March 29, 2021 • 50 mins
Pen and Harvey discuss the high rate of misdiagnosis for people with ADHD, including likely reasons for it and common comorbid conditions.
Note: Around the 38 minute mark, Harvey mentions & reclaims the r-slur. If that's something that makes you uncomfortable, go ahead and skip forward 40 seconds or so and you should be fine.
Featuring: Say "wahoo" in the fun voice; well-meaning clinicians can still be wrong; ADHD Is A Brain Condition, Not A Behavior Issue; When I say mood swings, I'm talking theme-park level here; Secondary diagnoses are real, but oof; We talk about dopamine again; A really bad take on autism from an article I wanted to like
Referenced/Related Links from this episode:
- https://www.additudemag.com/slideshows/adhd-misdiagnosis/ ADDitude article on common misdiagnoses (includes the bias & inaccurate part on autism)
- https://www.additudemag.com/mental-health-diagnosis-adhd-comorbidities/ Another article on common comorbidities, not directly referenced in the episode, but still useful information
Suicide Hotline & Resources for Trans People:
USA Suicide Prevention:
https://suicidepreventionlifeline.org/
Internation Suicide Hotlines:
https://www.opencounseling.com/suicide-hotlines
Suicide Hotline & Resources for LGBTQ+ Young People:
https://www.thetrevorproject.org/
Ways to support Black Lives Matter and find anti-racism resources:
https://linktr.ee/blacklivesmatte
Resources to support AAPI (Asian-American & Pacific Islander) communities:
https://www.advancingjustice-aajc.org/
https://stopaapihate.org/
Resources for US Immigrants:
https://www.informedimmigrant.com/
Resources to Support Undocumented Immigrants in the US:
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Harvey (00:00):
Hi, friends. Among other things, this episode addresses
the comorbidity between ADHD andautism, and also some of the
ways that that gets reallycomplicated. It should be noted
that, around the 38 minute mark,I reclaim the r-slur. Now, this
is something that I am allowedto do because I am autistic,
(00:20):
however, if hearing that slurmakes you feel uncomfortable or
upset, which is totallyunderstandable, just be
forewarned that that's going tohappen, and feel free to skip
past that point. Enjoy theepisode!
Pen (00:46):
Hello, and welcome to Beyond Introspection
where we talk about mentalhealth, neurodivergence, and how
it impacts literally everyaspect of our lives.
Harvey (00:53):
All of them.
Pen (00:54):
I'm Pen.
Harvey (00:55):
And I'm Harvey.
Pen (00:56):
And in this episode, we are going to be talking about ADHD
and misdiagnosis.
Harvey (01:02):
Which to my understanding is very common.
Pen (01:05):
Yes, yeah, it's actually--it's really, really
common, much like comorbidity iscommon. Which, those two, as you
might be able to imagine arelinked.
Harvey (01:15):
Hmm, who'd'a thunk it?
Pen (01:16):
Yeah, who would have thunk it? Apparently not a fair number
of clinicians, which... weirdtake, but okay.
Harvey (01:25):
That seems concerning.
Pen (01:28):
It's, uh--some of this is, like, it's not that i've seen a
lot of things where cliniciansare like, "No, actually, I don't
think that there's muchmisdiagnosis," it's just that
the misdiagnosis happens soconsistently in the first place,
that it's like, okay, maybe theunderstanding that you are
working off of for what ADHD isand how it looks is flawed, and
(01:51):
y'all need to take a minute toreexamine that.
Harvey (01:54):
Maybe you're doing a bad job
Pen (01:56):
Sometimes, even when you're well-meaning. But--ooh--ooh,
that's... yeah, that's a lot ofthings, huh?
Harvey (02:03):
Impact versus intent applies to a lot of things, but
I think, before we get into thisemotionally exhausting,
probably, episode, Pen.
Pen (02:15):
Harvey.
Harvey (02:15):
Tell me about your Wahoo! Moment of the Week.
Pen (02:19):
You...
Harvey (02:20):
Me?
Pen (02:20):
You know I'm gonna make you redo that so you say "wahoo" in
the fun voice.
