Thank you Claudine!
Thank you Claudine!
BuzzFeed puts out a quiz, apparently to raise awareness about privilege, and the quiz itself betrays remarkable ignorance about privilege. How about starting at the beginning:
The thing is, when you define privilege by the top rungs of the ladder, you are implicitly invalidating the status of others. You are also making their disadvantage invisible. Privilege is not an inherently bad thing. Ignorance of it is.
A couple in front of me are having a chat. The engine hums steadily but there are creaks and shudders with each hill and turn. Now, behind me, more talking … is that a language I don’t know, or just a strong accent? Random electronic noises meaninglessly disrupt the comfort of strangers. The scenery changes around me and I watch as the morning shakes off the rain and the sun pokes lazily through the clouds; sloth appropriate to its namesake day of rest.
I struggle to write this but the process calms me as I become more engaged. Narrative is a brush that paints pictures that thousands of years of storytelling have trained our brains to see. I am eventually less distracted by everything around me as my bus makes its way from one city to another.
The common belief about ADD is that it is an inability to pay attention. Depending on how you define attention, this can be true. It is also possible to see ADD as the opposite: ADDled minds notice everything. Our attention works like that of a photographer constantly seeking to be enthralled. Her camera has a focus that is sharp and revealing, but if a subject does not engross her, she moves on because she hungers deeply for one that does. Once she becomes engaged in a subject however, she will become so immersed in it that everything around her disappears.
The need for a stimulating subject is a powerful one for us. To describe it as a hunger is not really strong enough. Interest and engagement are like oxygen for the minds of those of us with ADD. If we are not keenly interested in something, the fact is that our minds do not work very well, or at least they do not at all work like neurotypical brains do. We search for stimulation because our brains need it like air. And we examine and are distracted by everything around us because our minds require that we search for stimulus.
If you do not have ADD spend a few minutes reading the last two paragraphs. Instead of saying “yes, well, everyone’s mind works better when they are interested in what they are doing” think about it from the opposite perspective. What if your mind barely worked at all unless you were intensely interested in what you were doing.
The ways in which we experience ADD are diverse (I don’t use the ‘H’ to describe myself because I can usually sit still, though staying seated can be quite difficult). Within that diversity are experiences that are so distinct in their commonality that when those of us with ADHD meet one another, we immediately recognize our kin. While the pathologizing and medicating of childhood is something to be deeply wary of, my life would have been much, much easier had I understood how my mind works when I was seven instead of thirty-nine. The signs were certainly all there from early childhood.
For parents wrestling with what seems like a daunting diagnosis, take comfort in the fact that a diagnosis, especially if accurate, is not a curse. And there are significant benefits to embracing, rather than trying to escape, the condition. I would suggest learning to recognize that photographer in your child. Notice the subjects that are enthralling and engross their attention. If you think that nothing does so, take your child out into the world and expose them to as many new activities, interests, and ideas as possible. (Actually, that’s a great idea for all kids, but there are so many challenges to being a parent.) Eventually, something will absorb your kid in a way that astounds you. Find ways to support them in pursuing these interests constructively, and celebrate their achievements as they do. Explore careers that build on their passion. Also teach them to feel a sense of pride when they complete and accomplish anything, but especially things that are mundane, which they likely don’t feel passionate about.
All of these approaches are especially important if your child is struggling to demonstrate success in more conventional pursuits. Be gentle with your children and teach them to be patient with their capacity for distraction and its consequences. Teach them the importance of working with others so that they can get help with the apparently simple tasks that they may find challenging. Often simply working with others is stimulation enough to get our minds to function in a more typical fashion. As team-members people with ADHD can contribute our excitement, our energy, our eagerness to get started, our ability to scan and notice everything around us, and to focus keenly on a problem until we find a solution. But often we must rely on the help of others to see a project through to completion. And we must practise how to mediate our capacity for disruption and how to work with others constructively. It does not hurt us to learn and accept these things about ourselves.
