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Comment by eyelidlessness | Hacker News Reader

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For folks finding this model/analysis compelling: many of these observations and coping skills are common in undiagnosed ADHD. It’s not a perfect circle venn diagram, but pretty close. Any kind of paralysis without progressive validation or structured achievement is very likely associated with dopamine release and absorption.

In adult-diagnosed ADHD cases, we often find ourselves discovering cleverly invented milestones and achievements or even convenient self deceptions that produce dopamine when it would naturally be a long way away. Speaking for myself, I allow myself personal congratulations and merits for utterly insignificant and pointless details for any task that feels “too big” or “too daunting” to make them achievable for my brain. I can take several hours to get my laundry going, a couple minutes work in all, and I allow myself to celebrate getting the dirty laundry into a basket, then another getting it into the laundry room. Usually by this point following through is automatic and doesn’t require more workarounds.

But ultimately the concept is the same. If the reward feels far away, and far away is demotivating, giving yourself rewards along the way opens pathways to keep going when it doesn’t feel feasible otherwise.

Just a nitpick: don't say dopamine production when you mean reward. Dopamine may be involved in some feelings of reward, but it's certainly not the only factor, and it also doesn't simply signal "pleasure" or "achievement" to the rest of your brain. IIRC, it's not at all certain that a sense of achievement can be compared to the typical scenarios in which dopamine is mentioned: eating, drugs.

When I saw this comment this morning I was a little surprised, and I second guessed my own familiarity with my own brain. So I did what I do when challenged on the facts and did more reading. It’s not ambiguous. ADHD is directly related to dopamine (reception/production) deficiency. Medicating ADHD improves dopamine uptake (and production depending on the meds), and that chemical regulation relieves ADHD symptoms. It’s a small but perfectly reasonable stretch to infer that behavioral coping strategies that produce reward experiences which also relieve symptoms are likely producing similar chemical outcomes.

Disclaimer to grandparent: I found your comment a useful read. This is a bit of a nitpick, but one that I thought quite long about.

--- the comment ---

Moreover, you can't actually measure whether it's dopamine, you're simply hypothesizing that it is. And while I'm inclined to believe that dopamine would be involved, you don't strictly know. Saying neuro-terms like "dopamine" may make things sound more real or true, but they aren't more real or more true as you're not measuring your brain.

In that sense neuroscience feels a bit similar to religion (just a bit, from my agnostic perspective). Yes, you use scientific concepts, but since nothing is measured, you as an interested person in neuroscience have no clue what is actually happening in your brain. But it does sound more compelling! Not needing to measure anything while using theories that sound highly convincing to a certain group with certain ideals is how most religion feels like to me (not all though, I can definitely appreciate certain theological discourses of all religions, and I also appreciate religions that don't have a strong emphasis on gods, for example).

So on HN I try to limit my neural babble as much as possible when I talk about my own experiences as my cortisol levels are spiking too much -- ;-) -- when I'm reading neuro-explained anecdotes. I hope that HN'ers see my point or feel that there are convincing counterarguments to this that might make for an interesting discussion.

When people say “dopamine”, I don’t usually interpret as them literally meaning dopamine. I think at this point in common speech it serves as a shortcut for saying “chemically based rewards“.

No, I definitely meant literal dopamine. Just as people who benefit from many conventional antidepressants are chemically benefiting from increased serotonin (reception/production), people who have ADHD chemically benefit from increased dopamine (reception/production). And while medicating the latter is mostly straightforward (most patients benefit from stimulants which improve dopamine reception, many from improved production as well), particularly adult patients have a variety of coping strategies that relieve symptoms and it’s not a wild leap to infer that when those strategies are successful they’re improving dopamine levels specifically.

I thought I came up with the idea of attaching symbolic importance to otherwise menial tasks so I can complete them. Things like mail, paperwork, printing materials I make up some kind of scenario where completing the task is of critical importance and reward myself somehow after. I don’t otherwise recognize myself as ADHD though. I think rather its odd people can easily interrupt their day to do this stuff.