Harvey (02:24):
Oh. Tell me about your Wahoo! Moment of the Week.
Pen (02:27):
Thank you so much. Yeah, I literally only remembered we
were gonna do this when we weretalking before I hit record. So,
give me a second to think.
Harvey (02:38):
I have--oh! Go ahead.
Pen (02:41):
The library that I work at, we are in the process of weeding
the nonfiction, getting rid ofthings that haven't been checked
out in ages, or just areirrelevant. And for one reason
or another, comics and comicbooks, a lot of them are in
nonfiction. In part, I thinkjust because, like, the Dewey
Decimal System doesn't actuallyhave a fiction versus nonfiction
(03:04):
category. Like, just, fiction iskind of in the 900s, we just put
it in a different place becausethat does make more sense.
Harvey (03:10):
Sure.
Pen (03:11):
So comics just fall into being in the nonfiction section,
which I imagine is part of thereason that they don't always
get checked out.
Harvey (03:16):
That is sort of bizarre, yes.
Pen (03:19):
But one of them that we were getting rid of is a Calvin
and Hobbes anthology that isactually a copy of the same one
I used to read when I was a kid.
The original one that I got intoCalvin and Hobbes with, so I
took it home, and now I have it,and i've been rereading it, and
it--it's cool
Harvey (03:35):
So that's why you mentioned Calvin and Hobbes in
the Discord the other day.
Yeah. I understand so many moreof the jokes now in my 20s than
I did when I was eight.
That seems about right. Iremember my mom also reading me
Calvin and Hobbes books when Iwas a kid. I have a very clear
memory of being, I think, sevenor eigh,t and having
heatstroke...
Pen (03:55):
Oh! Oh, no.
Harvey (03:56):
...the day before school started, and laying on my couch,
and my mom reading a Calvin andHobbes anthology to me. And I
fell asleep and woke up fine thenext day.
Pen (04:07):
I'm glad you woke up fine.
Harvey (04:08):
But I would--well, yeah, I didn't die, as you can see.
Pen (04:12):
I do, I see. I see you, alive.
Harvey (04:15):
Yeah!
Pen (04:16):
There's a picture in one of my mom's scrapbooks of me age,
like, seven or eight sitting ina toy box that one of my mom's
friends, like, made when I wasborn. So, you know, big enough
for me to sit in, which I waskind of laying it in my
carebears one--nightgown, sothat's how you know it was a
while ago, just reading thisanthology.
Harvey (04:39):
Yeah, that'll do it. All right.
Pen (04:41):
What's your Wahoo! Moment of the Week?
Harvey (04:44):
I have several.
Pen (04:45):
W-hey! That's nice! I think last time we did this, you were
like, "I'm depressed."
Harvey (04:50):
I'm still depressed.
That hasn't changed.
Pen (04:52):
I mean, me, too.
Harvey (04:53):
I missed a dose of my antidepressants last night, so
I'm extremely tired, but, youknow, like, good things have
happened, and I'll just--sincethere are several, I'll go
through them real quick. I gotmy first dose of the COVID
vaccine.
Pen (05:08):
Yeah!
Harvey (05:09):
Because I have a [snapping] underlying condition!
Pen (05:12):
Congratulations on vaccination. We believe in
science here.
Harvey (05:15):
We do believe in science here, to a degree. We take
science with a grain of saltbecause science is more biased
than people give it credit for.
Pen (05:22):
We absolutely consider the ways that science can be flawed,
but we aren't antivax.
Harvey (05:27):
No. Vaccines are safe and effective.
Pen (05:33):
Please.
Harvey (05:34):
That is not debatable.
Pen (05:35):
That's not--this is not a debate that we're gonna have.
Harvey (05:37):
Um, I just got back, today, actually, from seeing my
boyfriend, which was nice,because I hadn't seen him in
about a month and a half, so Iwas like, oh, boyfriend time. So
I got cuddles, and that wasnice. I've also been talking to
this guy. I'm polyamorous, bythe way, I don't think I've ever
(05:57):
mentioned that on the podcast.
