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Comment by kobeya | Hacker News Reader

> Two years ago I could spend a week not working because I was avoiding some task.

This is a great article and there’s plenty to talk about in organizational systems, even if this seems to be subtly pitching his own products in places. But if anyone reading this identifies with this sort of chronic procrastination, consider seeking psychiatric help. This is a giant red flag for adult ADHD, which is a serious and often misunderstood issue, and one of the few psychiatric diagnoses for which there is solid treatments (stimulants) with near universal efficacy and very few side effects. Getting on Adderall, then Vyvanse changed my life for the better, and basically solved this issue overnight, as well as a bunch of other benefits.

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Mental health professional here (well, currently on internship). "Giant red flag" is a bit of an overstatement in this particular situation. It is very common for people without significant attention problems otherwise to have major difficulty self-motivating and structuring when working independently. Many of my depressed and anxious clients became so by getting further and further behind, because there was no structure or accountability imposed on them and they simply did not know how to do it themselves. Most of them did not meet criteria for ADHD and improved quickly with scheduling, goal-setting and accountability systems.

That's not to say that procrastination is not a symptom of ADHD. It is. But the modern world is built to distract even the normal, and most people are capable of developing bad habits.

Also, the actual ADHD diagnostic procedure is very involved (3-5 hours of testing that can cost upwards of 2k). A lot of diagnoses aren't actual diagnoses, and no one is qualified to make a Dx from a brief verbal assessment.

So long as we keep those cautions in mind, I agree that if a person thinks they might have ADHD, by all means look into the symptoms, do a little research and consider getting tested.

To add a counterpoint to all the apologetics, ADHD as a cause rather than as a symptom is a point of view dominant in the US and not shared by most of the rest of the world. If you're inclined to take drugs to try to fix it then so be it, but you might want to try behaviour change first.

[FWIW this reply and "advice" is not directed at the parent, kobeya, but is a general point of information.]

> "Not shared by the rest of the world"

And that is their loss. ADHD is very much a cause whose impact goes far beyond just procrastrination. It causes people to be terrible spouses who are never there when they are needed. It causes lost friendships through blinkered social conduct. It causes persistent self hatred and anxiety and depression.

"you might want to try behaviour change first"

This is such a, forgive the harshness, ignorant way of thinking about ADHD that it makes my blood boil. Behaviour change works when the person in question has the capabilities of making that change stick. This is the equivalent of telling a handicapped person to try b-mod to climb the stairs.

It. Just. Won't. Work. A shortage of persistence cannot be solved through more vigorous exhortations towards greater persistence. Here's how I think of the drugs. The drugs lay the platform so that I can implement the behaviour change. They don't let me study better. They let me start studying in the first place, at which point, all the best practices and behaviour modifications can come into play.

Thank you. It's such a toxic sentiment which seems to only originate from people with limited exposure to the condition. It makes my blood boil as well to hear/read things like "you might want to try behaviour change first". I want to be like, "what do you think I've been trying to do since the age of 8?"

Meds have been absolutely indispensable for at least starting to implement good habits, extended focus, etc. And it's still a huge struggle.

As disinclined as I am to enter a discussion about this I'd like to suggest interpreting my hasty terminology "behaviour change" as encompassing a wide variety of behaviours, and not just of the affected individual. "Environment" might have been a better word. For example, under "behaviour" or "environment" as opposed to "medication", I include the poor conditions in public schools, the poor quality of food, the addicting quality of television, internet and computer games and the poor quality of many interpersonal relationships.

Thank you for saying the things I wanted to say. Environment is certainly the better word. Really, how much can an 8-year-old change? Not much.

*edit - of course, there is a level of individual responsibility as well.

As someone diagnosed with ADHD in their mid 30's, I've had plenty of environment changes over the years (including with a Psychiatrist who understood my then-reluctant view on meds); honestly none helped me nearly as much as meds.

