A.J. says:
The other great reason I haven't gotten around to it is that my health care provider is one of those blanket insurance/hospital corporations,
That's a good reason. Good health care starts with you shopping around until you find a doctor you like. If you can't find one within your current insurance structure, you have to decide whether or not to go outside, do without, or try to move to a different insurance program.
When I first went in for diagnosis, my coverage specifically excluded mental health. The psychiatrist was concerned. "You understand that it might cost up to $2000 to get a diagnosis?" "Yes." "We tried billing your insurance, but they don't cover it." "Yes, I told you they wouldn't when I first came in. If this process results in me being able to manage my life a little better, I'll easily make up that $2,000, never mind the fact I'll be a lot happier."
Out of pocket Cylert was nearly $100/month. For the difference it made in my life, $500/month wouldn't have been too much. Doesn't mean I wasn't thrilled to pieces when we found a way to get the medication covered by insurance.
Now, I was fortunate that I could *afford* those expenses at that time. Now, even $100/month extra is going to be dicey, which is why, although Focalin is working for me, I'm going to definitely try some alternatives. If plain Ritalin or Adderall or Dexedrine can work, I'll have to weigh possible lesser effectiveness or lesser convenience against the financial strain. Everybody's got to make that call.
But damn those sanctimonious bastards who would try to "help" me by preventing me from having a choice.
Good luck.
Cornfed:
It was all so wrenchingly familiar. Every year a new system . . . And at the end of it another pile of calendars, worksheets, guidebooks, organizational systems or whatever . . . stacked at the back of the closet like a little cairn of shame.
* * *
Yup.
I was fascinated to discover that, in fact, I was the most valuable resource any of my friends could have for advice on time management and being organized. They kept coming to me with things they thought might help: "Try associating things to remember with rooms of your house" or How to Prioritize a To-Do list, or Why A Palm Would Change My Life.
And I'd explain that the room method had certain limitations that were generally better addressed by using zoo animals or musical tunes, that they'd probably get better results including incongruent juxtaposition when they did this; that a far more powerful tool for To-Do lists involved understanding and applying the difference between Urgent and Important, and they should consider changing their system; that I'd owned a PDA before USRobotics had even created the first PalmPilot, and that I found the current tools still (!!!) inferior to my Newton for my needs, and even the Newton was gathering dust now because I spend all my time at home and a PDA isn't useful unless I'm moving around too much to use my laptop for those functions.
In short, I knew a hell of a lot more about how to be organized than anybody else I know. "So how come you're always forgetting stuff/losing things/blah blah blah?"
Wrong question. "How come you aren't *always* forgetting things/losing stuff/missing appointments/not doing homework/forgetting to eat?" "Because I've evaluated a thousand different schemes for being organized, and I use the ones that work for me in order to merely be as scattered as I am now, instead of being way worse." Given just how exasperating I know I was, the fact that they managed to push me toward getting that stuff done while never making me feel like a loser, and going to no small effort to help me find ways to do what I needed to do while wholeheartedly supporting me in efforts to avoid what wasn't really necessary, I find quite remarkable. They could have been so much worse in so many ways, and I know that there are lots of other people who weren't anywhere near as lucky as I.
A business associate once recommended an organizational executive coach to me. Said coach came over to my house (we were, and still are, working from home), and had me take her on a tour of my stuff. My financial stuff in envelopes by month, and the big stack waiting to be filed. My pantry, organized by type of food, with new cans in back, old in front. My color-coded filing cabinet, and the piles and piles of unfiled stuff.
She told me that normally, she was dealing with an exec who was feeling overwhelmed because their usually half-assed system, which had been adequate to their needs before, was failing under their new bigger load, and all she had to do was teach them a few new tricks and they were good to go. She had some good advice for my filing cabinets, but mostly, she said "You really do just need an assistant who can maintain the systems you've already established."
Reject the shame implicit in that cairn, Cornfed. You're being fooled by snake-oil salesmen into believing that their under-powered consumer-grade planner/organizer is The Best Ever, and that it's your fault if it's not working.
Not only are most of the "systems" out there poorly designed, but they're also targeted to people who are, for the most part, not *especially* intelligent, and mentally linear. The mental path of least resistance is playing back a known procedure; running down a list of steps. Repetition is comfortable.
