Post by Beth W on Nov 9, 2005 10:40:57 GMT -5
Inside My Brain
by Lou Schuler, Men's Health;
Step inside my brain. Careful—I just rehashed an argument I had 20 years ago. Here, wipe your shoes with this. No problem, it's just my unused Academy Award speech from when I used to write screenplays.
What's that noise? It's a song I heard on the radio three days ago; it pops into my head whenever I need to think about something else. Could be worse. Last week it was the theme from Teletubbies.
I spend a lot of time in here. It's a fun place, except when I need to get something done. Or when my wife needs to explain something important. Or when my kids...
Duck!
Close one. That was onrushing anxiety over all the work I'm not finishing because I'm puttering around in here. I've started a dozen projects but haven't completed anything. That's pretty typical for me.
As you can tell, I don't let many people in here. In fact, you're the first outside of my immediate family. And until recently, I didn't even let them in.
Why now? Because a few months ago I was diagnosed with attention deficit disorder (ADD). It's an incredibly simple condition—you can't pay attention when you want to, and you can't control impulses when you need to—but at the same time, it's mind-bendingly complicated.
Everyone knows a little about ADD. Hundreds of thousands of children have been diagnosed with it during the last decade, and there's been a huge public debate about the wisdom and effectiveness of treating all of these kids with the prescription drug Ritalin.
But far less attention has been paid to adults with ADD. No one knows if it's a small or huge problem. Researchers currently believe that anywhere from 1 to 20 percent of school-age children in the United States have ADD. (The most commonly accepted estimate is about 3 to 5 percent.) Because recent thinking suggests that ADD is genetic, at least one parent of each of these kids has it, too. You'll give yourself an aneurysm if you try to add up the number of adults that involves. Men with ADD are thought to outnumber women by anywhere from 2 to 1 to 9 to 1, but knowing this doesn't help much.
Scientists caution that there's a lot they still don't understand about ADD, and diagnosing it can be tricky. Even so, odds are you know someone who has it: that kid you sat next to in third grade who got sent to the principal's office every day; that guy at work who never shuts up; that visionary who was fired from every job he had until he started his own company—and is now your boss.
In other words, one of us has almost certainly affected your life, for better or worse. But I'll get to that part in a minute. As usual, I'm getting ahead of myself.
My son, Harrison, is five years old, and in his Kodak moments he's the sweetest, most charming little boy you'll ever meet. He'll walk up to strangers and start talking about his shoes or his dog or the leaf he just picked up off the ground. Unfortunately, the charm wears off fast. After 10 minutes in a room with him, even Mr. Rogers would reach for the Valium.
My wife and I started Harrison in a Montessori preschool last year, and within two months his teachers told us he had the worst ADD they'd ever seen.
So we went to see a child psychiatrist, who recommended that we read Driven to Distraction, the 1994 book that brought national attention to distracted kids and adults. A few pages into it, I realized the book wasn't just about Harrison; it was about me.
It was about all the times I'd disrupted classrooms because I couldn't sit still, about assignments missed, cars crashed, jobs lost, relationships blundered into and out of. It was about this noisy, cluttered, disorganized and often overwhelmed brain of mine.
I met with a psychologist, who confirmed that everything I told him about my childhood, my family and my behavior pointed toward ADD. I met with a psychiatrist, who went over everything again and agreed with the psychologist. Then, at the age of 43, I went on drugs.
The behaviors associated with attention deficit disorder aren't new, of course, and over the years the condition has gone by many names: minimal brain dysfunction, brain-injured-child syndrome, hyperactive-child syndrome, future Domino's Pizza deliverymen of America disorder.
Finally, in the early 1980s, the condition was dubbed attention deficit disorder, with an added "H" between the "D"s for kids with hyperactivity. About this time, researchers also figured out that kids who were diagnosed with these problems wouldn't outgrow them as adults.