Eight year olds can't change the environment much. But if we are making a lot of eight year olds struggle when we put them in an artificial environment, I hope we're considering whether we've make mistakes designing that environment.

agreed. I assume you are talking about the school environment?

I would add home environment (parents and siblings especially), culture, entertainment, friends, religion, sleeping habits, socioeconomic status... etc.

> ADHD is very much a cause whose impact goes far beyond just procrastrination. It causes people to

Just because ADHD causes other problems doesn't mean that ADHD itself comes out of nowhere. The previous post has a valid point that ADHD itself is a symptom of something else and that drugs aren't necessarily the best way to reduce/eliminate ADHD at the source.

The currently understood source of ADHD is a mis-wiring of the brain. Currently we don't know of a better way than meds to alleviate such a condition. CBT helps to a degree, CBT + meds works much better for more severe cases.

> The currently understood source of ADHD is a mis-wiring of the brain.

Is that actually understood, though? We had the heavily promoted social consensus for a long while that depression is caused by a chemical imbalance, which is now seen as a somewhat disproven theory that never had much evidence.

Very little about the brain is really well understood. That said, this is about the best we have so far.

From a video I linked elsewhere in this discussion:

Gallo, E. F., & Posner, J. (2016). Moving towards causality in attention-deficit hyperactivity disorder: overview of neural and genetic mechanisms. Lancet Psychiatry, 3(1), 555-567. Konrad, K., & Eickhoff, S. B. (2010).

Is the ADHD brain wired differenctly? A review on structural and functional connectivity in attention deficit hyperactivity disorder. Human Brain Mapping, 31(1), 904-916.

https://www.youtube.com/watch?v=V5tLi1bYilA

How is it ignorant to suggest behavior change as a first option? If the person can't make it stick then sure try the drugs, but if they don't need the drugs they're likely better off without them. Add in the fact that ADHD is commonly over-diagnosed and yeah, I'd try behavior modification first. People can display the "signs" of ADHD for a whole host of non-ADHD reasons.

You are right of course. The frustration comes because people with adult ADHD have likely had a lifetime of this suggestion, and a lifetime of failing to stick to such modifications, often to the point of developing comorbid issues like low self esteem. When medications finally open the door they have fruitlessly banging their head against, it's frustrating to hear people espousing that, actually, behavior modification is all you really need, even if it is not intended as such (though often it is).

This is very accurate. Thanks.

Learned inattention is different from ADHD. The whole world has learned innattentive behavior at this point. This can be solved without medication fairly simply. ADHD or as Dr Russell Barkley calls it, Executive Function Disorder, is neurological in origin. By all means try behavior changes first, like you said, but if that works, it was never ADHD to begin with. Finding a youtube video of Dr Russell Barkley was a godsend for me.

> but if that works, it was never ADHD to begin with

You're putting yourself in an irrefutable position then.

Yes, because the argument is that the US over-diagnoses ADHD. As in kids being kids and not being laser-focused are suddenly diagnosed with ADHD. In this case, someone procrastinating because they have something difficult to do would be ADHD. It may not be the case.

No, it's just saying that under scrutiny, it's not all that hard to differentiate "learned inattention " and bad habits from genuine ADHD.

What is most of the rest of the world? Most countries in Europe recognize it. International medical associations also recognize it. Are there countries where a psychiatrist would never diagnose ADHD?

I think this is about adult ADHD.

Some quick video material about the belief that ADHD doesn't exist, and is not a treatable condition: https://www.youtube.com/watch?v=V5tLi1bYilA - informative and entertaining.

But don't just take their word for it, have a look at the reference material in the video description.

Another interesting, and emotional, view of the effect of not being on meds from the same artist: https://www.youtube.com/watch?v=rD9qK8-sMGQ

Not even a just diagnosis as specific as ADHD. I was a chronic procrastinator due to anxiety and high expectations of perfectionism. Working with a psychologist using CBT has transformed my productivity by allowing me to learn that it's possible to let things not be 'perfect', whatever that meant anyway.

