Pages

July 16, 2015

ADHD Type Inattentive: Kafkaesque Inner Lives, Demons of Entropy, and a Life of Diminished Capacity

1. Introduction

I was diagnosed with ADHD (inattentive type) in January of this year and have been pursuing treatment ever since. I'm 26. In the 6 months or so since I've been taking medicine, I've been trying to come to terms with what this disorder has meant for me. In doing so, I've had to come to terms with what it means to be human, in order that I might understand how to live out my remaining decades as a human.

Now, that last bit may seem pretentious or overdramatized, but if we stop and think about it, it's not such a big question.

It's not such a big question when - for twenty-five years, for 300 months - I'd lived more or less in the top of a brain that cannot sit still. A brain that cannot sit still is remarkably fun to inhabit and remarkably exhausting, exhausting not only of energy but of means, fortitude, and identity. And yet... for all the trouble the disorder has always caused me, dealing with this brain is the biggest question (perhaps the only question) that I have to fix in my life. Now, while I can't prove this, I think most people have bigger questions in their lives than the question of how to be human. And I think those questions involve much deeper problems than the problem of how to live with being human. Strip away the veneer of the philosophical and put it in concrete terms of work and time and suffering. Put it all on a scale and strip of the metaphysical its usually-afforded privilege: I don't think it's that big a deal, for me. This is my biggest problem and it is a privilege to have this as my biggest problem. For people with ADHD type inattentive (or any other type) in general? This isn't necessarily true. They may have worse problems with the disorder than I do, or less resources to deal with them, or it may intersect with comorbid conditions like depression and anxiety, or it may intersect in a troublesome way with religion, race, or gender. Others may have more soaring ambitions, or a lower margin of error, or a more troubled family, or have more expectations foisted upon them. Others may have any number of obstacles which make it harder for them to deal with their disorder. I do not. I am a man without a country seeking only asylum and all I have in front of me is to seek.

I am extremely fortunate that my only major problem is largely philosophical and metaphysical in nature. And I do not take that good fortune for granted. I see in this fortune an obligation to seek out and communicate what I can of the challenges I've faced, so another person reading this may find some commonality and may find answers to their larger challenge, for whether for themselves or for a loved one.

2. Stand By Your Manager (Unless Your Company Sucks)

Despite being reasonably intelligent and having all the privileges of personhood that society has to offer, I submit that I have never fully enjoyed the full usage of those privileges until January of this year. My brain may have a normal capacity, but my life has never reflected the full measure of that capacity. My life is limited to the complexity which that brain can manage in a life, and that brain has never been able to manage much at a time. I can listen to Bach pieces I've studied and hear four voices simultaneously and how these voices interact. I can participate in video games or watch sports and "see the whole field" better than most people. I can read a book and solve a theorem pretty well. But these things are games whose rules are largely defined for me. When the prescribed rules go away, so too does my confidence and ability to thrive at the game, because I cannot enforce rules upon myself as most others can, In the sprawling eternity which stretches over every possible life a person can live, I cannot begin to fathom the voices and lights that others are given. I cannot know what calls most people to move one way or the other among their options. I simply lack something. And what I lack can lead people, if not always wisely, to lives far more commensurate with their abilities. For 300 months, I'd never heard such voices and have navigated my space of possible lives alone. What I heard and saw instead were noise and static punctuated incidentally by days and nights and the precious-few obligations I'd created for myself, usually by accident or self-deception.

No amount of habit-forming can make things fundamentally better, because there's a finite complexity my brain can handle. Fixing my ADHD-related problems is a zero-sum game on some level. I used to lose my keys all the time. Then I adapted to that, and now I rarely lose them. But when I was adapting, I would lose other things much more frequently. So I tried to address both. And when I'd adapted to that by carrying things in a central location, I got a lot worse at keeping track of all the things I now kept anchored to my person, best visualized literally as a full backpack with a hundred disparate objects. When I got better at keeping track of that, I started losing my keys again.

Let me talk in a more structured way about what it means to live inside this mind. This is a moderately-long tangent, but it's a tangent that will help premise and clarify what is to follow. Bear with me, if you will.