One of the distinctions between ADHD as an adult and ADHD as a child is the corrosive effect of the frustration that comes with decades of perceived failure. This is particularly harsh on adults who were not diagnosed as children or teens. Without a diagnosis we cannot understand why simple tasks like making one’s bed (which can take me half an hour, even when I am actively trying to keep focused on doing so) are so maddeningly difficult. Misplacing our keys in the three seconds between when we get into the car and when we need to start it is deeply unsettling when we have no understanding of why it happens. When we accept that our minds simply work differently, our lives become much less stressful. If we are fortunate we find a career in which we are outstanding, and we come to understand that the mind that enables us to focus so keenly on our areas of passionate interest is one that will inevitably struggle with the mundane.
With that understanding we are much more able to handle the frustrations that come with the irrationally daunting challenge of laundry, and the extra half-an-hour (or more, if we are unlucky) that we must spend every day finding things that we put down in the most ridiculous of places. We develop the habit of being forgiving and gentle with ourselves when we need to be. As I must be now because I realise that my bus is slowing down but I am too late to get off at my stop, and must settle for exiting at the next.
I recently wrote about never having experienced the feelings of isolation or despair that enable people surrounded by love to commit suicide. There is however one situation that I can understand in which the more people love you is the more isolated you become: when you believe that the “you” that others love is not who you really are, because you believe you have never allowed those who love you to see who you really are.
That is the plight of people who have not been able to share some deep truth about themselves with others. Sexual orientation and/or gender identity are examples of such a truth, but there are others. When society does not value who you are and places you in a position where it is dangerous to be yourself in the world, no love can ever be enough. And even when you love others deeply, that love itself becomes a terrible trap.
This amazing young woman is dead. I cannot know what that choice was about for her. But there can be no doubt that she was surrounded by people who loved her, and that she had a great deal of love for others. And when I think about the tremendous loss to all of us that her choice created, I cannot say any more. There are no words.
The last week has been unusually difficult for me. Rest assured I would score quite low on scales used to measure suicide risk, and I don’t think there is any real chance of my harming myself in any way. Nevertheless thoughts of suicide have not only lurked but lingered, and that is an indication that things aren’t good. So, among other things, off to see my doctor this afternoon, and I’ll be seeing another on Friday.
Neither one of them is a psychiatrist, for which I am thankful. One does have extensive experience with mental health and more counselling training than most psychiatrists do. No doubt we will discuss possible medication changes, but I have no fear of loss of control over my own care, and it’s possible nothing will change on the pharmaceutical front. At a minimum I will know that I have done something fundamental to my own self care in reaching out (as I am also doing in writing this), and pride in those actions will itself be a bulwark in facing all the
real challenges [regarding my strikeout of 'real' -- it's funny how even those of us who struggle mightily with them still see mental health problems as not real] that are the cause for my despair.
Much more than medication, someone in my state of mind needs increased companionship and physical affection, problem-solving support, fun and amusing distraction, things to do that are intrinsically rewarding and positive like exercise, helping others, completing simple tasks, making something. The mainstream psychiatric establishment is rarely a welcoming or desirable place for someone dealing with what I am dealing with — real and daunting, but solvable, problems in the context of a serious mental health condition. Accessing the most visible mainstream mental health services brings with it valid fears of unwelcome over-medication, confinement (though that alone is not frightening to me, were it not for all the things that may come with it), skeptical and suspicious observation, and artificial empathy.
That is one of the things I don’t understand about suicide: how as a society we (fail to) provide effective options for support. It does not surprise me that few people speak up and seek help until it is too late. Even without the direct experience of the mental health system that I have, the fears of how others will perceive us and what will happen to us if we access mainstream mental health services are strong and valid. Thankfully there are places, such as the Gerstein Centre, which offer a more accessible preventative approach, but their public profile is not as great as it could be, and the philosophy which the Gerstein works from is nowhere near as accepted or well known as it should be.