"People change as they grow older, and they learn to compensate. But most continue to show symptoms, and some get worse," says Steven Klee, Ph.D., chief psychologist at Brookdale Hospital in Brooklyn.
When a single problem goes through five different names in a little more than a half century, you know it's as confounding to scientists as it is to the people who have it. The pieces are coming together, though.
In particular, many studies have shown genuine biological differences between people who have ADD and those who don't. "There are genetic differences, neurochemical differences, structural differences and physiological differences," says John J. Ratey, M.D., a psychiatrist at Harvard Medical School, author of A User's Guide to the Brain, and coauthor of Driven to Distraction.
For example, recent studies sponsored by the National Institute of Mental Health point to two parts of the brain that are smaller in people with ADD. One is the basal ganglia, a pair of nerve clusters in the middle of the brain. The other is the right prefrontal cortex, the last part of the brain to develop in childhood.
Together, these two parts make up the brain's management system and its spin control. They not only help you organize stimuli as they come in from the environment, but they also help you form a plan of action to react to those stimuli. Having ganglia that don't dangle far enough is like being Sonny Corleone when you're trying to be Michael. It's going off half-cocked when you'd be better off thinking things through." ADD is a chemical frontal lobectomy," says Scott Williamson, my shrink in Allentown, Pennsylvania. "You're cut off from your frontal lobe. You can't police yourself."
Before I go further, I'd like to introduce someone else—someone I never felt I knew until I began to wrap my stunted ganglia around my ADD and that of my son.
Dad was one of those guys who was there but not there, supporting a houseful of kids he'd spawned, but with little discernible interest in any of us.
If you tried to talk to him, you could see his eyes turn into two glazed doughnuts. But he could listen to himself all day, dragging his words out slowly at the end of sentences. He found himself more fascinating than anything else in his world.
When he engaged with us, it was usually loud, often brutal, and occasionally bloody. He had the most explosive temper I'd ever witnessed—a hand grenade whose pin always seemed half pulled.
By the time I reached adulthood, I was convinced he was just a mean bastard and a lousy father who never tried to be anything else. It was a given that I would be a much better dad than he.
Except I wasn't, even though I was trying like hell. Each time I felt my attention to my own kids slip away, each time my temper got the best of me, I wondered, "Is this how Dad felt? Is this what it was like to raise me?"
Once I was diagnosed with ADD, I could finally see my dad for what he probably was: a guy whose ganglia weren't up to parenting a kid as challenging as I was.
Which is as good a time as any to talk about the drugs. You've heard of Ritalin. Maybe you've even heard of its generic name, methylphenidate. By either name it's the great pharmacokinetic cliché of our times, a stimulant that’s as defining of the late 1990s and early 2000s as Prozac was to the ‘80s, cocaine to the ‘70s, Halcion to the ‘60s, and martinis to the ‘50s.
The thing is, if you have ADD, experts say you may have tried all of the above to focus or relax your pinball brain. In a study in the Journal of Clinical Psychiatry, 28 percent of the men in chemical-dependency centers met the criteria for ADD. "You’ll find some way to stimulate your brain," says Williamson. "Do you get hooked on pornography? Video games? Bungee jumping? Crank? Alcohol?"
Me, I discovered Diet Coke in 1983. I was hooked almost immediately, and I put away at least a liter a day until a few months ago, when I started taking methylphenidate. Then I cut back on the Coke drastically, and now take in a lot only when I’m trying lower doses of my medication. My body immediately tells me when it’s not jacked up enough, and it’s "Granny, get the jug."
I did okay on methylphenidate for a while, but I found it to be a lot like caffeine. I'd go up fast and down even faster. My psychiatrist then switched me to Concerta, which is methylphenidate in a timed-release capsule that works for 12 hours instead of four.
Life improves dramatically on the days when the dosage feels right. I'm more patient with the kids, listen more carefully to my wife and do my job more efficiently—if not necessarily better. "With medication, you've got all 52 cards in your deck," says Williamson. "Ritalin doesn't give you 54 cards. It just gives you the same 52 everyone else is playing with."
