Functioning

The final post on this ADHD deep-dive

Personal Updates

Spent the last week renting out the studio apartment, and now I’m just trying to return to a quiet and boring life. Despite the eventful schedule, I managed to reach a point of happiness on Thursday. Recognizing how much I had on my plate early in the week, my mind picked up on a stressful feeling and pushed back against taking on any more. There’s probably some aspect of childhood trauma that increased my baseline stress to a much higher level, so I get uncomfortable when my stress is low because it’s an unfamiliar place. What a wonderful way to live, right? Resting and recharging have always felt itchy, almost to the point of painful, which has been…confusing.

My environment needs to be at least somewhat calm in order for me to be calm, which isn’t a controversial statement. It makes sense to be stressed when times are stressful, and it similarly makes little sense to be stressed during a peaceful period unless you factor in some sort of traumatic response. I developed anxiety from living in a dysfunctional home, so it’s not so surprising that I now present with both the hyperactive and inattentive forms of ADHD. Danger was always lurking somewhere in the room, planning a jump-scare after I let my guard down, so I have a skillset around dropping everything to attend to an urgent threat. It’s taken time and effort to create a quiet and peaceful life for myself, but I’m finally getting there.

A therapist shared an analogy where they picked up a grape with their fingers and asked how much juice I would expect to be squeezed out in the simple process of grabbing it. I said “None,” and they said I was right. Then they asked how much juice would come out if someone had first peeled the skin off the grape and then picked it up. They said that’s what trauma does to a person. All of my experiences should be viewed through the lens of someone being extremely sensitive, and it would appear that most people do not go through life this way. Being told to just “let things roll off my back” or “grow thicker skin” have proven unfruitful. Not news to anyone who’s read this blog for more than a month.

I recently passed Day 150 of meditation using my habit-building app. One of the most beneficial aspects of meditation for me has been the decoupling of the stress response from non-stressful events. Mindfulness doesn’t fix the problems directly, but it is an enabler of the solution. If you don’t stop to breathe and survey the landscape, you won’t notice the problems until they get much larger and become harder to fix. And the fix for my anxiety is exposure therapy. In my experience, sitting in silence to rest and recharge is not harmful to me like it once was. Hurray!

The ADHD Evidence Project

I’ve gone through the ADHDevidence.org website a few times, and honestly, writing about it feels tedious at this point, but you may not be surprised by someone with ADHD trying to quit a project early. Alas, allow me to talk at least a little about this wonderful resource.

It’s pretty cool that there’s a website that has all the robust evidence, indexed and summarized in an easy-to-read format. It is easy to share with anyone who suspects they have or someone they know has ADHD, and it’s got enough quality material to sway a person’s opinion and facilitate further research. I had a close friend also read “Scattered Minds” recently, and they could not relate to the experiences at all, though it was important for them to understand for the sake of their family member and friends who have ADHD. I got a strong hint from a friend’s suggestion earlier this year and from relating to ADHD memes on Reddit for months, but imagine how much time could have been saved and unnecessary suffering could have been avoided if someone could have shared the ADHD Evidence consensus statement with me. Now you know, so pass it on.

There are 206 statements based on current research. For my own records, the ones that jumped out at me were 18, 57, 59, 61, 65, 66, 77, 79, 88, 96 103, 104, 105, 106, 108, 117, 128, 129, 130, 132, 140, 142, 144, 145, 149, 207. Here are the top three that I felt resonated hard.

61. A Swedish national register cohort study of over 540,000 people found a dose-response relationship between cumulative indicators of adversity in the family and ADHD. A death in the family increased the subsequent likelihood of ADHD by 60%. Substantial parental substance abuse, criminality, or psychiatric disorder each more than doubled the likelihood as did residential instability and household public assistance (Bjorkenstam et al., 2018).

My dad’s mom passed away I think in like 1998. A parent is less capable of parenting when grieving the death in the family, which in my dad’s case was his parent. I’m not in a position to diagnose, but I suspect he also suffers from Narcissistic Personality Disorder, which certainly didn’t help my chances. We’re not Swedish, but I think the concept carries over mostly.

105. A meta-analysis found that children with ADHD had medium-to-large impairments in socializing with peers as measured by rejection/likability, popularity, and friendships (61 studies, over 24,000 children). They also had moderate impairments in social skills such as sharing, cooperating, turn-taking, reciprocity (68 studies, over 148,000 children), and social-information processing, such as recognizing social cues, identifying problems, generating solutions, and avoiding biases (23 studies, over 3750 children) (Ros and Graziano, 2018).

