adhd – Pertinent Observations

Blackjack and ADHD

My mornings feel like I’m playing blackjack. A few months back, I had a bit of a health scare (elevated blood sugar levels), and since finding good low-carb food in/around office is a challenge, after that I’ve been taking my own lunch box.

It’s a fairly elaborate lunch, which one colleague calls as “looking rather European”. It started with grilled paneer and grilled vegetables, but has now grown to a massive glass Ikea box with grilled paneer, boiled eggs, grilled vegetables (some pre-blanched / steamed before grilling), roasted and crushed nuts and (of late) kimchi.

And despite my cook occasionally helping me out with some mise-en-place, there are a lot of things to do every morning. Some of the processes involved are:

keeping water for boiling, for eggs
putting eggs carefully into the boiling water (without breaking), and setting a timer for 7 minutes. If I’m not wearing my Apple Watch, I need to also run around to find my phone
Putting water in the steamer for steaming vegetables
Putting the hard veggies (carrot, beans, broccoli) into the steamer and closing the pot.
Taking out the veggies from the steamer before they are too soggy
Slicing paneer
Grilling paneer on the frying pan with salt and pepper and olive oil
Grilling veggies on the frying pan with salt and pepper and olive oil (including the steamed veggies)
Pre-heating the air fryer
Adding almonds into the air fryer; shaking the fryer once in the middle, transferring almonds to the pestle and mortar
Putting cashews into the air fryer
Taking out cashews when they have just browned and putting into the pestle and mortar
Putting eggs in cold water after seven minutes are up
Peeling and slicing eggs, and seasoning with salt and pepper
Crushing cashews and almonds and adding them to grilled vegetables

I don’t think I’ve ever timed myself. However, pretty much every morning I get into a frenzy trying to finish all of this, and then take my daughter to school on time. Maybe some days I take twenty minutes. Maybe I take thirty. I don’t even know. Life is such a blur.

As you can imagine, the above process can be heavily parallelised. And while my menu is standardised, the process is not. Which means I’m trying to both experiment and measure at the same time. While cooking four different processes at exactly the same time.

Sometimes, life feels like playing blackjack. You would have flipped the paneer over in the frying pan maybe for one last time. And then you think “I can peel this egg before the paneer is done”. Before you know it the paneer is black. You are not wearing your watch, so you go in search of the phone – to put the timer for the egg. In that time the veggies are burnt.

I don’t even know why I sometimes put myself through this. Maybe this is yet another tradeoff between physical and mental health. For now, physical seems to be winning.

Maybe a sustainable long term strategy is to forego lunch as well (nowadays I don’t eat breakfast unless I’ve gone to the gym in the morning), and transition to an “OMAD” (one meal a day) lifestyle. Or maybe I should find myself some nice lunch I can take to office which doesn’t involve so many parallel steps.

Until I figure something out, I’ll continue running in the mornings.

Stereotypes, K-Dramas and ADHD

My wife is currently watching a K-drama which she said I might like, because the leading female character in that is autistic. “You have ADHD, and you might be on the spectrum, so you can at least half watch with me”, she said.

Given that it is in a language that I don’t know, I can’t really “half watch”, but I’ve sat through an aggregate of about ten-fifteen minutes of the show in the last 2-3 days.

My first impression of the show and the character was “gosh she’s such a stereotype”. They showed her in court or something (the character is a lawyer), and she takes something someone says extremely literally. And then there was something else that seemed rather stereotypical and then I almost wrote off the show.

And then they showed one scene, which is also possibly stereotypical (I don’t know) but which I massively massively empathised with, and then my view of the show turned, and at this point in time I’m “half watching” the show (to the best extent you can when you need subtitles) as I write this.

I might have written about this before – back in 2013, after about six months of taking methylphenidate for my ADHD, I had started to believe that it was crimping my creativity. What I thought had defined me until then, which is also something you see a lot on this blog, is connecting very random and seemingly unconnected things.

In fact, I considered that to be one of my superpowers – to see connections that a lot of other people can’t. After a few days of not taking the medication (when I saw myself making those connections again), I decided to get off them. I didn’t get back on till 2020 (as things stand I take them).

