So I found out some interesting brain stuff this week
NOTE: This story was originally published on June 15, 2018 on Geek Bravado, my former blog.
I’ve long been of the belief that one should be open about mental health. Aside from wanting to help end the stigma and ignorance around it, I’ve always thought telling others what you’re going through not only lets them know they aren’t alone but can provide insights into their own struggles and maybe, give them a basis to start figuring them out. The human brain is nothing if not insanely complicated and we’re all too often left to try to parse all the weird things it does ourselves.
Three days ago, I was officially diagnosed with ADHD and Major Depressive Disorder. Both of these come in numerous variants so for those curious, the official diagnoses are Attention-Deficit/Hyperactivity Disorder — Combined Presentation (DSM 5 Code: 314.01, Mild) and Major Depressive Disorder — Recurrant, In Partial Remission (DSM 5 Code: 296.35). In addition, while I did exhibit certain symptoms of ASD or what is also commonly called High-Functioning Autism (formerly known as Asperger’s Syndrome, a term now deprecated in the DSM), I did not exhibit enough of them and they did not combine into a significant enough detrimental effect to warrant a formal diagnosis of that. I do have the formal report I was given by the therapist and while I’m not going to post it here as it would in many ways be doxing myself, I’m happy to provide a copy to anyone I know personally who is curious. I am not ashamed or afraid of posting what I am here. Indeed, more people should be able to talk about this without fear. Anyone, whether a friend or an employer who will judge me negatively for this is someone I don’t wish to know.
The layman version of those two things are that I have ADHD but a version of it that doesn’t constiture a major detriment to my ability to function as an adult. It’s clinically considered “mild” but the therapist said the three stage scale they’re supposed to use is a system she doesn’t agree with and I shouldn’t pay it much mind. It doesn’t mean my life isn’t being negatively impacted by it, just that I can get by with it if I had to. I had been formerly diagnosed with depression and anxiety already so that was no big surprise but this more granular diagnosis means that I am prone to major depressive episodes (can confirm) but that they are less frequent than they were before I started treating them with medication (can also confirm.)
So now that all the doctor speak is done, what’s all this then? Back in early 2017, when my ex and I decided to end our relationship, I was getting some remote therapy with a Psychologist through my work’s Employee Assistance Program. We were talking about various things during one session and the therapist said “Out of curiosity, have you ever been tested for ADHD?” I was kind of taken aback because I’d never considered that before. I said no and asked why he thought that and his answer really threw me: “Well, I’m diagnosed ADHD and I can tell from our interactions that you exhibit many signs of it. It might be worth looking into.” After that, a good friend who has two kids diagnosed with it said “I never thought it was my place to say but I could tell within 5 minutes of first meeting you that you had it.”
I’ve always been a very fidgety person. I often talk a lot and hate silence in conversations. I have issues with eye contact and can come across as socially awkward, even when I’m comfortable with someone. I’m also extremely introverted and heavy social situations are draining for me. I will make almost any sacrifice to help those I care about but I also decide very quickly after meeting someone if they’re a person I want to care about and I don’t tend to give second chances easily when I’ve been burned. I’m easily distracted and passive activities like reading and studying I have very hard times with. Most of all though, my brain always runs a mile a minute, trying to process 10 thoughts at once, usually going nowhere fast with 8 to 9 of them. I have major issues with focus and have found that gaming is one of the only activities where I’m able to shut my brain’s multitasking down and just “think normally.” It’s a big part of why gaming is so important to me, even taking into account my love of the medium in general. I have a cousin with ADHD (with a big emphasis on the H part) and much like when I was diagnosed with depression and anxiety some years ago, I always assumed “There’s no way I have that, I’m sure it has to be way worse to even come close to being clinical.” Never assume.
