See Something, Say Something, Do Something

My New Year’s Resolution for 2024 was to get my proverbial house in order. The house, in this case, being a checklist of physical and situational concerns that I’d been ignoring for too long. Assuming natural causes get me in the end, I’m approaching the half-way point of my existence, and the thought of doing another four to five decades in my current physical state seemed…unwise.

But my body wasn’t my only problem, which was how I found myself waiting to see my medical group’s in-network psychiatrist. A nurse took my weight and my blood pressure, and before I could question whether or not I had the right appointment, moved me from the examination room to a small, closet-like office. The psychiatrist’s name didn’t match the name on the door, and she was the first doctor I’d ever seen (professionally) who was visibly younger than myself. I started having those old person thoughts like, ‘What in the Doogie Howser,’ and ‘God, when did she graduate medical school, yesterday?’ and then I started to hate myself, so I was ripe for the psyching.

This wasn’t my first attempt to see a psychiatrist. A few years ago, when the world shut down and we all spent time getting more introspective than was strictly healthy, I started saving sympathetic anecdotes I found online to a Pinterest board. It wasn’t long before I noticed the algorithm had picked up a theme. But surely, I argued to myself, it was just a coincidence that I found those tales of ADHD so relatable.

This is a familiar refrain in certain corners of the internet¹: I’m fast-approaching forty, and until just a few years ago, I never even considered the possibility of having ADHD. Attention Deficit Hyperactivity Disorder, or simply Attention Deficit Disorder as it was still known when I was in school, was the exclusive purview of 6-12 year-old boys. In the 90s I had newly diagnosed friends and they were wild things, unable to sit still for five minutes, constantly in motion, occasionally prone to throwing erasers, or markers, or chairs. As a polite, precocious girl who earned good grades and stayed out of trouble, I was about as far from the stereotype as it was possible to be. I loved to read; I was never impulsive; I was “a pleasure to have in class,” the rubric against which other, more disruptive children were measured². I was a teacher’s pet and goody-two-shoes. I was a mother-fucking angel in the school choir’s holiday show.

No one, including me, realized my ‘good behavior’ was born from a pathological fear of doing something wrong, raised on a diet of incessant calculations to identify what the ‘right’ behavior might be to survive school and social situations. No one noticed when I wasn’t paying attention to a discussion because I was too busy inventing a dialogue tree to anticipate the conversation’s conclusion. No one considered that I was quiet in class because I spent my time day-dreaming, making up stories or rewatching movies in my head while the teacher explained pre-algebra.³ When I started failing the advanced math classes in middle school, it was because ‘my brain hadn’t developed enough for the higher concepts yet.’ When I got caught reading non-textbooks under my desk in French class, it was a quirk rather than a punishable offense. Hey, at least I was reading.

And, I was Gifted.

Not in the 2017-2019 Fox-pseudo-X-Men way, unfortunately. Just clever enough as an 8-year-old to pass an IQ test I probably couldn’t pass today. While it put a target of expectations on my back, it also provided the ultimate cover for a girl whose ‘gift’ turned out to be half-assing schoolwork. By passing from one grade to the next with an aura of ‘Gifted,’ the burden of proof was on everyone else. It was almost a form of hypnosis; yes, that five-paragraph essay was written at the absolute last minute and despite many well-crafted sentences doesn’t really back up its argument about Oedipus and destiny, but have you considered — I’m Gifted? Yes, thank you, I’ll take an A.⁴

As John J Ratey, M.D. and Edward M. Hallowell, M.D. point out in their book, Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder From Childhood Through Adulthood (Anchor Books, 2011), ADD/ADHD was a relatively unknown condition until the beginning of the 21st Century. We can look back and recognize the signs in figures throughout history, but it didn’t have a name until the 1900s, and most of the research of the last hundred years centered around squirming male children. It would have been ridiculous for a teacher in the 90s or 00s with 40 kids to a classroom to look at my grades and general compliance, and suggest I should be tested for something with ‘hyperactivity’ in the name.

Even twenty-five years later there were skeptics. The first time I tried to get a diagnosis, after the Great Mental Health Crisis of 2020, I spoke to a psychiatric nurse practitioner over a video call. This practice had taken over management of my anti-depressants from my primary care doctor, and I thought it worth broaching the ADHD of it all.

“I don’t think you have ADHD,” she said with a wave of her hand during our 15-minute meeting. “You aren’t fidgeting, you’re making eye contact.”

I thought that was presumptive considering she couldn’t see my hands, the way I played with my jewelry, or picked at my nails, but that was that. I didn’t have ADHD after all. Though I decided to avoid that practice going forward, I also believed I’d let myself get sucked into the mental health version of a Web M.D. self-diagnosis. After all, if I had ADHD someone would have said something by that point, right?

But my version of thrill-seeking behavior wasn’t fast cars or playing with matches; it was the game I played to see if my intelligence would compensate for my apparent apathy. I used to brag about my ability to procrastinate, unaware that I was chasing the adrenaline response of getting as close to the line as I could without going over. It manifested as completing my history homework fifteen minutes before it was due. It showed in failing to turn in my science worksheets for an entire semester (but getting an opportunity to make it up because I was ‘going through something.’⁵) It appeared as forgetting to do an English project worth a quarter of my grade and trading on my reputation as a lover of books to earn Benefit of the Doubt and a three week extension. Sure, the guilt and anxiety in the face of failure kept me up at night, but that same fear drove me. I spent most of my school career waiting to see how far I could ride the Smart Train before someone realized my ticket was forged.

