Knowing what code not to write.
266 karma · joined August 5, 2010
As someone with adhd, my psychiatrist has explained it to me in terms of Dopamine. In his words, stimulant medications help to treat symptoms of adhd, in part, by creating dopamine when we either lack it or have a weakened response to it. This flood of dopamine keeps us from being impulsive, in his explanation.
In other words, I am more impulsive without stimulants and the explanation I was given is that my brain is too busy seeking out dopamine and thus always looking for excitement. By providing dopamine through medication, that seeking behavior diminishes and I am more focused and less impulsive.
So, something doesn't add up. Either my psychiatrist has been misinformed or there is a lot more going on here / my understanding is very off base.
However, to us it made sense that language increases the cognitive ability of the brain because it's like memoization. We now have a symbol to represent a concept. We don't have to re-compute it over and over again. So now we reference that symbol when we are thinking and can build upon it and attach new symbols. Without having to re-compute, so to speak, the whole underlying framework/structure we are better able to utilize our cognitive cpu.
Whether that is true in any way is beyond me, but it made sense to us.
There are different subtypes (not sure if they are in the DSM but they are often referred to in other literature), e.g. hyperactive vs non-hyperactive. Sometimes, though, the hyperactivity exhibits itself in ways that are non-obvious.
I think the negative stigma comes from what many (myself, included) believe to be an over-diagnosis in young children. It seems to be used as a catch-all for children who are difficult to handle, who aren't good at sitting still in class, etc. This over-diagnosis causes a lot of people to think the disorder isn't real.
Secondly, a lot of people will try to fake their way into an ADHD diagnosis (especially at the college-level) to gain access to the amphetamines. This makes it difficult for those with the actual disorder, as we are scrutinized heavily and often made to feel somewhat criminal when we pick up our prescriptions at pharmacies that have had issues with this in the past. I won't say it's overly common, but it does happen. I've been told they were out of stock before because I tried dropping off a prescription at 3am once. I had it in my wallet and had meant to drop it off on my way out with friends. On my way home, the subway stop I get off at (I live in NYC) is where my 24/7 pharmacy is. I didn't think anything of it, I'm just dropping it off to save myself a trip in the morning.. well, the pharmacist looked at me.. 3am, clearly had a few drinks.. and he gave me the "we're out of stock" line. Magically it was re-stocked at 7am.
And lastly, there is a stigma in the US, in general, when it comes to mental illness. These aren't things people can see, for one. And, perhaps more importantly, our mental selves are what we view as our actual selves, so people can have a hard time admitting to themselves that they have something about their mind that is considered abnormal. Other people have a hard time accepting it because they simply can't relate - how do you explain to someone what it's like to be ADHD?
You might tell them that you forget things a lot, feel impulsive, etc. and they simply say "Yeah, everyone is like that though, you just need some discipline and will power dude." What they fail to recognize is that, yes, everyone does feel that way sometimes. Just like everyone feels anxious sometimes. What makes it a disorder is the frequency, intensity, and duration of the feeling(s). Many people just can't accept this, especially in the US it appears. Our attitude is "pick yourself up by the bootstraps" or "be a man" or "put yourself together - no one's gonna do it for you. I certainly didn't need medication!" and there's a lack of empathy because they simply can't understand.
That being said, as I mention in another comment, there are valid reasons to be cautious with ADHD medication. And as for the stigma, I am very careful about who I talk to about my ADHD in real life. A few of my coworkers know, my boss knows, and a couple of my friends and family members. I discovered very quickly that ADHD itself has a pretty bad stigma, let alone the medication. Everyone thinks you just want to get high. So, I just don't talk about it anymore, even though I so often want to explain to someone that the reason I did something rude (like interrupt them 5 times in 10 minutes) is because I'm ADHD and my medication has worn off, ha.
