Thoughts on explaining brain fog that doesn’t fit ADHD stereotypes to a psychiatrist [avoid if discussion of stimulant medication, psychiatry, or brain fog causes you distress]
I had an illuminating conversation today with a psychiatrist, trying to explain what I call my “bad brain days.”
It helped me understand where neurotypical professionals can get confused and misunderstand, when trying to help people with ADHD get unstuck.
I have days where I don’t have the energy to do anything mentally taxing, especially writing. Should I attempt to write, I just sit there expending willpower, yet nothing comes out, until I get frustrated and give up.
Now, I forget this sometimes, but getting stuck like this can come with many different internal experiences. Some people with ADHD get stuck because they feel anxious and overwhelmed. Some get stuck because they are constantly interrupted by distracting thoughts or sensory stimuli. Some just can’t get motivated. The psychiatrist, being a thoughtful and caring person, asked if each of these different ADHD problems was what I experienced.
I told him, they were not. Well, I have experienced each of these things, but they’re not what I mean by a bad brain day, or brain fog, or fatigue. Moreover, I can deal with them if I’m not having one of these bad brain days.
Rather than constant racing thoughts, or distracting sensations, I experience a complete mental blank. The only thing I experience (other than frustration and anxiety about being in this state) is a feeling of painless pressure inside my head, as if the space that would normally be filled with thoughts were stuffed with cotton balls. I forgot to tell him, but I move slowly, too. It takes a while to reply when people talk to me, and if I try to play a real-time video game, I get killed constantly.
It’s as if everything–thinking, moving, and most of my emotions and conscious perception–ceased to function for no apparent reason, and I lost access to all the capabilities I normally have. Ironically, I even lose most of my capability to get distracted.
I told him what it was like to sit on the couch and will yourself to stand up and not be able to do so. As if your actions were a horse and your will were a rider and the reins had been cut, as someone on Tumblr memorably put it. To finally get back the ability to move by forcibly, with agonizing effort, moving your little finger or toe the tiniest fraction.
I told him, this isn’t distraction, this isn’t anxiety, and it’s not lack of motivation. It happens when I want to do things, they’re important and urgent, and I’m telling myself to do them with every bit of willpower I can muster. What I’m experiencing seems more like the fatigue people with certain chronic illnesses describe, only I have yet to discover any organic cause for my fatigue, and perhaps there isn’t one.
It’s like a car, I said. Suppose you have a really nice sports car and you’re a great driver, but you can’t get the car to start.
Now, suppose your sports car has brakes and steering that act up sometimes. You’re a good driver and you’re used to the car, so you can handle that. But you can’t even get to dealing with that if you can’t start the car in the first place.
And that’s where I get stuck. Yes, I struggle with time estimation, organization, and remembering to remember, but I can deal with those, so they don’t disable me as much. But all my knowledge about ADHD and coping strategies don’t work when I can’t muster the energy to move or think, much less implement those strategies.
He tried to paraphrase, saying something like, “so it’s trouble getting started?”
Well, yes, but not entirely. It’s trouble getting started. It’s trouble continuing. It’s trouble stopping, and trouble switching. It’s trouble doing anything but playing Sudoku, looking at Pinterest, or browsing Twitter and Tumblr. Or sleeping.
That’s why I take stimulant medications and drink coffee.
He asked what happened when I took stimulants. What sort of effects did I feel like they had?
Without them, on a bad brain day, I’d be at 10-20% of my capabilities. With them, I’m up to maybe 40-50%. Not enough to write, but enough to take care of myself, even clean up around the house a bit. Enough to feel alive.
I doubt he’ll ever fully know what this feels like, but I think I was able to communicate that there’s yet another way to get stuck, besides the ones he knows well. I think he knows what he calls “activation” and I call “lack of energy” causes me more distress than any other ADHD symptom. I’m grateful that he asked, and hope he’ll be better prepared to help others who have energy problems like mine.