initiative to start tasks around the house, but actually almost finishing most of them. I met up with my pshrink again yesterday, and – following the time-tested physicians' maxim "some good, more better" – we've upped my daily dose by 50 percent.

I'm actually pretty glad the effects have been subtle. It's reassuring. Still, it makes it hard to sort out pharmaceutics from placebo, and in this instance there's a mental factor that potentially makes the placebo effect pretty damned strong.

To wit: the diagnosis of ADD undermines the worst things I have believed about myself.

From as early as I can remember other people have informed me of the reasons I don't finish things or pay attention. I lack discipline. I am stupid. I am incapable of understanding complex concepts. I lack motivation. I am obviously not cut out to take part in the intellectual work required for me to succeed in the elite school for which my father shells out his hard earned money to pay my tuition. I am emotionally disturbed. I am lazy.

I plead no contest to the last two accusations. I am embarrassed to admit how much stock I placed in the others.

At age thirteen I was a senior in high school. I enrolled in a calculus class. Math was never a strong point for me unless the teacher avoided rote learning and concentrated on theory. Tell me how the numbers interacted one with the other, and I was rapt. Rely on rote and I was lost. Unless I had a private tutor, calculus – relying as it does on a nested series of abstract arguments – would even now be next to impossible for me to learn unless my life depended on it, which would provide the necessary measure of interest.

When I started bringing home the inevitable failing grades from calculus class, my parents – upset that their 13-year-old would disappoint them in such a fashion - scolded me for a day and a half and then sent me to a counselor. He was a nice guy, and he helped me come to terms with a couple of things bright 13-year-olds often have trouble with – isolation from peers and such. It wasn't a waste of time. But the only ways in which he could have helped me pass my calculus class would have been either to tutor me, or to diagnose my ADD and propose a course of treatment, which was unlikely in 1973.

One evening he asked me to draw a picture of my family. I decided to provoke a reaction. I drew stick figures, Mom, Dad, Carrie, Coral, and Craig, and then – next to them – I made the tiniest possible mark on the paper, and labeled it 'Me." Time was up, and he asked for the sheet of paper, and his eyebrows went up a little. "Don't worry," I said. "I was joking."

"That's an interesting joke to choose," he replied.

I spent the rest of the session losing track of what he was saying.

Early on in my school career, I gave up on taking notes. In order to pass classes, I had to battle distraction. Taking notes was a distraction. My memory was good enough that if I could force myself to pay attention in class, I could remember what was said. Despite the fact that it turned out to be a survival skill, I always felt like my not taking notes was a failing. Some years after I left school, I found an old notebook that contained a semester's worth of notes from an American Literature class. Below is the sum total of notes I took in that class:

"EMERSON"

I still don't take notes in meetings unless I'm responsible for minutes, in which case I only write down the results of decisions, and I shush people while I write so that I don't miss anything.

I have to be fair to my parents: ADD was not a familiar concept in the 1970s. I imagine they were at a loss for how to help me. But I have to be fair to myself as well. At age seven I was wondering whether I might have this problem, trying to put a handle on the intellectual frustrations I felt. The kid my age next door told me about being diagnosed as "hyperactive," which, he explained, meant that he had trouble paying attention in class, that he'd find himself spacing out, though that was almost certainly not the phrase he used. I thought about that for a while. The next weekend, my father was working in the yard behind our little yellow brick ranch house. I decided to ask an authority. "Dad, am I hyperactive?" "You're hyPO-active!" he replied.

(Later that summer, when - after skimming our copy of Dr. Spock's Baby and Child Care – I asked my father when I could expect to start menstruating, he replied with almost precisely the same mixture of sarcasm and impatience.)

My father was right about my lack of hyperactivity, and, for that matter, my lack of a uterus. One of the things that has masked this ailment all these years is my notable lack of interest in fidgeting. Given a comfortable place to sit and a compelling book, I can become absolutely torpid – more so in those days before caffeine. But had he taken my question seriously enough to give it more thought, who knows what might have happened? My neighbor was being medicated for his "hyperactivity," probably with Ritalin, possibly, in those days, with Dexedrine. I can say at the risk of understatement that I am not a good candidate for any course of treatment involving long-term amphetamine use. But had Dad decided I was onto something, I nonetheless likely wouldn't have been medicated at all. ADD as a syndrome distinct from hyperactivity wasn't recognized by pshrinkologists until 1980, and for years afterward most professionals thought it was a disease found only in girls.

