Category Archives: mental health

an ADD-friendly adaption of the 10-10-10 plan decision making

This morning I was watching the Today show as I prepared for work. I usually have it on while I get ready, as it’s a great way to keep on schedule in the morning. The segments are short, and they regularly announce the time, so it’s a lot harder to procrastinate with constant, cheery reminders. Today Suzy Welch was on the show promoting her new book 10-10-10: A Life-Transforming Idea.

Granted, this is an oversimplification, but the gist of the 10-10-10 plan is that whenever somebody needs to make a decision, they should stop and ask themselves about the consequences of that decision/action in the next 10 minutes, the next 10 months, and the next 10 years. The best/right decision is the one that leads people to  where they want to be 10 minutes, 10 months, or 10 years later.

I was intrigued by this simple plan both as an ADDer and an academic who professionally studies issues related to this, but also because I’d intuitively come up with a way to do this on my own, and have been using a modified version of this strategy for at least the last two years.  I can see how this would be particularly challenging for ADDers, who might end up feeling overwhelmed by the 10-10-10 plan.  I know that this strategy could be difficult to employ in the heat of the moment, but I think it’s worth it to give it a try, with or without an ADD-friendly modification.

Part 1: Set aside a few free moments and figure out where you want to be in 10 months and in 10 years. If this seems too distant, think in the increments that work best for you. I tend to think about where I want to be 6 months, 1 year, and 5 years from now. I write these down in one of my notebooks, and keep notes on the steps to reach these goals (i.e., what I’ve accomplished, what I still need to do, back-up plans in case things go wrong along the way). Revisit this plan on a regular basis as suits you, and make changes as your life and goals change. Knowing what you want out of life makes it easier to do the second part, which is the ADD-friendly modification.

Part 2: A short-term modification of this strategy is key for staying on track in day-to-day life, particularly for getting through those “off-track” moments. I suggest a 1-1-1 approach. Whenever I catch myself doing something counterproductive (e.g., procrastinating on Facebook, not doing whatever is on my daily list, etc.), I take about 30 seconds and ask myself “How is this getting me where I need to be in in one minute? In one hour? In one day?” If I’m having a really bad procrastination day, I ask myself “What am I doing in this one moment that is going to keep me from meeting the day’s goals? How else will I go off track for the rest of the week and month if I don’t keep on track right now?” (Disclaimer: As beating yourself up can be counterproductive for ADDers, I don’t recommend bringing out this second set of cognitions unless your motivation is at major lows).

As all the ADD books say, it’s all about small steps and keeping yourself motivated. Knowing where you want to go is a big part of this, and structuring your life so you can get there is another important piece.

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new rules for my blog

Part of the reason for my long absence was that I was contemplating ending this blog. On one hand, it started to feel like a personal liability, and on the other, I didn’t feel like I was meeting my goals for starting the blog. For the time being, I’ve decided to keep it going, but there are going to be some new rules.

Regarding it feeling like a liability… Non-academics might think academics are paranoid about protecting their “private selves” from the public at large (e.g., students and their parents), but let me assure you that there’s good cause for our paranoia. For example, my students regularly try to “Friend” me on facebook so they can see my profile and photos. Also, when candidates are on the job market, it’s not unusual for search chairs to “google” them to see what else is on the web in their name. Consequently, I have to be vigilant about the information that is publicly available. In sum, I blog anonymously for a reason. I ask that you please respect me on this matter, even if you know me in the real world.  I’ve opted to change my policy on comments so I may have better oversight. From this point forward, all comments will be moderated and will not appear on posts until I’ve approved them.  Don’t let this hold you back from commenting… just respect my privacy and your comments will show up as promptly as possible.

The reason I blog anonymously is because much of what I’ve written here details my personal journey with the mental health system in addition to my experiences as an ADDer in the academy. I do this both for my own benefit and for others out there like me.  I started this blog was to find other academics stuggling with the same types of issues, but unfortunately, there aren’t very many out there or my little blog hasn’t reached them.  I hope that this situation continues to improve, and that we can build a network of addled professionals together.

a clarification on my November post about knowing more than my doctor

I *loved* this comment from PreMedAA so much that I’m going to write a whole post in response to it. This comment followed my early-November post about my annoyance with my new psychiatrist.

