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Call Me By My Name
How I Studied ADHD for 15 Years and Didn't Know I Had It
It took me a year to write this essay. I promise it wont take you that long to read it. I thought this was the place it needed to be, though it departs from my usual form. I’ll be back next week with something a bit more pithy (at least by my standards), but if you’re down for this long-reads cause, I’m so grateful for your eyeballs and brain cells spending time on this thing I have just now figured out how to speak about. XO. - Sarah
I was diagnosed with ADHD on March 18th, 2020, five days after California went into lockdown, six weeks after I ambivalently asked my doctor to refer me to a psychiatrist, and 37 years after my brain was formed in the hot, dark, corners of a woman’s body, just like pretty much everyone, ever.
That was the day the term was first used to refer to me - put on my paperwork. But, as with all big bad words, stringing “ADHD” to my name on this day was only a formality, like how the day you attend your first AA meeting is not the day you became an alcoholic, and the day you sign your divorce papers is not, in fact, the day your marriage ended.
Despite being sometimes over-diagnosed (though it also remains, in many populations, under-diagnosed), ADHD is real. I’ve seen the brain studies. Smaller caudate nucleus, putamen, and hippocampus - the sea-horse-shaped memory-maker. Dysregulation in the dopamine system. It is not inattention, in fact, but over attention. Misallocation of attentional resources. An inability to accurately rank the importance of a crucial professional correspondence and an email advertising a sale on dish towels.
When I was a special education teacher, fresh out of college, the ADHD students were my favorites. It was easy for me to understand their lack of interest in mundane things, how the spotlight they shone on what they loved outweighed their inability to muscle through what they hated. I believed them when they said they had done something “by accident,” even if that something appeared highly premeditated, like throwing rocks at passing cars during recess. As far as they were concerned, they didn’t realize these things were happening until they already had. I was a mess then - falling asleep at traffic lights and getting alcohol poisoning at the school fundraiser after-party and giving all of my students’ parents my cell phone number. I told these kids that I loved their messes and that their messiness made them superior to the kids who didn’t invite them over for playdates and the adults who were always screaming at them to clean up.
Because I am a child psychologist who specializes in diagnosing ADHD, I know that every condition lies on a spectrum, but a bona fide disorder must impair one or more life functions. Do I have trouble paying attention? Everyone does. I have a graduate degree, don’t I? I have a (mostly) loving marriage and strong (seeming) friendships. I’m not an addict (anymore) and I don’t get into (major) accidents. I don’t get fired from every job; I just quit them. I felt that I wasn’t a victim of some grave neurodivergence, but simply an overwhelmed mother who had exhausted the structures of schooling and was desperate for someone to tell her what to do next. I also knew that, as I had told my students, ADHD could be a “superpower.” It helped Channing Tatum become both an action star and a serious actor, and Simone Biles win all of those medals, and Adam Levine marry a model and popularize the Deep V-Neck Tee.
I also know that society requires that women be responsible and likeable, and many girls with ADHD accomplish this at great cost to their self-esteem. Presented with a brain that does not like to sustain attention, control impulses, organize and plan, they find clever and often painful ways to fake it. A boy with ADHD can be brushed off as just very active, can use his charisma and cultural amnesty to become a Richard Branson or a Jim Carrey. A girl with ADHD (even Simone Biles didn’t escape this) is a weirdo, the klutzy sidekick who always has something in her teeth, who can't keep a job or a man. A mother with ADHD is even more intolerable: I ask too many questions at school meetings, volunteer for tasks I will never follow-through on, pick at my son’s scalp until it bleeds.