Anyway, back to the show, the protagonist is shown having a vision of a whale, and that vision reminds her of something else, and she keeps connecting one thing to another (I was really empathising with her in this snippet), and gets a massive insight that solves the case that she is on. My view of the show turned.

A few pertinent observations before I continue:

One of the speakers at one of the early episodes of NED Talks made a point about how some of have possibly evolved to have what are now considered as “disorders”. “Hunting and gathering are team activities, and you need different skills for it. Not everyone needs to run after the prey. The autistic person in the tribe will be able to detect where the prey is and the rest can hunt it”.
So we have evolved to be different like this. Putting together genetics and game theory, it is a “mixed strategy”.
The downside of being able to connect seemingly unconnected things is that you tend to hallucinate. I’ve written about this, in a completely different context.
Another downside of seeing visions and connecting unconnected things to find a solution to the problem that you’re working on is that it makes it incredibly difficult to communicate your solution. Having seen it in a “vision”, it is less explainable. You cannot “show steps”. Then again I don’t think this trait is specific to people with ADHD or on the autism spectrum – I know one person (very well) who doesn’t have ADHD by any stretch of imagination, but has a worse problem than me in showing steps
I have always been happy that I didn’t study law because it’s “too fighter” and “involves too much mugging”. But then the protagonist in this show shows remarkable attention to detail on things that she can hyperfocus on (and which her visions of whales can lead to). I’ve also read about how Michael Burry found holes in CDOs (back in 2008 during the global financial crisis) because he was able to hyperfocus on some details because he has Aspergers (now classified under the autism spectrum in general)

Anyway as I was writing this, I half watched parts of the second episode. In this again, the protagonist had another vision of the whales, which led to something else and an insight that led her to win her case. Now it appears stereotyping again, after I saw the same setup in two different episodes – it seems like the standard format the show has set up on.

I don’t know if I’ll half watch any more.

Trump, Tamasikate, NED and ADHD

My friend Ravikiran Rao has written a blogpost about how “Trump is Tamasik“. In this, he has used the Tamasik-Rajasik-Satvik framework from ancient India, modelled how most leaders are Rajasik, and how Trump is not, and is actually a Tamasik.

One of the hypotheses in the post is that a lot of commentators make the mistake of analysing Trump through a Rajasik lens (which they are used to since most other leaders are Rajasik), and so get him wrong.

The blogpost, like a lot of Ravi’s blogposts, triggered off a lot of thoughts in my head. My first reaction after starting to read was that “hey, can we compare Tamasikate to NED (noenthuda)”? The idea of Tamasik that I have is that it is about “doing nothing”. And “no enthu da” of course vocalises that philosophy – you don’t have enthu to do anything. And so Tamasikate is like NED.

That was the first thing where I found myself describing myself as a possible Tamasik.

And then Ravi goes on.

Trump, as I was saying, is Tamasik. He is driven by his impulses, and in his case, the impulses are all negative ones. Now, to be fair, all of us struggle with our impulses and emotional drives, but becoming a functional adult involves learning to rein them in, and converting them into higher order goals. We all have sexual desires, for example. The Rajasik nature involves sublimating them into a higher order emotion called love, and pursuit of love involves choosing one person and forgoing others; not giving into the impulse of going after every woman you find sexy. Trump has not made that transition at all. A Clinton may give into his impulse; Trump is his impulse.

I was thinking about the common theories about ADHD, which I’ve been diagnosed with. One theory is that ADHD leads to a “lack of executive functioning”. If we were to describe this using the Tamasik-Rajasic-Satvik framework, we can say that all of us have a “Tamasik base”, which is about our emotions, about our impulses and all that.

And then on top of the Tamasik base is a Rajasik “executive function”. It is this function that allows us to plan, think long-term, suppress our impulses when they are suboptimal, and do all the rest of things that society expects of functioning adults. However, the thing with ADHD is that this Rajasik executive function is impaired. So you are unable to plan well. You give in to your impulses. You frequently change plans. You are impulsive.

Sometimes I think that a lot of my theories are my attempts to rationalise myself and my own decisions. For example, after I first got diagnosed with ADHD in 2012, I realised that my seminal studs and fighters framework was an attempt to rationalise that.

Now Ravi’s post about Trump’s Tamasikate makes me think – I instinctively associate Tamasikate with NED. And your Tamasikate comes out in fuller light if your Rajasik executive function is impaired, which is what they say happens to someone who has ADHD.

