7 ms·

Why do you presume I'm neurotypical and undiagnosed with any psychiatric disorder? I'm formally diagnosed with severe OCD, depression, and ADHD. I was on SSRI,

Why do you presume I'm neurotypical and undiagnosed with any psychiatric disorder? I'm formally diagnosed with severe OCD, depression, and ADHD. I was on SSRI, then SNRI and additionally methylphenidate for years. Eventually I got tired for feeling like a shell of a human being, and weaned off of the SNRI. It took a lot of effort to induce neuroplasticity and ease my OCD and depression, but I did it. Eventually, I weaned off the methylphenidate because I believed I could do it if I tried. Later in life, I also gained and eventually lost weight, which was a similar acceptance that "bad" things, like hunger, are ok and a symptom of something good, my body consuming fat. Then the same for sore muscles at the gym. Over time, I accepted discomfort and the fight or flight my brain was constantly trying to force onto me was a lie, and eventually my brain and nervous system caught up. My physical and mental health improved, my social life, my professional life, etc. I bet if you knew your house would burn down if you didn't do "normal" things you would have done them no problem. Stimulants make otherwise unenjoyable things enjoyable? Who would have thought? Do you think people that do "normal" things enjoy them? Is it necessary to enjoy everything all the time?

interstice 1y ago
If I knew my house would burn down if I forgot where my keys where it wouldn't do much more than turn me into a paranoid barely functional mess. Higher stakes do not automatically help. Although ironically part of being ADHD is functioning well in high stakes situations, it's not healthy to create high stakes situations in order to function (although some people do this).
- BenjiWiebe 1y ago
  This is one of the most personally compelling reasons why I agree with my ADHD diagnosis - I've known for a long time that I work better in a state of chaos than not. I actually often enjoy it. And others have commented on that about me as well. Edit: by chaos I mean things breaking down, going wrong, catching fire, etc. I accomplish things easily once I've taken so long to get to them, that they're seriously urgent.
bgilroy26 1y ago
>I bet if you knew your house would burn down if you didn't do "normal" things you would have done them no problem Getting yourself to do things in a boring situation that you might only do in an exciting situation is a big challenge in ADHD management If everything was a "house on fire" level emergency, many ADHDers would get more done but would eventually collapse from running around on adrenaline for days These problems are not easily solved
- suggestion 1y ago
  The point is it's obviously a problem of perspective. Things are not important because they aren't considered important. If the stakes are higher they are elevated in importance and more demanding of attention. To pretend that humans are hedonic beasts incapable of cognitive adaption is ridiculous. We do not operate purely on impulse save for pharmaceutical intervention. We can force ourselves to give things more or less importance regardless of the actual stakes.
  - rini17 1y ago
    You are forgetting what people did before psych meds were available. Almost everyone treated themselves with alcohol and tobacco. Coffee is up there, too. There is cognitive adaptation, not denying it, but only up to a point.
    - suggestion 1y ago
      Tobacco didn't exist for most of the world until the 17th century and you're discounting the fact that life was objectively much worse by virtually every metric. People were constantly bombarded with death, disease, things like starvation were near term risks, violence was everywhere, etc. You're also overestimating the prevalence of alcoholism. Alcohol consumption was largely driven by safety and necessity, not abuse. Alcoholism was arguably more of a social stigma historically than it was today, certainly with harsher criminal penalties in many societies.
  - elcritch 1y ago
    And living, or rather surviving, on adrenaline fueled high stakes brinkmanship sucks. Especially if that's just to enable doing simple chores.
maximilianburke 1y ago
Just because something works for you to lead a normal life doesn’t mean it works for everyone.
- suggestion 1y ago
  What the DSM defines as normal is far too narrow and we're too eager for quick fixes without discomfort or discipline.
  - autoexec 1y ago
    A person's treatment doesn't depend on what's "normal" it depends on the level of impairment/improvement. Why do you even care if somebody takes medication for a condition they have and it makes their lives easier? Why should anyone avoid a "quick fix" to a major problem because you think they should suffer more discomfort?
    - suggestion 1y ago
      East Asians are "impaired" the least, and the presumption among Western scientists, particularly American scientists regarding Asian Americans, is that they are simply undiagnosed despite their out performance in nearly every metric of success. Why do you think that is?
      - autoexec 1y ago
        I'm sure it must have nothing at all to do with cultural stigma. If that were true we'd see signs of mental struggles in their home countries. In the US I'm sure all the model minority bullshit people project on them doesn't cause them any extra pressure or anxiety right? Asian Americans are so successful that they certainly must not have disproportionately higher rates of suicide right? That might be a sign of some "impairment" going unaddressed! Or maybe you see the rate at which they're killing themselves as yet another metric of success? Those scrappy East Asians are just so good at doing stuff!
KPGv2 1y ago
> Why do you presume I'm neurotypical and undiagnosed with any psychiatric disorder? Because you talk like one, with no apparent empathy for the neurodiverse, except perhaps people with profound issues. "We shouldn't treat any problems except the catastrophically bad." Gross. > I bet if you knew your house would burn down if you didn't do "normal" things you would have done them no problem. This is not arguing in favor of your stance, but rather in favor of mine. You're essentially saying "ADHDers can't get shit done without being in dangerous situations, and THAT IS ACCEPTABLE." And yet you think this supports your idea that non-catastrophic disorders shouldn't be treated.