As I understand the current science, the "deficit" in "attention deficit disorder" is less about attention and more about the executive functions of the brain. As their name suggests, executive functions are sort of like the mind's managers. These managers are responsible for planning our projects, dividing our goals into bite-sized tasks, and generally keeping us motivated. They keep us on task, help us allocate time, manage our resources for us, and tell us where we left the key to the break room. They get rid of the distractions and let us do one thing at a time. These managers are the editors who tell you to be yourself and let them figure the editing out. While we're busy living our lives, our mind's managers help us reason about ourselves and others from past to present to future. They take everything in and use it all to construct narratives. The managers living in our mind bring cohesion to all our thoughts. They manage the managers, even.

In short, the executive functions of your brain manage, govern, and organize your thoughts, which allows you the space to manage, govern, and organize your life.

And just as an unmanaged, ungoverned, and unorganized company is a formless mess to work at, filled with arbitrary requirements and the vague, mostly-unrealised sense that for the salary you've been given, you should be working harder... or smarter... or better... "But what?" Your bosses have no answer. They're too busy directing the entire company to solve 7x7 Rubik's Cubes today. "What profit can that bring the company?" you might ask, but your bosses don't have a good answer. They shrug and say "It's just what we need to do now. My boss told me to do that." And your bosses's bosses, if you should turn to them, don't have an answer either. They seem to feel that the company should apply to a temp agency, but they are also thinking that maybe the company will never have resources to do even that. Conflicted, they do nothing. So today, they tell you, working on the Rubik's Cube it is. Or nothing. Or a vocal arrangement of gospel songs. Whatever. It doesn't matter. Nothing does matter in the company you're at, until there's an emergency or an appointment some jerk in accounting accidentally made. And when your company's CEO must travel to Hong Kong or simply make a trip to the pharmacy and get groceries by the end of the week, your CEO struggles against the bonds of a torpid, Kafkaesque bureaucracy before going out without having showered, in a shirt buttoned hastily. Better than to miss the bus.

My mind is a fast-paced experience, one part intelligence, one part ADHD, and eight parts the natural seasickness of living on a world whose contours and geometry seem to shift and warp without my conscious direction and without my conscious foreknowledge. My room gets messy not because of my thousands of actions but because a demon is messing things up to screw with my head (and misplacing my keys). I have to run to catch the bus not because I dawdled for fifteen minutes but because I sat down and innocuously checked my email when all of a sudden a demon moved the hands of the clock three full notches. I'm not a freelance writer not because I've never had the skills to force myself to sit down and write something without self-deception, but because a demon has decided to curse me with a sensitive intelligence and deny me the peace and quiet I need to write. I'm unemployed not because I can't bring myself to organize my prospects and act upon them systematically in the here and now, but rather because a demon has taken another drop of my potential from me.

And in a way, though they're all obviously ironic, that last part has some truth to it. There is a demon which takes from me - it is entropy, thief of time, scourge of order. I'm not the only one afflicted by entropy (clearly no one is immune), but most people have managers who hire security just to deal with that particular demon. I have no such security. I must fight that demon myself, even when I know I should be working, even when the bosses' bosses get their act together for once and put all resources towards gainful employment or education. And I get seasick and disoriented living in this chaotic world and body of my own unwitting creation. This seasickness manifests not as sickness or migraine but as a deep mental fatigue. Just as it's hard to write and think through a headache, it's hard to put a life together through the thousand lingering wounds, emotional and financial, that a scattered mind's manager unwittingly inflicts upon its employees. And as one of the employees within this madcap company (I am the particular stream of thought you're reading now), I can tell you: My resources are always drained fighting with futility a demon, and the demon cannot be contained by fighting it on any one front or by any one stream of thought. As soon as my attack on it assumes a recognizable order, the demon at once adapts and finds a new angle of attack. And if you give up entirely, it splits itself in twain and pursues a fatal pincer.

And yet, since treatment, and since the all-important awareness of how this disorder affects me, I've begun to see how this demon may at least be rebuffed, if never quite conquered. And that leads me to the question: What does it mean to be a human being? So many aspects of human nature I'd quite lately derided as phony and affected, I now see instead as rational consequences of living in a society of managed minds. In other cases, a more managed mind has perforce pushed me far outside my default expectations for life, which has allowed me to realize that most of humanity functions according to different rules, and that those rules have different strengths and weaknesses.