What would make someone, after years and years of talking about ADHD every day, finally admit it had something to do with them? On a long drive to Palm Springs, in the before-times and also the before-kids-times, my friend admitted to me that she was in crisis. Her second child was getting older, she was ready to put her big brain to use, but she found that she couldn’t focus on even the tasks that made her happy. And, she realized, she’d always been this way. In my field, we use the term “twice exceptional” to describe the double-edged sword of being somehow very bright and very handicapped. She was smart as a whip and stuck as a horse in the mud. A year later, she got a diagnosis of ADHD, went on medication, and finally felt like herself. And now, she insisted, I was the same. I had left my dream job, spent years alternating between unmoored and inspired, never getting myself over the hump of my own self-doubt into a career I could sustain. But I could keep it together, even if that was all I could do. To humor my friend, I made the appointment. A few weeks later, the pandemic hit.
In my graduate seminars, I tell my class, “ADHD is a biological condition with dramatic environmental influences.” One of my favorite studies looked at a group of people called the Ariaal in Northern Kenya, who were tested to see if they had the genetic marker for ADHD. Some of the Ariaal had broken off and developed an agrarian society, while others had remained cattle-herding nomads. The researchers found that the farmers with ADHD were undernourished and low-status. But the ADHDers who were still nomads were well-fed and well-respected. ADHD is always with you. But it is only an impairment in situations where the things that are hard for an ADHD brain are essential to your survival.
When you are a mother, you wage a daily war on behalf of your personal space and time. When you are an “ADHDer,” finding small sanctuaries where your rich but sensitive mind can take refuge is a matter of survival. In my 1200 square foot apartment with two small children who needed structuring, a working partner, anxiety and insomnia, my mind was a pile of tangled electrical cords shoved into the back of a drawer no one wanted to open.
ADHD brains thrive on novelty. They are good in a crisis, lousy in an all-day staff meeting. Before the coronavirus requisitioned us to our cars, my four-year-old son and I would go on what we called "bus adventures" from our home in Oakland. Anyone could choose the route and the direction. If we saw something call to us from the outside (a mural of Steph Curry, a rabbit adoption center, a Japanese dollar store), we would jump up and rush off to explore. Looking out a bus window at the blurred city, a dozen snippets of strange conversation echoing around me, the weighted blanket of my son’s body on my lap, my frenzied mind finally settled. I was my best mother-self in those moments, attuned to my child and our shared experience. I was Adam Levine in the deepest of Deep V’s, performing in front of 100,000 people, while winking at my smoking-hot wife like she was the only face in the crowd.
Now, I desperately searched for newness within the endless sameness of our sheltered lives. We went to the drive-through car wash and I let them sit in the front seats. We drove down Lombard Street, the twistiest street in the country, and screamed out the windows. My children were amused by these things, but it was all for my benefit. They didn’t want novelty anymore. They were soothed by repetition and the safety of home. I played hour after hour of "space battles," in the same room, with the same script, shaking my restless leg, humming constantly, jumping up every thirty seconds to start some new project, attend to some abandoned task. I existed in a suspended agitation, willing myself to focus and failing miserably, trying to quiet my shrieking synapses, day after day. You probably felt something like this too, and I’m not sure what my psychiatrist would have said if you’d told him about it.
There is no “one test” for ADHD. I’ve seen children diagnosed after a 15-minute doctor’s visit, when no one bothered to ask whether they had a background of trauma, parents who only had eyes for the Ivy League, teachers for whom the slightest bit of rambunctiousness was unacceptable. I agonize over ruling out other explanations for my clients. Maybe he’s just bored. Maybe she’s just depressed. Maybe we’re all expected to be just a little too agrarian.
The doctor asks his questions. Do you start projects without reading the directions? Do you have trouble shifting from one activity to the next? Are you often late? Do you have frequent emotional outbursts? I cannot, in good conscience, say no to these questions, but I know there is a difference between imperfection and disorder. I teach courses on ableism, I know I am not disabled. I am impatient and lazy and rash and loud and the life of the party until I have said something to offend someone or left abruptly because I was offended or simply gotten so drunk I had to be taken home. I know that there are other explanations for my mistakes, and that most of them have to do with my not being worthy of a life without them.