Long term amphetamine usage has been shown to potentially be toxic to the brain, especially at high doses. It also increases risk for high blood pressure, heart attack, and renal failure for those with pre-existing conditions or who are at-risk for other reasons: genetic conditions, obesity, etc.
Most of us (myself included) will take long breaks from their medication. I don't take it while on vacation, I take most weekends off of it, etc. I take it when I need to be at my best for work and I take it if I am on vacation and feeling like my emotional reactivity is too high, etc.
Ritalin is actually shown to mitigate the effects of amphetamine toxicity, as well, surprisingly, because while it also work on dopamine it uses a different strategy. Instead of causing your brain to produce it (thus potentially frying the cells that do so), it simply prevents the brain from re-absorbing it, much like an SSRI does with serotonin. So, I've heard of some people switching back and forth between amphetamines and Ritalin, though I have not done so myself.
Lastly, there are other drugs such as Cymbalta and other SSRI/SSNRIs that seem do help some people. SSRIs have a whole slew of side effects (especially weight and sexual side effects), and, while SSNRIs tend to have far fewer side effects (Cymbalta seems to have barely any for most people), they are still a fairly new class of drug comparatively so I could understand someone being cautious.
All that being said, the risks are worth it for me. Even if it took 10 years off my life, I'd rather have the remainder of my life be productive, happy, and have healthy relationships than continue to be the shit show I was at times in the past.
I found out the hard way that the freelancing life did not work for me. Double booking clients on accident, forgetting deadlines, not being able to motivate myself to start projects, etc.
I certainly don't mean to project my experiences onto OP as fact, but ADHD often makes a lot of the skills that are required to run your own freelancing business very difficult to master and stay on top of, alas.
That being said, I think it's a really great suggestion if OP finds himself out of a job again. Especially if he can do projects serially and try not to overlap them. That's where I got myself into trouble.
I use medication and cognitive behavioral therapy. They are a tandem duo and neither alone would be nearly as effective.
First, do yourself a great favor, read the book Driven to Distraction. It's a super easy read and will give you a great amount of insight.
Second, try to really re-evaluate your fear of medication. ADHD medication gets a bad rap. My opinion is that it's because it's over diagnosed in children and abused heavily at the college level. For those who truly have ADHD, however, it can be a life-change overnight. I mean that.
The ADHD brain lacks dopamine, this shortage is a major component of the behaviors that follow. A low amphetamine dosage should have no ill effects on the patient (you're not trying to get high on speed here..), but what it does do is artificially boost the dopamine levels in the brain. This covers the shortage that your brain is constantly trying to fill by jumping from exciting thought to exciting thought or through thrill-seeking. Suddenly, your executive functions are much better and you can direct your focus far better. You'll never be "normal", but it's a world of difference. For me, not only did I immediately regain better control over my focus, but I also found I could transition better, I didn't procrastinate as much, and I wasn't as emotionally reactive as I normally was which has always been a major issue in my personal relationships.
This alone, however, won't fix all the issues. Once you have the medication and are able to wield your focus, the next step is unlearning all those bad habits you've learned over 40 years of struggling and compensating for your ADHD. This is where Cognitive Behavioral Therapy shines.
These two things together, along with accepting and learning to appreciate your brain for what it is and making use of tools (lists, calendars, regimented scheduling, written goals, etc.) that complement your way of thinking will go a long, long way.
Anyway, your mileage may vary, and your feelings on medication are between you and your doctor, but this is what worked for me and what I recommend to everyone I know who is thinking of seeking treatment. Best of luck.
The ADHD brain is always seeking dopamine and constantly seeks out the most "exciting" thoughts. When you are actually into something and engaged, the brain is producing dopamine (the reward chemical) and so an ADHD person will hyper-focus on that thought/activity intensely for long periods of time, barely noticing the time as it passes.
This is one of the reasons, in my opinion, a lot of people in the software field are ADHD. Being able to sit at a computer and code for 12 hours while having it feel like 2 is not normal, per se. Hyper-focus allows us to be amazingly productive at this job. It's a gift as well as a curse, however, because it's that same hyper-focus that can keep us playing a video game far longer than we should even when we cognitively know we need to stop.