Here are a couple of examples which hopefully illustrate the depth of the reassessments I've made in the past six months.

3. Appearances as reality and general social signals

How a person chooses to present themselves should not be used as the basis for judgment of that person, and especially not in the context of a workplace. Come on. That's just basic. First of all, they have no choices over many aspects of that appearance, and the parts they do choose, we cannot expect them to choose exactly nor meticulously. We need to judge one another on words, deeds, reactions, and intentions. To do otherwise is to monstrously oversimplify reality, and companies in our ruthlessly capitalistic economy, who worship the altar of efficiency and bring to the table a highly sophisticated and efficient approach to productivity evaluation, will necessarily judge people on the basis of their productivity and general social fit. There is simply no room for inefficiencies like that to remain for long in a major company.

The viewpoint described above (at least the last part) is a precious and naive view of the world that I held until I was about 19 or 20. Yeah, I definitely whiffed on that one. While my current viewpoint is likely only a shade less naive and idealistic, it's more complete: After all, appearances do say something, and can say quite a lot. For me, even after I'd disabused myself of the corporate idealism, the full importance of appearances was always elusive until I started reasoning about it after pursuing ADHD treatment and thereby getting a taste of these executive functions. Something that had always been opaque to me and missing from my mental model of human nature is that most everyone in a society has those little managers in their head telling them how to contextualize the information from their own lives and the information around them, including, most crucially, the social signals that comprise much of our culture. A person builds an appearance in full view of what their mind's managers are telling them to wear after reviewing all the data. Therefore, an appearance is not just a projection made to the world and held to without regard to feedback but is made in full view of continuous feedback. An appearance is a negotiation between a person and the particular culture they're in. Until very recently, I had not been aware any such negotiation was taking and, so, naturally, wagered very poorly.

Though I'd never had the parallax that allowed me to express this or reason coherently about it, I must have known this on an intuitive level. After all, like most young and scared children, I dressed so I wouldn't be embarrassed at school. But then, I suppose also like many young and scared children, I grew my hair long from very early in my life as a form of self-expression. Somehow I felt utterly embarrassed by the possibility of a shirt that looked dorky but was utterly horrified at the possibility of cutting off my unkempt, sprawling, impossibly-dorky hair style to satisfy the mob of classmates. And somehow when a jerk cut half of the long part in high school when my back was turned, I didn't really even care. Everyone else was telling me how significant it was, but I didn't care at all. It was just a bully, and it was just hair. I cut off the rest, went to a place, and didn't regret any of it for a second, and didn't grow it back. But I kept the hair in a binder as a memento, without any sentimentality. I wasn't just repressing my emotions (I did that too from time to time). No: I actually didn't care. Which, considering I thought of it as foundational to my self-expression, is pretty weird. I didn't change. I just didn't have either of those tendencies in me fully, and pivoted without even needing to attempt it. I didn't care because "I" simply did not exist as a coherent, identifiable thing. Somehow "I" was occupied by several different people in the exact same form and circumstance and went between them seamlessly. I didn't have a manager to warn me of the inconsistency and I didn't have a manager who seemed particularly worried about enforcing the inconsistency in identity. The truth is, while I had a personality and thoughts and classes and friends, mostly my childhood involved doing a bunch of random crap arbitrarily, punctuated arbitrarily by some shame and some pride, and none of it made any sense or made me feel anything significant. I apologized audibly and profusely to navigate busy hallways but didn't feel any shame about not talking to someone if I didn't feel it. I felt crushing anxiety over the most indifferent and innocuous masses of people but somehow didn't mind approaching anyone individually. I just made no sense, and that's because I wasn't really there, fully. There was no connection between my intentions and my actions, and my intentions as a youth were already so divided and undefined that it's hard to say they ever really existed.