Thanks for posting this. I suffer from perfectionism too and it leads to a lot of procrastination. Realizing that getting things to 'okay' was fine was an important step for me, because my okay was often others 'good' or 'excellent'.

My pleasure. It was only about halfway through my course of CBT that procrastination and perfectionism came up as related to anxiety. It was a mind-blowing moment.

The weird thing was I knew it all, but something hadn't connected in my thinking that it was better to do/make/release things than to not. The mind is weird place.

Regarding the universal efficacy of stimulants, it should be noted that stimulants helping with something is not diagnostic of a medical issue. Stimulants help everybody with with getting-work-done issues. That's why the majority of Americans take stimulants daily, and many workplaces give them away for free.

So sure, if someone is having trouble keeping up with the pace of their societally assigned hamster wheel and find stimulants help, sure, they should go for it. But they should not mistake that for an illness, any more than a person needing a step-stool to get to the top cupboard should think they have some sort of growth hormone deficiency. Artificial environments can require artificial compensation, but that doesn't mean there's some sort of medical problem.

Can I ask what is considered chronic procrastination. For instance, I am sitting on a tax filing task for almost 2 months now. It's not gonna endanger my life, but it's one of those things I can't get my mind to do.

Do something, do anything. Set a timer for ridiculously small amount of time, 2mins or something, and do something towards it. Like just logging into the filling web site, or looking at the forms. More often than not this gives me the motivation to do more.

Easier said than done though!

A few years ago I finally filed my income taxes, all 15 years of it that I had been procrastinating on since I was 18 years old. Achievement unlocked!

Afaik, it's not chronic in the sense that you procrastinate the one thing, but that you procrastinate lots of things constantly.

The worst part is when you procrastinate on everything that's not as important (but still important!) as the main thing you're avoiding, because how can you justify doing those things instead of working on that other, more important thing?

Thank you. I was suspecting that I might have ADHD for a while now but never got to actually test it. The country I'm living in is still very backwards when it comes to ADHD treatment and until recently only children could get diagnosed. For adult immigrants it was almost impossible.

Your comment was a good reminder though. I right away googled for a mental clinic, picked up my phone and asked if they are able to diagnose adults. Now I have an appointment for next week.

I hope of course that I don't have it, but if I do, and if I actually can get medicine for it, and if it would actually change my life, a big thank you!

That’s great! Glad you’re making progress.

I had my appointment. It looks like I indeed might have ADD and a hint of depression.

The next step is to try ADD medication and potentially undergo TMS treatment.

Glad I learned that there might indeed be something wrong with me. Now it’s time to fix that

Well actually I think people should first try getting off social media - and not just that - getting off Internet.

If you have ADHD it’s not so simple. When I’m off my pills — which is to say every day of my life before I was diagnosed — I don’t really make conscious decisions about such things. I open my computer to work and find myself on Twitter or Facebook or HN or whatever 20min later without thinking about it.

I mean that literally with no hyperbole. ADHD manifests from an under developed or under stimulated prefrontal cortex, which is responsible for such task prioritization and decision making. Without stimulants I’m not really making conscious decisions about most things. Much like how you’ve probably driven your commute sometimes and arrived without really much memory of how you got there (“driving on autopilot”). That’s every moment of every day in the most extreme ADHD case (it’s a spectrum of course and you should seek treatment if you think you’re anywhere on it, even if the above sounds more extreme than you).

I absolutely don't want to be rude, but the 'inventor' of ADHD (Eisenberg), when he died, said that ADHD is a pharmaceutical dease and the cause is social. Wrong food, bad sleeping habits, wrong teaching methods all influence the way we get stimulated. Studies agree with this.

I am not saying you don't have a problem, because I also feel like someone who has ADHD and feel a lot like the author of the article.

But I also think that, just like the author, you can change your 'ADHD' by changing your behaviour.

