Here’s part two of the ADHD thing I promised yesterday — I want to talk about panic. To do that, though, I need to take a few steps back, I think. Keep in mind that I’m not a doctor, nor have I studied this extensively as a layperson; this is just based on what I’ve picked up so far on a complex topic.
(Doctor types, if I got anything wrong below, please tell me; I don’t want to spread misinformation.)
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This bit is either quoted or paraphrased from here: https://my.clevelandclinic.org/…/22610-norepinephrine…
ADHD brains produce less norepinephrine (also called noradrenaline) than neurotypical brains. Norepinephrine is both a neurotransmitter and a hormone, and is made from dopamine.
As a neurotransmitter:
• it increases alertness, arousal and attention
• constricts blood vessels, which helps maintain blood pressure in times of stress
• affects your sleep-wake cycle, mood and memory
As a hormone, stress triggers the release of norepinephrine from your adrenal glands, causing a number of changes in your body, known as the fight-or-flight response.
Lots more info on that page if you want to follow the link, but the key thing I’d add for ADHD in particular is that our brains are often (not always, and I’ll get to that later) craving more dopamine, in order to cope with the daily challenges of modern life.
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So okay, my experience of ADHD is mostly about having trouble focusing. Not enough dopamine, means not enough norepinephrine, means difficulty focusing.
These days, I take Vyvanse, a stimulant medication, which lasts about eight hours. I take it at the start of when I want to work, and within 20 minutes, I can feel the effects.
Some of them:
• my heartrate picks up a bit (which can be disconcerting at first)
• I have less appetite (that symptom was most acute in the first few weeks of starting the med, and I lost a few pounds, then my body adjusted; it was something I had to be careful about, because I almost fainted a few times because I’d forgotten to eat without my normal hunger cues)
• I can feel stress dropping out of my shoulders; they literally relax, presumably because I’m not longer having to go to extreme effort to pay attention (these days, I try not to do any work requiring concentration before my Vyvanse kicks in)
• while I’m on Vyvanse, I’m less crabby with Kevin and the kids, again, presumably because I’m less stressed with efforts to maintain focus and concentration — that crabbiness is noticeable again every day when the Vyvanse is wearing off (what’s called a ‘Vyvanse crash’), and I usually try to take 30 minutes by myself doing something relaxing then, so as not to crab at them too much
So that’s the med, which I have to say, has been overall a really positive and helpful experience for me. It doesn’t fix everything, but it makes it much better. But what about without the med, or when the med isn’t doing quite enough?
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How do you create dopamine when you don’t have enough of it? Well, there are a lot of behaviors you can engage in, but unfortunately, many of them are at least somewhat self-destructive. People with ADHD are often (not always) risk-takers, adrenaline junkies — which is maybe fine if you become an emergency room doctor, but maybe not so good if it leads you to drug abuse, alcoholism, or even high-risk sports without sufficient safety precautions.
Interestingly, there’s also some correlation with higher levels of sexual activity with multiple partners, which may explain why so many of the people in my Women with ADHD FB group are in poly relationships — we get the novelty and stimulation our brains are craving, but without the destructive elements of cheating. I admit, I find it a little disturbing to think that my strong tendency towards poly relationships isn’t ‘part of my innate personality’ but instead possibly a component of my ADHD, but on the other hand, the way my brain works IS a lot of my innate personality, yes? So it’s not so surprising, I guess.
So anyway, lots of ways to create dopamine, some better than others. I want to talk more about one specific aspect: taking on lots of tasks.
TASK OVERLOAD:
Someone once explained it to me this way, which I found really helpful. Every time you mentally take on a task (remember to turn off the lights before you go to bed, remember to feed the neighbor’s cat while they’re out of town, remember you have that huge work project due in three months, remember that the children will need dinner in two hours, etc.), it’s as if you’re setting a little light blinking in your head.
That light is producing norepinephrine, a tiny burst of adrenaline that is going to help you focus and get your task done. That’s basically good, right?
But let’s say you take on a hundred tasks today. You now have a hundred little lights blinking in your brain, and you’re getting flooded with adrenaline, and you have LOTS. OF. ENERGY. for getting shit done, which is great! Except that it’s not really great, because all that adrenaline is hard on your body’s systems; it’s revving you up and stressing you out and eventually, you’re probably going to crash.