Whatever the case, I think my school years went pretty well. But given how warped my ADHD-stunted perceptions were in retrospect (even by kid standards) and in many ways still are, I have to think my fond memories of school came in part because I never really had my ability to manage and organize myself tested in a significant way. I was disorganized but that's just who I was. And I never felt a need to organize myself to socially signal anything... well, other than the signal that I didn't want to socially signal anything. I just wanted constant stimuli, conversations, alone time, and a never-ending simultaneity of joking conversation and smirking intellectual effortlessness that I could end totally if I ever got too bored of anything, and a notebook to draw endless crappy drawings and scribbles in that never got any better. I was never too popular and never sought popularity in school, though I wasn't unpopular either and never felt a pressure to differentiate myself (though I conspicuously never stood for the Pledge of Allegiance because public schools shouldn't promote religion nor nationalism and apparently I decided that for myself around 9/11, when I was 12. What a freaking weirdo/dweeb lmao). I made friends in high school by sitting at a table and listening until I was one of the people who sat at that table, and I honestly would not have cared if they had rejected me. I was so self-possessed despite not possessing much of a self, I was so self-confident despite having nothing to confide, and I was so self-assured despite the fact that I physically felt like I was overwhelmed in any crowd of people. I tried a couple other tables and got bored because they just talked about each other and I wasn't interested in them, or anyone. My school days were largely fine - even despite a crumbling family rent by death - largely because my limitations never infringed upon my goals. I never had a problem with high school classes, never had a problem with taking vanishingly few extracurriculars, and my main goal at the end of the day was to get home, take of feed and rid of waste, and go to sleep until 11PM where I could live my real life in my favored hours of cool substance. I could scarcely imagine wearing even a button-down shirt until several years into college; that is, outside of literally presenting myself to the entire town in the form of orchestral concerts.

All this to say that I lived a long time half-unable and half-unwilling to even think about what it means to exist in a culture. It was not forced upon me, it did not seem to align with my goals or my view of things, and the part of our brains that usually demands us to confront these things was running at low capacity in me. And all this to say that for the vast majority of humanity, the choices a person makes before they reach your field of view (in view of your view) can tell you a lot about that person, maybe as much as or more than the stuff they can't control. Are they meticulous? Did they get up in a hurry? Are they conscientious of their appearances enough to spend the 5 minutes per week to keep their hair cut regularly? Do they cut it short? Do they wear it long? Do they wear a buttoned shirt? Do they care if the buttons are right? Do they wear dress pants? Are they trying to impress potential lovers or potential employers? More than anything else, are they a person presenting themselves in a way that aligns with their goals? Or are they ascetic? Are they Bohemian? Are they unaware of the signals they're sending? Are they a wreck whose placidity belies the windstorm they'd clearly just walked out of? Did you remember to shower? Alex Dewey... is Alex here today? I raise my arm in a hurry. "Present!" I say, too quickly.

I realize this stuff is insanely basic to the vast majority of you out there and I did understand it on a visceral, unstated level. But until I'd used medication and consciously began to employ my executive functions to any effect, I could not reason concretely about these things as I did in the previous paragraph, because my default frame of reference has always been a Charlie-Brown-and-Lucy-esque relationship with personal organization, and the few times I kick the football I've also kicked myself in the head and spend the week in recuperation, Lucy mocking and o'er-looking me--smirking with triumph--for ever thinking I could succeed. I didn't have much control over what I did in life and I floated along just existing, and when I had anything at all to say it was in service of an intellectual pursuit or to enforce a terrible sense of humor on all of my friends, with tormentor's glee.

So, anyway, I've never dressed quite right. I've never dressed immaculately or even close. I can hardly reason about myself as a person, after all, and it's that much harder to reason about the intricate details of a non-entity's presentation. Only recently, with some treatment, have I come to recognize on a visceral level that non-entity as myself, and to recognize that I am really that person every day of the week, and that person is pretty much the same whole, integral unit. (Well, except for Two's Days. Ugh.).

Now, for precisely the reasons I've outlined but from a different frame, judging appearances as reality is still total BS and people who do so should seriously examine their underlying assumptions, lest they unwittingly contribute to a world less worth inhabiting (though I can see how you might think that a world with fewer of me in your purview is perforce a better world [please, bring it up next time you see me!]). Far from being superficial, judgment based on appearances is actually deep... and deeply misguided. It privileges received cultural and personal stereotypes over the complexity and substance of real people - especially the real people who don't have that extra half-hour a day to signal their desired place in a hierarchy, whether because of illness or poverty or the demands of a busy life which can be more important than the life of work or leisure. Or, simply, you're dealing with people who have made the simple (and perfectly adult) decision not to value that particular type of social signalling to the same extent. Are those people you want to exclude? Maybe, but it should be a careful decision. Judging appearance as reality is not my cup of tea and I try to challenge it whenever I can, because it reifies the American culture which is fundamentally built on exclusion and homogeneity, and does so invisibly to all participants. A better world is stymied every time we lose an opportunity to connect with someone who will challenge us over someone who will not.

