theunitofcaring:

mailadreapta:

theunitofcaring:

After I complained on here about my difficulty in getting ADHD meds, a friend referred me to her psychiatrist and other friends helped me actually get an appointment set up and I went to it and I got prescribed ADHD meds. A couple different kinds, so I can document how they affect me and figure out with the psychiatrist which ones work best.

I took them for the first time last Thursday. They’re supposed to last a fairly short time, four to six hours; I took one before I went to work and had a fine day at work, productive but not outrageously so, nothing to particularly write home about, and I had mostly forgotten that I was on ADHD meds by the time I got home.

There was a choir staging rehearsal, so I was watching the baby for the evening, and the dishwasher was broken so there was like a week of dishes in the sink, and I really wanted pasta with homemade tomato sauce so I started that on the stove and put the baby in his high chair with a spatula to chew on and sang him songs while I washed the dishes –

– and about halfway through this I realized that all of this was so profoundly out of character that my roommates, if they’d been home, might have suspected bodysnatching aliens.

I am too tired when I get home from work to cook dinner. Sometimes someone else cooks a thing I can eat, and sometimes I just drink an Ensure and go to bed. I hate doing dishes when the sink is full; I kind of hate doing dishes even when the sink is not full, and I’d done the dishes exactly once in the previous six months. I am not usually too tired to play with the baby, but only if he wants to come headbutt my pillows while I lie in bed.

Well, I thought, I guess ADHD meds actually do something! And I finished the dishes and finished the dinner and fed us both and did my laundry and cleaned my room and started putting the baby’s books on the bookshelves, which he objected to (he firmly believes that his books should be evenly dispersed through the house, so if he wants one it is always nearby), so I gave up and worked on a writing project I’m in the middle of.

If you knew two people, one of whom came home from work and cooked and cleaned and did childcare and then wrote fiction, and the other one who came home from work and crawled into bed and browsed Tumblr all evening, you would probably attribute other, underlying differences to them. The first one is motivated and driven; the second one is immature and not used to having to keep her own space clean and do her own chores. The first one is trustworthy and conscientious and gets things done; the second one, maybe not. The first one has more willpower; the first one works harder. 

It’s none of that. It’s brain chemistry.

I’m not saying that you can never accomplish anything through concerted effort – obviously you can, and effort matters a lot. I’m not saying that there’s no point in trying to expand the number of things you can do without changing your underlying brain chemistry; there is, and I do a lot of that, and it often works really well.

But I am saying that we attribute far, far too much of peoples’ behavior to virtue, to hardworkingness, to willpower, to passion, to values, when the actual underlying thing is none of those. And because of that, people hate themselves for being lazy, for being slow, for not trying hard enough. I wasn’t trying harder on drugs. I wasn’t trying at all. Cooking dinner on a normal night really is about willpower and effort and careful planning around my limitations and advance strategic decision making and triage. Cooking dinner on stimulants is just – the thing that happens when I walk into the kitchen and want to eat something. 

Drugs don’t work for everybody. (Honestly, they don’t totally work for me; I don’t like taking them two days in a row, and I wouldn’t want to take them if I had to get a specific thing done instead of Doing Things in general.) I think people who have a drug sometimes work for them are really lucky, in a lot of ways, because it’s hard to really believe that it’s not your priorities or personality, it’s your executive function, until you can observe how you behave with the same priorities and the same personality and vastly boosted executive function. But I also think this is true of people who never have a drug work for them. 

People vary, a lot, and one axis along which they vary is executive function, and it’s really hard to imagine what it’s like to be someone with way more executive function or way less executive function than you. At least for me, it doesn’t feel like trying harder or caring more. It feels like not needing to.

So I’m glad that OP was able to have this kind of positive change in their life. But aside from that personal victory, there’s two statements here which I have big problems with.

If you knew two people, one of whom came home from work and cooked and cleaned and did childcare and then wrote fiction, and the other one who came home from work and crawled into bed and browsed Tumblr all evening, you would probably attribute other, underlying differences to them. The first one is motivated and driven; the second one is immature and not used to having to keep her own space clean and do her own chores. The first one is trustworthy and conscientious and gets things done; the second one, maybe not. The first one has more willpower; the first one works harder.

It’s none of that. It’s brain chemistry.

The problem is: this is an unsustainable model of personhood. If you allow the distinction between personality and brain chemistry, you’re going to quickly find that everything is on the side of brain chemistry. There is no abstract, underlying person which can be separated from the brain chemistry that embodies them, at least not this side of death, so attributing the problem to the brain rather than the person is to assert a meaningless distinction.

Or, to use the terminology in the post above, we might attribute “other, underlying differences” to the two people above, but the brain chemistry is the underlying difference. By modifying the brain chemistry, we have modified the underlying difference, but there’s nothing else there.