So all of this applies to basically everyone, right? Anyone can end up taking on a lot of tasks, feeling stressed with how much they have to do, and eventually crashing.
But my understanding is that people with ADHD are *particularly* prone to this kind of behavior, because we’ve learned over time that our brains are craving more dopamine, more stimulation, and the only way we can focus enough to get anything done is to add a dozen more tasks to the to-do list.
The fight-or-flight response kicks in, and we’re finally capable of actually doing things, with enough alertness, arousal and attention from the norepinephrine to be successful at them.
Do that often enough as a teen, a 20-something, and it becomes habitual, a way of life, to load yourself up with way too many tasks, so you’re basically in a constant state of barely-suppressed panic.
To the outside world, you might look highly capable, and people might be amazed at how you do so much. But on the inside, you’re essentially running around screaming, trying to keep going as long as possible before you crash and fall down.
This is not good for you.
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Okay, so that was all generalities. Let me give you some specifics on how that shows up in my life:
• I was an English major at the University of Chicago, and loved it, but I wrote all my papers at the very last minute, literally staying up until 3 a.m. the day it was due before I could even start my paper, because I couldn’t pull together enough focus to work on it until the panic caused by the impending deadline kicked in and let my brain actually work properly.
• that worked okay for English papers, for subjects where I was already highly engaged with the material, had done all the reading, etc., and I still got A’s. But most of my other subjects, it was not a sufficiently good technique, and as the work got more advanced and difficult, often requiring longer periods of sustained study to really learn the material, my grades started slipping.
• I basically didn’t study for math or science, because I had no inherent interest in it, and couldn’t make myself focus on it — the impending exam panic wasn’t quite enough to get me through — and as a result, I flunked calculus, got C’s in my science classes, and said goodbye to any chance of becoming a doctor like the rest of my family. (I’m okay with that, but it’s interesting thinking about what might gone differently if I’d been diagnosed in high school and been on a stimulant medication in college.)
• grad school was better, because I was in my subject area where I had strong interest. (People with ADHD can often hyperfocus on areas they’re inherently engaged with.) I could talk literature for hours with passion and delight, and as the work got more engaging, I didn’t even need to invoke the task-overload-panic-response to get my work done.
• in my doctoral program, I even ended up setting up a study group to help me get through theory, which was very difficult material, and it was I think the first time in my life when I really used neurotypical studying techniques; it worked great! And was much less stressful than pushing myself into a panic! Who knew? (Yes, all the high school teachers who tried to encourage good study habits, I know, but they just…didn’t make sense to me back then? I was coasting on brightness and adrenaline, and somehow managing to get by, until the work just got too hard for that to work.)
• when I was writing Bodies in Motion in grad school, I was living alone, and although I wouldn’t say I was happy (Kevin and I had broken up, I was broken-hearted and miserable and lonely), I also had almost nothing I needed to do except concentrate on my work. I went to classes, I wrote essays and stories, I started putting the book together. I’d get up at 4 in the morning and light a candle and make my tea and with the world dark and silent, I’d write for hours, like a medieval monk in his cell. I could focus without the need for more adrenaline to help, and I think that’s because I had nothing else to do, nothing that was dragging my focus away.
• once I had kids, the number of tasks I had to do to just maintain our lives multiplied exponentially. And it would have been much worse if Kevin hadn’t taken on fully half of the childcare responsibilities.
• when they were young, I found it almost impossible to get any writing done, and the only way I could was by invoking task overload — piling on MORE tasks so that I had enough adrenaline to focus to get some of them actually done.
• this was the period when well-meaning friends would look at how much I was trying to do, and how stressed I was, and would try to convince me to put things down, and I didn’t really understand why at that point, but I KNEW that if I did less, it would make everything fall apart. I’m sure it was very frustrating for them, but I think I was right, for that (unmedicated) period in my life.
• task overload is conducive to getting things done, but mostly to getting lots of small tasks done. So it works for teaching, it works for raising kids, it works for domestic labor. It doesn’t work for writing novels, or anything that requires long periods of sustained deep work.
