The first step towards my diagnosis a month or so back was a quiz. Did I have trouble putting the finishing touches on complicated projects? Trouble sitting still for long periods? Did I interrupt conversations to finish people’s sentences? Did I fidget? How often?
My final score was very high. This, I understood, was a bad thing. It led to the second stage, a long conversation with a counsellor.
She politely but insistently asked me questions that covered my whole life’s history. How would my high school teachers have described me? (Bright but disorganised and distracted.) How did I entertain myself as a child? (Obsessive reading.) What things regularly caused conflicts in my relationships? (Chronic tardiness and untidiness.) How often did I lose things like wallets and keys? (All the time.)
A pattern began to emerge in the conversation that even I, in my befuddlement, could see. I had been living my life in a state of almost permanent distraction, which periodically descended into panic and chaos in the face of another wasted day, another lost wallet or another forgotten chore.
Compared with my peers, my capacities for self-organisation were brittle, and small setbacks could knock me off course for a whole day (such days would end in self-recrimination). My work habits too often relied on last-minute crunches, a mixture of on-deadline miracles and over-deadline apologies. A knack for writing and quickly absorbing information had seen me through a postgraduate education and career changes, but my learning style was unsystematic and idiosyncratic, proceeding in flashes and leaps. Too much happened at the last possible moment.
The people around me had put up with a lot. My family and friends had suffered through decades of missed appointments or late appearances. My perennially lost keys had become a running joke. Colleagues boggled their eyes at the industrial scale of the mess on my desk. I forgot tasks and errands, especially the ones that didn’t wholly interest me.
On the flip side, I could temporarily disappear into reading, or a project, with such obsession that others could not reach me, and my other responsibilities were forgotten. This rhythm lined up well with the pulse of freelance journalism but not much else.
Last year, as I continued into early middle age, it was all getting worse.
In our mid 40s, for better or worse, many of us come to the point where we figure that we are what we are. We took the paths we took — after all that’s how we got here — and whatever we might think about that, we can’t go back. Better not to think about it further.
We are, we hope, fully formed, and most of the work of the self is done. Imagining that things could have been another way with us is dangerous. Most of us have seen a peer, or more than one, consumed by their regrets. The best thing to do is to let it lie, let it be.
But now I was being asked to look back over (let’s be optimistic) half a life, and to realise that it had unfolded in a kind of fog. Much of what I had fondly considered to be my personality could be understood as a set of elaborate compensations for a condition which I had never quite understood.
Now it has a name.
ADHD, my doctor explained a week or so later, is currently theorised as an insufficiency, or systemic malfunction, in the distribution of the neurotransmitter dopamine. Popularly associated with pleasure, dopamine is now more precisely understood as conferring “motivational salience”. It forms our sense of how much time, energy and risk a particular desired outcome demands. It shapes our attention towards achieving our goals. It helps us put thought together with action.
Simply put, dopamine makes us want things, makes us attend to them in order, and steers us through the process of getting them.
People with attention-deficit/hyperactivity disorder don’t get enough of this stuff, or their peculiar neurology is not distributing it well enough. In any case, our lack of dopamine leads to diminished cognitive control. Cognitive control is not cognition as such. The problem is not so much thinking as harnessing thought. ADHD is not a deficit of raw intelligence but an inability to make one’s intelligence mesh with the gears that turn the world.
Some of us have problems with attention, inhibition or memory — the “executive functions” that put intelligence to systematic use. Others have problems regulating our emotions. All of this means that we can have problems with modern life and its demands for individual, entrepreneurial efficiency.
Somewhere between wanting and getting, between aspiration and achievement, we often become distracted and disorganised. We might forget the things not immediately occupying us. We might find it hard to manage the consequent frustration.
Even if we don’t know what we are missing, the doctor said, our brains do. People with ADHD, especially adults who have not been diagnosed, frequently seek forms of stimulation – dopamine hits – that might temporarily alleviate their permanent deficit. Self-medication is likely a part, though not all of the reason that ADHD has an association with addiction.
Some studies suggest that ADHD is five to 10 times more common among alcoholics in the US than it is in the overall adult population. About one in 20 adults in the US have ADHD but it is present in as many as one in four in people being treated for substance abuse. There are also indications that, on average, people with ADHD may start using alcohol and drugs earlier in their lives, and may become problematic users earlier, too.
Unfortunately, I can attest that you cannot drink your way through ADHD, and cigarettes don’t help much either.
The current first-choice treatment is pharmaceutical speed: I have been prescribed a combination of amphetamine and dextroamphetamine sold under the brand name, Adderall.
I was hesitant about this at first, not only because I worried that it would wreak some lasting and irreversible change on my personality, but because my history with medications made me think that I would inevitably forget to take it.
But so far I have remembered to swallow one with breakfast each day and it has been helpful, in ways that are difficult to articulately explain.
On the cognitive side, I definitely have a better capacity for sustained attention. I haven’t stepped away from this piece of writing since I started drafting it. Six weeks ago I would have had three snacks, a nap and a Wikipedia binge by now.
My memory is better. I am more methodical. I even keep up with my diary.
On the emotional side, it has put a floor underneath things. A bad day is just a bad day, not the cause for a downward spiral of self-recrimination. I can see better habits forming, and I can be patient about my own progress. I cope better with setbacks, I have more chill.
But none of that really gets at the thing which to me seems magical, but doubtless just approximates everyday experience for most. The only way I can put it is that there seems to be more time. More time in each day, so that more things on the list get done. But more time, too, inside each second, more time to conclude each passing thought. More time to make good choices, moment to moment. More time to recognise and avoid distractions. More time to breathe.
In the months before my diagnosis, all of my problems seemed to be becoming worse. I had more trouble than ever in starting and finishing things. The lists of unfinished tasks were getting longer. The troughs of frustration and despair about my own incapacity were becoming deeper.
Perhaps that is just down to the deterioration of one ageing individual brain. But it could be, too, that the world we now live in is uniquely challenging for those prone to distraction. The internet is a bottomless well of interlinked trivia. Social media is a minefield of tempting tangents and cheap dopamine spikes.
Especially since 2016 it has been easy to make the mistake of seeing Twitter as the source of all that is most interesting and important, and to mistake checking one’s timeline for taking the temperature of the world. Perhaps my increasing distress had something to do with the way in which this kind of industrialised beguilement has colonised public life and accelerated its rhythms.
But I can’t blame social media platforms for the choice to engage with them, which was mine. Similarly, I cannot blame the paths I have taken in life on ADHD, as if my own brain and its workings are somehow separate from me. Every life is lived within constraints and many people – including many with ADHD – have endured far more than me. My failings – especially the moral failings – are mine.
It’s better, I think, to be grateful for second chances. First, for the many given to me by family, friends and colleagues who too often saw only absent-mindedness, disorganisation, unpunctuality and bad moods. I was privileged enough to be cut slack, time and again, and this is not a privilege that everyone in my condition receives.
And grateful, too, for the second chance given to me by a quiz, a name, a drug. The chance that with some work and luck, the second half of my life will run more smoothly than the first. The chance that I can be more than, or different from, what I have been. The chance to take a different turning.