- suggestion 1y ago
  [flagged]
  - BenjiWiebe 1y ago
    This sounds to me like getting into "You say you're depressed? Come on, snap out of it!" territory. I guess I consider psychological disorders to be a disorder when you aren't able to "snap out of it" or "just do things that are unpleasant". Like yes, I do things that are unpleasant - ADHD doesn't mean I live a life of ease, avoiding unpleasantness all day long.
  - dns_snek 1y ago
    > You can accept the discomfort and move through it just like you do when the stakes are actually high. Just like I do. Have you ever considered that the things which you find doable or even trivial might be incomprehensibly more difficult for other people? You mentioned being diagnosed with ADHD higher up, but part of the diagnostic criteria for ADHD is quite literally about severity of the symptoms: DSM-5: "There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning." ICD-11: "Several symptoms of inattention/hyperactivity-impulsivity that are persistent, and sufficiently severe that they have a direct negative impact on academic, occupational, or social functioning" Being capable of pushing through basic adult responsibilities, regardless of discomfort and difficulties (without burning yourself out!), and failing to do so to the degree that it severely negatively affects your life is the defining line between "order" and "disorder". If you have a very demanding job then you might experience symptoms that are consistent with ADHD. That's why the diagnostic process is supposed to verify that there's a clear history of symptoms ranging back to your teenage years (or earlier) and that your symptoms aren't being caused by general life stressors. > The idea that everything in life should induce minimal discomfort or that "it's hard" is an excuse is a completely modern, first world problem, to speak of privilege. No, the idea is that people should receive help if we have a neurodevelopmental disorder that is severe enough to significantly impact our quality of life. Just like with any other medical condition. > Mindfulness and thinking about your thoughts are proven as effective or more effective than medication for a wide range of psychological disorders, including ADHD, or CBT if you want to formalize it. False: > CBT is best used within a multi-modal treatment approach and as an adjunct to medication as current research does not fully support the efficacy of CBT as a sole treatment for adult ADHD [274,[316], [317], [318]]. Most controlled studies have been conducted in patients taking ADHD medication and demonstrate an additional significant treatment effect [313,[318], [319], [320], [321], [322]]. The largest controlled multi-center CBT-study to date has demonstrated that psychological interventions result in better outcomes when combined with MPH as compared to psychological interventions in unmedicated patients [228]. In a systematic review of 51 pharmacological and non-pharmacological interventions [316], the highest proportion of improved outcomes (83%) was for patients receiving combination treatment. https://www.sciencedirect.com/science/article/pii/S0924933818301962 https://www.sciencedirect.com/science/article/pii/S092493381...
antonvs 1y ago
So your answer to mental health issues is “git gud”?
ohthehugemanate 1y ago
That's a hell of a journey! Congratulations on the accomplishment and thank you for sharing. Like many other biological systems, neurological wiring is multidimensional and not a natural fit into our arbitrary culturally defined abstractions, or even language. And the dimensions themselves are multifaceted expressions of multiple genes and environmental factors. I am happy to hear stories like yours, of people who can ultimately achieve "normal" functional parity without medication. Have you considered if that would have been possible without the journey? Had you, on day 1, cancelled that first therapist appointment and decided to grit your teeth and "try" instead, could you have "accepted discomfort" on your own? Or is it possible that the methylphenidate created supportive conditions that improved your chances? I ask because there is a body of well reproduced research demonstrating not only that ADHD patients have specific genetic and neurobiological differences from neurotypicals in areas associated with executive function, but that long term ADHD medication use can permanently bring the neurological differences into line with neurotypical controls. Something like 20% of medicated childhood ADHD patients can ultimately stop medication without losing points in functional testing or the associated brain structures. It's a lower percentage in adults and less well studied, but still exists. It's a big difference from the results of every non-chemical intervention we've studied, which have single digit efficacy percentages if they beat P at all. I'm interested in your feelings about this because ADHD is by far the most-studied psychological disorder in the world, and ADHD medications as a group are not only equally well studied, but also the most successful and least harmful of any psychiatric drug. There are more safety and efficacy studies for ADHD medication than for ibuprofen. So... if you feel your recovery was not helped by the neurogenetic compensations provided by methylphenidate, you should know that you are flying so far in the face of some of the best-validated medical science, that you imply invalidity of pharmaceutical or medical science as a whole. ... which is fine of course - it's your body and brain! But I bet it would help readers to know how you think this aligns with the science, or maybe what you think of medical science altogether. Questions like "Do you take ibuprofen?" And "Do you vaccinate?" Become relevant.
- suggestion 1y ago
  Yes I have and it was just as difficult post medication as it was pre. Ironically, while on the SNRI my ADHD was "worse" due to the sheer apathy I felt about literally everything, so I was prescribed to help me "focus" and be "motivated". You're leaving out the part about being "well studied" paired with your conclusions is almost exclusively in American and Western European populations, things are significantly less clear in other populations and cultures.