Another thing that I don’t understand about suicide is the journey to isolation that enables others to embrace it as an option. No matter how despairing I might feel, I have never been able to bring myself to make a choice that I know would leave so many people feeling deeply hurt, desolate, guilty, and remorseful. Sadly many who commit suicide do so in no small part because their social ties are limited or non-existent. But I cannot (thankfully) grasp the degree of despair, pain, and emotional isolation that those with loving families and friends must face when they choose to end their own lives.
Certainly some, particularly those facing chronic illness, make a careful and deliberate choice that engages their loved ones and seeks to minimize the distress to those who are left behind. But stories of those who end their own lives and who leave bewildered and distraught families and friends behind are deeply saddening to me because they speak of how little we know and understand about how to effectively connect with and support people facing that kind of pain and despair.
I did once write a poem describing the closest I have come to being in that place. I’ve shared it before and will again, because it speaks explicitly of a kind of love for others that is invisible, and not heartwarming in the way that love often is. And yet it is powerful for me to bear in mind in the face of the kind of emotional anguish and despair that can lead to suicidal thinking:
love that binds me here,
in its care
my selfish thoughts
be silent threats
of broken trust
no testament can silence give
they cannot know,
and yet my love
that does not satisfy
can still usurp a wish to die.
© David Mordecai 2002
Thank you to the many people in my life who leave me with no doubt that I am greatly loved, and valued, and would be deeply missed.
On a recent weekend, despite the wonders of modern medicine, my mood was heading for the down that usually follows an up. I reached out to several people to make plans, my goal simply being to get out of the house. In the end I went grocery shopping with a friend and thus avoided the risk of staying in bed for the day. I didn’t say why I wanted to go shopping together, but he knows me, so chances are my friend had some idea.
Another friend had witnessed my unusual upswing earlier in the week and when I called him in the hope of getting together I told him that I was trying to make sure I got out of bed. Although he couldn’t meet me that morning, a few hours later he did a very simple thing.
He called and asked if I’d gotten out of bed.
When he called he was clear about why he was calling; but he was also very matter-of-fact in asking the question. Perhaps because for years he’s watched others close to him deal with mental health challenges he realised how easy missing that fundamental first step in your day can be for us. Perhaps he intuitively gets that for those of us living with long-term health challenges it is important to see those challenges as significant, but there is a benefit to recognizing that many of them are also mundane.
His call cemented my connection to the outside world, and enabled me to carry on with a healthy and productive day. The fact that he so obviously cared was important, but what was as important was that he didn’t ask the question as if my life might be on a dark path to deepest despair. I wouldn’t presume to say the challenge of getting out of bed is any greater for me than it is for most of us. What may be different is how often I fail and why. But that’s the nature of my life, and being able to talk about it in a matter-of-fact way was no small part of why the call was so helpful.
I don’t know which comes first in terms of one affecting the other: emotional state or action/behaviour. To me there is much less value to trying to tease that dynamic apart than in thinking of them as one thing looked at from different directions.
I wish modern mental health professionals thought more in those terms.
Saw this article recently about botox as a treatment for depression — it stops you from frowning . Sounds ridiculous that this could have any impact on depression. When I read the article it reminded me of my deep love for William James. While I am still learning about his beliefs, from what I know he had insights that match my own experiences of mental health in startling ways. To me there is no divide between thinking, acting, and feeling. They are not the same thing, but they are different faces of the same shape. How you are and behave in the world are inextricably connected with mental health.
This may not seem that profound to those who have never struggled mightily to maintain our mental well being. For those of us who have experienced serious mental illness sometimes “how you behave in the world” means triumphing over tasks most take for granted: getting out of bed, washing the dishes, or sweeping the floor. Given the degree to which grooming and personal hygiene can deteriorate when things are tough, I was reminded of how much such small and basic things like cleaning your teeth and nails are a profound start to a journey back to wellness. Or how failing to stay on top of such simple things can be the start of slide into some very unpleasant places.
This is a picture of the template [I try] to use for my daily to-do list. I edited it for the first time in a couple of years today and in doing so realised how connected it was to this post, which I was about to write.