I’ve always wondered why I was so socially awkward, and if you know me even a little, you probably have as well. My pendulum swings from giving people both too much and too little attention. My emotions are too strong. I like people too much, my fear of rejection is beyond. I’ve had to work hard on this one while I watched the people around me getting along just fine with less effort.

132. A study of over 36,000 people from the U.S. reported that ADHD increased the risks for problem gambling, spending too much money, reckless driving, and quitting a job without a plan for what to do next (Bernardi et al., 2012).

I have trouble self-regulating. I need lots of external assistance, so I should just accept that; would that be considered externally-regulating or unregulated? Yes, I certainly try to use the healthier coping mechanisms like exercise and meditation, but damn. People used to be terrified driving with me, and I always thought it was just their own squeamishness. Then a family member confronted me while on a drive out to the mountains, and I’ve slowed down ever since.

A term you may have heard in casual conversation is when a person says they have an “addictive personality.” I’m not an expert on the topic, but I think addiction resides at a level deeper than the realm of personality. People of all personality types can struggle with addiction. Like so many problems with mental health, it’s more of a function of deep emotional pain, but we could probably pull out a nugget of truth from the “addictive personality” camp. Traits that are part of your identity enjoy a special immunity from commentary or criticism. There are protected characteristics that make you a unique individual, important stuff listed in acts and charters covering equality and anti-discrimination, like disability, race, age, gender, sex, sexual orientation, religion, pregnancy, class, political opinion, marital status, national/ethnic origin, among other things. (I wonder if there is a pnemonic device to easily remember them all. I got as far as DRAGS, but when you look up all the characteristics protected by legislation in even a few countries, the list becomes quite long, which is a good problem for someone who compulsively tries to make acronyms out of groups of words for his own mild amusement.) And thankfully, younger generations have been socialized better than previous ones to not attack such aspects of a person’s identity. Addiction does not define a person. Similarly, if a human being struggles with a dependency, it should be shielded from judgement. One misunderstanding of addiction is that the person makes a conscious to engage with it while failing to acknowledge the pain underneath driving it. It can happen to anyone, and it’s not nearly as simple as simply pulling up your bootstraps and crawling out.

With ADHD, the brain isn’t fully developed. If such a brain then has an increased risk for problem gambling, spending too much money, reckless driving, and quitting a job without a plan for what to do next, then the Harm Reduction mentality would say it’s better that they’re alive and not dead, even with the addictions. To the existential question, what’s the meaning of life? It’s anything that keeps a person going.

Anyways, this brings me to my main point.

Functioning

Objectivity versus Subjectivity (aka Sobjectiversusity)

One of the curious aspects of mental health is the objective and subjective measures of said health, and a person’s ability to function within society is one of the more objective measures. Surely, we want everyone to improve as time progresses, but there are peaks and valleys like anything else. So even with the best therapist suited for your personality and therapeutic goals, having some external bar to compare against helps to contextualize the sometimes wild swings from the relative scales.

Functioning is an objective measure in the same way that cheese can be hard. Subjectively, all of my productivity with home chores starts with refilling my Brita filter carafe. If I’m trying to scrub the bathroom, I have to go out to the kitchen to refill the water filter. Why am I like this? It probably has to do with knocking out an easy task to get a quick hit of dopamine, and though there are probably other ways of getting the ball rolling that might be more efficient, this system is functioning for me right now. It’s a self-fulfilling prophecy, to be sure, but I suppose the downside is what happens when I’m unable to refill the carafe. Heaven forbid.

In addition to the objective and subjective components, Time is a critical piece to the functioning measurement. How well are you coping compared to six months ago? For some reason, six months is a magical number that appears in numerous areas. Your performance is measured against that of your demographic cohort within the last six months. It’s a reasonable system to compare against the average, but it’s not a perfect metric, certainly.

Notice how, in the screenshots above, the DSM-5 mentions both functioning and time within the first sentences on ADHD. There’s probably a strong, empirical reason behind the specific time frame of six months, but who knows what it is? I’d guess that most people get over their problems in that time, or maybe that’s how long it takes for one being to notice behavioural changes in those around them.

And how is that working out for you?

