HealthyGamerGG - Why ADHD Makes You Feel Broken

Episode Date: July 26, 2024

In this video, we learn why ADHD can make individuals feel broken and how societal misconceptions and personal experiences contribute to this perception. Check out more mental health resources here! https://bit.ly/3xsk6fE Learn more about your ad choices. Visit megaphone.fm/adchoices

My brain does not have the capacity to focus. And yet I'm pushing it. I'm pushing it. I am pushing it. And I yield very little. Therefore, I must be fundamentally broken. There's a lack of effort. You need to live up to your potential.

If you just applied yourself, you do so much better. Where is the flaw? Where's the flaw? Where's the flaw? It's inside me. It's inside me. It's inside me. But because we've been trained to conceptualize things in that way if we have ADHD.

Every ADHD or at some point, what if I don't really have ADHD? What if I just have a complex series of personal flaws that map onto ADHD experiences that are incredibly relatable to other people with ADHD and every failing in my life is entirely and unequivocally my fault? Forget about ADHD for a second. This is a very common experience, right? And this experience happens for three reasons.

The first is that when we have flaws and someone tells us, hey, this flaw is due to your ADHD, What our mind actually says is it responds with this. Every failing isn't the ADHD. It is entirely and unequivocally my fault. Okay? So this is where like we don't like to blame our ADHD for our problems. This is number one. Because our understanding of ourselves is consistent with blaming ourselves.

So let's understand literally what happens. In summary, ADHD increases the risk for depression, especially during adolescence and young adulthood. However, it is not well understood why ADHD. increases the risk for depression at this stage. So this is true. This actually we've figured out, okay? So this is a review paper that's looking at cognitive mechanisms underlying depressive disorders in ADHD, a systematic review. And this is sort of looking at how ADHD leads to depression. I have a complex series of personal flaws that map onto ADHD. And every failing in

my life is entirely and unequivocally my fault. And it turns out that the reason people think this way is not because it's true, but because we've been trained to conceptualize things in that way if we have ADHD. So here's why people with ADHD don't think that they have ADHD. They think that they just have a set of very unique personal problems and they don't like to blame their ADHD. Here's you as a kid. And humans are actually pretty good at estimating IQ. Maybe that statement is factually incorrect. I don't know. But generally speaking, like kids can tell when like another kid is smart or another kid is dumb. This may change a little bit later once we start getting PhDs and we use big words.

But generally speaking, like you can tell when someone's stupid, right? And you can kind of tell when someone's smart. So kids go to school and there's a group of kids. And we all sort of recognize that our IQ is in the same ballpark. Now here you have a kid with ADHD and you recognize that I'm about as smart as the other kids. Then what happens is you look at your performance. So this kid gets an A, this kid gets a B, and I get an F. And there are lots of studies that show this.

We go into a lot of the detailed research in Dr. K's guide to ADHD and doing stuff. It's like super scary. So there's a study that looks at, if you look at kids with ADHD and depression, there's one study that found that if you get diagnosed with depression first, there is a 3% chance that you will get diagnosed with ADHD as an adult if you get diagnosed with depression as a kid. If you get diagnosed with ADHD as a kid, there is a 70% chance that you will have depression as an adult. So now you're a kid. And what we know from ADHD is that when you are a kid with ADHD, oftentimes it is not diagnosed.

So ADHD is both the most underdiagnosed and over diagnosed mental illness, in my opinion, which means that we diagnose it a ton in people who don't have it. And we miss it a lot in people who do. So this is also incredibly common for girls. So if you're a girl with ADHD, the rate of diagnosis of girls to boys is one to three. So three boys get diagnosed with ADHD for every one girl gets diagnosed. The interesting thing is that if you look at women to men, this is one to one. So how do we understand this?

Two things. One is that girls usually have a frontal lobe that is developed one year ahead of their male counterpart. So one study showed that if you look at a boy who, a girl at the age of 10 will have like a frontal lobe that's about 11.5 years old versus a boy will have a frontal lobe that's about 10.5 years old at somewhere around 10 years. Okay. So what that means is that when someone is like looking at a boy versus a girl, the girl is like their brains are like one year more mature. Another reason for that we missed a diagnose girls. We, we, miss the diagnosis of ADHD and girls is because the most common symptom that leads to diagnosis is hyperactivity and girls are much less likely to be hyperactive. The third thing that changes is during puberty, we get an increased estrogen alters our dopaminergic circuitry. And so we start to see a lot of like impulsivity and other kinds of like, dopamine seeking activity happen more in women. So there's a puberty effect as well. Anyway, point here is that this kid doesn't get diagnosed.