But I'm poly. And there's thisguy I've been talking to named
Devyn, who is very, very cool.
We're having a virtual date onFriday.
Pen (06:09):
Oh, fun!
Harvey (06:10):
Yes. And I--I'm probably going to be meeting up with him
at the end of April, because bythat time, I will--we will both
be both fully vaccinated.
Pen (06:21):
That's radical.
Harvey (06:22):
And the last thing. I've been having a bit of a rough two
weeks, as Pen knows. I'mintentionally being vague about
this, but something happened inmy life that was just really
rough on me. It was somethingthat I really hoped would go
well, and it just didn't go theway that I wanted it to. But I
did learn through thatexperience that I have more
(06:44):
people that I knew in my lifethat are going to be here for
me. So even though I am, like,wildly depressed right now,
like, at a lower low than I'vebeen in a long time, there are a
lot of good things to thinkabout.
Pen (06:56):
Oh, that's great, buddy.
Love that. Love that for you.
Harvey (07:00):
Okay! [clap] Let's get sad.
Pen (07:02):
It's not sad. I'm gonna be frustrated. You can believe
that. But it's not necessarily asad--a sad one.
Harvey (07:11):
"Sad" as an umbrella term. Thank you!
Pen (07:14):
Seasonal Affective Depression as an umbrella term.
[Laughter] Thank you forlaughing. Okay, so ADHD and
misdiagnosis. I--this is stuffthat I have been kind of
learning about more in the pastyear or so. I remember it was
last spring when I first learnedthat it's actually pretty common
(07:35):
for ADHD and bipolar disorder tobe misdiagnosed as each other.
Harvey (07:41):
Yeah.
Pen (07:41):
And I remember learning that and being like, are you
kidding me right now? Are youokay?
Harvey (07:46):
Oh, right, because at the time, didn't you have both a
diagnosis of bipolar II andADHD?
Pen (07:50):
Yep. I was originally diagnosed with bipolar type II
by my second psychiatrist, whowas better than my first
psychiatrist.
Harvey (07:58):
Didn't prescribe you any, you know, life-threatening
medications without the propertests.
Pen (08:03):
Yeah, she was actually the one who brought up like, "Oh, so
you've been getting the bloodtests?" And I was like, what?
And she was like, "So we'regonna get you off that
medication. That's some messedup stuff." And I was like, yeah,
it is, ma'am. Thank you. She,you know, we talked and she
listened to me about like, themood instability that I had and
brought up, "Hey, has anyoneever talked to you about
(08:26):
potentially a bipolar diagnosis,specifically type II?" and she
like, talked me through that andtalked me through the different
medications that could be used.
And legitimately, like, that wasvery good. She listened to me
and told me what was going on.
We had conversations about themedication and everything. Like,
that was very useful.
Harvey (08:44):
Alexa, play "Lithium" by Evanescence.
Pen (08:47):
Yes. The problem is that she was wrong.
Harvey (08:53):
Yep.
Pen (08:54):
And it was not because she wasn't listening to me. It's
because of a lot of complicatedfactors.
Harvey (09:00):
So many. So, so, so many.
Pen (09:02):
But yeah, it was only last year that I learned that things
like, you know, mood shiftsthat, honestly, it was me
learning about some of thesymptoms of ADHD that I had
never heard of before, primarilythe ones that have to do with
emotional regulation. Because,surprise, surprise, they're not
the ones that people talk about.
Harvey (09:22):
Which, like, if you know anything about the brain, if you
are into neurobiology, biology,psychology, it's not a hard leap
to be like, oh, yeah, no, thatmakes sense, why ADHD would
result in emotionaldysregulation. But good God,
the--the fact that it just nevergets talked about.
Pen (09:42):
Like, here's the thing, and we've talked about this on this
podcast before, that ADHD isliterally caused by, like,
there's some things that are upin the air, but it is a
deficiency of dopamine.
Harvey (09:53):
Right. And really, you can reverse engineer that from
figuring out what Adderall does,but--
Pen (09:58):
Like--the wild thing? it's caused by lack of dopamine.
