A frustrating non-presence of mind – what to do about adult ADHD
By the time I landed on my therapist’s chaise, I was at the point of desperation. I was dissolving into panic attacks at my desk at work and I had recently contracted shingles, a painful viral infection that generally afflicts people in their fifties and sixties. I had just turned 26.
The psychologist was blunt: “You have to do something about this now, or it’s going to get a lot worse.” For an hour he had listened to me through furrowed eyebrows, my abstracted stream-of-consciousness speech testing the limits of his therapeutic pedigree.
My new psychologist saw a lot of people suffering from chronic stress: many of them doctors managing the daily horrors of South Africa’s overstretched and underfunded healthcare system.
But, to me, this was something else. Life was becoming frightening. My mind was starting to autonomously block out most of what I was experiencing on a given day. Things that had happened even the day before felt distant and hazy.
I had been crossing a road one day when I was almost hit by a taxi. The difference between me and mincemeat was a matter of milliseconds. A week later I was the subject of a road accident statistic when I crashed my car into the back of a stationary vehicle at a traffic light. Fortunately for me, no one was hurt and the driver was gracious. But my brain was telling me that I wasn’t far off from wantonly ploughing straight into an innocent pedestrian or three. Soon afterwards I stopped driving altogether and stuck to walking and using Uber instead.
Mostly I felt hopeless – like I was clutching at smoke.
I left that first therapy session feeling confused and disquieted. The psychologist had reasoned that there was something forgotten in my psyche, something that had been systematically ignored and neglected. The problem was that we didn’t know what it was. Things were fast becoming untenable and I needed an answer. At that moment the thought of my future only filled me with deep dread and a vague perception that my entire existence was being quietly and incrementally dismantled and stolen by a seemingly indiscernible and omnipotent force. I was turning into an intellectually switched-on but barely functioning corporeal ghost, a minimum viable human.
Mostly I felt hopeless – like I was clutching at smoke. I ideated suicide constantly. I couldn’t stop picturing myself rotating in a closet like Anthony Bourdain.
When I first saw the contours of an answer it had a difficult label on it. It was a set of words that I never thought I would use to describe myself. I found myself strongly resisting the implications too. Fast-forwarding over 2½ years and a global pandemic, over an unceremoniously imploded relationship and work with three separate mental health professionals, over a lot of self-medicating and simple day-to-day survival, enough of the pieces in the mosaic fell into place, and I could step back and look at what the whole picture suggested, even if it was uncomfortable, to begin with.
The most beautiful enunciation of the “epiphany” that one undergoes when they see their own attention deficit hyperactivity disorder (ADHD) for the first time comes from Dr Gabor Maté, an expert in the fields of childhood development, trauma, and addiction.
He writes, in his book Scattered Minds, about “The shock of self-recognition many adults experience on learning about ADD [attention deficit disorder] is both exhilarating and painful.”
That self-recognition leads, often for the very first time, to a sense of deep coherence. Maté was past the age of 50 and already a respected physician, healer and writer when he uncovered his ADHD for the first time, through a sequence of events that must have felt (depending on one’s spiritual persuasion) like a serendipitous accident, the machinations of fate, or a moment of grace.
Before continuing, I should offer an unreserved caveat that no one should be looking to me for advice or guidance, medical or otherwise. There are things that I know now that would’ve been useful for me to know a lot sooner in life, but I’m extremely mindful that I represent a sample size of one.
ADHD is a neurodevelopmental disorder, which is characterised by symptoms that persist over time. These symptoms cause significant suffering and interfere materially with one’s life.
The symptoms cluster around three broad areas: attention, impulsiveness, and hyperactivity (two out of three, very roughly speaking, are sufficient for the diagnosis).
As Maté writes: “The hallmark of ADD is an automatic, unwilled ‘tuning-out’, a frustrating non-presence of mind…”
ADHD in adults can be highly idiosyncratic. I still struggle to connect some of the sterile-sounding symptoms to emotive words that adequately convey to people the reality of what living with ADHD (for me) feels like. At large, the feeling is of a mind that has been honed into a perpetual motion machine. It’s chaotic and constantly trying to pull itself in a thousand directions at once; it is literally unable to rest. There is natural vibrancy and spontaneity, and there is a side that is relentless and exhausting.
The problem with undiagnosed ADHD began to absorb me as I tried to push back against my own internal resistance to adopting the label. Surely someone in my childhood would have noticed, at some point. It legitimately seems that no one did.
As it turns out, this is upsettingly common (especially for women, who, like me, tend to have the sub-type of ADHD that leans inattentive, and not hyperactive). It is estimated that some 75% of adults with ADHD don’t know that they are suffering because of it. ADHD gets routinely mistaken for anxiety, depression or bipolar disorder, which frustrates the process of accurate diagnosis – especially for adults.
What I wasn’t expecting to find in the process of reconciling my wonky brain was a silver lining.
Another thorny question gnawed at me: how do I even know if my framing is real, or just an artefact of a modern world with built-in freneticism, obsessed with instant gratification, plagued by overloaded dopaminergic circuits and addicted to doomscrolling on social media? We seem to live in an epoch of ubiquitous ADHD, one in which people erroneously self-diagnose themselves on TikTok, starved of real answers in a noisy world and ever prone to wishful thinking and easy answers.
Despite many unknowns, my therapist helped me put word to what I was experiencing and understand the risks associated with ADHD: like the fact that I am possibly marked for early mortality, for comorbid anxiety and mood disorders; I’m more at risk than the general population of becoming obese, developing substance abuse problems, or getting injured or killed in accidents; on average I’m less likely to hold down a steady job, maintain functioning relationships and more likely to suffer from sleep issues.