In people with ADHD, the executive brain function has a very hard time overriding the impulsive side of the brain. So, if the brain is getting its dopamine fix due to playing the video game and you're running late for an important meeting, it's going to be super hard to override it even if you cognitively know that being late to this meeting is a very bad thing.
What I find even more interesting than that, though, is that being late is stressful, and stressful thoughts are, as far as the brain is concerned, exciting! It's a double edged sword; as soon as the stress of being late is more exciting than what you're doing, you'll get up and leave. Until then, you'll sit in denial and read Reddit or HN or play your video game.
This is also one of the reasons ADHD and Anxiety tend to be co-morbid, I believe. Anxious thoughts are "exciting" for the brain so we tend to fixate on them.
So yeah, transition, in general, is very hard for those with ADHD.
Don't be afraid of medication. Find a healthcare professional that you trust and will work with you.
There is a book I recommend to everyone who suspects they may have ADHD: Driven to Distraction
It's a very easy read and will give you a lot of insight.
One of the lines I use from that book often with regard to medication and the stigma it has is: would you deny yourself glasses if you couldn't see? The medication helps focus your mind the way glasses help focus your eyes. The medication is the catalyst for other treatment options to be more effective. Cognitive Behavioral Therapy, for example, works far better when you are able to actually concentrate and do the exercises properly without your mind wandering on you.
Most people find that the medication dosage they need of amphetamine is actually quite low. You're not trying to get high and become a speed freak like college kids popping Adderall the night before Finals to cram. Your brain simply lacks dopamine and is forever craving a fix for it - thus always latching on to the most exciting thought and causing impulsive thrill seeking behavior. A small dose of amphetamine feeds the brain this dopamine, rids you of the shortage, and restores the balance you need to be the person you expect yourself to be+.
+Very simplified explanation, obviously. But, it's the best way that I can relate to my brain's behavior - by always thinking of it in terms of a dopamine imbalance. While it's true, other factors are likely involved and ADHD is also often comorbid with anxiety and depression as many of the same chemical pathways are shared.
Additionally, Cognitive Behavioral Therapy has been huge for me. Since I was diagnosed late in life, I had just shy of 3 decades of bad habits to unlearn and replace with better ones. I still struggle with some things - punctuality, sleep schedule, for instance - but I'm far more productive and far happier.
It has also caused me to be less risk adverse and take career moves that have really helped me over the years. I haven't been afraid to try new things, to gain new experiences, etc.
But those upsides all had their downsides. The same impulsivity that let me drop everything and move to NYC for bigger and better things is the same impulsivity that saddled me with an embarrassing number of speeding tickets and car accidents, substance abuse issues (alcohol), etc. The same intensity that is a large part of my charm is also a large part of the reason many of my relationships become strained.
Being diagnosed and getting a handle on it has curbed the negative side effects greatly while still allowing the positives to shine through.
Do you procrastinate a lot?
Do you have a hard time transitioning? Are you late for things because you a) can't accurately estimate time and b) can't pull yourself away from the thing you're doing at that moment even though you know you're going to be late if you don't?
Do you have a very unstructured sleep schedule?
Do you have high impulsivity? Spending (sounds like it)? Speeding? Substance abuse - including alcohol?
Did you breeze through HS with decent grades without trying but then suddenly find college and its unstructured environment and lack of supervision much harder and hard for you to succeed in?
If you answer yes to many of those questions, then you may want to talk to a psychiatrist about the potential for you being ADHD.
I was very much the same way and was diagnosed at age 29. Best thing to happen to me. I've managed to turn my career and my personal life around.
Everything you describe sounds like the impulsive behavior of ADHD to me, but I am not a medical professional and I am not trying to diagnose you. You just sound an awful lot like I once did.
Best of luck..