In other words, it's not BS because appearances don't matter much... it's BS, because appearances can and do matter. They just matter in ways that shouldn't exclude us in a pluralistic world from approaching someone with a truly open mind, every time.

I wrote these last couple paragraphs in a bizarrely-neutral American voice in that I'm not explicitly mentioning classical categories like race, gender, religion, sexual orientation, gender identity, disability status, and class. Discriminating in a way that perpetuates these underlying power imbalances is so obviously wrong I need hardly mention it. But I always wonder if these categories (with a seasoning of intersectionality) really do cover fully the deep gulfs that exist in our society between people. Sometimes I think we in the US are just exclusionary, close-minded people looking for one more reason to build a moat around our bomb shelters made out of guns, and some people have simply borne the historical weight of that close-mindedness by coincidence alone, and while it's relatively easy to trace ex: the rise and partial ebb of racism, this close-mindedness in our very natures seems to exist in a place that cannot be viewed or even conceived of by us except in moments of transcendence of (or transcendent surrender to) this, our fundamental national evil. 

Happy Thursday!

4. Creative Life and The Voices

I find it hard to talk about myself as a person because I live a hundred different lives every day of my life. I occupy a hundred different voices, adopt a hundred different styles, know a hundred different ways to talk, and feel a hundred different impulses and motivations to do a hundred different things. And none of it fits into a coherent whole. Now, granted, the better part of such sprawling ambition never gets completed, and most of these hundred things are lost to random chance and recursive diversions that I never come back from. But the experience of being so many people - while as exhausting in its own way as living in an unmanaged mind - is a way of performing that gives me insight into the human condition and is the foundation of my creative inner life.

I don't know if this is ADHD or just generally the kind of mind I was born into, but I feel genuinely that I can write in any voice, adopt any mannerism, be any kind of person, write any kind of sentence, and do anything I can fathom doing. I can't do it as well as someone who lives their life as that kind of person, writing those kinds of sentences, and who fathoms with their whole being what it's like to do and be those things. I can't fake what a doctor would say. But I can mimic how they talk and act: I can listen, and listen well, and my brain seems constantly to record, reassemble, and recapitulate the auditory data I've gathered as if calculating the next move in a card game. And thereby I can reason about the nature of my fellow human beings in a comedic, musical language both beyond and immune to actual reason. My creative life has always been the interplay of a hundred Characters and Voices which I slip in and out of. My musical mind has always had a capacity and a compulsion to explore these Voices, and a capacity and a compulsion to switch Voices as soon as one wears out Its welcome.

Most of my favorite pieces on this website and that I've written in general tend to be cases where I've nailed some particular voice. When I nail a voice, the end result is either to bring enlightening illumination to bear on the darkness of the eternal and universal human condition, or else to make someone titter the tiniest bit. Okay, almost always that second one. And it's mostly me who titters. I love Twitter.

And in this vein, getting a good manager for my mind - and having the knowledge that I am entitled to one as a human being - has sometimes felt like a withering of my creative life in this respect. I simply feel much less fluidity in pivoting from one type of person to another. Stephen Colbert, quoting a Second City improv mantra, once said "Wear your character as lightly as a cap." I used to find this so easy, but I've found that part quite a bit harder in the six months I've been medicated. On the other hand, I feel much more energy to pursue the type of character that I really want to hit at that moment. I feel much less able to run rapid-fire dialogues in my head and much more able to run detailed character sketches in my head. And though the speech between the characters feels less musical and less natural, the characters themselves seem to have a richer, more coherent inner life.