Harvey (10:05):
Right.
Pen (10:05):
That's not how we talk about it. We don't say, like,
"ADHD (10:08):
a brain condition that's caused by a lack of dopamine."
And, like, from there, like, alack of dopamine, does that
affect your emotions? Of courseit does.
Harvey (10:17):
Yeah.
Pen (10:17):
That is not even close to a logic leap, but we don't talk
about it like that's the case.
Harvey (10:22):
So much of ADHD is just kind of predicated on effects on
the frontal lobe. and a largepart of what happens in--a large
part of emotional regulation, ithappens in the midbrain, and
then also parts of theforebrain, the frontal lobe. And
all of those are dependent ondopamine. But to your point,
Pen, I'm realizing--I had neverthought about it that way, that
(10:44):
it's not talked about as, like,a brain thing. I think ADHD is
definitely, now that you pointedit out, more and more talked
about in behavioral terms. Andthe behaviors do matter. But
that doesn't mean that we canjust, like, eschew the source.
Pen (11:01):
I think that's--that is my issue with a lot of it, is like,
yeah, we should absolutely talkabout behavior in ADHD, because
that's how it manifests.
Harvey (11:09):
Right.
Pen (11:09):
We don't talk about it like there's an underlying reason,
though. We talked about thebehaviors like they're all
separate things that just, like,pop up, and we can deal with
them one at a time. Like, wedon't really discuss it like,
okay, so all of these behaviorsare caused by the fact that this
is a brain condition that youare born with.
Harvey (11:28):
The behavior is posited as the problem, rather than a
symptom of the problem.
Pen (11:33):
Yeah. And that's just--that is a fundamentally flawed way of
discussing ADHD.
Harvey (11:38):
And it's also going to lead straight into victim
blaming. And in my mind, it'sdeeply rooted in that "pull
yourself up by your bootstraps"Western ideology,
Pen (11:46):
Which is a--something that is so messed up, and also so
common that, you know,neurodivergent people here is
like, you pull yourself up byyour bootstraps thing, and it
has been, you know, veryvalidating, and in some ways,
kind of liberating to learn,like, yeah, I can put in all the
(12:06):
effort that I want. There'snothing I can ever do to force
my brain to produce moredopamine, so some things are
just going to be harder for methroughout my entire life.
Pretty messed up that that was aliberating and validating
realization.
Harvey (12:20):
Yeah, that should sort of just be, like, the basis
for--for how one experiencesADHD.
Pen (12:28):
Yeah, but because it's not, and because we don't talk about
ADHD like it's something that'sinherently going to affect your
mood. Even though, if you lookat the underlying thing, there's
literally no way it wouldn't.
Because of that, I didn't know.
Despite, like, I brought up ADHDto my psychiatrist, Jada--
Harvey (12:53):
Jada Butler!
Pen (12:54):
Yeah!--as a potential thing to get screened for a year
before I learned this. Like, Ilooked into it, I looked into
ADHD, I saw the way thataffected me, and I didn't come
across any information that mademe--like, that was based on how
ADHD and bipolar disorder getsmisdiagnosed each other until
(13:17):
another year had passed, whichtells you a lot of things,
including that, even if you takethe research into your own
hands, that doesn't mean thatit's going to be good
information that's readilyavailable.
Harvey (13:30):
Well, yeah, I was gonna say, I mean, somebody has to
produce that knowledge and--
Pen (13:34):
Make it accessible.
Harvey (13:35):
Make it accessible. And the accessible information about
ADHD is so just based on thatbehavioral view of it.