No one ever did. Instead of considering any kind of neurodivergence, I became haunted by the phrase, “Smart, but lazy.” Capable of more, but unmotivated. Well, fear of failure was my motivator, so I tested well enough, and graduated high school with a decent grade point average and a college acceptance letter. Similarly, I graduated college magna cum laude – good, but not as exceptional as might behoove The Gifted. And maybe I lived with an elephant in the room called Potential, but once I had a Bachelor’s degree, my parents chose to focus on encouraging my creativity. The train kept running.

Unfortunately my creativity also failed to live up to its potential, as my nascent career as a professional writer never got off the ground. I assumed my post-college reluctance to get out of bed, or my inclination to sit on the couch and watch reruns of Golden Girls, was due to a simple lack of effort or even a symptom of depression. Never mind that my brain was still constantly racing, churning, begging my body to get up and do the things I had to do or the things I wanted to do, instead of listening to a St. Olaf story I’d already heard a dozen times. Now I call it executive dysfunction, but as a fresh college graduate with plenty of time on my hands, I couldn’t understand why I seemed incapable of writing without a workshop deadline.⁶ Or why reward systems for work never worked for me. Or why it seemed impossible to stick with any hobbies for longer than a year.

So how did I find myself sitting opposite the world’s youngest psychiatrist, babbling answers to her questions, and hoping I was doing it right, while simultaneously wondering if I was trying too hard and thus faking it after all? The Tumblr anecdotes were a start, but surely everyone let vegetables rot in the crisper, and surely everyone struggled with object permanence, and surely everyone felt exhausted all of the time because their brain Never. Shut. Down. What changed?

One simple little word: inattentive.

In 1994 the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) introduced subtypes to the definition of ADHD, including “predominantly inattentive,” which was a fancy way of saying the hyperactivity manifested in the mind, not the body. And when, in my digital clipping of funny Tweets and threads to my virtual corkboard, I came across multiple sources claiming ADHD Inattentive Type occurred frequently in women, and thus my ability to sit still for an hour was not evidence to the contrary, I started to pay attention.

The reluctance I had to self-diagnose faded. My digital board of evidence grew as I considered traits of mine through a new lens: I was habitually ten minutes early to events and appointments – not because I was organized, but because I was terrified of being late.⁷ My short temper in the face of losing control could be “poor frustration tolerance,” and not just a character flaw. Though the research is limited, there’s a significant overlap between ADHD and premenstrual dysphoric disorder (PMDD) which I was diagnosed with in high school. There’s an even higher occurrence of comorbidity between ADHD and anxiety, which had been eating away at me for years.

Though I didn’t know what, if anything, would change with an official diagnosis, I thought having certainty would bring relief, one way or another. At the same time, the closer I got to knowing, the more I worried that I’d turn up to the psychiatrist’s office only to be told, “Sorry, no ADHD, you’re just lazy. Gifted, but lazy.” Guilt started to churn; was I just seeking a diagnosis as a way to excuse a lack of discipline? In the months leading up to the appointment, I reviewed the stories that brought me to that point and looked for all the places where my experiences didn’t line up. I prepared a defense against anyone who might say, “But you don’t fidget.”⁸ “You’re not impulsive.”⁹ “You have no trouble sitting and reading a book.”¹⁰

Some of those defenses came up preemptively as I responded to the psychiatrist’s questionnaire. She tragically lacked a sense of humor, which only made me more nervous, as my go-to for easing tension received no response. I wanted to cover all my bases, make sure I was being assessed on all the evidence, and not just whatever I could remember in that moment.¹¹ I was prepared to open my Pinterest app and read from the saved stories, as other people had said it so much better than I could in that office.

It wasn’t a particularly long interview, and at the end of it, the doctor started discussing options for treatment.

“Wait, just so I’m clear, you do think I have ADHD?”

“Yes, I do,” she said, and started telling me about medications. I sat back in my chair, let out a breath, and began the next chapter of my life.

1. Primarily the female-leaning ones. ↩︎
2. My fourth grade teacher sat me next to the most out-of-control student in the class, in the hope that I’d be a good influence. That kid almost stabbed me in the eye with a pencil. ↩︎
3. If you were a kid who counted the number of students ahead of you when it was time to read out loud and compared that to the number of paragraphs in order to predict your turn, particularly so you could tune out until you were called on, welcome. ↩︎
4. Maybe I did have a mutant power after all. ↩︎
5. I was going through something. It was called 7th grade. ↩︎
6. I went back to school and got a master’s degree just so someone would tell me I had to write. ↩︎
7. I judged tardiness in everyone else; if I could manage to be on time (by virtue of padding every excursion by 30 minutes) then what was their excuse? ↩︎
8. What I do is mask really, really well. ↩︎
9. Tell that to my grocery budget. ↩︎
10. Reading is actually a form of multi-tasking – while I’m processing the words I’m also picturing the scene. And I have a familiar ADHD tendency to skip ahead to a future paragraph before realizing I didn’t finish reading the paragraph before it. I expect ‘speed-reading’ is common amongst ADHD bibliophiles. ↩︎
11. Poor memory was another ADHD symptom that really resonated with me. My inability to remember large swathes of my life really derailed my aim to be a memoirist. ↩︎