According to the Diagnostic and Statistical Manual of Mental Disorders—the bible of brain abnormalities—ADD is a combination of inattention and impulsivity.
But at any given moment, anybody could demonstrate symptoms of ADD. "One hundred percent of us meet the criteria for ADD some of the time, just as some of us get depressed and meet all the criteria for depression...at that moment," says Lucy Jo Palladino, Ph.D., a psychologist and author of Dreamers, Discoverers, and Dynamos.
"ADD is a very seductive diagnosis," says Edward Hallowell, M.D., a psychiatrist and coauthor of Driven to Distraction. "Once you understand the condition a little, you start seeing it everywhere."
The key, though, is this: "There's no such thing as adult-onset ADD," says Klee. "If you didn't have it as a child, you don't have it now."
Which brings me back to my favorite subject: me. If I can last into middle age with a treatable but untreated problem that causes me daily grief, how many people remain undiagnosed?
Probably a lot, says Peter Jaksa, Ph.D., a clinical psychologist in Chicago and president of the National Attention Deficit Disorder Association. (Check out its Web site at
www.add.org/
.)
Nobody knows how many adults are currently being treated for ADD, but whatever the number, Jaksa says it's not enough. "There are millions of adults with ADD living chaotic, underachieving, underemployed lives. Not everyone with ADD requires treatment, but those who do are often lost without it. Having treatment can transform your life."
As for me, I'm still a little at sea, even with treatment. I still yell at the kids, fight with my wife, get lost inside my head, say things I wish I hadn't. With the drugs, however, I do all these things less often.
Some days that seems good enough. On the days when it doesn't, I give myself the Dad test: Do I see myself, 50 years from now, sitting in a chair in front of the TV, alone and dying, and wondering why my wife and children never saw the wonderful me that existed inside my head?
Not likely.
URL:
articles.health.msn.com/id/100111031/site/100000000/
by Lou Schuler, Men's Health;
Step inside my brain. Careful—I just rehashed an argument I had 20 years ago. Here, wipe your shoes with this. No problem, it's just my unused Academy Award speech from when I used to write screenplays.
What's that noise? It's a song I heard on the radio three days ago; it pops into my head whenever I need to think about something else. Could be worse. Last week it was the theme from Teletubbies.
I spend a lot of time in here. It's a fun place, except when I need to get something done. Or when my wife needs to explain something important. Or when my kids...
Duck!
Close one. That was onrushing anxiety over all the work I'm not finishing because I'm puttering around in here. I've started a dozen projects but haven't completed anything. That's pretty typical for me.
As you can tell, I don't let many people in here. In fact, you're the first outside of my immediate family. And until recently, I didn't even let them in.
Why now? Because a few months ago I was diagnosed with attention deficit disorder (ADD). It's an incredibly simple condition—you can't pay attention when you want to, and you can't control impulses when you need to—but at the same time, it's mind-bendingly complicated.
Everyone knows a little about ADD. Hundreds of thousands of children have been diagnosed with it during the last decade, and there's been a huge public debate about the wisdom and effectiveness of treating all of these kids with the prescription drug Ritalin.
But far less attention has been paid to adults with ADD. No one knows if it's a small or huge problem. Researchers currently believe that anywhere from 1 to 20 percent of school-age children in the United States have ADD. (The most commonly accepted estimate is about 3 to 5 percent.) Because recent thinking suggests that ADD is genetic, at least one parent of each of these kids has it, too. You'll give yourself an aneurysm if you try to add up the number of adults that involves. Men with ADD are thought to outnumber women by anywhere from 2 to 1 to 9 to 1, but knowing this doesn't help much.
Scientists caution that there's a lot they still don't understand about ADD, and diagnosing it can be tricky. Even so, odds are you know someone who has it: that kid you sat next to in third grade who got sent to the principal's office every day; that guy at work who never shuts up; that visionary who was fired from every job he had until he started his own company—and is now your boss.