This is a fine thing, in and of itself. The mail arrives, and you check who it's for. You open this kind and stamp it with the date and put it in an interoffice envelope and address it and set it here. That kind you forward unopened to there. This kind you throw away. That kind you evaluate, and forward if it's relevant. Put a process-oriented thinker to that task and they'll get it done quickly and accurately. Me, I'd be in Hell.
I know that I will NOT have a task organizational system that *mostly* works until I can afford to have a part-time assistant again. Until then, my best system is to change what system I'm using every couple of months, to keep it fresh and clear the gunk that the previous one will have collected. And they're always custom-designed, because the kind of people who make planning systems are apparently the kind that could never even wrap their head around the way mine actually works, and their schemes play to my weaknesses with a vengeance.
I don't blame my friends for having failed to grow tall enough to get glasses off the upper shelf in my kitchen cabinet. I just get it for them or expect them to use a stool. "You can't reach that glass? Well, *I* have no trouble reaching the glass. I guess you're just not trying hard enough. Apply yourself. Grow some more. Stretch farther. Quit being so lazy."
Did I forget your birthday this year? Too fucking bad. I'll remember to send you a gift on your birthday when you can get the glass off my cabinet shelf unaided. You need a stool? I need Ritalin/pemoline/whatever. Still can't reach the very top shelf? Right. I can't clean my house, either, even with medication. The tedium and monotony put that task beyond my reach. Period.
I thank God that I have fantastic parents; they were frustrated that I wouldn't "apply" myself, but it was more "we know you're smart, but it's important to *do* the homework. Yes, we understand that it seems like busywork, but sometimes you just need to do stuff you don't like to do."
I'm sure I'll spend the rest of my life trying to deal with inappropriate guilt; feeling badly because I didn't manage to do something that thought I could, because it's obviously easy: everybody else can do it without any problem. Thinking Different isn't obvious to the eye like being short or tall is, but it's just as unreasonable to blame somebody for not thinking the way you do as it is to blame them for not being the same height as you.
People will keep doing it, of course. Get used to that. Expect to spend the rest of your life with the envious, the morons, and the ignorant saying stupid, cruel things. Pity their narrow minds. But reject the guilt they're trying to give you because of their own inadequate ability to understand. And take the time to educate the well-meaning fools who are trying to "help." Those of us who Think Different, who lie on the edge of the bell curve, are a very valuable resource. The great majority's brains won't ever give them these thoughts, this artwork, this poetry, these scientific breakthroughs, these insights, these observations. The world *needs* the outlying thinkers, even though they don't understand them.
Most of them never will. But most of them are nice people, nonetheless, and if those that sincerely want to help learn what *is* helpful and what *isn't,* how to take advantage of your unique talents, skills, and style of thinking and how to *not* play to your weaknesses, we all end up much better off.
Every time you ('you' as in "all y'all") correct somebody's delusion that "there's no such thing as ADD" or point out that just because they can easily remember appointments doesn't mean everybody can, or reinforce the meme that we're not all the same inside our skulls any more than we are outside, you help everybody. You help yourself, your friends, and the world, by making it easier for people who live on the fringes of human thought to spend more time *there,* thinking the things that are easy for them and hard for the rest of us, and less time struggling to deal with the kinds of thought are such well-trodden ground.
Man. I feel like I'm just getting started, but I think it's time to pry my attention from the interesting task of commenting on blogs, and try to actually get something knocked off my To Do list for today.
Y'all are smart enough; you know what I'm saying.
Emily:
I recognize that the current GSM IV classification is ADHD. No-one describes me as hyperactive, so ADD is a more accurate label for me.
I'm with you. I think calling it ADHD is just stupid. It perpetuates the myth that hyperactivity is integral to this condition. Personally, I think the final D is also inappropriate and misleading. The same characteristics that make me late and forgetful are the ones that led to my alma mater selecting me as "Outstanding Recent Alumnus" in 2004, for "Visionary Work in the Arts and Sciences." (They pick one a year. "Recent" means it has to be somebody that graduated in the previous 15 years.)
What I have, thank you very much, is far more accurately labeled Variable Attention Syndrome. I mostly "suffer" from a surfeit, not a deficit, of attention, and calling it a "disorder" fails to acknowledge the benefits. There is no discernable hyperactivity, and never has been.
The GSM has a long history of being wrong, especially with ADD, and I'm certainly not going to encourage them by using their inappropriate designations unless I'm filling out an insurance form or something.