I didn’t recognize myself as ADHD either. I was diagnosed at 37. If I hadn’t taken a (seemingly separate) mental health dive I probably would never have known. It turns out almost all of my anxiety and quite a bit of my depression are easily traced to dopamine deficiency and (sometimes unhealthy) coping strategies. The way I explain the laundry thing to people who don’t experience it is... almost exactly your wording: if I have a “big” task and a “small” task that have time overlap, stopping the “big” one to do even a few minutes of something else is extraordinarily stressful. I can’t interrupt one for the other. On really bad days, both block each other, like a deadlock. Recognizing that it’s happening and creating basically fictional arbitrary rewards helps.

Obviously I’m not in any way qualified to say one way or the other, but if things like this meaningfully impede your life I’d recommend reading about adult ADHD, see if things feel like they have explanations you’ve never known you needed... and if you do, seek diagnosis.

For my experience when I finally had enough confidence that there was really something to it, I had to read a lot of non-diagnostic literature to really understand how to navigate that process. The DSM criteria are almost entirely designed around diagnosing children, and almost entirely around misbehavior. Adults will not relate to most behavior descriptions and will have developed so many coping alternatives that the answers often form as “well, no, but here is how I’ve learned to compensate”.

Edit: I’d be remiss not to credit the actual human on the internet who gave me the most insight into this and ultimately prompted me to seek diagnosis. For anyone looking for someone who speaks extensively and knowledgeably about adult ADHD, I highly recommend following Erynn Brook on twitter.

> It turns out almost all of my anxiety and quite a bit of my depression are easily traced to dopamine deficiency

In cases like yours, are dopamine levels in brain actually tested (measured in a lab) in patients or is it just conjecture?

Testing ADHD is based on symptomatic and diagnostic analysis, as well as behavioral testing. Not chemical. Medicinal treatment aids validation of the diagnosis: if stimulants work well and don’t produce the kinds of side effects that people with “normal” brains experience, it can be inferred that the chemical imbalance exists and can be addressed by further treatment.

After my initial diagnosis, my first doctor who treated me said that if I’m being treated appropriately I should be able to sleep while the stimulants are active. Not only could I sleep, when I first started meds, I started taking daytime naps for the first time in my adult life. Even “taking” is an understatement. About an hour after the stimulant (at this time it was ritalin) kicked in, I would zonk so hard that I needed to sleep for anything between 15 minutes and an hour.

Thanks for talking about the deadlock! That's what I've been facing the past years...

I hope you have developed good coping strategies for this. It’s really hard to navigate in the moment! But if you have a good structure for how you approach it, it can really help. For me personally:

- I have a very large set of (recurring, time specific, urgent, and lax) reminders

- I have very clear expectations of removing myself physically from situations that make me feel stuck, and taking dedicated and time bounded breaks

- I have a very internal/non-verbal separate monologue for forgiving myself, particularly when the harm I may have done or be doing is to myself (I’m a very verbal internal monologue person otherwise)

- I reset and recalibrate goals/ambitions/expectations frequently

- I find ways to allow myself helpful fictions and know I’m lying. (Side note: it’s worth noting that many neurodivergent disorders commonly overlap; I’m not diagnosed ASD but strongly suspect I’ll get a positive diagnosis when I’m able to seek one; lying to myself is generally only possible when I acknowledge the falsehood somehow)

- And as mentioned, I create artificial rewards that unblock when I feel blocked. Being (now based on comment feedback) hesitant to describe this as relating to literal dopamine... I give myself invented victories and milestones that are only meaningful and exciting to me, so I can carry on to the next step or stage of a thing I need or want to do

I have no idea if any of this will help. But even just getting external validation of your experience can help. It’s awful to feel like something other people find easy is difficult, when you know you’re generally a capable or even talented person.

I hope however you navigate this, you know you’re not navigating it alone and the things that seem impossible inexplicably aren’t because you’re doing it wrong.

Yes, I've found when I'm stuck like this doing anything that's "constructive" or makes progress in some way can "wake me up" again.

I think that's also why I've been really happy being part of team that does agile. The ticket swim lane thing is surprisingly motivating.

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