[rufsketch1]

This is reposted from my forum blog, as I figured it might be worth discussing here. If you're too lazy to read, there's a TLDR at the end.

-----------------------------


Thoughts on Identity, Medication, and ADD


[HIDE="Feel free to skip this part"]
In general there's a long and seemingly random span of time between the moment at which I deduce something with potential to somewhat alter my outlook on life, and the moment when its significance bears on me in that forceful sort of way a proper realization ought to punch one in the gut.

I'm not sure if it's clear what I mean, so as a simple example, it's perhaps a bit like the difference between understanding what being in love entails, and actually experiencing love.

You're clever of course, you know I must have very recently experienced something to bring this up. And you've certainly deduced by the title in bold that this post will somehow tie into those sparsely interrelated topics. I'll cut to it then, since I wouldn't want to make a waste of this brief time you're wasting.

That the concept of "self" borderlines on meaningless is one of those things I'd deduced so long ago that speaking of it now seems to brush against cliche. I can't remember exactly when I came to the realization (I suppose I must have been 16 or so) but it was in response to some generic existential crisis, and all that particular metaphorical deductive blow really did was graze my gut as a novel fear that when I sleep "I" might die and an entirely new person with my memories might wake up. But I was in bed and tired and didn't want to think about death anymore so I gladly fell asleep anyway. Over time, the idea slowly changed shape, as ideas (and people) tend to do, until it more or less crystallized its self as a realization that whoever I am is constantly changing, and there's no real way to define myself or reason to care about my future or my past any more than I should care about a stranger's, as I can't change the former and I can't experience the latter.

In any case, it remained for years as a simple deduction, and the true weight of it only recently hit me on a drive home after comforting my girlfriend. What was I doing? Why the hell was I so invested in making things turn out well for myself? A self I'll never meet, a self who will in all probability hate the naive child I currently am. And most importantly, why had I split my conception of self into two parts? A worthless part competing with an amazing part, and an amazing part perpetually attempting to dumb its self down to make the worthless part feel less worthless. Of all the ways to split it, between time, need hierarchies, cognitive functions, etc. why did I settle on my current unhealthy divide?

That last bit requires explanation, of course. And the things that follow from here on out are things that I speculate are issues with other people who have been on ADD medication since childhood. [/HIDE]


Throughout their lifespan, people generally create an idea of themselves in regard to their past likes, dislikes, approaches, quirks, and tendencies (and other stuff I'm too lazy to consider).These traits probably act to some extent as their own reinforcement in a person's decision making process, and thereby further cement their existence in a persons idea of self. This collection of traits and ideas in regard to ones existence is generally termed identity. Certainly a problematic concept in almost every regard, but nonetheless one that has been useful from a social, socioeconomic, judicial, and evolutionary standpoint. But our world changed a few decades ago to make more obvious some contradictions. As prescription psychiatric drugs get more advanced, these contradiction will continue to become increasingly apparent.

As of now I think the effects of drugs on development of identity tend to be generally ignored because of drugs' temporary natures. You are you, and you do different things on drugs because you are on drugs. Bear with me through the following boringly simple example, because it leads to a more interesting one.

Consider a clever, curious, caring, creative person in his late teens or early twenties. We'll call him Jim. Jim is considerably more clever, curious, caring, and creative than the average person, and (to make our character more likable for the heck of it) though he doesn't think of himself as someone who is as clever, curious, caring and creative as he actually is, does nonetheless understand that he possesses these traits to some above average extent. They form a large portion of his concept of self. Now imagine that at a party, some friend plays a silly prank and slips something into Jim's drink that for the next 10 hours or so makes him unintelligent, apathetic, unsociable, and dull. When he comes to and his friends explain why he completely ruined his chances with some girl he was trying to impress, his concept of self doesn't change, because he'll resume under the logic that he is who he is and the drug messed with him for a little while and his friends are total assholes. The drug is not who he is of course.

Now, consider someone else with the same personality traits as Jim, leading to a similar self identity to Jim's, but with the exception that this person, whom we'll call Jake, has been on some medication since childhood. One year, Jake and his family go on vacation for two weeks, but Jake forgets to bring his meds. Throughout these weeks, Jake finds that he is not only more unintelligent, apathetic, unsociable, and dull than usual, but actually more unintelligent, apathetic, unsociable, and dull than the average person. Eliminating all other possibilities, Jake correctly concludes that this is because he hasn't taken his medication. What now is Jake left to believe about who he is? In the last example, Jim could easily brush it off as the affects of some drug, but Jake doesn't have a drug to blame these negative traits on. Quite the opposite, the drug he had been taking was given to him specifically to change these traits. Jake is left now left to realize that for much of his life he's been living the life of someone better than him. His identity had unwittingly been the drug.

A substantial portion of people who are put on ADHD medication decide to reject it after a few years and opt instead to try hard to just restructure their lives to compensate for the cognitive skills they lack. Indeed, there are
To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
dedicated to helping people who no longer want to resort to medication. The reason this portion of people is so large hasn't to my knowledge been deeply explored, but I've gone through this phase of discarding ADD medication (twice, actually) and, though I'm reluctant to generalize, think I have a fairly good idea based on personal experience (I also don't want to imply that a large number of people are deluding themselves, but if you've taken adderall and you click the link, you'll note that most of the excuses under the "5 signs that you're ready to quit" section seem pretty fake). Simply put, the reason you're likely to renounce the medication is because you resent that you are better than you. In coming to the realization that your traits were a result of medication, you either accept the repugnant conclusion that the medication is now an integral part of your identity, or you lose a considerable sense of your self worth in understanding that you've been living a very pretty fantasy. It's this second conclusion which makes you want to do one of two things. One is to prove to yourself that your identity wasn't a lie, and that you really are the way you thought you were, or at least aren't quite as bad as you now understand you are. The other is to resort to denial in the hopes of convincing yourself your natural brain chemistry makes for a better person than your medicated brain chemistry (to anyone choosing the second route, sorry, but I can't see any way but denial to conclude that you're better when pretty much all of your positive traits are gone [and denying that what society deems are good traits are actually good traits is still denial if you don't have any way to back up the belief that the opposite traits are preferable]).