So through this, is NED also a symptom of ADHD?

Using ADHD to combat anxiety, anger and everything else

Sometimes I find that documenting thoughts can really help for later on in life when you’ve forgotten certain workflows. As you are well aware, I document pretty much everything here. However, some things sometimes get left out, and the problem with not documenting those things is that you end up forgetting what you had made.

In some way, it’s like the Guy Pearce character in Memento – who has extreme memory loss to the extent that he needs to take polaroid photos and make tattoos on his body as notes for himself. It’s not that bad for me, but I find that when I don’t document stuff adequately, I tend to forget thoughts. And even when I forget thoughts and ideas (that happens all the time), having documented them somewhere means that I stumble upon it sometime (yes, I randomly read my old blog posts from time to time), and that surely helps.

For example, I know that when I go through a prolonged period of depression (most recently happened last December), reading the first chapter of Jordan Peterson’s 12 Rules For Life helps.

Anyway, this is one thing I’ve followed from time to time since 2013, but have never really documented it. As long-time readers of my blog might know, I was under medication for both anxiety-depression and ADHD for the large part of 2012. I discontinued most of it in early 2013, but have occasionally gone back to taking ADHD medication (it’s a pain to get that medication – being highly controlled, you need doctor’s prescription in triplicate, etc. to get it. In the UK, the entire process through the NHS took a year and a quarter!).

Part of the reason why I’d been able to discontinue the medication was the realisation that it was in some way my ADHD that had contributed to anxiety and depression (making lots of small mistakes -> some of these mistakes proving costly -> fretting endlessly about these -> random pattern recognition based on small samples).

The other reason I was able to step down on all the medications was that I could actually “use my ADHD” to combat anxiety. The thing with ADHD is that while you can sometimes be incredibly distracted and unable to focus, you are also able to go into “hyperfocus” when you are doing something you are interested in. This thing you are hyperfocussed on could be work, or watching certain kinds of TV, or even getting lost in old cricket scorecards (or reading my own old blogposts!).

So the method I developed to combat times when I was anxious about something was to find something quickly that I could get hyperfocussed about (there are plenty of those) and use that to fully distract myself from whatever my thought process was at the time. Having ADHD also means you can let go of whatever thoughts you have in your head rather easily. And so once you’re done with your hypefocussed task, you don’t usually return to the earlier state of high anxiety, and you can get on to normal life.

It’s a simple enough process, but ADHD also means that you very often forget simple solutions you’ve found to problems earlier, and keep reinventing the wheel. And hence the need for this documentation.

Recently I discovered that this method works for other forms of mental instability as well. For example, the common advice given to deal with anger is to “walk away from the scene” or “take a break”. This has largely worked really badly for me. I get angry. I walk away. Obsess over what just happened. Come back angrier.

But I have a secret weapon to deal with this – ADHD! Just walking away doesn’t help. I just end up hyperfocussing on what just happened. Instead the trick is to find something I can get absorbed in. A rabbit hole I can get into and get out of without remembering what had happened just before I got in. And there’s no way the anger can survive this kind of an experience.

The only problem is that when you’re angry with something, and that’s resulted in a “live fight”, walking away to do something totally unrelated can get the counterparty even angrier. I didn’t say I have solutions for all the problems in the world, did I?

Context switches and mental energy

Back in college, whenever I felt that my life needed to be “resurrected”, I used to start by cleaning up my room. Nowadays, like most other things in the world, this has moved to the virtual world as well. Since I can rely on the wife (:P) to keep my room “Pinky clean” all the time, resurrection of life nowadays begins with going off social media.

My latest resurrection started on Monday afternoon, when I logged off twitter and facebook and linkedin from all devices, and deleted the instagram app off my phone. My mind continues to wander, but one policy decision I’ve made is to both consume and contribute content only in the medium or long form.

Regular readers of this blog might notice that there’s consequently been a massive uptick of activity here – not spitting out little thoughts from time to time on twitter means that I consolidate them into more meaningful chunks and putting them here. What is interesting is that consumption of larger chunks of thought has also resulted in greater mindspace.

It’s simple – when you consume content in small chunks – tweets or instagram photos, for example, you need to switch contexts very often. One thought begins and ends with one tweet, and the next tweet is something completely different, necessitating a complete mental context switch. And, in hindsight, I think that is “expensive”.