Pen (13:46):
Which is flawed. But all of that to say, when I learned that
ADHD--it--it was a fundamentalchange in how I viewed my own
ADHD as well. Because I hadthought of it as something that
is more based in, like,executive dysfunction and just
kind of how my brain works anddifferent from like, my anxiety
(14:06):
and depression that, you know,just hurt me. Like, I didn't
think of my ADHD as somethingthat hurt me in that way. But
learning that the mood swingsthat categorized a lot of the
stress and pain of my,especially later, teenage years
are far more than likelydirectly linked to my ADHD was
(14:30):
really--like, that hit kind ofhard. Like, oh, okay. So I don't
think that my bipolardiagnosis--I'm not 100% sure
that it has been removed exactlyfrom my file. I have no idea how
all of that fits. But, like, Ihad that conversation with my
psychiatrist, and I was like,hey, I learned this, and she was
(14:52):
like, "Oh, yeah, that totallymakes sense. And especially when
you're in--like, you're incollege, and you're under a lot
more stress, your mood, like,shifts a lot." I was like, you
right, though, Jada.
Harvey (15:01):
Yuh.
Pen (15:03):
And like, regardless of whether or not I have bipolar
disorder, she didn't take me offof lamotrigine, which I had
originally been put on becauseit helps treat bipolar disorder,
because it's a mood stabilizer,and an anticonvulsant. Brains
are so weird.
Harvey (15:18):
Right? It's got to be a neurotransmitter thing.
Pen (15:21):
Probably. She didn't take me off of that because, like,
one, there's no real need to.
Like, lamotrigine doesn't messwith you, really. It's pretty
lowkey kind of medication, notmany side effects, thank God.
Harvey (15:37):
And given that, probably, if she took you off,
you know, your body might havehad a worse reaction to, you
know, just not taking it coldturkey, which I doubt she would
have done, like--
Pen (15:49):
No, I don't--
Harvey (15:50):
Jada Butler is a good psychiatrist, from what I
understand. But it's probablystill easier on your body and
brain.
Pen (15:57):
And if nothing else, like, even if it's not treating
bipolar disorder, it is a moodstabilizer. That's--like, yeah--
Harvey (16:04):
Like, those are helpful.
Pen (16:05):
I don't know exactly how much it's doing for me, but if
it's stabilizing my mood, evenlike 5%, that's--thanks. Because
my mood is very unstable. I havea lot of mood changes, and they
are fast. And that's actuallyfits in really easily with going
over to how bipolar and ADHD getmisdiagnosed as each other.
(16:27):
Because we all kind of have anunderstanding that bipolar
disorder is categorized by moodswings.
Harvey (16:35):
And really dramatic ones, too.
Pen (16:37):
Yes.
Harvey (16:39):
I think we've done a pretty good job talking about
sort of the scope of mentalillness and just, like, how
significant it can get. So whenwe're talking about mood swings,
we're not talking about just,like, you know, like your
average day--like, everybodyexperiences mood swings. That is
something that happens, or eventhe mood swings that you
experience with depression.
Bipolar, whether it is type I ortype II is really characterized
(17:00):
by those super intensedepressions. And in the case of
bipolar I, those high maniasand, in the case of bipolar II,
something called hypomania,which is still mania but less.
Pen (17:15):
Yeah, but it's, like--it is extreme. And it's also
prolonged.
Harvey (17:20):
Yes.
Pen (17:21):
And, very, very importantly, often is not
triggered by anything inparticular, except just your
brain.
Harvey (17:29):
Just happens. Also runs in families.
Pen (17:31):
Yes. And that's like, those are all very significant things
about bipolar disorder, and verysignificant in differentiating
it between ADHD. With ADHD, yourmood can swing in really intense
extremes. And this does happento me. Yeah. But it is one
always triggered by something.
There is always something thathappens. And we've talked about,
(17:51):
like, RSD - rejection sensitivedysphoria - before. That is one
example of ADHD mood swinghappening.
Harvey (18:01):
Yeah. And those mood swings happened with me and RSD
as well.
Pen (18:04):
But, like, that, something happens when you have a really
intense negative reaction to itthat is not necessarily--what,
equivalent to or appropriate to?
Harvey (18:15):
It's disproportionate.
Pen (18:16):
Yeah, disproportionate.
Harvey (18:17):
Possibly irrational.
Pen (18:18):
Yes. And that is triggered by something specifically. And
also with ADHD, sometimes after,like, a very small change
happens, like, maybe you listento one song or just a little bit
of time passes, or you just,like, sit somewhere comfortable,
it can be pretty much anything,your mood can change right back
(18:39):
to feeling good, very, veryquickly. That, like, positive to
negative thing can happen almostinstantaneously, which is not at
all what bipolar disorder islike.
