The Medication Window

Almost every adult I know starts the day by taking a stimulant.

We don’t call it that. We call it coffee. But make no mistake about what is occurring here during that first quiet cup. You are reaching for a chemical because it sharpens your attention, shakes you out of the fog of sleep, and pulls the morning into focus. Nobody thinks this is strange. Nobody feels the need to whisper about it. We’ve built cafes, entire rituals, and a good chunk of the global economy around the simple fact that human beings like to medicate their attention first thing in the morning to address the needs of their day.

I bring this up because it puts in perspective the strangeness of the usual conversations that tend to happen in hushed tones about stimulant medication for ADHD (but really this medication issue can be generalized to just about any psychotropic medication). The stimulants that help an ADHD brain aren’t exotic. They’re on the same shelf, chemically speaking, as that thing most of the planet drinks before it will speak to anyone. Their usefulness isn’t even specific to ADHD, which is exactly why so many people without the diagnosis take them, and why some end up abusing them. To put it simply, stimulants work on attention, ADHD is, in part, a condition of attention, but ultimately any condition that is affecting attention can be treated with a stimulant. But not cured.

I don’t think anyone would say coffee solves anything, but it does make the solving more do able.

So let me say something that may sound, at first, like I’m against medication. I’m not. But when you live with a neurological difference there is always this strange tension around medication, and it keeps us from being precise about what the medication actually does.

A medication, regardless of what it is, does not give you organization. It doesn’t hand you a different memory. It increases your attentional vigilance or maybe calms the experience of anxiety, but doesn’t erase years of dropping the ball or thoughts of insecurity.

What it gives you is a window.

A stretch of chemical focus. A clearer hour than you’d otherwise have. A window is not a cure. A cure would fix the problem and let you walk away. A window just gives you a moment of decent light to work by, and then it closes. The entire question that decides whether the medication changes your life or just changes your afternoon, is what you do while the window is open.

This is where a good teacher builds their practice. It is where a person can learn to work with their own mind through real labor. The window the medication provides you with is simply a space to work. A spot that improves your odds of problem solving your disorganization, building a defense against your forgetfulness, or working within systems that were clearly not designed with people like you in mind.

Even if the medication were perfect.

Even if it worked all day and never wore off and had no cost or side effects, it would still only be treating one layer of a larger issue at play in your life. Because the problems that gather around a diagnosis like ADHD, or Dyslexia, or Autism, or whatever, are largely not biological. Natural variation will produce a diverse interlocking mesh of layers of impact.

Consider the layers.

One layer is lived experience.

There is an anxiety and sadness that so often travels with ADHD, and other diagnosed neurological differences, which are frequently not free-floating brain chemistry. They are tied to things that actually happened. Loss. Trauma. A hundred small humiliations that may have taught you what to expect from rooms full of people.

There is no pill for grief. There is no dosage that reaches back and un-happens the thing that hurt you. You can medicate the biology of a low mood, but you cannot medicate a reason, and a great deal of human suffering has reasons… And reasons can be addressed, just not through medication. At least not directly.

Then there is the layer of habit.

We are creatures who lay down pathways by repetition. Do something ten thousand times. For example, flinch at a certain kind of feedback, avoid a certain kind of task, tense before you even open the email, and you’ve carved a groove in the nervous system that will fire by rote, on its own, long after the situation that created it has become forgotten. Medication does not un-carve those grooves, old habits fire because they are over learned behavioral responses, not merely a chemical response to the environment.

And then there’s the social layer.

This is the one the medical model has historically been least equipped to deal with. It is one the science is increasingly finding impacts individuals more than we ever realized. Conditions that the medical model has been historically able to paint as outside their biological jurisdiction. But we now know the conditions that tax attention and executive function the hardest, are chronic stressors like unstable housing, food or even food that is cheap instead of nourishing. Environmental toxins abound and many have been known for decades to impair developing brains, but remain in use with little public discussion or even a cost gain analysis.

And we know these impacts do not fall evenly across a population. They pool. They concentrate in communities that are already carrying more than their share of these kinds of burden. What has become clear is the biology we have been so quick to medicate, and the impacts of social marginalization we equally, reflexively, ignore are in fact impossible to cleanly separate. When we treat a struggling attention as a private, purely medical condition, we are quietly agreeing not to look at much of what is actually going on. Layers that medication is oblivious to.

Layers that build a general social fear of the unknown and disdain. A disdain foisted upon others for simply being outside their expectations, broken or inferior.

There is no medication for being hated…Maybe hate is too strong a word. Maybe you would prefer to call it being discriminated against. But call it what you will. There is no prescription that touches the experience of being the target of another person’s contempt. To be disliked or dismissed simply for existing in the way you exist.

No dosage reaches the pain of a lifetime of neglect.

These are real forces. They shape behavior and biology. And the medical model, for all its genuine power, has absolutely nothing to offer the person whose central problem is that the world has been cruel to them.

And then the world carried on as if nothing happened. Too oblivious to even look.

This may even be a source of the pain, the guilt and shame that keeps many from doing the right thing.

Now, I have been told this sounds like an argument against diagnosis, and it isn’t.

I am genuinely for diagnosis. Naming hidden forces that are acting on your life is the first step in problem solving. Naming identifies the forces that are negatively acting on your life, and can be one of the most freeing experiences a person can ever have in developing their neurodiversity and unique skill set.

Naming gives this very abstract thing about our neuropsychological makeup a form. You can suddenly point at a thought, or even a way of thinking, as if it were a tangible object. And once you can point at it, you can start to work with it. A good part of what I do is help people learn to do this naming thing for themselves, and frankly, the best part is what happens when they turn around and do it for someone else. Supporting another person, in a careful and very specific way, so that they can become a diagnostician of their own experience. There is a difference between knowing a diagnosis and actually understanding how the whole picture, not just the label, but knowing how to execute an intervention that actually works. Even the simplest medical solution depends on it. A pill only helps the person who understands it well enough to take it as prescribed, notices its side effects, and adjusts as their body changes over the years.

A diagnosis is a slice. It names the part of the problem that fits inside the medicalized box we have drawn around the body. Unfortunately, that slice is not where the deepest or most fundamental trouble lives. The deepest trouble lives in the grief, the habits, the poverty, and the contempt. The conditions of the condition, the parts no medication was ever built to reach.

Those parts still need a remedy. They need one just as urgently as the parts of the diagnosis the pill can help with. But what is needed is something different than a pill. Something that treats not only the individual but the environment and the memories and forces that conspire to keep us from identifying, and solving, the problems we face.

Because the problem is not just chemistry. The problem is living. And unfortunately a large piece of that living piece is not simply biological, it is the fact that we live in a world that mostly does not make room for it, even as it provides a seemingly endless stream of new medication for it. Medications that do not cure, because you don’t cure living. You live differently. You learn how to do it better than the day before. For some that may mean using the window that medication opens. For some that may mean finding a teacher or mentor like myself who can help you see yourself well enough to support you through what you have to do to be successful. Helping you build those memories and the long term experiences that will become the habits of your own success... And for some it may be stepping out of your comfort zone and taking a leadership position as a teacher or mentor yourself.

Thank you for your time reading. This article is part of a larger chapter in the book I am writing on Wholistic Problem Solving, if it stimulates any ideas, comments or questions please comment. If you could please consider becoming a paying subscriber and supporting this educational movement.