It’s clear that to live with ADHD means to manage the ensuing suffering or potential for it, using the perspective of pathology and mental illness. What I wasn’t expecting to find in the process of reconciling my wonky brain was a silver lining.
Over the last 20 years, this has been provided by the burgeoning movement around a concept called “neurodiversity”, which encompasses new thought, activism, education, employment practice and policy geared towards understanding and treating “disorders” such as autism, mood and anxiety disorders, ADHD, dyslexia, intellectual disabilities and schizophrenia as natural variations in the tapestry of the human fabric – as normal (and as beneficial) as diversity in culture, sexuality, race or gender.
Dr Thomas A Anderson, in his book The Power of Neurodiversity, points out that there are probably good reasons why these traits have persisted in the evolutionary history of humanity. Genetic and physiological diversity within a species can confer profound advantages. One of the pithiest distillations of this argument comes from the scientist and autistic person Dr Mary Temple Grandin, who quipped: “Some guy with high-functioning Asperger’s developed the first stone spear; it wasn’t developed by the social ones yakking around the campfire.”
Anderson underlines some important principles that relate to “neurodivergent” people and their eventual fate in life. In particular, the way that society views and values your neurological differences depends largely on where and when you were born. Especially in today’s world, ADHD seems to represent a deep violation of the kind of Protestant work ethic embedded in hustle culture and modern knowledge work, which appears to demand focus, rigorous execution and the ability to drive tasks to completion and reach well-identified milestones. These are things that don’t come naturally to those with a more diffused attentional style characteristic of ADHD, which is more geared towards the type of spontaneity and lateral thinking that allowed Einstein to come up with the theory of relativity, or Leonardo to paint the Mona Lisa.
Another insight from the field of neurodiversity is the concept (borrowed from the biological sciences) of niche construction. Much as a spider weaves a web, or an otter creates a holt, organisms adapt the environment around them to their advantage and conversely will suffer in habitats not suited to their individual needs. In much the same way, the success of an organism with ADHD or any other neurodivergence comes both from adapting to its environment, and also, critically, from the shaping of the external world to curb the innate hostility of the environment to which they are exposed.
It became crystal clear to me that the bodily reactions that drove me to seek help initially were direct responses to deeply inappropriate niching. This was especially evident in my work and career. I began to see why melting down in the face of stress wasn’t a measure of my own inadequacy: it was the inevitable consequence of a highly dynamic system that had become fundamentally unstable.
Spending your time daydreaming in class while mimicking the focus and effort that most kids need to achieve good outcomes is an ingenious strategy for a smart seven-year-old. An adult faces tougher opposition: working a job that demands long stretches of highly sustained focus and the ability to juggle an overwhelming number of informational inputs provides low levels of oversight and direct feedback, and when it takes place in an environment of extraordinary growth, transition and chaos, is tough for anyone. It could be reasonably described (in my case) as existing in ADHD hell.
I had also violated the first career suggestion for people on the attention deficit spectrum – it’s probably better if you don’t work as an accountant. No amount of hard work or ingenuity would have seen me through this situation unscathed; I was engaged in unconscious defiance of my natural tendencies.
The obvious benefit of knowing about your ADHD is that (maybe for the first time) you are able to treat it. Medication can be a godsend (but also not a silver bullet) and you are dealing with something that is essentially a delay in the development of your neural pathways – the brain is neuroplastic and while ADHD can’t necessarily be cured, it can definitely be ameliorated if you are strategic and intentional. There is a lot of low-hanging fruit in terms of reversing a lifetime of neglect in many areas of your life. You can start to navigate your own niching process with more determination and clarity.
I can’t yet, however, shake the inherent unease that a force so large and powerful effectively hid in plain sight for close to 30 years of my life, and the feeling that things might have turned out very differently if I were to rerun the simulation.
Later on in my therapy process, my psychologist said to me (to paraphrase): “Thank god all of this happened to you now and not when you were 60.” Looking back at decades of lost time, I can only treat a statement like that with a profound sense of gratitude. A weird kind of gratitude for being confronted with a situation that became too big to ignore, for breaking now and not later, and breaking lightly enough to avoid true catastrophe.
I’m grateful for being born into a time and a place where I had access to information and knowledgeable people not available to those who passed on the genetic components that contributed to my disorder. Grateful for my position on a social apex – with access to doctors, treatment and credulity not generally available to women, minorities and the destitute. Grateful to be in a position where I can ask for the world to change for my needs, most of the time.
That thing I labelled as an indiscernible and omnipotent force wasn’t really that at all: it was really just a combination of two things.
The first was a natural consequence of pushing my physiology far beyond its own inherent level of comfort, and of treating my body as an infinite resource. We don’t live in a universe in which Cartesian dualism is the law of nature: the mind and the body exist in an indivisible feedback loop (and other people are integral to that system as well).
The second was the rigidity of my own stories around what was happening to me. I framed my experiences as being a victim of something that was fundamentally beyond my control because I didn’t know any better. The power of my own ADHD epiphany was the melting away of the old story about a part of my psyche that I had been happy to isolate and villainise. It got replaced with something more nuanced: a picture in which the good and the bad ultimately stem from the same source. It’s a picture that is uncomfortable, maybe, but also deeply empowering, and better still, it is hopeful. You can do a lot with hope; perhaps most importantly, you can get back to your life with a sense of clarity – because now you know. DM/ML