For all the good and security our public health care system in Canada provides, mental health is always one aspect where it’s fallen very short. Psychologists and assessments of this nature are not covered at all, something that’s always frustrated me when you look at some of the things that are covered. While many corporate benefit plans can help, my employer offers a miserably low cap for mental health every year. They’re looking at rectifying this in some way but it hasn’t happened yet. To get a professional diagnosis from a well-regarded clinic that specialises in this kind of thing was between $1,800 and $2,500 when I researched it. The clinic I chose (one that’s considered excellent and also happens to be near me) was on the high end of this scale, partially because they also suggested we test for ASD traits as well. I make a decent living but not enough to just have that kind of money lying around. I ended up scrimping and saving for a number of months and even then, was only able to do this so soon because of a major freelance tech job that came about earlier this year. Thankfully, I’ll be able to write some of this off on my taxes but I still won’t see that for a while and this wasn’t chump change. I consider myself very fortunate I was able to make this work and it really bugs me that so many people who could use it, can’t because our system doesn’t take mental health seriously.
A key thing to note is that despite the high cost, I wasn’t going into this expecting to come out with an ADHD diagnosis. While many signs pointed to that being the case, I knew that if I was going to do this, I had to be prepared to accept the result, even if it was that I didn’t have anything and was just someone who overthought things and stressed out too easily. If you’re convinced of what you have from the get go and are just going for validation of that, you’re doing it wrong. You have to go in with the mindset that you’re asking for a diagnosis but you might also just have it confirmed that you don’t have what you thought you did and it’s going to cost the same either way.
Getting diagnosed consisted of a couple of very long interview sessions, 3 to 4 hours each. In many ways, it’s like going to a Psychologist for general therapy for the first time, where they’re mostly getting to know you and your history, except condensed into two long sessions instead of several short ones. The therapist I saw was very kind, understanding, patient and a pleasure to deal with and I instantly felt comfortable relaying my extensive mental health and life history to her (if you’re in Ottawa and want to know the clinic I dealt with, leave a comment with an obfuscated e-mail address or DM me on Twitter.) I was also asked to provide a copy of my high school transcript for her to analyse as obviously, ADHD can have a major impact on education performance. She had a short phone interview with my Mom and we were both asked to fill out some lengthy and detailed questionnaires. I also did some longer electionic ones in my second session.
My life growing up and indeed, throughout much of adulthood was not a simple or easy one. Though it certainly could have been far worse, I had a lot to make her aware of. Since ADHD is a neurological disorder that you’re born with, we went back pretty much as far as I could remember and worked forward from there. She took a phenomenal amount of notes and was writing something down with just about everything I told her. We talked about my home life, childhood and adult friendships, school experiences (both academic and social), romantic relationships, employment history, life goals such as children, and hobbies. A lot of this involved explaining a lot of past unpleasentness but thankfully, I’m at peace with most of it. She didn’t just want to get to know me, she wanted to know how the ways I handled many key aspects of life could have been influenced by ADHD and other things.
She was not a gamer and didn’t understand the hobby much but was very curious to hear about it, my content efforts like YouTube and Twitch and in particular, how those have benefitted my mental health and why I feel gaming has been the only hobby I’ve found that can truly let my brain focus. My content has paid phenomenal dividends in terms of making me feel at ease talking to crowds and interacting with others and she was interested to hear about how that all works. I told her my theory of why gaming works so well for calming my brain, which is the non-passive nature of it and how being in control of what’s happening and having to manage that while also observing it, keeps my brain more occupied than a more passive activity like watching a movie or reading can. I can do those activities but will always uncontrollably have many other thoughts going at the same time, which can not only diminish my enjoyment of it but also impact how much of the experience I mentally retain. With gaming, that’s far less of an issue. She agreed that seems a likely reason but also agreed that there’s probably other things that could have a similar impact that I just hasn’t discovered yet. Indeed, I’d like to find other hobbies I can enjoy as much as gaming and I hope I can at some point.
Once the interviews are done and the questionnaires are filled out, it takes 4–6 weeks for the report to be completed. It seems like a long time but like with most things, I’m very much of the belief that it should be done right, not fast. They don’t just hand you a printout and bid you good luck, they actually sit down with you for another 90 minutes or so and go over the whole thing in detail, including what next steps might be involved. The therapist and I already had a great rapport so she knew I just wanted an accurate diagnosis and wasn’t going to be upset at anything she told me.
