Adult ADHD: I Am My Brain. I Am Not My Brain.
Due to cultural norms and gender expectations, ADHD often goes undiagnosed in women. Our writer details a midlife reckoning
I look up at the wall in front of me. Next to a colorful marker drawing of our family my daughter Ella made on notebook paper, a bright pink sticky note proclaims the reminder my doctor repeated to me clearly and sternly but with kindness.
Maura is not her ADHD
Maura is not her brain
Don’t identify yourself w/ your ADHD
I take a deep breath and try to internalize the message, but cognitive dissonance presents itself as tightness in my chest. My hand goes to my heart, and I close my eyes and press against my ribcage to feel like I’m in my body. Breathe. I am not my brain. Maura is more than her brain.
The problem is that I don’t believe that. At least not yet. My identity has been tied up with my brain since I was little. Once a test identified me as gifted, my parents’ attempts to make sure I was challenged academically put me on a trajectory that continues even as I approach my 50th year in this body.
I have always lived in my head, letting my powerful but scattered brain lead the way. I’m a Pisces, so people who believe in that sort of thing have casually categorized me as a dreamer. Decades of yoga and meditation helped me connect to my body, but it’s called a practice for a reason.
ADHD Signs and Symptoms
I first realized I might have ADHD in 2022, the year I turned 48. The idea didn’t come to me all at once; it was more of a slow garden hose trickle that turned into a steady soft flow of data points flooding an overwatered strawberry patch.
During Covid lockdown, the nooks and crannies of my house had filled up with unfinished creative projects: acrylic paintings on the coffee table in the living room, jigsaw puzzles on the far end of our 10-foot antique farmhouse dining table, piles of books everywhere, and personal essay snippets in Google docs and on my iPhone.
I was reading a lot of books, many more than I had in previous years. I devoured a mix of novels and nonfiction business and psychology books, but I struggled to focus: my mind would wander, and I’d have to read the same phrase over and over. I’d obsess about understanding a minor detail, grab my phone to Google it, and go down a rabbit hole before remembering what I had been doing when I got distracted. Slogging through a book started to feel counter to my purposes of engaging curiosity or escapism.
But sometimes I’d get so absorbed in a novel that I would forget about the world around me. My husband and daughter both go to bed early. I might read until midnight or 1 a.m., forgetting that I had other things on my to-do list that night and missing out on a full night’s sleep to boot.
Piles of clean laundry surrounded me in a variety of baskets, wrinkling to the point where I’d need to wash them again. I bought more baskets thinking that a storage shortage was the real issue and not the compulsive shopping and laundry avoidance.
Getting returns to the UPS store, the library, or a store became a running joke between me and my husband, but it wasn’t truly funny to either of us. I might put a black Rent the Runway canvas bag in the car to return it to UPS and forget to stop there on my way home from running other errands. Four days later, the bag would be in the trunk, having been thrown back there to make room for someone to sit in the passenger seat and emails alerted me that they still hadn’t received my shipment.
People tend to toss around mental health diagnoses as a joke or a casual aside in our culture.
“Oh that’s my OCD making me check the locks,” a friend might say.
“I’m so ADD I can’t focus enough to read a whole book,” a mom friend mentioned when I asked if she was in a book club.
“We’ve gotten schizophrenic in our business tactics. We need to pick one idea and stick with it.”
These types of throwaway phrases threw off my instincts about my own situation.
I had assumed my scatterbrained nature was somewhat normal. Surely ADHD must be a much more serious condition than whatever was going on with my brain. Family, friends, and doctors often tell me I’m “just taking on too much.” If I had more downtime or took on fewer projects, they’d say, I’d probably struggle less with memory issues.
But the possibility I had ADHD started to seem more and more likely. My psychiatrist suggested we do an assessment, and I dutifully filled out the forms.
I had to rate myself using a reference scale: Never, Rarely, Sometimes, Often, or Very Often, describing how I felt and conducted myself over the previous six months. I was mostly checking the “sometimes” category, but a few were absolutely on the “often/very often” end of the scale and I cringed as I read.