Again: I dont want to put anyone down that is labelled with ADHD, but I think this culture is on it's way to create an ADHDer of everyone.

> Wrong food, bad sleeping habits, wrong teaching methods all influence the way we get stimulated. Studies agree with this.

This part is severely misunderstood. If I don't sleep, eat, and exercise reasonably I completely lose focus. Taking adderall will help, but it treating the symptom rather than the cause. This looks like ADHD, but isn't.

If my children lack sleep and are overburden (thanks modern school system), it looks like ADHD, but it isn't.

Now, some people, children and adults, do have ADHD no matter how well they sleep, meditate, eat, and exercise. With our current understanding, their best bet is medication. But for the vast majority, they simply need to slow down.

You may both be right. There is an increasing amount of scientific evidence that screens (TV in particular) and junk food (sugar and saturated fat in particular) are severely impairing brain development in children, leading among other issues to difficulty to focus and ADHD. So yes, keeping children off screens as much as possible (+ healthy food + sport) looks like a good advice.

However, when you have this condition as an adult... well, there is some level of plasticity in the brain, but it looks harder than just "change your behavior", it may be required to also treat the symptoms.

The same argument can be made about user's of cholesterol and blood pressure medicine, as well.

Exercise more, eat 'better'.

> I absolutely don't want to be rude, but the 'inventor' of ADHD (Eisenberg), when he died, said that ADHD is a pharmaceutical dease and the cause is social. Wrong food, bad sleeping habits, wrong teaching methods all influence the way we get stimulated. Studies agree with this.

Do you know anyone with ADHD? When you talk with them and something happens, like a phone rings, their minds completely zoom out and they instead become focused on something else. It is not possible to continue the original conversation because they have forgot everything about it. It can be incredibly frustrating because it is like talking to a human gold fish. Although they can't do anything about it because it is just the way they are.

My point is that it is incredibly obviously a clinical condition and not something "behavior change" can fix.

It is very likely to be a combination of innate predisposition and behavioral effects. Like almost all diseases that are not caused by external bodies, or extremely hereditary. So ADHD is not really a condition, rather, it is an axis on which you can fit somewhere. In extreme cases, I can imagine it's very hard to manage without pills. In most cases, one can probably work through it without pills.

FMRI Brain scans tell a different story. If Dr. Eisenberg really believed that in the end, he was wrong.

I don't understand how what you described is ADHD and not average human behavior. If people were not easily distracted by Twitter and Facebook, they wouldn't have a functioning business. There are entire business models that rely on the truism that a huge fraction of the population will procrastinate on a trivial task that will clearly and unambiguously benefit them. Mail in rebates for instance. When does this become ADHD?

Were there things on the other hand that you could focus on very well, were you dived in deeply? Or did your autopilot drive you away from everything you were focused on after a while?

thanks for sharing your experience

This is anti-advice.

This is like telling depressed people to be happy or victims of violence with PTSD to 'grow a pair' and 'snap out of it'.

This is the kind of simplistic, unhelpful, shaming advice that keeps mental illness taboo.

I think you misrepresent the parent post. Suppose you had insomnia. Wouldn't it be a fair suggestion to cut back on coffee and other stimulants first, before trying sleeping pills?

I think the point is that by the nature of ADHD telling people to "get off the internet" as a solution to the problem would be more akin to telling the insomniac "just stop staying awake all the time!"

Not really. Leaving a phone at home and taking a notebook or book with you while sitting outside is not like "stop staying awake". It will, in fact, get you off the Internet and is unlikely to result in withdrawal symptoms for most people.

Unlike "stop staying awake" which is not actionable.

A book might not be a good suggestion for everyone, and finding the right "off internet thinking environment" is not easy for some, but it's doable for most.

> Unlike "stop staying awake" which is not actionable.

That's the problem: you think "stop staying awake" is not actionable, while "leave your phone at home" is actionable for a person with ADHD.