I kind of spoiled the big reveal up top but there were some interesting details in the report that helped determine the diagnosis. Firstly, my academic performance was very telling. Overall, I was an exceptionally average student. I squeaked by in the majority of subjects and the ones I did really excel in were those that involved less direct absorption of information and more hands-on tasks, such as Computer Science, Creative Writing and Stage Crew. This really didn’t surprise me as I’ve never been good at studying, something that’s continued to haunt me to this day as I’ve found studying for IT certifications much more difficult than they should be.
We also discussed a lot of my social quirks, like how I ramble to avoid silence in conversations, issues with prolonged eye contact. and strong introverted tendencies. It was those things that led to the decision to also test me for ASD (high-functioning autism) as they’re common with that. The conclusion was that while I don’t have ASD, the ADHD can definitely be contributing to those and treating it could help alleviate them.
She also detailed something that threw me a bit. I’ve often referred to myself as “solutions oriented to a fault.” Since I’ve had to overcome many challenges in life on my own, my first instinct when I see a problem or difficulty is not to seek pity or comfort but to immediately figure out a way to fix it. Indeed, this is one of the reasons I’m so good at my job in IT. However, this instinct also kicks in when I see someone else in distress. I’ve always found it difficult to just let someone be upset or vent about something. I always have to pivot into a discussion about what they’re going to do about it. In my mind, I always go “Well, the faster we can solve the problem, the sooner it’ll stop upsetting you.” This may often be the most pragmatic approach but it’s certainly not always the best, especially as a lot of people just need comfort before looking for solutions. What threw me though, is that she said even though this approach can be interpreted as cold by others, she said I’m also extremely empathic and more attune to the emotional state of others than many people. My solutions oriented approach may be overly practical at times (as oddly contradictory as that sounds) but it’s done out of genuine concern and empathy because I see it as the quickest path to providing relief to someone. It was put to me that it’s not a fault per ce and not something I should stop doing, I just need to be better at understanding when someone just needs comfort and to check my want to always fix things and just give them that because the solutions can always come later. This probably sounds rather elementary to many of you but it was a revelatory thing to hear.
When we started this process, I was asked what my end goal was. That was always to find out what specific afflictions I had that were impacting my life and figuring out what to do about them. Like I said above, the key thing is go to into something like this not to have your exising self-diagnosis confirmed but to be open to whatever is told to you. It turns out that my self-diagnosis was broadly correct but there was a more nuance to it and learning how it affected specific elements of my life was very eye-opening. In particular, I was told that untreated ADHD can often lead into things like depression and anxiety and while those things could also be operating independently for me, dealing with the ADHD could suddenly make those far less prominent as well. That’s something that can only be found out through treatment.
So why did it take until I was almost 40 to finally have this figured out? I worked with several mental health and learning disability specialists when I was in school try to to boost my academic performance and the concept of ADHD was never raised once, something my Mom confirmed. The answer unfortunately is that much like Autism, ADHD has only really become understood and more clinically identifiable in recent years. When I was in school in the early 80s through the late 90s, only the most extreme cases were considered for diagnosis because that’s just how the disorder was treated back then. Even now, my case is not considered severe. I can be frustrated about that in retrospect and sometimes am but it doesn’t really matter.
On the flipside, there was also a period until recently, where any child that was fidgety, had any kind of difficulty concentrating or in many cases, was just being a freakin’ kid, was considered to have ADHD. The common medications for it were wildly overprescribed and the disorder was being used as a catch-all for any overprotective parent who thought their less than perfect little angel was that way not because they’re simply human, but because they had to be sick. It’s not unlike the current but diminishing trend of everyone assuming they have gluten intolerance, only much worse. These two extremes both happened in my lifetime and are why I really wanted to know for sure what I had and to have a professional be the one to tell me. I hate how overmedicated our society has become and am determined not to take anything that I don’t have someone who knows better, tell me is necessary.