The background for readers who don’t want to refer back to old posts (plus filling in some gaps I’ve previously omitted to help hide my real identity): I switched shrinks when I moved to a new state over the summer. Hubby and I knew that we wanted to start to try for a family sometime this autumn, which was my first in a faculty position after 3 years in a health sciences postdoc. Having discussed the issue of medication and pregnancy at length with my old shrink (a fellow in geriatric psychiatry at one of the best psychiatric hospitals in the nation who I very much  miss), I was keenly invested in seeking the best care possible in my new setting. My old shrink was supportive, and asked me to keep in touch with her about my treatment in this new setting. My old shrink appreciated that since Hubby and I have started talking seriously about kids, two limitations have been foremost on my mind: a) I’m able to work up to my full potential because of ritalin, and taking a 2-year break from it in order to conceive could potentially tank my chances for tenure, and b) having spent 9 years in pre- and postdoctoral training, I’m no longer a spring chicken. If we’re going to start a family, we need to start trying soon, or we risk running out of time.

S0, imagine my dismay when I called for an appointment at my new university’s med center specialty AD/HD clinic (in July) and found out I’d have to wait 2 months in order to get an appointment (September). My dismay was further magnified when I met my new doc and discovered how inexperienced she was. I brought up the pregnancy & meds issue at our first appointment in September. She promised to do research before our next appointment, and wrote me a prescription for the SSRI I take for PMDD (note: she wrote it for the bi-weekly dosing, which is quite standard for treating PMDD). When I came back in October, she hadn’t yet done any research on pregnancy & ritalin. I brought up the research I’d done on my own and with my old doc. She promised to look into it and get back to me. When I came back in November, she still hadn’t done any research and seemed to have forgotten about the bi-weekly dosing of SSRIs for PMDD (despite having written the prescription herself just weeks before). She promised to consult with her network of supervisors and colleagues, and assured me she would call me in a week. I had to call her a week later to remind her of our phone appointment. She was rather unprepared when she called me back, and asked me to come in before Thanksgiving for a short chat in person about the literature & promised to bring an important research publication. I made (& paid for) the extra appointment, for which she ran 30 minutes late. She forgot to bring the article (promised to fax it, but it still hasn’t happened & I’m not holding my breath), but still couldn’t say anything conclusive or provide me any strong evidence for any option during pregnancy. She pushed really, really  hard for my trying fish oil, which apparently shows decent efficacy with young children (alas, if I were only in the 2nd grade and just learning simple multiplication instead of spending my days doing matrix algebra…).  So I’m still on hold, and yet can’t get another appointment in the clinic until  early January.

So, my hubby and I have put off trying to conceive for an additional 6-7 months, and 4 months of that delay is due to my new shrink being inexperienced and inefficient. I’ve also wasted a total of 4 hours of my semester in the waiting room filled with people who function at a far, far lower level than I do… and to put this in practical terms, 4 hours = the preparation of 1 full lecture or 4 written pages of a research article.  The bottom line is that I sought a specialty clinic thinking it would save me time and effort, and I probably could have received better treatment from a GP.

(I suspect that quite a few ADDer readers have had similar treatment experiences. My situation is anything but unique.)

So, now I’ll deal with PreMedAA’s lovely comments…

Would you have preferred for the resident to attempt to cover her ignorance and simply take her ‘best educated guess’?

A physician at any level may not have confident answers on the tip of their tongue, especially if their patient has a keen grasp of pharmacology and medicine.

I agree with you; no, I wouldn’t want her to ‘cover’ by making a guess, but a competent medical professional in a specialty clinic shouldn’t need 3-4 months to come up with an answer to this sort of question, regardless of who the patient is, or how threatening the patient’s competence is to the physician’s ego. It’s not like ADD is a new condition, and I’m hardly the first woman who wants to get pregnant without tanking her career by going totally med-free.

