After being asked to do so by a conflict therapist, my brother just got an ADHD diagnosis this summer, at age 58. He has led a life full of conflict, with me and many others. He faced a staff rebellion at work and was reprimanded, was divorced and fired from his own book club. He is lonely and remains in a relationship with a woman who he says treats him poorly, for that reason.
Unfortunately, he also has built a bullet proof narrative that his behaviour isn't related to his isolation.
He manifests what seems like RSD. His brain instantly erases memories which reflect poorly on him, so he never learns from experiences. I am not qualified to know whether this is ADHD or deliberate cognitive dissonance management, but it is infuriating.
Bro tells himself that he has managed his ADHD really well. He even suspected during 6 years of therapy that he had ADHD, but he never investigated, because he didn't want to feel "more broken". He says his marriage was solid, despite ending in divorce and creating a very hostile former wife, because any other conclusion would be "devastating" to him.
Having recently received a long letter from him, quoting bible passages and insisting that I need to change, I find myself in a dilemma.
I have come to the point where I do not want more face to face contact with him, as long as he remains untreated, but I cannot oblige him to seek treatment. We do not live in the same city, so we do not run into each other. Although we can talk on the phone, our relationship doesn't work in person because of his low empathy, low self awareness and high impulsiveness.
I believe if I respond to him and make our relationship conditional on his getting treatment, which probably means medication, he is likely to respond with great anger and more biblical quotations about forgiveness, because he cannot accept responsibility for his behaviour.
Yet I do not want to just slink out of his life with no explanation, as he is my only brother.
This is how i felt about ADHD... before it became a crazy. Its almost become a culture bound syndrome. Now its literally every single adult intake who cant focus, maxes out ASRS scales and your questions, recalls "always" struggling with focus and attention. By the time these intakes get to psychiatry, they have thoroughly investigated the diagnosis. They know A LOT about it. Their memories start to get colored to reinforced their belief of having this diagosis. "I took a stimulant and it helped". I disagree people want to get "High". There are some who will abuse it. Id argue its more for (perceptions of) performance enhancement and energy. Even if you dont have ADHD and taking a stimulant - its going to make one FEEL that they are doing better. At least in the beginning until the tolerance kicks up.
Testing is another supportive feature to back up a dx instead of giving everyone who asks for stimulants stimulants. The truth is we weren't there in their childhood and have no idea how they functioned. It remains a neurodevelopemental diagnosis that CAN persist into adulthood. For those who do have missed ADHD diagnosis through adulthood, I do feel for because of all of the roadblocks, but its very unlikely to be every single intake. As below said, "Most people don't make til 45-50, and have successful life with adhd"
ADHD dx has unfortunately dichotomized into 1) What's the big deal, treat the inattention and give stimulants out. They aren't that bad. [...They're not?] 2) You can focus, you just don't want to and trained yourself not to. You don't need stimulants, you made it this far. You just need to change your behaviors [...Oh, wow okay thanks for the wake up call. So easy!].
We really need better guidelines here. Above is notorious in both psych and primary care. Without biomarkers, its hard to over/under diagnose, but I would argue its over treated. The more lenient we are with the diagnosis, the more right were going to move that 10% on the far end of the spectrum. Were going to have an entire country on stimulants (with a huge shortage as it is). As prescribers we became the gatekeepers of stimulants.
Part of the problem, as I see it, is that people have conflated stimulant treatment with a diagnosis of ADHD, as opposed to making a diagnosis that isn't predicated on what the presumed treatment is. Adult adults with ADHD who need to understand their diagnosis, but might not benefit from treatment with stimulant medication's, or might not want to tolerate them, or not have the risk be worth the benefits.
I was diagnosed 25 yeas ago..now every mom around me has adhd. I seriously think in this age group it's not adhd and Perimenopause.
I also think electronics have a great deal with the numbers. I don't think 15% of population has adhd and its really 4% but tiktok, etc makes everyone feel it. I also married a man who has adhd( not diagnosed in 70s but he was given ritalin) and have a kid with severe presentation. Everyone is better on amphetamines ( Joel Paris has a fantastic book examining overdiagnosis in psychiatry) ironically I can't take the meds anymore due to raynauds syndrome and Perimenopause making my heart wonky. Most people don't make til 45-50, and have successful life with adhd so I seriously feel it's overdiagnosed. Also for kids, esp ASD or the tourettes triad stimulants aren't the best choice and they have much higher percentage of diagnosis then other kids. We're they included in study or removed.
