Hacker News Reader

Comment by JoeCianflone | Hacker News Reader

No. ADHD does not work this way for me, or people like me who are inattentive . This article is the equivalent of the time my primary care physician said, “just use a calendar”. You want me to maintain a set of documents? Buddy, without meds I can’t remember to brush my fucking teeth. I’m not exaggerating. ADHD is a spectrum, articles like this paint everyone with the same brush, which furthers many people to feel like complete failures.

View on HN

One of my motivations for getting into programming was to be able to learn to have the computer take on much of the remembering. I tried various paper methods, but all of them required one thing I didn't have: the ability to remember to actually look at them for the information I put into them. When I got a computer capable of managing my calendar, tasks, grocery lists, etc, it was a dream because I only need to put something in and tell the computer to remind me. Andy Matuschak calls it "programmable attention" https://notes.andymatuschak.org/Programmable_attention

I can relate to this. Without medication I don't have any motivation to do ANYTHING, and that quickly leads to depression. My doctor recommended that I don't medicate on weekends, but what about my personal life? I have things I need to get done at home. My wife likes to with me and my executive functions, too.

I can relate. My compromise is to only take my morning dose on the weekends(most of the time). Do things and sort of wander off into the evening. The timing, dose, rhythm of your meds may differ, of course. Mine is not the extended release.

For me, there is a big difference of how effective the meds are during the week because I have gone light over the weekends.

As an introverted ADHD person, my doctor recommended taking only the afternoon dose on weekends, as much adult social interaction is skewed later in the day on weekends. Only works on non-XR meds of course.

My guess is that recommendation is meant to combat building a tolerance.

Brushing your teeth is a great example - I just brushed mine after reading this. It seems like there are so many things people just take for granted - remembering what you're supposed to do today specifically in addition to the 100 things normies seem to do automatically, knowing what day it is. The only thing that's helped consistently is using Google to "remind me to call the school in 20 minutes"

I use my Android phone's stock alarm app for reminders, set to a very annoying ringtone. It works great about 50% of the time when I actually have the opportunity to stop what I'm doing and do what the alarm says...

Exactly right, and also, thank you for reminding me I forgot to brush my teeth.

Very much this. My son has ADHD (full neuropsych eval) and he has attention issues, but his main challenge is executive functioning. Daily routines do exist, but are achieved through literally months of repetition, not by conscious effort to identify and organize all of the things that need to happen before school, after school, etc.

Establishing and sticking to a formal program to read books is literally the hardest thing he could do, but when he finds a book he likes, he'll stay up late to read it, and would stay up all night if we let him.

It sounds like your kid has a similar ADHD experience to how mine was when I was younger, so I feel compelled to say this:

The best thing my parents did raising me (and it wasn't easy) was to put a lot of effort into exposing me to books I was interested in and to exercise a very light hand in terms of how late into the night I read. The combination of reading habits and a practiced ability to educate myself from books has served me very well in the decades since. It's operated as both a coping mechanism for the drawbacks of ADHD (such as habitual inattention to in-person communication) and, as my other skills have caught up, a key tool that some of my peers are lacking.

Daily routines were more difficult for me, and took a set of experiments in my early 20s (think daily alarms/calendar events on the order of "wake up" ... "work out"... "eat breakfast" ... "take shower/brush teeth" increments) to really lock into place (although they have taken a blow in the last year).

Thank you for your reply. Unless he's up super-late, we let him read as late as he wants.

Despite the cost, doing the full neuro-psych evaluation was the best thing we've ever done. It helped us (the parents) really get insight into how his brain was working, which completely reset our own ideas of how to best help him.

Thanks, this comment reminded me to brush my teeth.

More seriously, I think that people have a tendency to mix up broad, high-level symptoms of ADHD with the more specific ways that those symptoms manifest for them.

For some (not all) people with ADHD, acting on their motivations is very difficult; so the technique they come up with to help is to either drastically increase their motivation (moving up deadlines and hyper-stressing about tasks, or rewarding themselves, or whatever), or to try and decrease the barriers of entry to the task (automating parts of it, getting help from another person, etc...)

So it sounds like this author falls somewhat into that category, and one of the specific reasons they've found for them personally that's a barrier to reading is guilt over the idea that they aren't finishing books. And what they've done is given themselves permission not to finish books, which allows them to read more overall. Which, great. Genuinely glad that works, and it might work for other people too.

But lots of people who fall into that category of struggling with executive dysfunction are not going to have the same barriers over reading. For many of them, turning reading into a chore will actually be counterproductive. Having a document that you forget to review every week might increase guilt. "Read to find one improvement" might not even line up with why they're motivated to read books in the first place.

And that's obviously ignoring that ADHD also covers people who struggle with inattentiveness and other problems that could also be a barrier to reading more -- but the point is, just because a solution works for one person with ADHD, it might not be applicable even to other people who are struggling with the same problem, because the general issue "I can't act on my motivations" is still going to manifest differently and have different solutions depending on what the individual's barriers are to a specific task.

Lots of addicted folk talk this way. I couldn’t function without ____, where ____ could be anything from coffee to amphetamines. That isn’t to say that you are abusing the medication, but that the dividing line is more arbitrary than most people understand. Many addicts are simply people with inadequate health coverage who are forced to self medicate, often with the exact same substances (adderal, benzodiazepines, pain killers) that those with better doctors and more wealth get quite easily without stigma or threat of prison. The fact these substances operate as performance enhancers for entire industries (truck drivers and programmers are big amphetamine users) all point to the ridiculous double standard that we arbitrarily erect to classify some as addicts and others as patients. Mostly it’s a question of the wealth of the addict, which for programmers on speed tends to not be a limiting factor.