The doctor patiently listens as I plead my case. My history is riddled with inconsistencies, which, I have to admit, is classic ADHD. I wait, impatiently, for him to say that I don’t have it, though it’s not something you can catch, like a cold or an underhanded throw. I prepare myself for a gentle, doctorly version of “Stop feeling sorry for yourself because you happen to be both incredibly ambitious and incredibly incompetent.”
But he doesn't say anything like that. Instead, he explains that, like many adults who are diagnosed with ADHD later in life, I have compensated for the challenges that have been there all along, until all of a sudden, I couldn't. I was a nomad, enough of the time, but now there are fields to be plowed and crops to be picked and I am lying down in the dirt and curling into a ball, waiting for the crows to take me before someone makes me submit another timesheet.
The diagnosis is both life-changing and inconsequential. When I close my laptop and stumble into the living room to tell my husband what has happened, he isn’t sure whether I am feigning my disbelief. He doesn’t want to hurt me, I am not fun when I am hurt. I stalk into the kitchen and turn the music on too loud, how I like it, realize I haven’t eaten all day, start to cook an egg and then forget all about it, curse at myself and this strange classification that is, in fact, quite familiar.
I tell some friends and family, slowly, tenderly, about my diagnosis, and they do not seem convinced. Like most people, they associate ADHD with failure, and I am an accomplished person. But every achievement, I know, has felt like walking in a wind tunnel. I had thought that wind tunnel was called Depression, Entitlement, Self-Loathing. I had thought it was just, me.
I join a Facebook group for mothers with ADHD in academia. Could there be so many of us that we require such subgrouping? Many of the women have had trouble getting professionals to endorse their own self-diagnoses. One was told that she was “malingering.” I read a description of what it's like for one woman to walk into a coffee shop, how each little detail -- the mood of the barista, the wobble of the table, the intimate confidences of her conversation partner -- thrusts itself at her with equal weight, and my heart leaps into my throat. I didn't know this reality was worthy of explanation, that other people weren’t wired this way. No, that's not it. I had my suspicions.
I try Adderall, the smallest dose, and text my friend at 11am to ask if my skin is supposed to feel like it is radiating light, and not in a good way. I write for four hours straight but it is mostly gibberish and leaves me with a headache. I imagine my son as an adult, tracing his problems back to his rash and flighty mother, but I don’t take the Adderall again.
My husband shares the gentle wisdom he seems to have about my condition, clues I had failed to notice entirely, despite the fact that all I seem to think about is myself. Apparently, I cannot open a package where it is intended to be opened, at the perforated seam, but always, always, make an impulsive tear somewhere else entirely. Things leak out, get wasted, and he quietly cleans up after me. He finds this charming, which is why I chose him. He is surprised I didn't know this about myself, but how was I to know what the rest of the world was up to when it came time for them to open a package? It is silly, I know, to cry about raisins, but I am horrified by such knowledge. All I see is the damage I’ve done, the messes I’ve made. The ones I have yet to make.
I had always told my students that they were not a label. Then what, I wonder, is the meaning of mine? A name for a thing that is so you, hearing it spoken aloud is like a homecoming. A name like a hundred-dollar word that you learn once, and then begin hearing, all of a sudden, everywhere.
Everything is a symptom. An enormous late fee on a credit card I am sure I canceled is “difficulties with executive functioning.” Screaming at my child is the result of “sensory overload.” The way I fold into myself when I ask for feedback, but only meant for it to be positive, is “Rejection Dysmorphic Disorder,” a common comorbidity. I am tired of reading about my deficiencies and tired, even, of my superpowers. I read one article about Buzzfeed selling us micro-identities to distract us from the evils of capitalism. I feel impostor syndrome about the thing that explains why I’ve felt like an impostor much of my life.