Harvey (18:51):
No, to my understanding, you don't really go straight
from intense depression tomania. It's sort of like, you
have those intense depressiveepisodes, you kind of stabilize
for a little bit, and then youstart working your way up into
that mania.
Pen (19:06):
And they last for quite a while.
Harvey (19:07):
Yeah, that's--that's my understanding, that those
periods--like, I believe, withhypomania, like, you need to
experience at least one periodof mania for, like, a week or
more.
Pen (19:18):
Yeah, it has to be, like, minimum several days of
experiencing this thingconsistently. That's not what
ADHD mood swings are like. No.
It can be like half an hour, itcould be several hours. Probably
isn't going to be more than aday or so, except in the cases
of how ADHD can kind of mimicdepression.
Harvey (19:38):
Yeah, real--real--real quick aside. I was just gonna
say, if you've heard about thesymptoms of mania or hypomania,
and they sound familiar to you,what I will say is that
experiencing hypomania does notnecessarily mean that you have
bipolar. I experience occasionalperiods of hypomania, but
(19:59):
they're usually pretty shortlived. In any case, I'm--like, I
don't believe I have bipolardisorder. But yeah, just so you
know, hypomania is--is a symptomyou can experience without
having bipolar.
Pen (20:11):
Yeah, totally. Some of my ADHD, mood swings that have been
characterized more heavily byirritability, and like, kind of
this... feels like sort ofitching under my skin a little
bit, like, just very--it'sintense, and it's not quite
distress. It's not happy. It'sjust a lot.
Harvey (20:33):
Bothersome.
Pen (20:34):
Yeah. that I thought was hypomania. Turns out it doesn't
last nearly long enough to becategorized for bipolar type II.
But that was something that Idid experience, and was part of
the reason that I was diagnosedwith that. So, you know, if that
sounds familiar to you, it's notnecessarily bipolar, but I would
(20:55):
definitely encourage you to,like, if you have a psychiatrist
or therapist, to talk to themabout it. Do your own kind of
research, if that would help youout, like, whether or not--like,
whatever diagnosis, it ends upbeing. I think it's great to
know these things aboutyourself, and to also figure out
ways to help deal with that.
Harvey (21:14):
And at the end of the day, like, regardless of the
diagnosis, like, those symptomsare still happening to you, and
they still matter.
Pen (21:20):
Absolutely. Whether or not you perfectly fit in with the
DSM requirements for aparticular diagnosis doesn't
change how you're actuallyfeeling and what you're
experiencing.
Harvey (21:30):
Yeah, I mean, DSM requirements are bull hockey,
Pen (21:34):
Yeah, there's a lot of messed up stuff in DSM
requirements.
Harvey (21:37):
Anyway, do you want to talk about ADHD and depression?
Pen (21:39):
Yeah. I actually have some fun--well, I say fun--I have
some facts--
Harvey (21:46):
Facts.
Pen (21:48):
--that I got from ADDitude.
Harvey (21:50):
Yes, we love ADDitude.
Pen (21:52):
Oh, I'm gonna get somewhere with it. Give me a minute to get
to--I'm gonna get there in aminute with autism and ADHD.
Harvey (22:03):
Ope.
P (22:04):
here's a quote from ADDitude.
"Clinical depression is commonin adults with ADHD. Experts
estimate that depression existsin approximately 47% of adults
with ADHD, and 14% of children,but depressive symptoms don't
always indicate a full blowncomorbid condition." And that.
(22:24):
That is the part I want to talkabout. That was something that I
realized very recently aboutmyself. Way back when I first
got into therapy, I wasdiagnosed with major depressive
disorder. I was doing verybadly. My therapist,
Charlie--remember Charlie? Thetummy guy?
Pen (22:39):
Yeah, tummy man. He did not do a bad job in diagnosing me
Harvey (22:39):
Tummy man! with depression. I was doing
horribly. And like, probably, Idid qualify for the diagnosis.