When this kid doesn't get diagnosed, I want y'all to think about, imagine that you're a seven-year-old child and you recognize that you are just as smart as your friends, but you see that there is a huge performance difference. And then on top of that, what happens is your teachers, your parents diagnose you with an effort problem. They said that you just need to try harder. I don't understand why you can't just study. Why can't you sit still? Why can't you go to bed on time? I've been calling you 15 times. You need to try harder. So I think the single most damaging thing I've seen as a psychiatrist is when someone is doing something completely correctly and you tell them that they are doing it completely wrong. So the single most damaging thing, what really screws people up for

life is when they get taught that up is down and down is up. So I'll give you all a simple example of this. So let's say I have abusive parents and I am doing my best to make them happy, right? So I'm actually like being extra careful. I'm trying extra hard. I'm working extra hard. I don't want my parents to yell at me, but my parents are alcoholics. And so they're drunk and then they yell. And then they blame me even when I don't do anything wrong. So the reason that this is so psychologically damaging is because your brain thinks that doing the right thing is the wrong thing. And then if you go through life thinking that the right thing is the wrong thing, it fucks up so many parts of your life. And we see this also, I see this in like romantic relationships, right, that are abusive,

where there's like one partner who's like, you do everything wrong. But the person is, is like technically doing everything right. So when you get taught that right is wrong and that there is no way to achieve right, this creates learned helplessness. This creates a very confusing way to navigate life. Because then the right answer no longer becomes right. You know, it's like, you want to know how to fuck up people's ability to do finance. in mathematics, you tell them two plus two is five. And they're like, no, I think it's four. And you're like, no, two plus two is five.

Two plus two is five. There's this great scene from Star Trek TNG. Basically, like in this episode, and this is what makes Captain Picard such a Chad. Picard is getting tortured by the Kardashians, Cardassians. And so basically the guy's like, you know, there's four lights and he's like trying to convince that he tortures Picard until Picard says there are five lights. So he's like trying to get Picard to lie. So he's like trying to divorce this person's mind from reality. And what I think is is hilarious and sad about this is in the show, Captain Picard is like very, very resolute, right?

So he's like very strong internally so he can resist torture. And the problem with ADHD is it's the exact opposite. So Picard is like a 65-year-old, you know, starship captain of the flagship of the Federation. And but when you're like six with ADHD, you don't have the internal fortitude of a. 65-year-old fictional character. Like, you just don't have that internal fortitude. So when the rest of the world tells you that you need to be working harder, it really messes you up.

You begin to learn that 2 plus 2 is 5. You begin to learn because everyone around is telling you, everyone around you is telling you that you're screwing up and you need to put forth more effort, right? So let's say that what you see in other people is you see that they have an IQ of 100 and they get an A. You have an IQ of 100 plus X, but you. get an F. So what do you conclude here? You conclude that X must be some large negative number. And this is literally what happens, that we have studies on this. So then what happens is you, you begin to believe

that you have some kind of deficit. There is something wrong with me. There is something fundamentally broken. And when there is something wrong with me and fundamentally broken, this belief is what contributes to the depression. So what happens is people with ADHD carry, they have this learned belief of shame and that there's something I am putting forth so much effort because my brain does not have the capacity to focus. And yet I'm pushing it. I'm pushing it. I am pushing it.

And I yield very little. Therefore, I must be fundamentally broken. This mathematical equation is what I see time and time and time again with ADHD. And now what happens is you carry this belief, even though it's not true, that you have a broken something that is always with you. And when you have a broken something, then what happens is you look at your life and you say, I am broken. There's something every failing is my life, in my life is entirely and unequivocally my fault. This is what happens.

So this is a consequence of ADHD. If you doubt your ADHD in this way, this is the consequence of ADHD. And why do you believe this? it's because when you were failing, no one said something else is wrong, right? The blame got placed on you. There's a lack of effort. You need to live up to your potential. If you just applied yourself, you'd do so much better.