In general, when I've written, I've felt more ability to express an idea rigorously and on command when on medication, and less ability to express beautiful-but-nonsensical prose. I'm more able to read poetry but less able to feel poetry on an auditory level. I'm more apt to feel emotion towards literature in general and less able to feel emotion at my own ability to make a distant connection in that literature. The bizarre-but-distant connections are still there but they're less vigorous and immediate. By contrast, while I've always felt an impulse to think and speak rigorously, the demand for rigor in my ideas has never been more vigorous and immediate. I'm less able and less willing to kill a sentence with three metaphors. On the other hand, I'm less able and willing to curry together eight or nine metaphors into an amazing paragraph.

To be clear, I still have the same basic aesthetic and the same love of writing - I still love attempting the dense, silly, impossibly-delicate, ironic-and-satiric prose that aspires poorly to Wodehouse, Chekhov, and Borges, My favorite part of this blog has always been the weird, awkward, dead-on prose. For example:

"If [then-Cavs-coach] Mike Brown lost his glasses and they [Brown and then-Hawks-coach Mike Woodson] were standing together, I would have legitimate trouble handing the glasses to the right one, even if I'd seen from whom it had dropped."

This moderately-long throwaway sentence from 2010 is nevertheless worth far more to me than the many thousands of words I'm writing right now, and the only reason I'm writing these words is to get to those words. My life goal (other than, like, helping people? idk lol) seems to be to write the kind of comedic two-sentence description that all at once 1. says nothing, 2. contradicts its own literal premise, 3. establishes or characterizes a narrator, 4. establishes or characterizes a person to which that narrator refers.

In me, the spirit of playfulness is as strong as ever but for good and for ill it has found more use for rules and structure.

And I'm still just as bad at sitting down and deciding to write something. The "trick" this time was a long bus trip to a doctor's appointment which forced me into people-watching (impossible before treatment/diagnosis) and reading.

Apart from trying to systematize tricking myself into writing (no easy task, as alarm-clock-snoozers everywhere can attest), my goal must be to blend the two impulses - to find creative processes that give me back my fetish for baroque and impossibly-distant constructions even while my mind's hardass, no-BS middle manager keeps me on the path to rigorous expression.

5. Conclusion

To sum up a conclusion that will hopefully finish the sequence of words that the above chain of ideas has started and developed: As a person who lived with massive undiagnosed and untreated ADHD for 25 years, I wouldn't necessarily recommend it. I'd maybe give myself a "B minus" (though I did well on the exam today!) and bump it up to an "A" because of the many other things about life I have been blessed with. But as with all unqualified music reviewers, there are extreme, insane nuances to my opinion (and my grading system would take days to explain) that mostly reside in my own limited perspective.

On the other hand, I feel comfortable speaking from my limited perspective today precisely because the last months have seen that perspective become much broader and deeper. The question of what it is to be a human being has become far more apparent to me, even as I sense its development yet lags far behind the average person: In short, to be a human being is not just to live and think and consume and produce, but also to aspire and to plan, to reflect and to reconcile ideas, to exist in four dimensions and to be able to see one's past self and future self as real (or at least real potentialities). To be a human being is to be able to give a command performance of that humanity in speech and song and rejoinder, and not to slink away and regroup whenever something unexpected shatters your ability to process information well enough to address a situation. To be a human being is to have some kind of mental and emotional integrity and stability that persists from moment to moment, and to be able to manage my mind both in the moment and in the long-term. It's to be able to react to a situation in real time and to be able to provoke a situation in real time, and to do both in full view of what is pursued (even if the full causes and implications of that pursuit may yet elude us).

I have always been human, and my humanity with ADHD was as real when untreated as it is real when treated. But certain fundamental aspects of being human - and seemingly all of the active, situational components as well as much of the subtler, planning components - had always eluded me until my diagnosis and treatment. Then as now I had certain inalienable rights to live my life. Then as now I - as with every other human being - had certain exceptional capacities that I was able to express.

But only recently have I been able to employ those inalienable rights and my special capacities to anything like the fullest measure. Only now has the fact of being human been known and present and a premise to reason from, finally having stolen a foot of space back from that all-pursuing, all-ruining demon of entropy never to be known, never to be present, and never to cease its unreasoning quest to destroy me.

I still have far to travel to develop my mind and body and habits to reach any semblance of a life fully lived. For now, I am biding my time, trying to contend with the awesome fact that there is, in fact, at least a person in there.