Mood Matters

When your mood is good, you’re more likely to do things than if your mood is neutral or low.

Although this may seem obvious, it isn’t easy to notice in the moment. Humans are not designed to assess their own mood states, which are usually only evident in retrospect.

When tasks and activities on your agenda are weighing on you, the feeling of “should” bubbles up in the form of anxiety or guilt, which leads to avoidance of thought and action. Even if you “want” to get started, feeling down or just “blah” is an invisible but real obstacle.

On the flip side, tackling tasks and stepping out is relatively easy when mood is even just a little better than OK. For those of us with ADHD, mood can make or break our best intentions.

Optimism arises from positive vibes, the essence of confidence. When you feel like things will go well, you do those things. When you’re pessimistic, doubtful your effort will yield a satisfactory result, initiation yields to inertia.

When you don’t feel like doing anything, try not to beat yourself up. Take a step back and be open to the possibility that you’re just “not feeling it.” Then take the extra step of saying (or thinking) “And that’s OK.”

I am of the opinion that you can’t force optimism, but being aware of and accepting your mood can bring an invisible obstacle to light.

How to Create Urgency: Outsourcing Motivation

You have been taught that motivation should come from within you. Relying on external factors is discouraged because it is fickle, unreliable, and will lead to disappointment. True change comes from within.

I disagree. 

When considering whether or not to take action, internal and external factors exert unequal force.

Take intention, for example. If you intend to do something, you’ve put thought into it and decided to proceed. Maybe you’ve written down this intention. If you haven’t discussed it with anyone else, declared your intention in the presence of others, or openly committed to a course of action, then your intention is internal. If you don’t follow through, you might be disappointed in yourself, but you’re used to that.

Risk and reward are similarly divided between public and private domains. If you do not take action despite your private intention, you punish yourself through guilt, shame, remorse and self loathing. If, on the other hand, you’ve made your intention known publicly, inaction or failure might invite criticism, disapproval, penalty, or damage your reputation. Personal shame is endured more willingly than public disapproval, even if the “public” is one other person.

Internal rewards of pleasure, satisfaction, pride and confidence are nice, but external praise, validation, money and approval are more potent reinforcements.

When you want to do something, it makes sense to share your intention. The internal motivation, risk and reward are multiplied by accountability. It’s a lot easier to let yourself down than others with whom you have shared your intentions, made commitments and set expectations. 

Outsourcing motivation works because it creates urgency, which is required for action.

-Thor Bergersen M.D.

Chat GPTerminator

Humans are designing machines to “think” like humans. The most recent innovation, Chat GPT, has been combined with the search engine Bing to offer “conversational responses” to web inquiries. The results have been mixed, and some people have reported bizarre responses.

By all accounts, we have a long way to go before there are humanoid robots walking around, being our friends or servants, doing the things we would rather not do.

Ever since watching The Terminator at age 15, I’ve been fascinated with the idea of human-like robots. The most appealing aspect of robots, in my opinion, is their logical capability. The Terminator had a specific directive: Kill Sarah Connor. It did not have any doubt, insecurity, shame or guilt about this directive. When it killed the wrong Sarah Connor, it went to the next one in the phone book (no internet back then) and killed her. Logically, if all Sarah Connors were dead, then the one that would eventually give birth to John Connor, the leader of the rebellion against the machine overlords in the future, would be dead.

The Terminator’s programmers (also machines) did not take the time to write code specifying that it should not kill every Sarah Connor. They were either sloppy, lazy, or figured “How many Sarah Connors could there be in Los Angeles in 1984?” I think there were 3 or 4, so valuable time was spent killing the wrong ones. Sociopathic machine programmers sent a flawed sociopath back in time to do a simple job. It didn’t work.

Humans, unlike robots and other machines, use concepts rather than discrete bits of information to navigate through life. We use analogies, metaphors and abstractions in order to make sense of the environment. We also have a conscience, morals and ethics.

At a basic level, we seek pleasure and avoid pain, and behave in a way that maximizes our chance of survival. A lot of the time, however, we are several levels above the pain/pleasure/survival mode, leaving plenty of room for making a big deal about trivial shit. We create drama, cultivate appearances, strive for status, play mind games, and second guess everything we possibly can.

What if humans were more like robots? Or at least like an ideal robot that used logic to make decisions about what to do and what not to do? Life would be easier if we were not burdened by fear, guilt, shame, depression, anxiety, stress, insomnia and ambivalence. If we could simply analyze sensory data, process the input using an algorithm, and generate output in the form of speech or action, our lives would be much easier.