Again, this is not different than saying "just be happy" to a depressed person. To that person, in that moment, "stop wasting time on the internet" is not actionable just as much, otherwise it would not be a problem in the first place.

Going with your examples, I think "leave your phone at home" is more actionable than "stop wasting time on the internet", and both are vastly more actionable than "stop staying awake" and "just be happy".

Right, and his point is that actionability of advice depends on brain configuration. I have no problem lifting my mood, or falling asleep. So those actually seem more actionable to me. However, I have empathy for people whose brains work differently, who struggle with different things, and who might need intense therapy and medication just to stay afloat at these kinds of mental tasks.

> you think "stop staying awake" is not actionable, while "leave your phone at home" is actionable for a person with ADHD.

I'm not an insomniac; nor do I have ADHD, as far I know.

I assure you that I cannot action an instruction to 'stop staying awake'. I certainly can 'leave [my] phone at home', and frequently do.

It's more like telling a person with symptoms of depression or PTSD that they should see a therapist to get to the bottom of things rather than just popping pills. In fact, PTSD suffers really should be in therapy instead of on a drug regimen. Many people are wrongly diagnosed with a depressive illness when they have psychological problems better addressed by therapy, so it's actually good advice and can avoid a lifetime of drug dependance that doesn't solve the actual problem.

>This is like telling depressed people to be happy or victims of violence with PTSD to 'grow a pair' and 'snap out of it'.

It might go against the "just feed them drugs" mentality, but lots of times it totally works.

They had plenty of "traumatic stress" before the 21st century, in all parts of the world -- huge wars, conflicts, disasters, even genocide. But those involved (like older friends and relatives that have survived bombings and wars and dictatorship) also could grow a pair and snap out of it, and even thrive afterwards. I don't believe they had a different DNA or mental wiring back then.

  At an FDA hearing on March 23, 2006, I testified: “Saying any 
  psychiatric diagnosis ‘is a brain-based problem and that the medications 
  are normalizing function’ is an anti-scientific, pro-drug lie” [ 14]. 
  Yet this has become standard practice throughout medicine, for example,   at the American Psychiatric Association [ 15], American Medical 
  Association [ 16], American Academy of Child and Adolescent Psychiatry, 
  American Academy of Pediatrics, Child Neurology Society, American 
  Academy of Family Physicians [ 17], FDA [ 13], and virtually all US 
  government health-care agencies.

  Journal articles [ 6], press releases, ads [ 18], drug inserts, and 
  research informed consent documents say, or infer, that psychological 
  diagnoses are abnormalities/diseases. All patients and research 
  participants with psychological problems are led to believe they have an 
  abnormality/disease, biasing them in favor of medical interventions, and 
  against nonmedical interventions (e.g., love, will power, or talk 
  therapy), which presume, as is the case, that the individual is 
  physically and medically normal and without need of a 
  medical/pharmaceutical intervention.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518691/

  Currently, depression is not diagnosed via objective chemical
  tests, nor is treatment guided by any such tests. If depression did
  result primarily from a known chemical imbalance, such tests
  would likely be available and in widespread use, and depression
  would be easily and quickly resolved for most patients.

  Luckily, a number of effective interventions are available for
  treating depression. Such interventions include a variety of 
  pharmacological as well as nonpharmacological approaches, sometimes
  used alone and sometimes in combination with one another

http://www.brown.uk.com/brownlibrary/france.pdf

> They had plenty of "traumatic stress" before the 21st century, in all parts of the world -- huge wars, conflicts, disasters, even genocide. But those involved (like older friends and relatives that have survived bombings and wars and dictatorship) also could grow a pair and snap out of it, and even thrive afterwards.

To the contrary, I think the past generations of my family who have survived WW2 and Stalinism were, till the end of their days, heavily impaired by it. They "snapped out of it" to the degree that was required for not starving, but I would not say they had developed nearly up to their full potential.