How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
Very often. I must first realize they’re talking to me, then that I wasn’t listening, then decide if I should reveal that I didn’t catch what they said.
How often are you distracted by activity or noise around you?
Leafblowers and lawnmowers paralyze me now that I work from home. And when I worked in an office, I struggled to focus on tasks if the people around me were talking.
When you’re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to, before they can finish them themselves?
Ugh. That one hurt. I wish I weren’t like that. I don’t want people to think I’m a know-it-all. But I have little control over blurting things out. Now that I’m a coach and consultant for a living, active listening is even more important. I can’t assume what someone is about to say. Interrupting is not only rude and off-putting but also counterproductive.
I met or was above the threshold for every one of the behaviors psychiatrists evaluate to diagnose ADHD. Every one.
The doctor told me the importance of boundaries and of planning my day. “Your work will never end,” he said. “It’s extremely important that you prioritize. Your brain will try to cut corners.” I nodded and took notes and filled my prescription every month and figured I was on my way to a better life.
The diagnosis brought both relief and anger. I finally had an explanation, but I was angry at the five previous psychiatrists and countless therapists (with various combinations of certification letters after their names) I had worked with for my anxiety in my 20s and 30s who never even mentioned the possibility of ADHD to me.
I remember a yoga class where the teacher described “the monkey mind” – when a human’s brain jumps from one idea to another and gets into a pattern of distraction. That was it! That absolutely described what I had always felt like. I told my therapist at the time, but instead of exploring my thoughts about the analogy, he laughed it off.
ADHD Denial and Women
After anger, I continued to work my way around the stages of grief. Although I’d always known my brain was not the same as others, I thought it was somehow still “normal.”
I read articles and learned that ADHD has long been considered a condition that afflicted boys and men. According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), girls with ADHD often don’t get diagnosed until adulthood, leaving them to struggle much longer with their symptoms untreated.
Cultural norms and gender expectations are thought to be a big component of this disparity. It’s not that girls have a lower rate or different symptoms of ADHD, but their behavior is markedly different than boys with ADHD. Girls and women adjust to societal expectations of our gender, internalizing hyperactivity and covering up symptoms of inattention with high performance and toxic perfectionism. And then we feel bad asking for help with something we feel we should be able to handle on our own – because we have always done it alone.
Another reason women are underdiagnosed is because they are first diagnosed with a mood or personality disorder. Between 65–89% of all adult patients with ADHD suffer from one or more additional psychiatric disorders. And Hormones also complicate treatment for women.
All this has been changing, but adult diagnosis in women is still far more common. The CDC released a report in 2018 that showed that “the number of privately insured U.S. women ages 15-44 years who filled a prescription for a medicine to treat attention-deficit/hyperactivity disorder (ADHD) increased 344 percent between 2003 and 2015.” For ages 25-29, the number increased by 700 percent.
Dealing with Diagnosis
I moved right into the bargaining stage.
There’s got to be a way to hack this. If I try harder. If I find the right planner. If I buy that three-ring binder and a hole punch. If I hire help. If I can get my husband to take on some of the mental labor. If if if…
I downloaded every app I thought might help.
Trello, a productivity tool I have used for many years, took on new power and possibility.
An AI transcription app called Otter helped me with conference call notes. But I often forgot to refer back to the transcripts because, well, who has time?
Speechify read aloud any document I uploaded in a voice of my choosing: I like Gwyneth Paltrow and Mr. President (a close approximation of Barack Obama). Sometimes I listen to Matteo, who reads English words with a thick Italian accent. Even though he’s AI, he’s kind of sexy.
Sidekick, Scribd, Blinkist, and Voxxer. I hired a virtual assistant (a human one) who helps me stay on top of my business strategy and marketing. I started buying both audiobook and paper versions of books so I could highlight and write in the margins, adding Post-it flags to important sections.
But after a few months of medication and trying to list and hack my way out of this condition, I hit depression.