Functioning is also a measure unique to what each individual wants out of their present and future conditions. That is, you create your own goals. Every once in a while, I might ask myself if I’m living the life I’d like to live right now. Well, I’d personally like to own and live in a detached, single-family house in a mixed-use neighbourhood, but the markets for employment, real estate, and urban design have different ideas for people like me. Or do they? Perhaps if I really got my shit together, I could make a lot of sacrifices and buy a house that I can afford. It wouldn’t be anywhere near a city, I might have to sell a few Apple devices, but I’d have a house. Then I could tick the checkbox on my Mental Health Report Card that says I’m functioning, yes? But how could I be functioning when I don’t live anywhere near the people I want to spend time with? Or if I’m not in a walkable community? I would have space for my favourite possessions, to engage in my hobbies, and even for loved ones to come by and sleep over. But how often would I see my friends? Maybe I don’t need other people to check the boxes on my report card, which also happens to be an inevitable part of adult life. Everyone kind of goes their own way, even if they all try to stick together, so I should set my goals accordingly. I’ll stick to renting a condo for now and then renting a house in the near future, but who knows? Future Jon might have different goals than I.

Working Out Your Core

Is there a set of core responsibilities a person has to fulfill in order to qualify as functional? Supposing there were, it probably includes some of the lower levels of Maslow's hierarchy of needs. There are the physiological needs, then safety, belonging and love, esteem, cognitive, aesthetic, self-actualization, transcendence. My immigrant parents were probably more concerned with my physiological needs like food and shelter than my safety or esteem. Since we touched on addiction earlier, there are people suffering from a substance dependency who are said to be “functional,” as they can still fulfill most of their responsibilities, chores, errands, tasks. My Adderall prescription is probably creating a physical dependence, but I’ve never felt better. There was a time when I would have said that I was functioning even without the medication, so I probably simply had to make up the difference in neurotransmitters some other way. Everyone’s circumstances are so wildly different, even for a single specimen over time, that it seems somewhat pointless to enforce a common measure. Necessarily, functioning doesn’t have an absolute core set of measures that can be used against everyone, which seems like pretty good news.

Peer Evaluations

As unique as an individual’s definition of functioning can be, your neighbours can still have a say. There are those who are in denial, lying to themselves to cope. Kids these days call each other out by saying stuff like “cope,” “seethe,” “smoke more copium,” which is pretty hilarious and reasonable given they’re the social media generation. When it comes to group dynamics, your ability to function shouldn’t violate another person’s ability to do the same. Note the differences in meaning between the words “prosocial,” “asocial,” and “anti-social.” Does an action benefit the social group, harm it, or is it neutral? Most people say they’re being anti-social when they really mean asocial. Wanting to stay home instead of going out to the big party means you’re being asocial. Attempting to overthrow the government in reaction to policies that protect the wider group against an international health crisis could be argued to be antisocial. Social justice is a prosocial means to allow everyone to function equally, whether it goes by the name of feminism, Black Lives Matter, queer rights, or any of many causes. It asserts that there are people who have been unfairly given far more resources and capacity to function than others, often stolen and for many generations. Thus, taking back those rights is correcting an injustice, which is not the same as prioritizing your own rights over those of others. Seeing gay people kiss on TV is not quite as offensive as the lynchings, erasure, and disproportionate imprisonment of queer folk. Young voters in America between the ages of 18 and 29 showed up big to vote in midterm elections this week, standing up for social issues like equality for everyone and putting the Red Wave out to sea. It’s nice having prosocial neighbours who recognize that when everyone is allowed to function and participate in society, then we all win more than if we only priotize a few in-groups.

As for me? Seven months after I had my mental breakdown, I am functioning again. I don’t have the energy left to spell out everything on my Mental Health Report Card, but rest assured that most of it is checked off. Some of the focuses on the Report Card are shifting these days, which makes sense given the transitional period I find myself in. I’ve already written at length on this topic, so you probably don’t want to hear any more on it for a while. 😛

Wrap It Up

So that’s it for the ADHD topic as a central focus of my writing. I’ve done some reading on the disorder, implemented plans to mitigate its effects on my functioning, and I’m ready to close it off and kiss it goodbye. Thanks for sticking along with me as I did this deep dive for the past few months. I’m sure most aren’t going to need the information, but I hope it’s been helpful for the few that suffer from it or who have a close friend or family member with it. If you have burning questions that go deeper than what I’ve covered in print, then feel free to contact me privately.