After being asked to do so by a conflict therapist, my brother just got an ADHD diagnosis this summer, at age 58. He has led a life full of conflict, with me and many others. He faced a staff rebellion at work and was reprimanded, was divorced and fired from his own book club. He is lonely and remains in a relationship with a woman who he says treats him poorly, for that reason.
Unfortunately, he also has built a bullet proof narrative that his behaviour isn't related to his isolation.
He manifests what seems like RSD. His brain instantly erases memories which reflect poorly on him, so he never learns from experiences. I am not qualified to know whether this is ADHD or deliberate cognitive dissonance management, but it is infuriating.
Bro tells himself that he has managed his ADHD really well. He even suspected during 6 years of therapy that he had ADHD, but he never investigated, because he didn't want to feel "more broken". He says his marriage was solid, despite ending in divorce and creating a very hostile former wife, because any other conclusion would be "devastating" to him.
Having recently received a long letter from him, quoting bible passages and insisting that I need to change, I find myself in a dilemma.
I have come to the point where I do not want more face to face contact with him, as long as he remains untreated, but I cannot oblige him to seek treatment. We do not live in the same city, so we do not run into each other. Although we can talk on the phone, our relationship doesn't work in person because of his low empathy, low self awareness and high impulsiveness.
I believe if I respond to him and make our relationship conditional on his getting treatment, which probably means medication, he is likely to respond with great anger and more biblical quotations about forgiveness, because he cannot accept responsibility for his behaviour.
Yet I do not want to just slink out of his life with no explanation, as he is my only brother.
Thanks for reading. These problems can be disruptive.
This is how i felt about ADHD... before it became a crazy. Its almost become a culture bound syndrome. Now its literally every single adult intake who cant focus, maxes out ASRS scales and your questions, recalls "always" struggling with focus and attention. By the time these intakes get to psychiatry, they have thoroughly investigated the diagnosis. They know A LOT about it. Their memories start to get colored to reinforced their belief of having this diagosis. "I took a stimulant and it helped". I disagree people want to get "High". There are some who will abuse it. Id argue its more for (perceptions of) performance enhancement and energy. Even if you dont have ADHD and taking a stimulant - its going to make one FEEL that they are doing better. At least in the beginning until the tolerance kicks up.
Testing is another supportive feature to back up a dx instead of giving everyone who asks for stimulants stimulants. The truth is we weren't there in their childhood and have no idea how they functioned. It remains a neurodevelopemental diagnosis that CAN persist into adulthood. For those who do have missed ADHD diagnosis through adulthood, I do feel for because of all of the roadblocks, but its very unlikely to be every single intake. As below said, "Most people don't make til 45-50, and have successful life with adhd"
ADHD dx has unfortunately dichotomized into 1) What's the big deal, treat the inattention and give stimulants out. They aren't that bad. [...They're not?] 2) You can focus, you just don't want to and trained yourself not to. You don't need stimulants, you made it this far. You just need to change your behaviors [...Oh, wow okay thanks for the wake up call. So easy!].
We really need better guidelines here. Above is notorious in both psych and primary care. Without biomarkers, its hard to over/under diagnose, but I would argue its over treated. The more lenient we are with the diagnosis, the more right were going to move that 10% on the far end of the spectrum. Were going to have an entire country on stimulants (with a huge shortage as it is). As prescribers we became the gatekeepers of stimulants.
Crucial points all! This is why I write about non pharma options
PS It was a really good read, I forgot to add that.
How inattentive of us!
Part of the problem, as I see it, is that people have conflated stimulant treatment with a diagnosis of ADHD, as opposed to making a diagnosis that isn't predicated on what the presumed treatment is. Adult adults with ADHD who need to understand their diagnosis, but might not benefit from treatment with stimulant medication's, or might not want to tolerate them, or not have the risk be worth the benefits.
I was diagnosed 25 yeas ago..now every mom around me has adhd. I seriously think in this age group it's not adhd and Perimenopause.
I also think electronics have a great deal with the numbers. I don't think 15% of population has adhd and its really 4% but tiktok, etc makes everyone feel it. I also married a man who has adhd( not diagnosed in 70s but he was given ritalin) and have a kid with severe presentation. Everyone is better on amphetamines ( Joel Paris has a fantastic book examining overdiagnosis in psychiatry) ironically I can't take the meds anymore due to raynauds syndrome and Perimenopause making my heart wonky. Most people don't make til 45-50, and have successful life with adhd so I seriously feel it's overdiagnosed. Also for kids, esp ASD or the tourettes triad stimulants aren't the best choice and they have much higher percentage of diagnosis then other kids. We're they included in study or removed.