When I’m stuck, sometimes I ask myself, “What would Robot Thor do?” Stripping away ego and emotion can reveal the logical next step. The tricky part of this exercise is to keep morals and ethics intact, both of which I consider uniquely human forms of logic.

The Interest Fix

Interest is an interesting topic. It is individually unique, but groups of people share interests. What I find interesting might not interest you at all.

It’s much easier to talk about things that interest you. It’s easier to make conversation by raising a topic of interest to the person with whom you are conversing.

What we’re talking about here, however, is the kind of interest that gets us to do things. What is interesting enough to get you moving? To get out of bed, or off the couch, and take action.

Interest can be impetus. It can be the energy of activation required to actively engage in conversation, work, hobbies or recreational activities.

Interest can be fleeting. Fascination can quickly fade to boredom as novelty becomes familiar.

The type of interest that gets you going might not be the type of interest that keeps you going.

Sometimes interests become obsessions. We recognize that as unhealthy. It is possible to be too interested in something or someone. Of course, this is also a blurry line. Sustained, intense interest can lead to expertise and mastery.

The problem for most people with ADHD is that interest is often intense but ethereal. They start something with gusto, and then they’re just not doing it anymore.

Interest has something to do with novelty. When something is new to you, it is more likely to be interesting. Every day, we encounter something new, because nothing is ever exactly the same. New must be different enough, however, to qualify as interesting. Even something never seen before might not be interesting, however. Surprising maybe, but not always interesting.

Interest has to do with identification. That is, in order to be interested, we must identify with whatever it is - topic, object, activity, person. There must be some relevance to us, or we must feel something toward or about it/them. There must be some association in our minds with the thing, some shared quality, history, or similarity in our minds.

Problem solving is a bit different. Problems are puzzles to be solved. This type of interest is derived from intuition that points toward a solution. Almost like a word that is on the tip of your tongue, the resolution to a problem is sensed, but not fully visualized. The process of investigation provides the next clue, leading you along, sustaining interest. Once the problem is solved, there is nothing to sustain interest. The quest for the next problem begins.

Problems are most appealing when the solution can be reached without significant delay. When many steps are required, and especially if the steps involve the agreement of other people, paperwork, phone calls and uncertain response times, the problem is far less appealing.

Fixing something that is broken is a good example of an appealing problem. Even if what needs fixing is fairly complicated, like an engine or electronic device, as long as it is tangible, visible and able to be manipulated, it will hold interest. A lot of parents of children with ADHD complain that their kids take things apart and try to put them back together, even if the thing they take apart was not broken to begin with. Adults also like to take things apart and put them back together. There is satisfaction to be found not only in fixing, but in finding out how something works and what’s inside.

-Thor Bergersen M.D.

When Should Becomes Want

Humans are, by nature, creative and productive. We want to explore, build, learn, solve problems and change our environment. It gives us satisfaction to manifest externally what we think or feel, so that we and others can see, hear, taste smell and touch what we have imagined. Creative acts can be anything, from a baby laughing or throwing a toy, to an adult playing the trombone or mowing a lawn. The ability to say “I did that,” and have other people nod and agree, “yes, you did that,” is in our nature.

Most people also want to cooperate, which is why society exists. We are the product of both group and individual selection pressures, evolutionarily speaking.

What humans create is a reflection of the way their minds work. This is true from a micro and macro perspective. The computer, for example, is a machine that does some work our minds might otherwise do. Computers are complicated tools, like engines. They do work for us. We create software for computers, as they are just tools that need instructions to do the work we require of them. We build cars around engines, so we can get from one place to another in comfort, using the power of the engine to move us around.

We create laws and governments, outward manifestations of our internal desire for order, so that we have some structure within which we can cooperate with each other. We investigate what we don’t understand, experimenting to reveal predictability in our environment so that we can manipulate it more effectively. We call this predictability “laws of nature” and record them so that we can build upon the accumulated knowledge.

From the time humans picked up rocks and sticks to use as tools and weapons until present day, we have been driven not only to survive but to effect change around us to make future survival easier.

We do this because it is our nature to do so, and we derive satisfaction from the doing. When our desire to manifest is thwarted, we are dissatisfied.