• if I tried to settle into writing for a 3-4 hour stretch (which is what I mostly need if I’m working on a novel), I would run out of focus within 30-45 minutes, and would find myself looking to switch tasks, so I could get another adrenaline rush, a little more ability to focus
• this failure to focus for deep work is what eventually drove me to actually go talk to a psychiatrist and be evaluated for ADHD, because it was a huge handicap in my chosen field of work
• I did manage to find some hacks that helped along the way — going to coffeeshops for an afternoon, or taking a few nights at an AirBnB (even in town, just a few blocks away), or building a writing shed in the backyard, or using conference travel as writing retreats, or actual writing residencies of 2-3 weeks…
• all of those helped me basically drop all my other tasks, leaving just the novel-writing, and then I could manage to focus enough for that, with nothing else to distract me with promises of shiny adrenaline…
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So where I am now is feeling like there are basically four states I might be in:
1) under-supplied with norepinephrine, but with few enough tasks that I can focus on the ones I do have (grad school, writing retreats — but the problem here is that I’m usually isolated and lonely in this situation, so I can’t happily sustain it for more than a few weeks)
2) under-supplied with norepinephrine, unfocused with many things calling for my attention, and mostly failing at most of them (this is the state where I’m constantly losing my keys, my wallet, forgetting to water the plants, etc.)
3) over-supplied with norephinephrine due to intentional task overload, where I do get a massive amount done….but then crash and burn periodically, which isn’t really sustainable or happy; this is the state where I end up bursting into tears a lot, picking fights with anyone who tries to talk to me when I’m working, and oh, I’m working all the time, 16-18 hours / day often, so it’s terrible for my relationships
4) appropriately supplied with norepinephrine with a combination of medication, exercise, and other healthy dopamine-producing behaviors, when I get quite a lot done (if not as much as in state #3), and am overall pretty happy.
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Obviously, #4 works best for me, and where I am now is trying to transition from #3 to #4 (with occasional bursts of #1 applied as needed, when I take myself off somewhere else to isolate and focus). Transitioning out of #3 has been a long process, because one you set up and become habituated to task overload, high adrenaline, and high stress, your body starts craving that. Your mind is accustomed to it too, and I can’t speak for others, but I often feel really guilty that I’m not working hard enough, that I’m not accomplishing enough, etc.
So the main thing I’m working on these days is consciously relaxing, saying enough, that an 8 hour work day is plenty, and actually, 6 hours would probably be better. Most days, I still work probably 8-12 hours, but that is actually less than what I used to do.
This has gotten super-long, and I haven’t even talked about how task-switching plays into all this (with both benefits and costs), so I might come back and do an addendum on that, at least. I’ll stop for now, though. Hopefully it was interesting!
(see prior connected post on ADHD and fidgeting here: https://www.facebook.com/mary.a.mohanraj/posts/10163265456754616)
Photo of shed, where I’m working now. I light incense and candles, put on music, ritualize it all, which also helps me move into deep work mode, pushing away the task list. (It doesn’t always work, but it helps.)
Footnote: there is apparently some argument in the ADHD research world about whether ADHD folks engaged in high-risk activities do so because they’re unable to effectively evaluate risk (which I find improbable) or because they’re seeking higher arousal.
Studies are mostly done in children, I think, which I suspect makes it harder to tell whether they’re effectively evaluating risk. But that said, I am certainly less risk-averse than most adults I know; to me, most folks seem overly risk-averse, and my evaluation seems more accurate. But we may have to agree to differ here.
“Other studies (Zentall and Zentall 1983 and Douglas 1983) indicate that children with attention problems need a higher level of stimulation. According to the research, children with ADHD are under aroused by dull or repetitive tasks and will seek out high interest or high-risk activities to compensate.
Further, (Farley 1981,1985) children that are under aroused will search for more intense activities and will be more open to different experiences. They will prefer complex tasks to simple tasks; will seek new and novel experiences that include the need for high energy and high risk. In short, Farley found that children with hyperactivity seek high stimulation. His recommendations for children with hyperactivity included modifications to education to include more interactive and creative experiences to provide the extra stimulation needed.”
Read more about this (including the argument for poor evaluation of risk) here:
https://www.healthcentral.com/…/adhd-and-high-risk…