[tl;dr: Psychiatrist refuses to treat or diagnosis ADHD without a separate evaluation to differentiate from depression.]
Just decided to pop into my old psychiatrists' office to see if I could get ADHD meds ahead of my neuropsych eval a little later down the road (which will also evaluate for autism, but there's no meds for that so I don't care if my psychiatrist thinks I have it or not).
I talked to an intern, who was very nice, and then we connected to the psychiatrist that had treated me through my bipolar and depression.
She told me she couldn't treat me for ADHD because my PHQ-9 score, an inventory to measure depression, was too high and she wanted to wait for a neuropsych evaluation before she prescribed medicine for ADHD. She also was really pushy about getting me into therapy, which I had started coincidentally a few weeks ago.
My thoughts on that:
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This is the trap: because you are neurodivergent, you fail at work, you fail at society, and you fail at your own self-designed goals. The natural result is that you get depressed. You see the professionals that are supposed to help you, but they are always treating you for depression. By treating you for depression, which is a perfefectly natural response to your situation as a neurodivergent individual living in a neurotypical world, you learn that you are the problem. And since, for some reason, you keep getting fired, people keep not being your friend, and you keep having unfinished projects scattered throughout your house, you never stopped being depressed. And because you never stop being depressed, even though the entire medical system is trying to help you be not depressesd with therapy and medicine, you eventually conclude that you are irretrievably broken. And the results: you are in ineffective treatment for depression for years, decades, or your entire life and you are miserable and feel terrible about yourself the entire time.
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How is a trained and paid professional looking at a single number (PHQ-9) than reflects depressive symptoms without reference to depressive situations and punting on something so basic as distinguishing between depression and ADHD, which can cause depression and is in the DSM? Isn't doing a differential diagnosis in her wheelhouse? Is she stupid? [rhetorical]
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Why does she think there is some objective way to distinguish between depression and ADHD? I could go to 10 different psychologists and there is a 0% all of them would agree. So if it's essentially a crap shoot, why is she deferring to someone else, unless she's obviously incompetent or, more likely, a total coward that doesn't want accountability.
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Why does she think therapy is going to help? I've been in therapy on and off the 30 years and I'm in exactly the same place as I was when I started. I know it does not work, at least not if the focus is on depression. It's like I'm saying, "I want do try something different because what I've been trying for 30 years and she's yelling no! keep doing the same thing!
Seriously. If anyone has any suggestions on how to navigate this. I'm borderline thinking I need to mask my depressive symptoms if psychiatry is going to be so fucking ignorant about the relationship between situation and mood.
Hm. You failed to address any of the underlying reasons for my reaction, so this feels a bit awkward.
Well, if you want me to:
I have done all this and am currently living in poverty on basic government support in my country. I'm feeling the best I've ever felt.
Because if I "fail at work", I know that the system around work is designed in a way that makes me fail, if I were given certain freedoms and simply allowed to work in a certain way for a goal that is actually worthwhile (so other than just corporate profit), I could work a lot and "succeed". However I have realised that productivity in a work-related sense is just not very important in the first place, me not participating in consumerism by creating more and more products is actually a good thing.
If I "fail at society", that is fine, too, because I'm part of several queer groups and have made lots of local friends just like me or that handle being with me perfectly. Just because I can't handle fitting in with the majority of society, doesn't mean I can't have a rich and rewarding social life and community on a small scale.
I can't "fail at self-designed goals" because I don't have them. I am either goal-less or only commit to a goal that I can actually tackle, which is not much. I live a life of "not doing much" and I'm completely fine with that.
Many people would rate my situation very shitty. But for me, nothing feels shitty. I can barely afford enough food and have like a biiit of spending money. While this is the minimum for my country though, I recognize that the social safety net in some countries or some situations is actually nonexistent, and you're going to starve if you can't find work. I don't know how I would fare in that context, but I know that I currently have much of the same challenges that you do, just that I'm not miserable with it, but happy.
I think your biggest problem is that, like you say, you think you are the problem and you are broken, while the truth is that you are neither. ADHD medication probably is not going to help you to stop thinking like that, but therapy, i.e. just talking with people that don't believe that, likely can. That requires a therapist though, that actually believes you are not the problem and not broken. Finding such a therapist amid the sea of incompetent ones is going to be difficult.
Edit: oh, and I'm also diagnosed with depression, but I don't feel depressed. I have no drive to do anything, but not because I feel bad, but because I believe it's not a worthwhile thing to do. My neurotypical psychiatrist interprets that as depression, because they can't really imagine thinking like that in a productivity-obsessed world, and that is honestly fine with me, because through his diagnosis, he's helping me act in accordance with my wishes. The thing is, other people in the system don't actually need to understand or think like me, they just have to allow me a compromise arrangement. Right now, the compromise is that I "work on bettering my depression", and I get left alone with work and all kinds of shit otherwise. Obviously it's not a perfect world, but it works.
Oh, I was referring to why I was reacting the way I was reacting to my psychiatrist this week, but this was a welcome change of subject.
Yes, many years ago, I used to feel like a worthless waste of space. I'd go through life looking at everything thinking, "Someone designed this, someone built that, someone shipped it, some sold it, someone accounted for it" and I felt so useless and broken without a capitalist person.
Then I started noticing all the celebrated people that did nothing, but still had respect. The first of these were religious ethicists, closely followed by religious officiants. These people don't provide any real value to society, other than the necessary delusions required tolerate this hellplane of existence.
Then I also noticed that many women were largely exempt from their entire value being tied to their capitalist productive capacity, though obviously for full membership they had to bear children; but even if they didn't, just having a rich husband freed them from a lot of financial and status burdens even if they were working.
And of, course, most recently, I've realized that the most celebrated people--the 1%, the owners, actually contribue nothing to society, and I think it is hilarious that honestly the practically the job most replaceable by AI is CEOs. Angela Collier absolutely ripped a new asshole on the CEO of Zoom when that CEO said that in the future AI bots would attend meetings for you; Angela pointed out that this CEO obviously did nothing but attend useless meetings and so he doesn't understand that people actually do get paid to do actual useful work, not to attend meetings that may as well be attended by AI.
So, I'm happy if I can get on disability and have a low-stress part-time job. That's kinda my plan.
But I'm also not ok spending 9 hours on Lemmy and not developing the skills I want to develop. Like I actually do want to grow as a person, by my own standards, and have a life that is rich by my own standards. But right now, my ADHD gets in the way of my developing the job skills I need. For instance, maybe I can learn to re-pad clarinets and hire myself out to band directors in the summer or something. It would also give me a reason to leave the house.
But, yeah, I'm still lingering in that capitalist mindset. And when I'm in that mindset, I realize that the only space available to autistic people is if they have useful skills to provide. The only other jobs are based around gladhandling people, which I will fail at, or they are extremey repetitive and boring, which is precluded by my ADHD.... so I absolutely do want to target my ADHD specifically because it would help my capitalist life and also my spiritual life.
I am coming to grips with there being nothing wrong with me other than an inability to instictively gargle balls of everyone around me (one YouTuber has a rant about not wanting to join the herd as a primary instinct overrridng everything else the way neurotypicals do), but it's a slow process. That's the autism part, anyway. The ADHD part does actually reasonably seem like a disability on my part because that presents itself as problematic in my own sphere of influence, but maybe that's still a hangover from capitalism (and my immigrant parents).
I did find a neurodivergent-aware (maybe autistic) therapist and I don't think she's great at treating this condition in anyway, I'm already kind of frustrated by how she doesnt really have solid path forward, but she at least is extremely supportive of the diagnosis and hasn't invalidated me a single, and that's pretty worthwhile at this point.