That said, what is my treatment anyway? Well, at least to start, it’s you guessed it, medication. I already take an anti-depressant (plus I have a stronger on-demand one for when it’s needed) and have for a couple of years now. It has evened out that element of things somewhat but it’s not perfect and I still have depressive relapses (I’ve been dealing with one for about a month or so now.) It also does nothing to help with the focus issues or social ticks. The therapist was a Psychologist, not a Psychiatrist, so she didn’t have the ability to prescribe me anything. This involves me having to talk to my family doctor, which is a fun time in and of itself but that’s another story. I’ll likely end up being prescribed one of the two major medications for ADHD. I’m not going to name them here but trust me, you’ve heard of them.
Here’s the really interesting part though. I had always assumed that since these medications alter brain chemistry, they worked the same way anti-depressants do. If you don’t know, an anti-depressant is a process. You have to build it up in your brain when you start taking it and for a period of time, your symptoms will feel significantly worse. A similar things happens when you need to change your dose or get off of it. If you don’t wean yourself down, things can go very bad because depression is nothing if not a treacherous beast. It turns out, ADHD medication enters and exits your system so fast, you can take it on demand, much like an off-the-shelf painkiller. Some people take it daily, others do that but stop on weekends and holidays, others only take it when they need to. You’re able to experiment and find a method that works for you, all without worrying about sudden side effects. This blew my mind and actually makes me kind of excited to try it and see what happens. I had no idea this kind of thing could be so flexible.
The therapist also advised continued therapy if I could manage it. She said she enjoyed working with me and would be up for continuing to. I certainly would be as well and it’s honestly something I’ve thought I needed for a while but sadly, the diagnosis ate all of my measly benefits for the year. I’m hoping that once a raise kicks in at work, I’ll be able to budget a least a session a month with her and hopefully more if our benefits improve. Others have suggested things like daily meditation as well. I’ve always wanted to get into that but having a brain that won’t shut up made it never stick with me. If medication can help me focus, I can easily see it becoming part of my routine. Exercise was also recommended, a no brainer I also really need to start doing as after several years of achieving decent weight loss, I put almost all of it back on in 2017 because of stress and my tendency to emotionally eat.
So after this lengthy story, what’s the the end result of all this time and expense? Though it may sound cliché, it’s a sense of hope, one I’ve not had in a long time. Will treating my ADHD fix my depression or even lessen it? Will it finally allow me to focus to the degree I need to make up the knowledge deficits that have been holding my career back? Will it allow me to finally enjoy hobbies and activities not gaming related the way others do? Will it just shut my damn brain up and let it do 1 thing at a time well instead of 10 things half-assed? I honestly can’t tell you right now. However, getting this diagnosis and knowing there’s a path to treating it has for the first time in my life, made me think that yes, I can take control of what I know has been holding me back and yes, I can overcome obstables that I thought were just going to be there forever. This isn’t a one-stop fix and I’m always going to have struggles and difficulties that many people won’t experience. However, I’ve had to overcome a lot of challenges in my life to get where I am now and though my brain often tries to tell me otherwise, where I am now is pretty damn good. I can only imagine where things could end up once I’m in even more direct control of my mind and by extension, my future. Was that worth $2,500 that it took months to save up? No, it was worth far more than that.
I know this post has mostly just been a lengthy retelling of my diagnosis and I don’t know if it’ll really help anyone or not. However, if you’re someone who has struggled with this stuff, I hope it makes you remember that you’re not alone in your quest and that it inspires you to seek help and guidance if you’re able. I know depending where you are, getting this done isn’t a cheap endeavour. Don’t forget though, you may have benefits better than mine and it may not be as expensive as you think. Even if it is, if you have the means to make it a goal, I can’t recommend it enough. And of course, anyone who needs to can always reach out to me for help or advice and I’ll offer whatever I can from what I’ve learned. Just remember, I’m solutions oriented to a fault.
Our brains are amazing but they can also be real jerks sometimes. When they’re sick, they’ll lie to you, get in your way and make you feel like you can’t do what you know you can. With the right tools, you can fight back, smack it in line and when you can then realise your full potential, it gets a lot easier to keep it that way.
Thank you for reading and good luck and good fortune. You deserve it.