I’ve listened to many people tell me they “should want” something, or that they “want to want,” which seems oxymoronic but makes sense. They also want to do what they should. Sometimes, they say they need to do what they should, and for that reason, they must do whatever that is.

The process of convincing oneself that a “should” is a “want” is not straightforward. Often, this happens as a result of some external force that changes the equation. For example, many children I’ve seen over the years have shown no interest in doing well in school. Academics have no relevance to them - there is no want or need, only “should.” They often show little interest in personal hygiene, like brushing their teeth or showering. They eat what they want, when they want, despite their parents’ best efforts to offer healthy foods at mealtimes. No matter what is attempted to change their lack of interest and often outright hostility to doing anything they “should” for themselves, they are steadfast in their refusal to cooperate.

Then everything changes. Should becomes want. They put in an effort in school, are more cooperative with teachers, parents and peers, take an interest in their appearance and hygiene, and begin thinking about goals. They want to do well, look good, have friends, and see the point in all of these things. What changed? Not treatment, although they might be more engaged in therapy or find a medication useful for focus without any changes in either of these modalities. What changes is that they care. They care about having friends and looking good for someone to whom they’re attracted or is attracted to them. They see some point in learning, even if there is no immediate relevance. They start to see that eventually, what they are doing now will be relevant, even if only temporarily. They develop their own “why” for doing what they should, and it is because they want to for themselves. It is not because other people told them what they should want or should do. They have known the opinions of others for some time. For real change, as cliche as it might be, they have to want it.

I have seen changes like this happen thousands of times, and have reassured concerned parents that it will happen at some point, and that they must simply do their best and wait for it. That often does not sit well. The same can be said for people of any age, but it is most striking in young people who seem to have no cares or direction and then suddenly do. When asked why this change happened, they usually say “Because I decided.”

-Thor Bergersen M.D.

Losing Track of Time

Time is a fraught subject. Some say it’s an invention of humans. Others say it is a fact of nature.

Time may be at the core, or the core, of attention.

Time is always there, lurking, passing, nagging and tugging at our consciousness. It occupies part of our awareness, because it must. The way things are constructed around us necessitates that time takes root in our minds.

Everything is within time. It contains our lives, events, periods, epochs, eras and generations. How old is the universe? We have a pretty accurate idea. But our minds are incapable of comprehending that amount of time. We can comprehend what we have invented, based upon the rotation of the earth on its axis, or around the sun. It gets light, and then dark and then light again. Seasons come and go. We get older.

At a higher resolution, we have to be "on time." We are "late." We lose track of it, waste it, spend it, save it, even make time. All of these are figures of speech, but only because they have to be used figuratively. Nothing we can say about time is "real." We measure it - or our phones do for us. It's displayed in the upper left corner of the screen upon which these words appear right now. When you read this, which will be some time from now, these words will be from the past. But you are reading them now. Now is always the same, because the present is always now. Everything else, past and future, do not exist - really. We have to either imagine or remember for them to exist - in our minds.

We reminisce about (fondly, perhaps wistfully) or regret the past. We mull it over, replaying what has happened in our minds, from our perspective, which is only one perspective. We anticipate or dread the future, as it is unknown to us. A lot of time can be spent simulating possible future events, most of which is wasted.

How are we to know how best to make use of time? No one always uses it wisely, at least in retrospect. I don't know anyone who would say, "I have spent every second of every minute of every day of my life in exactly the way I wanted to, and continue to do that right now."

Some say that things happen as they "should," or that "everything happens for a reason," which may be true. But that begs the question: Do we decide what to do, of our own free will, every moment? Or is it all in some way predetermined? This is, of course, the big rabbit hole.

Assuming we do actually make choices and have free will, then we bear the weight of choice at "all times." That is to say, every moment, we must decide what to do with our time. Because it is always passing, moving, slipping.

In physics, there is a thermodynamic principle which describes the constant dilution of useable energy, the inevitable transition from a higher state of order to a lower one. Things fall apart. The center will not hold.

From this stratospheric, even cosmic perspective, time is conceptually slippery. It is true that we all are born and eventually die (for now). Without maintenance, things decay. What is in perfect working order today could be useless garbage tomorrow, or several years from now. We try, but we cannot stop this inevitable march toward disorder that we call time.

For those with minds that do not provide ample space for the "internal clock" that is constant awareness of time, life can be difficult. In order to synchronize with other people, situations and events, we must, in civilized society, give at least some of our attention to time. If we do not, we are late. We miss stuff. We upset ourselves and others if we are not paying some of our limited attention to the passing of time.