Where is the flaw? Where's the flaw? Where's the flaw? It's inside me. It's inside me. And what happens with these kids, it's super sad. Because at some point, the kid may try to talk to the parent and say, like, I know I'm smart, but they don't know how to articulate, like, I don't know what's wrong with me.

Sometimes they'll say that, right? Actually, that's what they say, literally. They say, I don't know what's wrong with me. But there is something wrong with you. You've got ADHD, right? You're a neurodiverse individual trying to succeed in a neurotypical world. So there's even some evidence when we look at sort of the stress diathesis model of illness. What it presumes is that illness is the result of an environment plus like a genetic risk. Right. So it's not even that something is objectively wrong with you. It is that there is an environmental component to the manifestation. of disease. So you can look at someone who has a predisposition for alcohol, and then you can give them stressful circumstances, you can give them trauma, you can even start them on an SSRI or antidepressant medication. So even the idea that, no, this is not ADHD, this is something that, what if I have a complex of personal flaws that map onto ADHD? You'll see how absurd that is, but this is the way that the mind thinks. And why does the mind think this way? Because it was taught to think that way. Because as a kid, you may have asked or wondered, I don't know what's wrong with me. And no one actually took that question seriously. No one sat down and did a differential

diagnosis. No one stopped to think what could be wrong with this kid. And instead, what we get told, live up to your potential. So there's like this complex that develops in the mind of someone who has ADHD where they think there's just something like, these are all my personal flaws and I have to own them a lot because that's what you were taught. You were taught to blame yourself. And chances are parents don't let you make excuses, right? So they're like, no, you can't make excuses. This is your fault. Now, there are a lot of good parents out there who do allow their children to make excuses.

Those are the kids that get diagnosed. Those are the kids that don't wind up with depression. Right. Remember that the comorbidity between ADHD and depression is somewhere around 30%. Right. So still there's 70% of people out there who don't wind up with depression. Some amount of luck, some amount of genetics, some amount of like whatever the cognitive mechanisms are, then that, you know, underlie the two if you dodge that bull.

it, then you're, you're in good shape. The last thing to consider about this, this like shame of ADHD is experiences that are incredibly relatable to other people with ADHD, right? So you've got like, oh, people say they have ADHD and I have it too. Like, I experience the same thing, but I'm not willing to diagnose myself with ADHD and you shouldn't diagnose yourself. You should go get a clinical evaluation. But, you know, this is exactly what it looks like. This is the manifestation of the shame. I don't, I mean, it's possible that you have a collection of things that perfectly overlap with ADHD, relate to other people's experiences with ADHD, and you still don't accept that you have it.

I think that's completely like normal. I don't think it's correct, but it's a very, very common experience. And it's because of this shame complex. You know, some people are saying, getting on ADHD meds took away more than half of my depression almost immediately. So that's, that can absolutely happen. So a lot of medication, I mean, medication for ADHD is incredibly effective. And it is also doesn't work, doesn't, is not a miracle for like a lot of people out there.

So for some people, they see instant benefits. There's also euphoria component to stimulant medication, which I think elevates people's mood. And yeah, someone else is saying short acting focal and messes me up more than taking nothing. Yeah. So like that's like really common is that there's a highly variable effect, especially for women. Female side of pharmacotherapy for ADHD a systematic review. Several sex differences are demonstrated in the prescription, usage and efficacy, effectiveness of both stimulant and non-stimulant ADHD pharmacotherapy. A single daily use of, this is probably methylphenidate, may possibly not be optimal for girls with ADHD, and admoxatine may be a promising medication for girls and women with ADHD.

And the reason for that is really simple is I want y'all to think a little bit about how ADHD drugs are developed. So what is the most, what is the symptom or sign, it's really a sign that correlates the most with ADHD diagnosis is it is hyperactivity. And so what do we really look for? What makes a parent or a teacher happy with a medicated child? It is the reduction of hyperactivity, right? So the kid fucking sits in their seat. The kid stays seated during dinner. The kid isn't running around all over the place.

Thank God they're finally medicated for their ADHD. So when this is the main sign that we're looking to treat and then we develop a stimulant medication, turns out stimulants are very good at dealing with hyperactivity. The problem is that hyperactivity is more common in boys than in girls. So the medication was developed specifically for, not specifically for hyperactivity, but that's a huge part of the efficacy of the medication, and it applies more to boys than girls, so the mileage for girls varies quite a bit.