In other words, one of us has almost certainly affected your life, for better or worse. But I'll get to that part in a minute. As usual, I'm getting ahead of myself.
My son, Harrison, is five years old, and in his Kodak moments he's the sweetest, most charming little boy you'll ever meet. He'll walk up to strangers and start talking about his shoes or his dog or the leaf he just picked up off the ground. Unfortunately, the charm wears off fast. After 10 minutes in a room with him, even Mr. Rogers would reach for the Valium.
My wife and I started Harrison in a Montessori preschool last year, and within two months his teachers told us he had the worst ADD they'd ever seen.
So we went to see a child psychiatrist, who recommended that we read Driven to Distraction, the 1994 book that brought national attention to distracted kids and adults. A few pages into it, I realized the book wasn't just about Harrison; it was about me.
It was about all the times I'd disrupted classrooms because I couldn't sit still, about assignments missed, cars crashed, jobs lost, relationships blundered into and out of. It was about this noisy, cluttered, disorganized and often overwhelmed brain of mine.
I met with a psychologist, who confirmed that everything I told him about my childhood, my family and my behavior pointed toward ADD. I met with a psychiatrist, who went over everything again and agreed with the psychologist. Then, at the age of 43, I went on drugs.
The behaviors associated with attention deficit disorder aren't new, of course, and over the years the condition has gone by many names: minimal brain dysfunction, brain-injured-child syndrome, hyperactive-child syndrome, future Domino's Pizza deliverymen of America disorder.
Finally, in the early 1980s, the condition was dubbed attention deficit disorder, with an added "H" between the "D"s for kids with hyperactivity. About this time, researchers also figured out that kids who were diagnosed with these problems wouldn't outgrow them as adults.
"People change as they grow older, and they learn to compensate. But most continue to show symptoms, and some get worse," says Steven Klee, Ph.D., chief psychologist at Brookdale Hospital in Brooklyn.
When a single problem goes through five different names in a little more than a half century, you know it's as confounding to scientists as it is to the people who have it. The pieces are coming together, though.
In particular, many studies have shown genuine biological differences between people who have ADD and those who don't. "There are genetic differences, neurochemical differences, structural differences and physiological differences," says John J. Ratey, M.D., a psychiatrist at Harvard Medical School, author of A User's Guide to the Brain, and coauthor of Driven to Distraction.
For example, recent studies sponsored by the National Institute of Mental Health point to two parts of the brain that are smaller in people with ADD. One is the basal ganglia, a pair of nerve clusters in the middle of the brain. The other is the right prefrontal cortex, the last part of the brain to develop in childhood.
Together, these two parts make up the brain's management system and its spin control. They not only help you organize stimuli as they come in from the environment, but they also help you form a plan of action to react to those stimuli. Having ganglia that don't dangle far enough is like being Sonny Corleone when you're trying to be Michael. It's going off half-cocked when you'd be better off thinking things through." ADD is a chemical frontal lobectomy," says Scott Williamson, my shrink in Allentown, Pennsylvania. "You're cut off from your frontal lobe. You can't police yourself."
Before I go further, I'd like to introduce someone else—someone I never felt I knew until I began to wrap my stunted ganglia around my ADD and that of my son.
Dad was one of those guys who was there but not there, supporting a houseful of kids he'd spawned, but with little discernible interest in any of us.
If you tried to talk to him, you could see his eyes turn into two glazed doughnuts. But he could listen to himself all day, dragging his words out slowly at the end of sentences. He found himself more fascinating than anything else in his world.
When he engaged with us, it was usually loud, often brutal, and occasionally bloody. He had the most explosive temper I'd ever witnessed—a hand grenade whose pin always seemed half pulled.