While the constant stream of diverse thoughts is especially stimulating (and that is useful for someone like me who’s been diagnosed with ADHD), it comes with a huge mental cost of context switch. And that means less energy to do other things. It’s that simple, and I can’t believe I hadn’t thought of it so long!

I still continue to have my distractions (my ADHD mind won’t allow me to live without some). But they all happen to be longish content. There are a few blog posts (written by others) open in my browser window. My RSS feed reader is open on my browser for the first time since possibly my last twitter break. When in need of distraction, I read chunks of one of the articles that’s open (I read one article fully until I’ve finished it before moving on to the next). And then go back to my work.

While this provides me the necessary distraction, it also provides the distraction in one big chunk which doesn’t take away as much mental energy as reading twitter for the same amount of time would.

I’m thinking (though it may not be easy to implement) that once I finish this social media break, I’ll install apps on the iPad rather than having them on my phone or computer. Let’s see.

Back to methylphenidate

I can’t remember the last time I was unable to fall asleep. I mean I’ve lost sleep on several days in the last month or two, but on all occasions it’s been after I’d gotten woken up in the middle of my sleep. Today is different – it’s nearly 1 am, and I’ve been in bed for two hours tossing and turning, and completely unable to fall asleep.

I think I left it until it was a bit too late today to restart my methylphenidate, after a three year gap. The dosage is half of what I was used to in 2012-13 and 2015-16. Just 5 milligrams to be taken twice a day. This convinced me that it would be okay to take it in the afternoon. Big mistake. I’ve been completely unable to switch off this evening.

The good thing is that this afternoon ever since I took the tablet I’ve had the kind of hyperfocus I hadn’t been able to achieve for I don’t know how long. I continue to get distracted, but it’s easier to get back to where I was. The big change is that I no longer feel the constant need for stimulation. The need to “feel accelerated”, as I call it, which would result in my opening dozens of tabs on my browser and checking websites one by one without any need to do so. Sometimes it would end in the rabbithole of playing online chess, and wasting hours at a time.

I’ve written about ADHD before on this blog, and elsewhere. I’ve written it as a condition where you’re unable to hold attention on what you are doing, and getting distracted easily. In the past I’d come off medication because I missed being distracted – in my methylphenidated state, I have missed the ability to think laterally which I’m so capable of in my “ground state”.

Thinking about it, though, it’s not distraction or the lack of it that’s the problem with ADHD. It’s the constant need for “stimulus”. It’s the constant need to “keep doing something” that makes me fidgety. It’s possibly the same feeling that made me run out of class when I was in kindergarten and do somersaults. The same feeling that would make me open my computer and open a dozen chat windows upon coming home from work a decade ago. Well the latter had its good parts – a lot of the time, one of those dozen chat windows would involve the person who I later married.

It’s funny how I got here today, in this methylphenidated state. As you might know, I’ve been living in London for nearly two years now. And the medical system here is government-run.

In October 2017, when I was in the middle of my last (and largely unsuccessful) full time job, I felt the need to get back on to ADHD medication. I got an appointment with, and met my general practitioner in November 2017. He asked me to share with him my diagnosis of ADHD from back home. In December 2017 I was back in India, and I got back my medical records, and shared a copy with him in January 2018.

In February 2018 I got a call to set up an appointment with the mental health practice. It was at a clinic some distance away from home, and I met the psychiatrist in March 2018. I was administered the usual ADHD questionnaire and told that I would be contacted by the “national ADHD centre” in a “couple of months”.

It was finally in January of 2019 that I heard back about this. It was my GP once again, saying my prescription for methylphenidate was ready, and I should start taking it asap. The next day I got a call asking me to meet the psychiatrist again, in the faraway mental health clinic. And today I started taking the medication. And I’ve been so unable to switch off that I’m unable to sleep!

PS: I’m publishing this a day late. I wrote this last night but couldn’t publish it since daughter started crying and I had to rush back to bed. Hopefully I’ll be able to sleep well tonight

Mental health triggers

My ADHD seems to have become much worse over the last couple of days. Like this morning I had this episode where I couldn’t decide whether to go back home to get an umbrella, and thus turned around twice while I was in the middle of crossing a road.