The ridiculous double standard is that we see physical devices -- glasses, hearing aids, canes, as corrective, but drugs that treat disabilities are seen as "crutches", which happens to also be a physical metaphor, but one that implies some transience, suggesting that eventually we'll get better and not need the drug.

Try telling a deaf or blind person that their assistance devices are "crutches" they'll eventually not need and see how that works out. Would you say a paraplegic in a wheelchair is an addict? Do you expect them to somehow magically grow legs and be able to walk, if they could just "give up" the chair?

That's what accusing people who need pharmaceuticals to function sounds like. It's implying they are morally inadequate for needing their drugs.

I think you might have been missing his point. It came off to me that he was trying to defend drug addicts not shame people using drugs. Like if you have no money the way you might treat your anxiety is different than the way the wealthy developer does. Someone might get a new prosthetic leg, but they might have to fight their asses off to learn how to not rely on their former chair or crutches and they’ll likely keep them around when they just need a break and will always have a cane.

Right now people like me with ADHD can easily get drugs. But why should I assume I might not be struck by misfortune. If I end up poor and on the street, unable to afford nice drugs. If I have learned how to manage without a drug that would genuinely help me I’d probably be better off in that case.

Saying he is shaming those who use drugs is just covering your ears and wanting to pretend that there are no negative effects. Me saying if you learn to live without Netflix you’ll have more fun when the power goes out, isn’t meant to say Netflix is a wrong way to entertain yourself, simply that if you rely on it for entertainment it can be hard to find entertainment if the lights turn off.

Calling it an addiction, doesn’t mean that addiction is worse than the alternative. By reacting as you do, you paint addictions as something reprehensible and shame those who have them.

> It came off to me that he was trying to defend drug addicts not shame people using drugs

Perhaps, but it's a non sequitur -- A says "medication", B immediately says "addict"?? -- and especially with the first two sentences it presents like somebody with a "psychopharmacology is an evil conspiracy" axe to grind.

You read me right. We stigmatize low income people as “addicts” and throw them in prison. People have pain and other issues which will cause them to seek drugs and other solutions. That’s a fact of human nature. We shouldn’t classify that as good or bad based entirely on a person’s access to healthcare. But we do.

My second point is that we have a system where the capitalist incentive structure is driving the drug seeking. People need these drugs to “function” only in the sense of attaining better wages or holding a job. That has nothing to do with medical need. It is capitalism perverting medicine, defining mental health as employability seems misguided at best.

Lastly, neurolink. Do the the math.

>only in the sense of attaining better wages or holding a job >nothing to do with medical need >defining mental health as employability

I reject this entirely. The same meds give patients the ability to pursue their hobbies, self-care, and lifelong learning effectively, which can be vital for self-esteem, quality of life, and avoiding depression.

I am in favor of medication (and drug use) that improves quality of life. I am not in favor of using drugs for competitions, regardless of the domain, eg employment, sports, academic. I feel that many people medicate for the wrong reasons and that we are over medicated as often as we are under medicated, because of our competitive nature. We can do better if we had better reasoning about when how and why to medicate and didn’t draw the arbitrary line around legal substances (cocaine and opiates being less prohibited than marijuana).

I have a hard time without eyeglasses. Am I also an addict? ADHD medications are quite similar in their effect for those with this condition.

Agreed. Most medications work by correcting a chemical imbalance. If I understand it correctly it kind of makes our brain work more like that of someone without ADHD. With similar balances.

So I do see ADHD medication as similar to eyeglasses or hearing aids. A correction for the way our brains work.

Hey, I'm someone with ADHD but that never had any medication.

Most of the time, I can't function. I'm exactly as they describe they are without medication. The only way I get through it is by doing things that need to be done faster.

And thankfully for me it's not as hard to focus on programming. Actually programming is probably the thing I'm best at, despite my inattentiveness costing me. It's everything else that is the issue.

I got by okay without meds as a bachelor. On non-productive days I'd leave the office at 4. On productive days I'd leave the office around 8. That way I would get 40+ hours of productive office time while still having plenty of time for myself.

Marriage made that harder. Kids even more so. Meds made it so much easier to have consistent productivity.

Best analogy I have is vaguely RPG like. Let's say "normal" is 0, and the medication at a given dosage adds, say, +5.

So people without ADHD, take Ritalin, hit 5, get a buzz, smash out that project.

Then there's people with ADHD, who're starting at -5. They take the drugs, hit 0, don't get a buzz, and maybe actually start that project now that they're better able to ignore the delights of Wikipedia articles on the role of headwear for class signaling in Victorian England.

There's people who take morphine to get high, and there's people who take morphine to treat pain. Same shit.

Assuming normal distribution most fall in the middle of this spectrum. The notion that there’s some binary state of “chemical balance” where you either are -5 or positive 5 is a myth. I’m pro-medication mind you, but I’m also pro-reason. The reasoning here is filled with inconsistencies, bias and outright misinformation (eg debunked “chemical imbalance” theories)

It was an attempt at an analogy to explain to people without ADHD who get high from Ritalin why people with ADHD don't get high from correctly dosed medicine.

If you've a better one, please do share.

Reply on news.ycombinator.com