Because humans have made time central to attention, we have created a problem. It is not socially acceptable to ignore it, as it is always taken to mean that one does not “care," especially if lack of attention to time involves making others wait. That is rude. It is inconsiderate. If you ignore time, or do not give it enough or your attention, you are, by definition, selfish and self-involved. You care about "your time" more than the time belonging to others. Your time is then "more valuable" than that of others who you stand up, delay, or keep waiting.

Many people with ADHD have little sense of time passing. They find it very difficult, sometimes impossible, to estimate how much time a task will take to complete. As a result, they are often late or miss events they intend to attend. Their intentions are good, and they do care - a lot. It is painful when others attribute lateness to apathy or selfishness. Most of the time, the opposite is true. We very much want to be on time, and we judge ourselves harshly when we are not.

-Thor Bergersen M.D.

You Are Not Your Brain

Your brain is a useful tool. You can use it to think if you choose to do so. Most people are under the impression that their brains are in control. They talk about things they “have to do,” or “can’t help but think about.” This is completely understandable, because it really seems like the brain is calling the shots.

Since the earliest writings of philosophers, people have been trying to control their minds. All religions are derived from words of wisdom on this subject. Original sin, desire as the cause of all suffering, surrendering your will to God - ways in which to unburden, and provide an explanation for, our unruly minds. 

Along the way, some good ideas have come about. Many people claim that your mind does not control you. In fact, you can control your mind. After practicing psychiatry for 23 years, I have come around to agreeing with this, with some qualifications.

The concept of being in control of your mind, and therefore your thoughts and behaviors, is appealing. If you could always think logically, make good decisions, formulate plans, and follow through on your intentions, life would go smoothly.

The problem is, humans are not robots. We are capable of rational, logical thought, but we also have feelings, wants and needs. Our brains are powerful, consuming 20% of our energy. They’re always working, even when we would prefer to take a break. Our brains don’t let us relax, so we have various ways to quiet them down: meditation, exercise, social media, alcohol, cannabis - the list goes on.

Psychiatrists and psychologists have made a long list of mental disorders, or ways in which a mind can malfunction. These labels help us to talk about problems with fewer words, conduct research studies, and bill health insurance using “diagnostic codes.” Sometimes it helps to have a couple of words to describe something complex, like Bipolar Disorder or Attention Deficit Disorder.

Naming a problem does not solve it, however. Often, it creates more problems.

Two decades of talking with and treating people with a variety of issues has led me to a far simpler way to understand how our brains work, and how to work with them. When you and your brain are in sync, you can get stuff done. Or just relax.

-Thor Bergersen MD

The Coach in Your Brain = Prefrontal Cortex

Your brain has roughly 40 anatomically distinct regions, all with different functions. Think of those regions as a team of players. The area right behind your forehead and above your eyes is called the prefrontal cortex. Think of that as the coach.

When the coach is alert, it directs the players to cooperate with each other. The timing is right, the plays go smoothly and everyone is happy. When the coach is asleep, the players will goof off. They might practice individually and hone their skills, but the game won’t start until the coach wakes up.

For people with ADHD, the coach is often dozing off when the environment is not stimulating and interesting. This manifests as daydreaming, being distracted and not listening. It can also lead to physical restlessness, or the need to get up and go. Difficulty sustaining attention, impulsiveness, procrastination and starting lots of tasks without finishing them are ways in which people experience ADHD.

When the situation gets exciting, intense or at a crisis point, the coach always wakes up. That’s when the brain engages, especially for those with ADHD. In this state of hyper-focus, nothing else matters. The task at hand is all that exists, and time seems to stand still. You forget about hunger and other bodily functions. Like a horse with blinders, all you see is straight ahead.

This all-or-nothing focus happens because the dopamine threshold must be reached for our coach to wake up. The nerves in the prefrontal cortex communicate using a chemical messenger, or neurotransmitter, called dopamine. When there is enough dopamine floating around between the nerves, signals are sent. When the level is insufficient, nothing happens.

Dopamine levels are determined by rates of release and recycling. It’s released from the nerve cells to send a signal, and then recycled to be used again. If there are too many recycling pumps, or if the pumps are very efficient, then the dopamine level outside the cell where communication happens is too low. Thanks to genetically programmed cells with excess recycling capacity, that’s exactly what happens in the prefrontal cortex of people with ADHD.

-Thor Bergersen MD