In part, I blame this on having just read a book on ADHD – the second such book I’ve read in the last week (I found this book from the bibliography of previous one). While this book told me the impact of ADHD on relationships, and helped me understand what someone married to someone with ADHD goes through, in the course of doing so it reminded me of all the problems that one faces when you have ADHD.

So in some way, as I read through and “revised” the list of problems that one has with ADHD, all these problems have started surfacing (more likely I have noticed these issues every time they’ve come up). And this has led to a positive feedback loop, and thus much shorter attention spans and massive distractions and even mild addiction (to online chess).

This is not an isolated incident. In the past as well, when I’ve read material related to mental health problems that have affected me as well, the precise problem gets triggered. So when I read some stuff about depression, I’m likely to have a depressive episode after that. Similar with anxiety.

Interestingly, there is no impact when I read something related to a problem that I myself have never faced – like I once started reading Siddhartha Mukherjee’s essay on bipolar disorder and it had no effect whatsoever on me.

It wasn’t always this way. Long back, before I got diagnosed, reading stuff about mental health issues which I later got diagnosed with would make me feel hopeful – hopeful perhaps that there was in fact a diagnosis for what I was going through and it wasn’t simply “laziness” or “ineptitude” on my part that was causing me all that I was going through. But once I got the diagnosis, and figured out lifestyle changes to deal with my issues, reading more has only triggered the respective issue.

I guess the solution for this is simple – unless absolutely necessary (say there is a specific issue for which I seek help on) I shouldn’t read stuff about mental health issues that I might be facing.

I won’t spare you, though – here is an essay about ADHD that I had written three years ago (which I dug up after a conversation on ADHD with a friend yesterday).

11/13: Support

Careful readers of this blog might remember that things weren’t going very well for me on the health front at the beginning of the decade. Increasing stress from a job that was in hindsight not all that stressful led me to seek help, and I’d gotten diagnosed with anxiety and depression. Soon a diagnosis for ADHD followed. This was immediately after I’d quit my (supposedly stressful) job and was trying to establish myself as a consultant.

As I’ve documented on this blog earlier, I came through this difficult phase of life fairly successfully. I managed to use the medication I was on as some kind of a “stimulus“, and then built upon my later success to pull myself out. I also made necessary changes to my lifestyle and working style to take advantage of my brain being supposedly wired differently.

What I’d failed to mention in that post about coming out of depression was the role that Pinky had played in helping me back then. The biggest impact on her was in terms of my erratic behaviour. The medication I was taking, while helping me get out of depression, was also altering my mood in ways I hadn’t imagined, and she increasingly became the target of a lot of my outbursts.

Moreover, she was also really young at the time, and having yet to see the quarter life crisis, found it hard to empathise with what I was going through. She started with the reaction that most relatives of people with mental health issues start off with – denial followed by accusation that I was using it as an excuse. It’s to her extreme credit that she soon came to understanding things from my perspective, and appreciating what she was going through.

After that, she was a constant pillar of support for me as I battled my depression and ADHD. She helped me talk over any fears I had (it turned out I had a lot of them, mostly irrational). She was nice to me when I wasn’t being nice to her. She put up with my outbursts and fights. She forgave my once frequent transgressions, and took my side in fights where she could’ve easily turned against me.

She even regularly accompanied me to the psychiatrist which was never a particularly pleasant experience for her, and stood by me as I made fairly important decisions about life and mind-altering substances. And finally, when in January 2013, I decided to get off the medication, she made sure she was accommodative in case my old behaviours took off again.

I’m still not “perfectly okay”, and possibly will never be. And there are transgressions and bad behaviour on my part from time to time. Pinky, while not condoning such behaviour, has remained patient with me, and constantly helped me improve myself. She has stayed positive through the process, and made extreme efforts to make sure that our relationship remains intact.

And for all this, I can never thank her enough. If I were the religious sort, I would’ve said that I could never thank her enough either in this life, or in our next seven lives!

1/13: Leaving home

2/13: Motherhood statements

Discrete and continuous diseases

Some three years or so back I got diagnosed with ADHD, and put on a course of Methylphenidate. The drug worked, made me feel significantly better and more productive, and I was happy that a problem that should have been diagnosed at least a decade earlier had finally been diagnosed.