Stating that you know more about something than a doctor may or may not be true. Your ‘knowledge’ may have been garnered from secondary sources or your educational background may be insufficient to properly digest the primary pharmacodynamics proposed by the manufacturing company. Your doctor is not a CPS or PDR, if they were, those compendiums wouldn’t exist.

Actually, I have a Ph.D. in the health sciences, and my research specialty is self-regulation, the set of skills directly impacted by the medical condition of AD/HD. It takes longer to get a Ph.D. in  my field than it does for a M.D. to complete medical school, and I have 3+ years of postdoctoral training on top of that. Furthermore, I’m 2+ years past diagnosis, and have been very actively involved in my treatment. This has included spending a great deal of my free time reading the literature on AD/HD and medication. Yes, I read the primary sources, and yes, I understand them, even the “yucky” stats part in the middle. In short, I have more years of research training in the field, and unless my doc has ADD herself, then most likely I also have more first-hand experience.

If you were particularly impatient, which you claim to be, then perhaps stating your acceptance of her consultation of her reference books in your presence would have saved you both time, as its likely that she didn’t feel dragging out the books in front of you would inspire much confidence, which you could have offered to alleviate.

For pete’s sake… the November post as just a blog entry, not a direct transcript of my conversation with my doctor. I actually would respect her more if she had dragged out her reference books. Of course I consented to allow her to consult with colleagues and do further independent research. I’ve repeatedly told her that I understand that residents are still training, and have also repeatedly expressed a desire to consult about primary references (i.e., current research). She’s the one who’s not been willing or able to meet me halfway on this. How much more open, supportive, and non ego-threatening can I really be? How long should someone be reasonably expected to wait?

You claim to know more about treating ADD/ADHD than your 1st year psychiatry resident-attending physician which is unlikely unless your a physician yourself and in the case of Adderall…at least a pharmacologist.

I’m not writing anything else about my specific academic credentials because I risk outing myself, and that’s  not a good thing pre-tenure.  Just a few points… a) she’s a 1st year resident, not an attending; b) it’s “you’re,” not “your,” and your sentence structure doesn’t make much sense; c) finally, if you’d bothered to read any of my other entries, you’d realize that I take ritalin, not adderall.

But since you don’t have time to permit your physician to ensure the validity of her counsel, then perhaps you ought to consult with a pharmacist about the possible effects of your drug regime on pregnancy…and perhaps they would be familiar with your atypical SSRI rotation.

The possibility that you havn’t done this already on your own suggests that such comments in regard to having a superior clinical knowledge of your diagnosis may not be advisable on your part, especially towards a medical professional.

Doctors are not gods, and the rest of us are not “lesser” beings.  Contrary to the belief of many MDs, they don’t know everything, they do make mistakes, their time is no more valuable than anybody else’s, and they don’t deserve to be treated any better or worse than anyone else.  I’ve given her plenty of time, and she’s wasted it. As a faculty member who is currently working 60+ hour weeks, I don’t have time or the patience to train somebody how to do their job OR remind them about how they’ve treated my condition at previous appointments. In these circumstances, I shouldn’t have to bend over backwards or jeopardize any aspect of my future in order to keep them from feeling badly about themselves or their abilities.

still nothing

I wish I could give a more exciting update, but I still don’t have any job offers. I did, however, receive a rejection letter on Friday morning (the “cooking” job). Not a big shocker, nor a huge disappointment. I’m starting to freak out because my options are becoming more and more limited. I leave for a final interview tomorrow at a small, midwestern liberal arts college similiar to my alma mater (Keep your fingers crossed for me, please!. I also just submitted an application for a position overseas, in Hubby’s dad’s current country of residence.