My coded reminders of the routine that sets the tone for my day:
R = medication
Eat, Teeth (clean), Clean (house)
Some may be surprised that I need to be reminded to do such basics. However for some of us mental health starts with staying on top of remarkably little things …
Upon persistent examination I have always found that I am depressed for a reason. That is not the harsh truth that motivated this post. However identifying the reason, and recognizing a need to do something about it, is a significant step in improving. There are certainly other paths to feeling better, but understanding what is provoking a depressive response can create a significant foundation upon which to build lasting, improved mental health.
Determining what needs to be done is rarely easy. In the simplest of situations there is a problem — more often several — that needs solving. The problem may not immediately be evident. The solution is usually even less so. Sometimes the situation is one in which current circumstances provoke an excessive response because they resonate with a past experience which was especially painful or traumatic. The work of identifying origins is rarely easy. The work of setting the past aside is even harder.
However, until a reason is found, the harsh truth that it important to confront when I am depressed is that if I do nothing, nothing will improve. If I grasp this truth carelessly I can wound myself deeply with self-blame. But if I grasp it gently, with compassion for myself, it becomes a tool with which to cut myself free.
This is a harsh fact to confront because so often depression is the experience of feeling incapable of doing. One loses both a sense of motivation and of agency. Doing nothing becomes a habit of mind from which it feels impossible to escape. However seeing the opposite of doing nothing as making even the smallest, most incremental of intentional choices is an approach that can enable things to change for the better.
If I recognize my capacity for intentional choice, without burdening myself with judgement about all that I am not doing, I start a process of healing. Sometimes the first step is accepting that I am choosing to withdraw and retreat from life, rather than feeling powerlessly drowned and overwhelmed. Owning, without negative self-judgement, a choice to make that retreat is still an improvement over being trapped in a belief that I am powerless.
Accepting, and actually validating, the choice to take a break from the perceived intensity of life is still a far healthier choice than actions that are more immediately harmful. And for those who suffer from serious depression the capacity to turn away from drastic actions like suicide, or reckless substance use, is an achievement worthy of celebration, even if the alternative is a period of time spent achieving little else.
Almost two months ago I started medication that I haven’t taken in years. A drug called lamotrigine that is both an anti-epilectic and mood stabilizer. After gradually increasing the dose for two months this is the first morning that I take what is considered a therapeutic amount.
Lamotrigine’s two advantages are a very low side-effect profile (provided one escapes Stevens-Johnson syndrome — the reason for the gradual increase) and a benign mode of action which is mildly (at least mildly for me) anti-depressive. It is the only mood stabilizing drug I have ever taken that does not have any noticeable negative effects on cognition or emotional response (lithium, antipsychotics, and clonazepam all noticeably affect both thinking and feeling in ways that are often disturbing) .
I started lamotrigine primarily so that I could once more try medication to deal with my challenges with focus and attention. Although I’ve been on meds for ADHD before, and they have never precipitated mania, it is a rare doctor who would prescribe them to a patient with a medical history such as mine, if that patient was not also taking a mood stabilizer on a daily basis. Indeed the reason I stopped using ADHD meds in the past was partly because the psychiatrist who was prescribing them to me did not believe that I was manic depressive and so was not particularly worried about the possibility that the meds he was prescribing might end up making me manic. One of my more unsettling observations has been the degree to which doctors frame my symptoms and diagnosis in terms of their area of expertise or therapeutic philosophy.
While my primary reason for starting medication was to facilitate further trials with meds for ADHD (and whether this will work when I go to see a specialist remains to be seen as lamotrigine is not a recommended medication for controlling acute mania) I was also curious about the impact it would have on my mood, which, while relatively stable, was often noticeably on the depressive side. While I’m hesitant to say it has had an effect, it certainly has done no harm (not always true for drugs like the anti-psychotics), and I am beginning to feel hopeful. Because the effect is subtle it can be hard to tell, but in time perhaps an improvement will be clear.