Jules:
As I'm sure I've mentioned here before, I believe myself to suffer mildly from ADHD (although my doctor is resisting the diagnosis on the grounds that I don't exhibit any symptoms of hyperactivity, as if that was all there was to it...) . . . And while I'm hoping an ADHD diagnosis will help me with day to day life, I'm not looking forward to dealing with this consequence of the medication.
Same advice to you as to A. J. Bluntly, you're being silly.
_If_ you get diagnosed with AD(H)D _and_ get a prescription, then you have a chance to decide if the "consequences of the medication" are worth the benefit. If they're not, then you don't take it. If they do, then this concern of yours, in restrospect, will look absurd.
If treatment seems to make your life worse, you stop. If it makes your life better, you win.
The only way to lose is if the drug actually does some kind of permanent or long-term damage to you, and any competent doctor is (a) going to ramp you up really slowly, (b) explain all the possible side-effects and tell you what to watch out for, and (c) take your current medications and conditions into consideration when deciding where to start.
Please do make sure that you've selected a psychiatrist that you're comfortable with before you start treatment, though.
Lila:
Again, I'm not saying that Ritalin/Adderall isn't useful, or even vital, for some ADHD patients. What I'm saying is, here we have a patient for whom those drugs failed to do the job, and for whom the school environment made the problem worse instead of better.
Hmm. I can't help but wonder if it wasn't AD(H)D in the first place. But that's not especially relevant. The important implied misconception here is that the drugs EVER "do the job." Medication doesn't work in isolation, it works in an environment.
If you give a nearsighted kid eyeglasses, they'll *probably* figure out on their own that there's now a reason to look at the blackboard. But reading the blackboard is a new behavior they have to adapt. Glasses won't *make* them look at anything. Ritalin et al. makes it easier to 'stay on task,' but if they don't have people around them trying to teach them what to DO with this altered mental state, it won't do a damn bit of good.
I managed to stay undiagnosed until my late 20's because I'd already developed myriad coping mechanisms. Getting medicated meant that suddenly they worked *even better!* Woot!
Put a paraplegic in a motorized wheelchair, and forget to mention where the "on" switch is, or how to recharge it, and you haven't done them much good. Fortunately, most ADD kids get medicated as part of a program that's also explaining to the parents how to guide the kid into developing better study habits, into creating structure that means predictability and this ease of focusing, into all sorts of new time/thought management tools that take advantage of the assist provided by the drugs.
A. J. Luxton:
Reading these threads is starting to convince me that I might want to actually see a doctor after all these years. But a part of me is balking. Not necessarily a very rational part. . . .My mother, however, saw me reading on Saturday, asked me to clean my room, and when I wouldn't, came in with a pill and a glass of water, determined to feed it to me so I'd be more tractable.
GO!
You are an adult. Your doctor is _hired_by_you_ to _assist_you_ with your physical and mental health. Just because they prescribe something doesn't mean you have to take it. If you don't like how a drug's changing your behavior, you can stop.
A lot of people with ADD take medication on an 'as needed' basis. They've got a meeting or presentation coming up, or it's a long work day, or this saturday is Cleaning Day, or something. When they need to be more focused, more "get the job done," they take the medication. When they can be more creative, more relaxed, or more energized (whatever their baseline state), they don't.
Along with (or instead of) a prescription, a good psychiatrist provides you with behavioral techniques, coaching, and advice for friends, partners, and loved ones, on how to provide effective support.
GO! The doctor can't make you do anything. But they have an awfully good chance of putting some new tools in your toolkit that you'll wonder how you ever managed without.
alex:
"Don't worry--Ritalin won't be banned until the patent expires and there are generic comptetitors. And I'm sure Ciba-Geigy will have a much superior product waiting to take its place. If it doesn't work so well for your problem, that's scarcely their fault."
As many have pointed out, it did a long time ago. The much superior product is Focalin, it was approved in 2001, and it's from Celgene, not Ciba-Geigy. Novartis is the licencee and distributor. Focalin, for the curious, is *dextro*methylphenidate. Ritalin is d,l-methylphenidate, and it appears that levomethylphenidate is basically an inert junk chemical, that mostly just increases the liklihood of side effects.
I'm on Focalin now. It's an inferior replacement for pemoline. It has about the same effectiveness, but the SR form doesn't last as long as pemoline (and the non-SR works for about 3 hours), and there's this rebound when it wears off that almost renders me unconscious if I'm not physically active.
I plan on trying Adderall or some other amphetamine-based product next, as I keep looking for a replacement for the pemoline.
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| 2006 | 8 |
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