Second: Reading things written by people with severe executive dysfunction, I appreciate that their internal experience is not one of “laziness”. They sincerely intend and desire to do certain things, they just have a terrible time actually doing them. Which is fine, and it gives one a better perspective on their view.

The problem is that if I’m the friend, spouse, or employer of such a person, where does that leave me? Knowing about their internal experience and good intentions does nothing to mitigate the fact that I simply can’t count on them to do things. Externally, the behavior of the person with executive dysfunction is not meaningfully different from that of the person who’s “just lazy”; in neither case can you really rely on them.

(I understand that a lot of people with ED work fine under external motivators like employers, but the problem still crops up in other contexts.)

So again, I’m not trying to get on anyone’s case. I just look at this and think, huh. What am I actually supposed to do with this?

Most people actually do feel differently about a coworker, friend or partner saying “I can’t carry that for you because I broke my arm and it can’t lift things” and “I can’t carry that for you because it will be effortful and unpleasant”. Similarly, I think most people feel differently about “I can’t schedule that appointment because the machinery is broken” and “I can’t schedule that appointment because it will be effortful and unpleasant”, to the extent that they’re able to internalize that “the machinery is broken” is a thing that sometimes happens.

Feeling differently about it doesn’t oblige you to interact with people who you don’t want to interact with. If you’re trying to find someone to carry a box for you, then the person who doesn’t want to and the person who broke their arm are equally unhelpful, and no one is arguing that you should consider them just as helpful as the person who can pick up the box. 

But if you have an internal model of “the machinery is broken” then you’re less likely to do some counterproductive things. For example, if someone says “I can’t carry the box because of my broken arm”, you probably wouldn’t say “too bad, you’re fired if you don’t carry the box”, and you might be more likely to say  “hmm. The box really needs to move; if I get it onto the trolley can you push the trolley with your good arm?” It can move you from “I just need to increase the consequences of defiance” mode to “there is a barrier which I will need to work around if I want this outcome” mode.

And again, it’s okay not to want to work around the barrier! If there’s someone else around who can carry the box, you ask them! If carrying boxes is a huge part of your life, your life probably won’t have many people with broken arms in it! That’s fine! But when you are interacting with people with broken arms – either because they’re a coworker or someone who you don’t choose to interact with, or because they have other, great traits which make up for being unable to assist you in this important aspect of your life – you gain a lot by understanding why they won’t lift boxes for you.

Similarly, it’s okay not to want to have friends who will be late to things, or not to want housemates who don’t do the dishes. But if you have decided to have an interaction with a person, it will be a richer interaction if you actually understand what’s going on with them.

For an example of something you can do with this, my manager really likes to ask “what tools could you have which would make you more productive?”  This is useful because I can consider the question and answer “I want to have an ordered list of all my tasks for the day, by urgency, with tasks vanishing from the list as I finish them”. And then he can build that. And now I have that and am more productive. This worked because my manager assumes that I am being as productive as I can be, and that increasing my productivity is a matter of creating a good environment for me to succeed in; if instead he assumed that I was being lazy, and tried to get me to work faster by threatening me, or assumed that I was unmotivated, and tried to get me to work faster by offering me commissions, I would not work faster. 

(I don’t just think that’s good management of executive dysfunction, which my manager doesn’t know I have; I think it’s a good approach to working with people in general, if you trust that you hired diligent and motivated people.)

For another example, imagine that I have a wife and I am frustrated with her because I ask her to remember to be at home to sign for my deliveries and she often forgets and goes out or puts on headphones and misses the doorbell. If I think that my wife doesn’t care about me, and would remember this task if she cared about me, then I’ll resent her and be upset that she doesn’t care about me; if I think that ‘remember a task’ is missing mental machinery then I’ll ask her to set an alarm, or I’ll get a louder doorbell, or I’ll ask her to put a sticky note on the door that says “don’t go out if you haven’t signed for the delivery yet!”. 

(If my wife actually doesn’t care about me, none of these methods will help. But if she’s forgetful, we’ll probably never have a problem again.)

For another example, imagine that my room is always messy. If I think that this is because I am a messy person, it will stay that way. If I think that this is because I have executive dysfunction, then I might consider things like “have three trash cans so one is always in reach” and “have three laundry hampers for the same reason” and “don’t own many things, so they can’t get messy” and ‘at the end of the week, identify all the things that are a mess and figure out what strategy would have prevented that”.

All of these seem like cases where you can accomplish more and have healthier relationships by virtue of correctly diagnosing the problem – and where the strategies actually wouldn’t work if the problem was “I don’t want to be productive at work” or “my wife doesn’t care about me” or “I like my room being messy”. They are strategies which solve executive dysfunction and don’t solve “different preference”. And so I think there’s a legitimate thing worth isolating here.