By the time I reached adulthood, I was convinced he was just a mean bastard and a lousy father who never tried to be anything else. It was a given that I would be a much better dad than he.
Except I wasn't, even though I was trying like hell. Each time I felt my attention to my own kids slip away, each time my temper got the best of me, I wondered, "Is this how Dad felt? Is this what it was like to raise me?"
Once I was diagnosed with ADD, I could finally see my dad for what he probably was: a guy whose ganglia weren't up to parenting a kid as challenging as I was.
Which is as good a time as any to talk about the drugs. You've heard of Ritalin. Maybe you've even heard of its generic name, methylphenidate. By either name it's the great pharmacokinetic cliché of our times, a stimulant that’s as defining of the late 1990s and early 2000s as Prozac was to the ‘80s, cocaine to the ‘70s, Halcion to the ‘60s, and martinis to the ‘50s.
The thing is, if you have ADD, experts say you may have tried all of the above to focus or relax your pinball brain. In a study in the Journal of Clinical Psychiatry, 28 percent of the men in chemical-dependency centers met the criteria for ADD. "You’ll find some way to stimulate your brain," says Williamson. "Do you get hooked on pornography? Video games? Bungee jumping? Crank? Alcohol?"
Me, I discovered Diet Coke in 1983. I was hooked almost immediately, and I put away at least a liter a day until a few months ago, when I started taking methylphenidate. Then I cut back on the Coke drastically, and now take in a lot only when I’m trying lower doses of my medication. My body immediately tells me when it’s not jacked up enough, and it’s "Granny, get the jug."
I did okay on methylphenidate for a while, but I found it to be a lot like caffeine. I'd go up fast and down even faster. My psychiatrist then switched me to Concerta, which is methylphenidate in a timed-release capsule that works for 12 hours instead of four.
Life improves dramatically on the days when the dosage feels right. I'm more patient with the kids, listen more carefully to my wife and do my job more efficiently—if not necessarily better. "With medication, you've got all 52 cards in your deck," says Williamson. "Ritalin doesn't give you 54 cards. It just gives you the same 52 everyone else is playing with."
According to the Diagnostic and Statistical Manual of Mental Disorders—the bible of brain abnormalities—ADD is a combination of inattention and impulsivity.
But at any given moment, anybody could demonstrate symptoms of ADD. "One hundred percent of us meet the criteria for ADD some of the time, just as some of us get depressed and meet all the criteria for depression...at that moment," says Lucy Jo Palladino, Ph.D., a psychologist and author of Dreamers, Discoverers, and Dynamos.
"ADD is a very seductive diagnosis," says Edward Hallowell, M.D., a psychiatrist and coauthor of Driven to Distraction. "Once you understand the condition a little, you start seeing it everywhere."
The key, though, is this: "There's no such thing as adult-onset ADD," says Klee. "If you didn't have it as a child, you don't have it now."
Which brings me back to my favorite subject: me. If I can last into middle age with a treatable but untreated problem that causes me daily grief, how many people remain undiagnosed?
Probably a lot, says Peter Jaksa, Ph.D., a clinical psychologist in Chicago and president of the National Attention Deficit Disorder Association. (Check out its Web site at
www.add.org/
.)
Nobody knows how many adults are currently being treated for ADD, but whatever the number, Jaksa says it's not enough. "There are millions of adults with ADD living chaotic, underachieving, underemployed lives. Not everyone with ADD requires treatment, but those who do are often lost without it. Having treatment can transform your life."
As for me, I'm still a little at sea, even with treatment. I still yell at the kids, fight with my wife, get lost inside my head, say things I wish I hadn't. With the drugs, however, I do all these things less often.
Some days that seems good enough. On the days when it doesn't, I give myself the Dad test: Do I see myself, 50 years from now, sitting in a chair in front of the TV, alone and dying, and wondering why my wife and children never saw the wonderful me that existed inside my head?
Not likely.
URL:
articles.health.msn.com/id/100111031/site/100000000/