We have here the outlines of a classic identity crisis. But as bad as identity crises have potential to be, this situation is arguably even worse. It's not simply a matter of resolving who you are, but a matter of proving that you aren't the type of person you specifically didn't want to be. So in preference to denial of inferiority, and in refusal to accepting reliance on a pill as part of your identity, you resort to proving your non-inferiority. And you discard the drug and you try very hard to get as good off it as you were on it. It's ultimately useless of course, creativity and compassion and intelligence and motivation very much have chemical components which you don't have mental control of. But that isn't to say resolving the identity crisis in a psychologically healthy was isn't impossible. You can go on trying to get better until you just forget how good you were, and can guesstimate you're roughly on par. Of course, just taking a pill again would quickly reveal how far you'd have yet to go.

Anyway, I don't object to the use of cognition enhancing drugs; it would be ridiculous to wish people be less happy, caring, creative, intelligent and compassionate than they are. But for its potential to cause an identity crisis, I don't know how I feel about prescribing it to children who still haven't formed a firm concept of self. But I also don't know how I feel about letting a child grow up with the social and academic impediments that come with ADHD, as the consequences of those impediments tend to leave a negative mark on self image anyway.

There is one potential saving point to the practice however. In general, children with ADHD or ADHD-PI tend to be significantly less emotionally in tune without medication. For me personally, the identity crisis wasn't something that caused me considerable grief, but something like a problem to address because well, it was a problem to address. Indeed, it causes me more grief when on the medication than when off, if for no other reason that the increased sense of compassion quickly turns to pity for the unmedicated self, and pity for self is, well, self-pity. In any case, so long as the drug isn't used while attempting to resolve the crisis, from my experience the emotional burden should be minimal (though I have anything but resolved my own identity crisis).

But amusingly enough I feel I should add that there's a caveat to that saving point. In general, children (and adults) with ADHD and ADHD-PI also tend to have much shorter fuses in regard to anger. Admittedly, I was typical in that regard as well, but realized the first time that I was taken off of the medication by my father (independent of the two times I did so voluntarily) that as I was considerably less emotionally in tune with my peers/self than I used to be while on the medication, but considerably more likely to get irrationally angry, I was essentially living a life of generally dulled emotion (roughly equal in contentment value to 0) plus anger (roughly equal in contentment value to -|x|). And, anger being a negative, I was thus living a life of contentment values in the negative. So figuring that 0 is better than -|x|, set on doing away with anger by getting into a mental habit of just quickly switching thoughts in situations likely to induce anger (I'm pretty pleased that it's gotten to the point where it's now difficult not to do). All this is to say, I'm atypicial in the anger regard, and I don't know if such an identity crisis would cause anger in typical ADHD individuals. If that is the case, then the saving point mentioned in the previous paragraph is probably invalid. As we're just creating people who are exceedingly angry about the confusion regarding who they are or aren't.

I have more to say along maybe more interesting lines, but I'm ridiculously tired and sleep deprived, so I'm going to bed. If you're wondering, yes, I am on medication, and no I wouldn't write anywhere near this much if I weren't on it. I will continue soonish.

--------------------------

TLDR: If we put a child on medication to compensate for his/her shortcomings, and the positive effects of that medication as the child matures become a part of his/her identity, then the realization of the non-existence of those traits in absence of medication can have serious consequences in terms of self image. Though whether the ensuing identity crisis resulting from a newly found negative self image is preferable to growing up with a negative self image is a point I think worth exploring.

[jonathanb]

My entire family is ridden with ADD. My little bro is on meds and it helps, but turned him more apathetic than he already was. I'm the only one who got himself better on his own. Martial Arts and standing meditation. But even before that, years before that, I managed to get through highschool with good grades with sheer force of will. The mind can overcome itself, but the person has to make a decision for it to do so. Medicine shouldn't be the answer.

[sommers71]

I have taken Adderall for minor periods of time in inconsistent patterns of like 1/2 - 2 week periods (experimentally), but have never been diagnosed with any psychiatric problems. Then again I would only check if my problems severely effected my life, or if someone trusted could convince me through rational reasoning how my actions produce negative implications. I have had my own suspicions though. ; )

With that in mind, I can say that I have noticed/experienced many of the relationships that you have mapped out nicely here. It really does do a number to your cognitive functions, and by extension personal identity. I might even speculate by saying that it has profound effects on personal worldviews. I think ADD medications are purposely designed for these effects. Aimed specifically to enhance certain abilities. If you chemically set up the dominoes they are likely to topple over in a predictable direction. I don't mean this literally, but the effects are undeniable. If you drink alcohol you get drunk.

In regards to your concerns about personal identity I also agree. To me the asymmetrical relationship has alot to do with how humans generally bias positive self associations, yet have a tendency to disassociate from negative associations. (This reminded me of Markedness in linguistics btw.) I see this as an area of potential concern. These days most psychiatrists seem to believe that the only mindset worth exploring is a positive outlook. Sure it feels good, but at the same time it may be acting as a mask over much more severe underlying issues. ADD medications are becoming the de facto cure all even for minor attention or conduct problems.

This experiment is very old and outdated, but the relationships it draws might interest you.

To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.