interstice 1y ago

If I knew my house would burn down if I forgot where my keys where it wouldn't do much more than turn me into a paranoid barely functional mess. Higher stakes do not automatically help. Although ironically part of being ADHD is functioning well in high stakes situations, it's not healthy to create high stakes situations in order to function (although some people do this).

BenjiWiebe 1y ago
This is one of the most personally compelling reasons why I agree with my ADHD diagnosis - I've known for a long time that I work better in a state of chaos than not. I actually often enjoy it. And others have commented on that about me as well. Edit: by chaos I mean things breaking down, going wrong, catching fire, etc. I accomplish things easily once I've taken so long to get to them, that they're seriously urgent.

bgilroy26 1y ago

>I bet if you knew your house would burn down if you didn't do "normal" things you would have done them no problem Getting yourself to do things in a boring situation that you might only do in an exciting situation is a big challenge in ADHD management If everything was a "house on fire" level emergency, many ADHDers would get more done but would eventually collapse from running around on adrenaline for days These problems are not easily solved

suggestion 1y ago
The point is it's obviously a problem of perspective. Things are not important because they aren't considered important. If the stakes are higher they are elevated in importance and more demanding of attention. To pretend that humans are hedonic beasts incapable of cognitive adaption is ridiculous. We do not operate purely on impulse save for pharmaceutical intervention. We can force ourselves to give things more or less importance regardless of the actual stakes.
- rini17 1y ago
  You are forgetting what people did before psych meds were available. Almost everyone treated themselves with alcohol and tobacco. Coffee is up there, too. There is cognitive adaptation, not denying it, but only up to a point.
  - suggestion 1y ago
    Tobacco didn't exist for most of the world until the 17th century and you're discounting the fact that life was objectively much worse by virtually every metric. People were constantly bombarded with death, disease, things like starvation were near term risks, violence was everywhere, etc. You're also overestimating the prevalence of alcoholism. Alcohol consumption was largely driven by safety and necessity, not abuse. Alcoholism was arguably more of a social stigma historically than it was today, certainly with harsher criminal penalties in many societies.
- elcritch 1y ago
  And living, or rather surviving, on adrenaline fueled high stakes brinkmanship sucks. Especially if that's just to enable doing simple chores.

maximilianburke 1y ago

Just because something works for you to lead a normal life doesn’t mean it works for everyone.

suggestion 1y ago
What the DSM defines as normal is far too narrow and we're too eager for quick fixes without discomfort or discipline.
- autoexec 1y ago
  A person's treatment doesn't depend on what's "normal" it depends on the level of impairment/improvement. Why do you even care if somebody takes medication for a condition they have and it makes their lives easier? Why should anyone avoid a "quick fix" to a major problem because you think they should suffer more discomfort?
  - suggestion 1y ago
    East Asians are "impaired" the least, and the presumption among Western scientists, particularly American scientists regarding Asian Americans, is that they are simply undiagnosed despite their out performance in nearly every metric of success. Why do you think that is?
    - autoexec 1y ago
      I'm sure it must have nothing at all to do with cultural stigma. If that were true we'd see signs of mental struggles in their home countries. In the US I'm sure all the model minority bullshit people project on them doesn't cause them any extra pressure or anxiety right? Asian Americans are so successful that they certainly must not have disproportionately higher rates of suicide right? That might be a sign of some "impairment" going unaddressed! Or maybe you see the rate at which they're killing themselves as yet another metric of success? Those scrappy East Asians are just so good at doing stuff!