Short version of the above blathering: I have lived for 46 years with a disability I thought was a severe character flaw, and god damn it, I can't blame anyone for not figuring it out.

I am especially intrigued by the apparent undercurrent in psychological thinking that holds that behavioral modification approaches to ADD – the to-do lists, the making sure the keys go in the same place every night, the post-it notes proliferating on the monitor, the syncing of PDA with computer with online database to make sure you have your meeting schedule no matter how flaky you were when you left the house – I am intrigued, as I said, to hear that some experts think such Behavior Mod stuff cannot work by itself.

"Such Behavior Mod stuff cannot work by itself." You want an example of a simple concept that shakes a man's self-image to its foundations? There you have it.

It's not that I want to pathologize my leaving around of dirty socks and thus abandon any hope of reformation. I want to find a way of solving the problem. And 46 years of having the best intentions did not work. Forty-six years of flunking class after class, of parental shrieking and girlfriends leaving and employers cutting off the paychecks. Forty-six years of me telling myself the only problem was laziness. I want to say that no one would accuse a paraplegic schoolkid of malingering, but that glass is half-empty. I know there are teachers out there, and parents, who would tell a kid with cerebral palsy not to flail like that, who would tell a kid with Down Syndrome to "stop being so stupid." I spent the first eighteen years of my life hearing people telling me, in effect, to just stop having ADD. I have spent the last three decades telling myself the same thing.

I want to call the last 46 years, struggling with this problem, this sieve of distraction clamped around my mind that has only just now begun to dissolve – I want to call it a waste. That would be silly. I've accomplished a hell of a lot, especially in the last fifteen years, and those accomplishments look all the rosier now that I know I scaled those hills with a hidden bag of cement in my pack. Besides, if the ADD were the worst thing to have happened in my life I'd have been a lot luckier than, in fact, I was. And now I'm doing something about it. Some people never figure this out. And even if the Wellbutrin doesn't help long-term, at least I know now. That's something. And ADD takes with one hand, and gives with the other: it's linked to creativity in expression and thought. And and and.

But I'm sorrowful that it took so long. And I'm angry - searingly angry – to think of that eight-year-old's enthusiasm as it succumbed to frustration and repeated insult, and to think of the twelve-year-old he became, certain that he was the worst waste of skin in the world.

Posted by Chris Clarke at January 13, 2006 04:47 PM TrackBack URL for this entry:
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Comments

Well, this is a familiar rant.

I hope Angus shows up to offer the much-needed perspective he gave me when I was agonizing over whether or not to medicate my 6-yr-old, and at what age it might be "fair" to do so.

My ADD did not become a hindrance until I hit puberty, and I think treating it prior to that would have been a mistake. But that's a subjective call made with 20/20 hindsight.

Would sympathy, non-drug therapy, and explanation have been enough for you at 8?

I completely agree that you can't do the drugs without the therapy. My analogy is along the lines of, "I've had blurry vision my entire life. Now that I can finally see, I need to learn how to read."

And -- heh -- calculus and biology were the only two courses I studied for and failed anyway.

Posted by: Tiltmom at January 13, 2006 05:41 PM
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Oh, my heart aches for your 8- and 12-year-old selves. Our painful experiences are such powerful shapers of who we become. Those hurtful little kid self-images are so hard to shake. But, as you said, they give and they take. Hopefully we become more compassionate adults because of them. Anyway, thanks for your continued sharing of how this issue has affected and is affecting your life.

Posted by: nina at January 13, 2006 05:58 PM
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You know, after reading you and Tiltmom and Angus, I'm starting to wonder if I had ADD. I took Welbutrin for a few months when I was dealing with my PTSD, and if I didn't need to get off it again to get my pilot medical back, I would have loved to stay on it.

One of the symptoms most prevelent today is that I can't pay attention in a meeting. I play solitare on my PDA because otherwise my attention would be a million miles away. Most people don't understand that my playing solitaire actually enhances my ability to pay attention rather than detracts from it.

Posted by: Paul Tomblin at January 13, 2006 06:19 PM
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I have successfully wrestled my initial impulse to blather away about my own fidgetty-ness and distractability (which I _know_ doesn't rise to the level of ADD, because I _can_ concentrate if I have to) and just want to say that this is a really wonderful piece of writing, even if you don't take my sympathy for this as personal experience into account.