On some days, I get the eerie feeling that I am standing in front of one of those bulletin boards that traces the path of a serial killer. Photographs and bar tabs and newspaper clippings with little red strings in a web. All the pieces are clicking into place, replayed over and over for no one’s benefit but my own. There are my parents, juggling five children and a troubled marriage, outmatched by the emotional reactivity of their youngest daughter. Here are the hours I roamed my elementary school hallways, bored by my times-tables and having charmed my teachers into letting me do as I pleased. There is my eighth-grade writing teacher, aptly named Novella, telling me that I have a strong voice, but I don't work to my potential. Here is my college roommate, with a good-natured lament about how I never go to class, skim the book and write the paper the night before, and get a B+. She thinks this is a power move. I know it is my only move.
And the biggest box of evidence happens to be my own profession. There I was, described with creepy precision in articles and diagnostic manuals and in my own goddamned PowerPoint presentations. The call was coming from inside the house. The detective dropped the coffee cup and it shattered and when he went to retrieve the pieces he realized the words “How did it take you this fucking long?!” were etched on the bottom.
Reading this, you are probably wondering if you, too, have ADHD. Maybe you do. As someone who gets paid to tell people whether or not they have ADHD, I can tell you that there’s no way, for sure, to know. I get to say it because someone told me it was true. But that was only one truth, just like plowing fields and sowing crops is just one way to make a living.
Why did it take years of studying ADHD for me to consider that I had it? The psychologist in me has nice, neat answers. Because ADHD is still thought of as something that affects young, squirrelly boys, and the ways that women manifest it are quite different. Because we are learning more each day about how it is more complicated than difficulties with focus. Because weaknesses can cancel out superpowers and make the whole thing seem, just, unremarkable. Because I didn’t want to try on a micro-identity that was really a capitalist platter of Soylent Green. Because we never see what is right in front of us.
But none of these valid complexities are the truth, not my truth at least. The marrow in the bone I had to pick with the whole thing was that I could not be ADHD because that word would take away something much closer, much older and more tenacious. That I was, to put it simply, bad. A bad daughter, a bad student, a bad friend, wife, mother, teacher, pot-watcher, bag-opener, plan-maker, street-crosser, Lego-player, deal-closer, time-tracker, deadline-meeter, job-holder, oath-keeper, person. I would rather be the villain of my own story, I realized, than be misunderstood. This is the very demon I have spent much of my career trying to exorcise from the children I work with, children who have already decided, at age seven or eight or nine, that if something is terribly wrong, it must be Them. The sickness I found mirrored in my own being was not in fact, an attentional disorder, but a tale that traced all of my shortcomings back to my own bloody hands.
I am told there is another drug that might work better and it does, amazingly, help me finish a sentence and make Play-Doh spaghetti without tearing my eyes out. I am told my children will start grade school in a few years, that then I will write my book and tend to my marriage and finally become someone who can manage to send out a holiday card. I am told it will help if I can speak to this part of me that is ADHD, tell her that all of this is not her fault. I don't know yet what I will say. I try to picture her, a DRD4 gene with a minor mutation, a little girl pacing the empty hallways, a grown-ass woman grabbing her son too roughly and muttering "It was an accident." More and more, I think I may be learning to love this person, not just because I’ve learned that there’s a name for what’s wrong with her, but because I see, in the people I have known who are like her, what is also right.
When I went to write this essay, I found five or six separate drafts, written over several months. Some were thousands of words put down in one glorious rush. Some were just a few fragmented lines. A paragraph voice-texted to my husband with no explanation. An email to myself. An untitled, buried Google Doc. There are most definitely others out there, that is the way of this errant brain of mine.
Am I a fuckup who can’t care for something as simple as a digital document? A psychologist in a late-stage-capitalist society with a delayed case of “medical student syndrome?” A mother who has simply been run ragged by the captivity of parenting in a global health crisis? Am I a superhero, who only needs to find the right crisis in need of my powers? A nomad trying to traverse a modern landscape? Am I ADHD?
I know by now that I won’t reconcile all of these narratives. But I am coming to see that whatever name I choose to call the multiple versions of my story, they all have some truth to them. And, most importantly, they are all mine.