KPGv2 1y ago

> Why do you presume I'm neurotypical and undiagnosed with any psychiatric disorder? Because you talk like one, with no apparent empathy for the neurodiverse, except perhaps people with profound issues. "We shouldn't treat any problems except the catastrophically bad." Gross. > I bet if you knew your house would burn down if you didn't do "normal" things you would have done them no problem. This is not arguing in favor of your stance, but rather in favor of mine. You're essentially saying "ADHDers can't get shit done without being in dangerous situations, and THAT IS ACCEPTABLE." And yet you think this supports your idea that non-catastrophic disorders shouldn't be treated.

suggestion 1y ago
[flagged]
- BenjiWiebe 1y ago
  This sounds to me like getting into "You say you're depressed? Come on, snap out of it!" territory. I guess I consider psychological disorders to be a disorder when you aren't able to "snap out of it" or "just do things that are unpleasant". Like yes, I do things that are unpleasant - ADHD doesn't mean I live a life of ease, avoiding unpleasantness all day long.
- dns_snek 1y ago
  > You can accept the discomfort and move through it just like you do when the stakes are actually high. Just like I do. Have you ever considered that the things which you find doable or even trivial might be incomprehensibly more difficult for other people? You mentioned being diagnosed with ADHD higher up, but part of the diagnostic criteria for ADHD is quite literally about severity of the symptoms: DSM-5: "There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning." ICD-11: "Several symptoms of inattention/hyperactivity-impulsivity that are persistent, and sufficiently severe that they have a direct negative impact on academic, occupational, or social functioning" Being capable of pushing through basic adult responsibilities, regardless of discomfort and difficulties (without burning yourself out!), and failing to do so to the degree that it severely negatively affects your life is the defining line between "order" and "disorder". If you have a very demanding job then you might experience symptoms that are consistent with ADHD. That's why the diagnostic process is supposed to verify that there's a clear history of symptoms ranging back to your teenage years (or earlier) and that your symptoms aren't being caused by general life stressors. > The idea that everything in life should induce minimal discomfort or that "it's hard" is an excuse is a completely modern, first world problem, to speak of privilege. No, the idea is that people should receive help if we have a neurodevelopmental disorder that is severe enough to significantly impact our quality of life. Just like with any other medical condition. > Mindfulness and thinking about your thoughts are proven as effective or more effective than medication for a wide range of psychological disorders, including ADHD, or CBT if you want to formalize it. False: > CBT is best used within a multi-modal treatment approach and as an adjunct to medication as current research does not fully support the efficacy of CBT as a sole treatment for adult ADHD [274,[316], [317], [318]]. Most controlled studies have been conducted in patients taking ADHD medication and demonstrate an additional significant treatment effect [313,[318], [319], [320], [321], [322]]. The largest controlled multi-center CBT-study to date has demonstrated that psychological interventions result in better outcomes when combined with MPH as compared to psychological interventions in unmedicated patients [228]. In a systematic review of 51 pharmacological and non-pharmacological interventions [316], the highest proportion of improved outcomes (83%) was for patients receiving combination treatment. https://www.sciencedirect.com/science/article/pii/S0924933818301962 https://www.sciencedirect.com/science/article/pii/S092493381...

antonvs 1y ago

So your answer to mental health issues is “git gud”?

ohthehugemanate 1y ago

That's a hell of a journey! Congratulations on the accomplishment and thank you for sharing. Like many other biological systems, neurological wiring is multidimensional and not a natural fit into our arbitrary culturally defined abstractions, or even language. And the dimensions themselves are multifaceted expressions of multiple genes and environmental factors. I am happy to hear stories like yours, of people who can ultimately achieve "normal" functional parity without medication. Have you considered if that would have been possible without the journey? Had you, on day 1, cancelled that first therapist appointment and decided to grit your teeth and "try" instead, could you have "accepted discomfort" on your own? Or is it possible that the methylphenidate created supportive conditions that improved your chances? I ask because there is a body of well reproduced research demonstrating not only that ADHD patients have specific genetic and neurobiological differences from neurotypicals in areas associated with executive function, but that long term ADHD medication use can permanently bring the neurological differences into line with neurotypical controls. Something like 20% of medicated childhood ADHD patients can ultimately stop medication without losing points in functional testing or the associated brain structures. It's a lower percentage in adults and less well studied, but still exists. It's a big difference from the results of every non-chemical intervention we've studied, which have single digit efficacy percentages if they beat P at all. I'm interested in your feelings about this because ADHD is by far the most-studied psychological disorder in the world, and ADHD medications as a group are not only equally well studied, but also the most successful and least harmful of any psychiatric drug. There are more safety and efficacy studies for ADHD medication than for ibuprofen. So... if you feel your recovery was not helped by the neurogenetic compensations provided by methylphenidate, you should know that you are flying so far in the face of some of the best-validated medical science, that you imply invalidity of pharmaceutical or medical science as a whole. ... which is fine of course - it's your body and brain! But I bet it would help readers to know how you think this aligns with the science, or maybe what you think of medical science altogether. Questions like "Do you take ibuprofen?" And "Do you vaccinate?" Become relevant.

suggestion 1y ago
Yes I have and it was just as difficult post medication as it was pre. Ironically, while on the SNRI my ADHD was "worse" due to the sheer apathy I felt about literally everything, so I was prescribed to help me "focus" and be "motivated". You're leaving out the part about being "well studied" paired with your conclusions is almost exclusively in American and Western European populations, things are significantly less clear in other populations and cultures.