Posted by: Rana at January 13, 2006 07:29 PM
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hello chris,
a swell piece of writing, as well as the next bit, about zeke wading. & i'm hoping the medication increase gets you where you need to go.

i was also torn up by:
From as early as I can remember other people have informed me of the reasons I don't finish things or pay attention. I lack discipline. I am stupid.... [snip] ..emotionally disturbed. I am lazy.

I plead no contest to the last two accusations. I am embarrassed to admit how much stock I placed in the others.

At age thirteen I was a senior in high school. I enrolled in a calculus class. ...

you had me up to the point you said you were a senior in high school at thirteen. :c) if you'd gone on to say you'd enrolled in a soccer team, or a scout troup... but no-o-ooo!

a while back, i spent eight years helping grown ups who'd for the most part had the *sense* to leave school at thirteen, never mind a calculus course, get back in the saddle again, and finish high school. the brighter ones managed most of what they needed in as little as two weeks, which made me realize what a waste most of *my* four years in high school had been, never mind the subsequent five years in the academe factory.

and i'm mostly only bitter, now, about not getting anywhere with my own attempts, over the years, to *learn* calculus. of course.

still, the only way the pshrink you saw might have made a dent in the cruelty you -- and countless other children -- have had to endure at the hands of their parents (well intentioned though they doubtless were...) would have been to have had the good grace to have told them to eff right off. in the nicest possible way, of course.

in the absence of that ever happening in this world, at least in my lifetime, i can only advocate for the re-appraisal of that eight/ten/ or thirteen year old's circumstances within one's self, somehow.

and if upping your dosage of wellbutrin helps that happen, well, it can't happen soon enough.

i'm thinking of my dog, binkie, who's 13 now, and of how i had to climb down a rock pipe to lift him up so he wouldn't hurt himself trying to rejoin his alpha (me). zeke, of course, is you, also, just as binkie is me, sans cynicism, i.e. the eight year old who might-have-been. happy trails, dood.

thanks again. hth.

Posted by: dfa at January 13, 2006 08:27 PM
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I spent the rest of the session losing track of what he was saying.

How do you remember so perfectly what it's like to be thirteen?? My son is thirteen now and I swear, he has this happen to him when I go on a blathering jag. It's a feeling that moves beyond boredom into something that would be confusion if he cared enough about what I was saying to invest losing track of it with any negative associations.

It's humbling to witness and I try to shut up as soon as I see "the look" come over his face.

Posted by: eRobin at January 13, 2006 11:15 PM
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I hear you. Well, I heard a few words and then spaced out. Like when I ask a question and don't pay attention to the answer.

Contrarily, the ability to pay attention for long periods of time also exists alongside the distraction. There's this place called My Own World where I can totally focus.

Posted by: KathyF at January 14, 2006 12:29 AM
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Interesting ...
as a teenager I got rants from my father, for doing homework with music or radio in the background (ok, I cannot write if on the radio they speak the same language, that gets confusing). If I'm not REALLY tired ... I NEED the music in the background, else my mind starts to wander around ... People usually do not understand, when I tell them, the music keeps part of my mind occupied, so that the rest can concentrate ;-) .. interesting ...

Posted by: Yubi at January 14, 2006 01:45 AM
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Just writing to show my support. I'm glad you acknowledge your accomplishments - your writing alone is something to be very proud of. A successful marriage is something beyond a great many people who don't have disabilities. It is a shock to the system to realize you've got a disease, when all along you thought you were just worthless. My therapist helps pull me out of the low spots by getting me to look at how far I've come since starting treatment for depression.

Posted by: Buffalo Gal at January 14, 2006 05:47 AM
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I used to think that mental illness had a stigma, but lately I'm beginning to wonder if that has disappeared, or, at least, diminished somewhat. I deal with complications that go along with chronic pain; maybe people just talk about it any more around me. But I like to think that highly intelligent and talented people like yourself talking about it has made people realize it's just a medical condition (I cringe when I write "just"), and sufferers can still be valuable members of society.

By the way, did you "get" calculus? I struggled with it until I started to apply it in problems in physics. Made all kinds of sense then. I also have an excellent resource that takes this "application" approach to learning calculus. Drop me a note if interested.

(I wish I had more mornings like this when I can catch up on all the well-written blogs I used to read.)