Yet, there were people telling me that there was nothing particularly wrong with me, and how everyone goes through what are the common symptoms of ADHD. It is a fact that if you go through the ADHD questionnaire (not linking to it here), there is a high probability of error of commission. If you believer you have it, you can will yourself into answering such that the test indicates that you have it.

Combine this with the claim that there is heavy error of commission in terms of diagnosis and drugging (claims are that some 10% of American kids are on Methylphenidate) and it can spook you, and question if your diagnosis is correct. It doesn’t help matters that there is no objective diagnostic test to detect ADHD.

And then your read articles such as this one, which talks about ADHD in kids in Mumbai. And this spooks you out from the other direction. Looking at some of the cases mentioned here, you realise yours is nowhere as bad, and you start wondering if you suffer from the same condition as some of the people mentioned in the piece.

The thing with a condition such as ADHD is that it is a “continuous” disease, in that it occurs in different people to varying degrees. So if you ask a question like “does this person have ADHD” it is very hard to give a straightforward binary answer, because by some definitions, “everyone has ADHD” and by some others, where you compare people to the likes of the girl mentioned in the Mid-day piece (linked above), practically no one has ADHD.

Treatment also differs accordingly. Back when I was taking the medication, I used to take about 10mg of Methylphenidate per day. A friend, who is also on Methylphenidate and of a comparable dosage, informs me that there are people who are on the same drug at a dosage that is several orders of magnitude higher. In that sense, the medical profession has figured out the continuous nature of the problem and learnt to treat it accordingly (a “bug”, however, is that it is hard to determine optimal dosage first up, and it is done through a trial and error process).

The problem is that we are used to binary classification of conditions – you either have a cold or you don’t. You have a fever or you don’t (though arguably once you have a fever, you can have a fever to different degrees). You have typhoid or you don’t. And so forth.

So coming from this binary prior of classifying diseases, continuous diseases such as ADHD are hard to fathom for some people. And that leads to claims of both over and under medication, and it makes clinical research also pretty hard.

Do I have ADHD? Again it’s hard to give a binary answer to that. It depends on where you want to draw the line.

Zen and the art of shooting

So I was at this resort near Nandi Hills for a day-long workshop on Saturday (actually it was a three-day workshop but my session was only on Saturday so I went there only for one day). One of my colleagues and fellow-teachers had brought along an air gun and at a time when students were busy doing some homework we had given them, we went off for some shooting practice.

First we used cardboard pieces and drew targets on them. I remember taking some four or five rounds at it. First three times I shot way to the right of the target. The following time I decided to correct for this bias and aimed a little left of the target. However, it turned out I had overcompensated and I ended up shooting left.

This was the first time ever in my life that I was shooting (barring toy guns when I was a kid). The first couple of shots I was just getting use to the feel of the gun, the posture, etc. What I found tricky was that there were two viewfinders through which you had to look through simultaneously (genius design – to eliminate parallax error). And then you had to concentrate, focus and shoot.

My first few shots I figured that I thought too much about shooting. I took aim, and then held the position for a while till I was convinced that I was aiming right. Then I would get distracted (damn you, ADHD) and then I would have to try and concentrate again. This would happen a few times until I would go impatient and shoot randomly, and thus miss the target.

After a few rounds of shooting at the cardboard, we moved on to shooting a fruit. Four of us took two cracks each at the fruit, and I was the only one who didn’t manage to hit the fruit at all. On both shots I missed by a long way. I had that sinking feeling I always have when I’m trying to learn something as part of a group and end up being clearly the worst in the group. That’s a frequent feeling for me nowadays.

So for the last round where we used an empty Bacardi carton as our target (the aim was to hit the face of the Bat logo on the carton), I decided to adopt what one of my friends called the “Zen method”. “The first time you take aim, just shoot. Don’t over think”, he said. I had some reputation to salvage.

We all took two shots each at the carton. I did what I was told. As soon as I had taken aim, I shot. I ended up hitting the bat logo once on the tail and once on one of its legs. Here is a photo taken as soon as I had shot the tail (red circle; the other shot on the bat is a colleague’s). The Zen method worked!

PS: I think this is the first time ever I’ve put up my photo on my blog. So all those of you who read this but don’t follow me on any other social medium – you finally know what I look like.