At this point, I’m just feeling resigned and flat. It doesn’t help that I’m in the thick of the PMDD blues (started taking medication again on Thursday, but it’s not working very well yet), and just feel like a distracted piece of crap while trying to prepare for this interview and cope with my phone’s silence.  It also doesn’t help that Hubby’s going through a crisis at work (i.e., is so frustrated that he’s getting closer and closer to walking away and finding something else), and would love for me to get the job in his dad’s current home country. The fact that neither of us really speak the language spoken in this area is not even on his radar, while I start to panic at the thought of having to lecture in a language I haven’t studied in years.

One thing at a time… one thing at a time…. one thing at a time….

feeling a bit better today

I am feeling a bit better today, thank goodness. I think it was the stress of the last few days combined with chemical/hormonal fluctuations and allergies. I forget sometimes that I’m allergic to dairy products because I hardly ever eat it, and consequently, hardly ever feel sick because of it. I had quite a bit of milk this past weekend, and it made me feel pretty crappy. I haven’t had any today and am feeling better so far.

In terms of recent stress, Hubby and I had a tough weekend. His travel department had messed up his plane tickets and Hubby had to run to the airport instead of attending his birthday party. Quite literally we were dashing out the door as our friends walked up to it to join us for dinner and cake. Hubby is terribly stressed and exhausted to the point that he’s not his usual jokey-happy-smiley self. Between this and the job market stress…. well, let’s just say that neither of us are having too much fun these days, and that we’re really looking forward to improvements in our situation!

There’s been another step forward on the job market in the last 24 hours. I’ve now set the “initial interview” meeting later this week. Small steps, small steps…

I think I could de-stress myself a bit if I were more comfortable with waiting…. waiting to hear about job applications, and pacing myself in terms of research. I keep telling myself that I need to be satisfied to go with the slow-moving pace of academia this year. It’s hard, as any ADDer can attest, regardless of career!

medication, therapy, & web graphics (today’s miscellanous thoughts)

 

irst and foremost, let it be known that I have a new favorite graphics website. Clipart etc is a free site that includes a massive quantity of old-fashioned graphics, many taken from old books, etc. There are also sister-sites with powerpoint presentation & website backgrounds and maps. Very cool stuff, accompanied by a very friendly usage license for educators and students. I am suspicious that we will end up using this website for non-educational purposes. After all, who wouldn’t want to add a 16th century map of Scandinavia to their collection? (And yes, I am a big nerd, in case you didn’t know already). My blanket acknowledgement…. I will use their graphics as I can, I love having my blog look like a book from the middle ages. If there is no credit given to a particular old-looking black & white graphic on my blog, it’s from Clipart etc.

 

econd, I am pleased to announce that I tapered off of Lexapro over the past 2 weeks, and have not taken any in 48 hours. Unfortunately I am still experiencing SSRI discontinuation syndrome (AKA withdrawal), despite the fact that I took a tiny 10mg dose for a bare 3-4 months and reduced my dosage 2.5 milligrams every three days. If this is what it’s like to stop after such a short period of time, I hope that I never have to take it again. Today’s fun is dizziness and brain zaps. I don’t know when these symptoms will stop, but it’s still worth it to be rid of the side effects I experienced while taking Lexapro.

hird, I had my last appointment with Talky-Shrink last week. We didn’t quit therapy because I’m completely cured or no longer require additional support. It’s because she is a resident, and her year of training in Cognitive-Behavioral Therapy (CBT) ended at the end of the “school” year on June 30. It’s sometimes possible for residents to keep patients on their caseload after their training period ends, and Talky-Shrink tried to do that with me because we knew that I have recently been doing quite well and wouldn’t require too much more therapy. Unfortunately her supervisor disagreed, decreed that she needed practice with terminating the therapist-patient relationship, and issued the ultimatium that he wouldn’t continue to supervise her unless she terminated with me. Naturally I didn’t want her to have to find a new supervisor, so we terminated.