As someone growing up in rural Austria in the 80s, when lots of grandfathers had been Wermacht soldiers, I firmly agree.

In hindsight, it was painfully obvious with so many of them. And the number of functional alcoholics (with often a rather loose definition of "functional") was huge.

Dunno, we have had huge WWII impact, dictatorship, civil war, and other such things in my parts, and they didn't impact much the generations involved in everyday life. I know tons of people that survived those events. Speaking to friends and relatives it was just things that happened. So it goes, etc.

Maybe they were more lucky. In case of my grandparents, they were children whose parents were executed by Nazis or sent to Auschwitz to die, or who themselves were sent, as teenagers, to a Stalinist prison.

Yes, both kinds of concentration camps are very extreme experiences.

I'm talking more general war and civil war scenarios (e.g. having your city bombed, being in a war, having family members die in such scenarios, etc -- which have been common in many places in the developing world (and Europe).

But the constant terror of a concentration camp for months or years on end is another thing.

I think this is why we need to get back to using books for our resources, looking on the internet is too distracting.

The books still exist. I still use books as a crash course or refresher from time to time. And I've gotten back into reading more on my Kindle or phone while walking my dog in the mornings.

I wrote about this last year. I called it the "social loop of death":

https://nickjanetakis.com/blog/schedules-arent-a-constraint-...

It's super distracting, but you can easily break out of it with being accountable for your time.

Nowadays I've found a healthy balance and am more productive / happy / successful than ever.

A lot of it had to due with following these 3 things too: https://nickjanetakis.com/blog/how-to-overcome-procrastinati....

I was trying to get tested/diagnosed ran out of insurance before getting out of school. I don't know, they say (who?) if the stimulant "Adderall" makes you feel "pumped" or "happy/excited" then you probably don't have ADD/ADHD

No doubt though, being able to sit down and work 12 hours straight without eating, absorb a crazy amount of information... crazy. But then the come down/depression afterwards. Also the effects on your body, weight loss is cool but other stuff not so much.

This is mostly correct, although it is a matter of dosage. People can exhibit symptoms that to the average person seem the same either because of a deficiency or an excess of the pathways amphetamine (the active ingredient of Adderral) controls.

In the case of someone recreationally taking stimulants, whether Adderall or methamphetamine/speed, they’re putting the control centers of the brain in overdrive which makes them feel pumped up and exhibit excited off-the-wall behavior.

In the case of someone with ADHD they have a deficiency that ameasured amount of the drug will address, bringing them back up to “normal” levels. Without the drug this might seem excited it off the wall with distraction, but this is due to a lack of self-control rather than too much stimulation. Even though the symptoms are nearly identical externally.

Hence the “paradoxical” effect on ADHD patients where the application of stimulants results in focused, normalizing behavior.

Yeah without a prescription hard to sustain namely the tolerance problem in my experience eg. need more and more not saying indefinitely but say 1 20mg xr for a day versus eventually 3 of them in a day

I second this advice. My symptoms didn't show up until I started being challenged - which was about the middle of college. Took a while before going to therapy and even longer to get medication, but it's been good so far.

I have the same issue due to depression and Lexapro has helped immensely. The negative feelings persist but the motivation and lack of apathy toward work has been greatly improved.

I take Lexapro with Vyvanse. Fantastic combo. The persistently negative thoughts just turned off. I try to take "medication vacations" for tolerance and I can tell by the end of the 1st day the shitty thought patterns come right back in a hurry. It's incredible. The self-loathing and obsessive perfectionism (including having to correct everyone on everything, and not being able to be wrong without getting angry) has nearly completely vanished.

I literally just started this combo. I've been on Vyvanse but just added Lexapro to address other issues. My psych seems to think med vacations are a bad idea due to instability. Any thoughts on how they're helping out?

Interesting. Thanks for the information. I'll discuss it with my psychiatrist.

Can you share your story in a bit more detail?

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