Posted by: Robert at January 14, 2006 06:19 AM
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i downloaded your book to leaf thru it and check it out. thanks for the courtesy. if you can write like that w/o meds we've all got a big treat on the way as the meds kick in. tried the paypal thing. not sure if it worked. i will keep track of that and make sure you get yer $.

much sympathy for you as a kid. i recognize me a bit, tho i was functional enough to get by ok. i was forever in trouble for not paying attention. but i always knew the stuff needed to get by.

Posted by: dread pirate roberts at January 14, 2006 08:06 AM
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My 25 year old nephew who has been diagnosed with ADD and is bi-polar, has just decided to enlist in the Marines. Seriously. He has quit every job he's ever held. In fact, he had a brand new job last Thursday, and by Tuesday he was out the door with this new plan. The Marines. I sense that he is seeking a regimented discipline as a way of mediating his wandering mind, but I am so concerned by this choice of authority as intervention. I left him a long voicemail message, but have not heard back.

I am glad you are finding some relief and groundedness, Chris.

Posted by: Rexroth's Daughter at January 14, 2006 08:08 AM
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"Most people don't understand that my playing solitaire actually enhances my ability to pay attention rather than detracts from it."

Your distraction distracts us. It's an unfair world that we live in.

As a depressive (42 yrs old, only on meds for the last two, same lament - what took me so long?) I need to focus like a laser to keep from losing things. Information drops from my mind like leaves from a tree in fall. I need to write everything down for review later, lest it be lost in the fogs of my mind.

I've an aquantaince whom I might be might much better friends with, if only I could just stay in the same room with her. For her to function at full capacity, she needs the radio on, blinking lights flashing at odd intervals, several conversations going at once - each rising increasingly louder as everyone strives to hear and be heard... I flee... and if I stay, it all becomes a continuous wall of sensation and noise, and I end up in a bubble of silence - totally apart from all of it - hearing and understanding nothing.

Very frustrating, for all of us.

Posted by: jenn at January 14, 2006 08:09 AM
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Meds are great things, and I wish you the best of luck with it. It's too bad that people often don't get meds when they need them because they think they're just not capable of grunting through their problems - be it depression, anxiety, ADD. When it's a brain chemistry thing, it's seen as mental/emotional failing instead of physically based disorder that's treatable and not the fault of the person with the disorder any more than cerebral palsy would be. I do think it's changing, though, as people communicate their stories such as you're doing here, Chris.

(Point of reference, a couple of my family members are on meds for anxiety disorders.)

Posted by: leslee at January 14, 2006 12:56 PM
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Kim: I hope Angus shows up to offer the much-needed perspective he gave me when I was agonizing over whether or not to medicate my 6-yr-old, and at what age it might be "fair" to do so.

I don't know that I have much to add. But if you ever want to chat with someone who's in a similar boat, Chris, you've got my address.

Posted by: Angus at January 14, 2006 08:17 PM
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I can't blame anyone for not figuring it out.

Neither can I, but I can blame them for the explanations and strategies they came up with instead. In my case, the diagnosis was laziness compounded by perversity (I could easily have done well in school, but chose to do badly to spite my parents.) The prescription was punishment: confinement to my room, denial of privileges, and extensive, mostly verbal, abuse. Unsurprisingly, this proved an ineffective treatment for depression, but my parents never lost faith in the technique. I still wonder how much the severity of my depression owes to the underlying condition and how much to the 'cure'.

Posted by: Beth at January 15, 2006 04:29 PM
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I meant to comment on this last week, but my own attention issues defeated me.

I know the relief of getting on the right medication - sodium valproate has been the one for my mild bi-polar disorder.

This post of yours has been linked to in the latest Skeptic's Circle as a counterpoint to the "Indigo Child" craze. How do you think you might have turned out if instead of being told you were worthless you were told you were superhuman and destined to save mankind?

My own stance is that both of these approaches suck, of course. Working on doing better with my own ASD/ADHD boy.

[link fixed - C]

Posted by: tigtog at January 22, 2006 12:15 AM
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Did I fuck up my HTML? Sorry about that - thanks for fixing it.

Posted by: tigtog at January 23, 2006 12:43 AM
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Hi. Good writing. Understand this as I lived and live w/ it now and as above glad to chat via e-mail. I'm the same age as you. Got the same stuff from parents siblings and teachers. The help I've found is to be for the most part alone. Though I am a single parent. I try to go running three to four times a week, only its not always possible. This clarifies things briefly.

Posted by: Pat at January 25, 2006 02:40 PM
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