Just in case I do need help in the coming year (entirely possible, given the stress involved in the academic job search), my med-shrink has agreed to provide supportive therapy on an “as needed” basis. This sounds like a good plan to me, despite med-shrink’s overall weirdness. Med-shrink is also a resident, and is 1 year ahead of talky-shrink in their program. Med-shrink and talky-shrink share the same supervisor. Strangely, however, the supervisor allowed med-shrink to keep me on her caseload because med-shrink is “still learning from me.” I’m not quite sure what that means, other than med-shrink enjoys having me on her caseload. Apparently I’m a good patient because I come to appointments on time, am pleasant in interactions, take my medication as directed, and call her when I’m experiencing medication problems. This really makes me wonder what her other patients are like…

anticipate a change in medication dosage soon, incidentally. I’m having gaps in coverage during the day. I’m also spending a lot of time focusing on the wrong things, like blogging and decorating my blog with fancy capitol letters. Not a good use of time, even if it is stress-relieving!

…and now back to our regularly scheduled programming.

At some previous point, I stated that the intent of this blog was to chronicle my experiences as an academic with ADD. For some reason, it seems that everything I’ve written recently has been about our wedding, not academic life!

From one perspective, academia is a life-encompassing choice. When I decided to embrace the identity of academic, I knew I wasn’t just choosing a career. Deciding to become an academic also means that one’s career is inevitably connected to one’s life and vice versa. As a developmental scientist, I view marriage as just one of those life transitions that inevitably impacts the rest of life. Getting & being married definitely impacts my work & my identity as an academic as a whole. I don’t necessarily see a clear division between my work and this aspect of my life. Naturally, it could just be my tangential ADD-type thinking that has led me to this conclusion.

From another perspective, me writing about our wedding is just fluff, and nobody really cares anyway. Get to the good stuff, Addled!

Regardless of your perspective, please let me state for the record… the wedding stuff is almost entirely over. Aside from stating now that our professional pictures have been formatted on DVD, which Hubby’s mom will send to us via snailmail tomorrow. Beyond posting a link to these pictures, I anticipate just one more entry reflecting on the whole experience following our stateside reception, which will occur in two weeks. That’s it!

Without further ado, here is the planned entry about academic life & ADD.

The Chronicle of Higher Education recently published an announcement requesting diaries from this year’s batch of academic job seekers. I hyperfocused for a few enjoyable hours while preparing my submission. Naturally it’s about my looming job search, starting with my experiences the last time I was on the market (pre-diagnosis), continuing on to my anticipated assets & constraints this time around. As this is clearly relevant to my blog, I’d post it here now, except that could lead to plagiarism concerns. I will link to this submission if they choose to publish it (under a pseudonym, of course), or will post it here myself if rejected.

In other news, the job market madness has now started in earnest. There are now officially 18 jobs for which I will apply between now and December 1. I expect that number to climb substantially during the next two months. The jobs are primarily in psychology departments, at universities and colleges of varying sizes, and are located from coast to coast. There’s a good mix, and hubby and I are pretty excited about some of them. But please let me reiterate yet again… to have so many ads posted so early is quite unusual. Usually the postings don’t begin to pop up like weeds until after Labor Day (maybe this is another effect of global warming?). I’m not complaining about the early start, because later postings make it harder on applicants to get their full packets to the search committees on time. It’s always better to be early than to be late… and as I know I have to worry about at least one letter writer being late with her materials, I’d better get my apps in as early as I can.

True to form, I’d intended to start revising my materials directly after returning home from the wedding. This hasn’t happened yet. I have revised outlines on my hard drive at work, deadlines set with colleagues who are also working on their materials, but am still procrastinating. Why can’t I hyperfocus on this important task instead of on cheap J. Crew dresses on eBay?

Last but not least, I’ve already restricted my profiles on sites like Friendster, MySpace, and Facebook to friends only. Just as a reminder, my blog will become much more anonymous the night before I mail that first job application in approximately another month. All personal pictures & the remaining identifying details will be removed. Although I don’t list my blog on my vita, I don’t want to run the risk that somebody on a search committee will find it accidentally or on purpose. I can’t anticipate how search committee members might react to learning that I’ve struggled with depression & am being actively treated for ADD. I can’t think that it would help my prospects. It’s always just better to be proactive and cautious.