“You’re personalizing this,” my psychiatrist told me. “You need to see that this is a biological condition that you have. Your brain will play tricks on you. You must separate yourself and your brain.”
When he started to talk about deficiencies in executive function, I realized I really didn’t understand the chemical and neurological mechanics of ADHD.
“Well you read the book,” he said with certainty, referring to Driven to Distraction by Edward M. Hallowell M.D. and John J. Ratey M.D. This was the book he told me to read when he first diagnosed me six months before.
I had not read the book.
Turns out I was reading a completely different adult ADHD book that was somewhat informative, but not the one he had suggested. And I hadn’t even finished that one. When I found my copy of Driven to Distraction, I saw that I had only read to page 18.
No matter, because the month after this all went down, a third book finally helped me understand and accept what he had been trying to tell me.
There I was one Saturday morning, folding laundry when I heard the series of ideas that lined up to point to one big realization: my relationship with time and productivity is completely fucked up.
In Four Thousand Weeks: Time Management for Mortals, Oliver Burkeman compares our modern notions of time with a fictional hypothetical medieval peasant to illustrate how absurd our current thinking about productivity and efficiency has become. Economist John Maynard Keynes predicted that in the future (our present), no one would have to work more than fifteen hours a week due to advances in technology and the growth of wealth. Of course, Keynes was wrong.
“It turns out that when people make enough money to meet their needs, they just find new things to need and new lifestyles to aspire to; they never quite manage to keep up with the Joneses, because whenever they’re in danger of getting close, they nominate new and better Joneses with whom to try to keep up.” – Burkeman (p. 11)
The underlying uphill battle I had been fighting with my brain for decades was suddenly illuminated: capitalism and the resulting culture programmed humans to idealize productivity and perfection as core values and virtues.
And I felt guilty, weak, and lazy because somehow, I was never quite up to the task.
I Am Not My Brain
Realizing I wasn’t alone was blissful. Humans are always looking for tools and tricks to make us more productive and bring us closer to perfection. These aspirational values are torturing us and even killing us. He likened inbox zero, the idea of getting your email inbox completely tackled and everything filed or deleted, to a Sisyphean task – because what’s the reward for getting through everything on your to-do list? More to-do lists.
I went back to Driven to Distraction. Rather than plow through the whole book, my brain and I took a much-needed shortcut. I found what I needed in Chapter 8: What can you do about it?
And with just a few underlines, I realized the meaning of the title.
I had been blaming myself for all of my shortcomings when the truth was, there were unseen forces “driving” my thoughts and behavior. And it wasn’t just my brain driving the bus. but all the inputs it had absorbed and connected via since I was a zygote of combined DNA.
The way my parents raised me. All the conversations and newscasts I heard. Millions of data points over my first months, years, and then decades. The rewards I associated with certain behaviors. The degrees and certifications that promised prestige and purposeful living. Leadership books like What Got You Here Won’t Get You There. Corporate performance reviews and promotions led to more hours, harder work, and deeper emotional labor.
I was groomed for the rat race. The desire for more information, more money, more cachet, and more connections propelled me through a repeating cycle of burnout. And through it all, I felt like a failure. Like I was at the same time too much and not enough.
An engine was controlling me, and I wasn’t even aware. It seemed like a sci-fi concept, the premise of a “Doctor Who” episode. The people who think they are superior, emotionally intelligent specimens, but are just one of the hordes.
I felt like I’d been part of an experiment in human futility. It might as well be a simulation.
Simulation theory is one of those scary thoughts that can keep people up at night – the idea that we’re all part of the Matrix. But I found it comforting. If someone is programmed, they can be re-programmed.
I am not my brain. My brain is not all of me. I will learn to recognize when my brain is telling me a story that’s not universally true. I will separate my identity from my condition.
Then I can get to work on really understanding what executive function is so I can work with what I’ve got.
I will stay in my body and work toward making conscious choices.
I will exercise free will.
My brain is not the most important part of me.