Here's the thing in ADHD and
comorbidity (22:53):
difficulty dealing with ADHD symptoms can cause
secondary depression andGeneralized Anxiety, as well as
some other things. Obviously,some of the comorbid diagnoses
like bipolar disorder or autism,those are [not] caused secondary
because that's not really howthose work.
Harvey (23:11):
Right.
Pen (23:12):
You don't just develop autism. That's not--that's not
really how it go.
Harvey (23:19):
Nope, nope, nope.
Pen (23:20):
But things like depression and anxiety, oart of the reason
that they're so comorbid withADHD is, when people with ADHD
don't have the tools or thesupport to deal with their
symptoms, it's--it's incrediblystressful, and it's compounding.
Like, the mood instability thatis just a part of ADHD, as well
(23:43):
as, like, society's inherentableism that means that, like,
the way my brain works doesn'tfit with any of the models that
I'm expected to be a part of. Ican't consistently pay attention
like I need to. My sensoryprocessing issues are just going
to exist no matter what, andsome of the adjustments that I
(24:04):
need, like, sometimes wearingheadphones, or having lights be
lower, or being able to takebreaks, or juggle like three
different projects at once, orget up and move around. When I'm
not allowed to do thosethings--just--good luck.
There's--there's nothing I cando to make myself not feel
depressed and anxious, and thenpotentially qualify for these
(24:24):
disorders that are, in reality,linked to my ADHD. And if I was
being treated well andrecognized for my ADHD, which
did not happen until I was 20,and I was originally diagnosed
with generalized anxiety andmajor depressive when I was 14
or 15, so going five to sixyears without any of my ADHD
(24:46):
symptoms being properlyrecognized for what they were,
and certainly not being treatedfor ADHD, meant that those
things got more intense.
Harvey (24:56):
Ee-yup.
Pen (24:56):
Would I have been diagnosed with those things if I'd been
diagnosed with ADHD at thebeginning? I think so. If I had
been diagnosed with ADHD andproperly treated when I was much
younger, then maybe not. I'llnever know. But as it is right
now, I definitely havedepressive swings. I'm in one
right now, folks. I don't thinkit is depression so much as it
(25:17):
is linked to ADHD and how thataffects my mood, and
particularly, its instability.
Harvey (25:24):
Yeah, no. And that makes sense. And I think maybe the way
that you would figure that outis just trying to identify,
really, the source of thedepression. Like I know, in my
case, you know, autism anddepression have some
comorbidity, not a lot, butsome. But in any case, even if I
wasn't autistic, like, I havedepression, I totally do. Um,
(25:46):
and the thing about that isthat, yes, there are triggers,
but also my depression comesapropos of nothing, sometimes.
My anxiety, in particular, justcomes apropos of nothing. I
actually don't know if I stillmeet the criteria for GAD, but I
know that I experience panic.
And kind of the crux of panicdisorder is that the panic
attacks come from nowhere, andthen also, it's a vicious cycle,
(26:10):
because you become afraid ofhaving another panic attack and
whatnot. All of this to say, mydepressive symptoms are more
identifiable as depression, Ithink precisely because of the
lack of cause.
Pen (26:25):
Yes, that is-- that is huge thing, like, some of the
intensity and instability thatcomes with ADHD, there is still
a trigger for it. It's becausemy brain does not have the tool,
dopamine, to deal with thingssometimes. And so it's a lot
more intense for me to try andprocess it, because I'm just
lacking the tools for something.
But I'm still trying to processsomething. Or it's not a direct
(26:48):
trigger, so much as it is,things just stacked up on top of
each other. Eventually, when youare stressed by so much of your
life - because of society'sinherent ableism - and also just
because things are hardsometimes, like whether or not
the society was inherentlyablest, I still don't have to
dopamine, that's stillgonna--that's still gonna do
something to me. And when thatstacks on top of each other,
(27:10):
sometimes you get into a moredepressive state. Maybe you
can't figure out the one thing,but if you've been feeling
stressed for quite a while, andthat follows through to a more
depressive episode, there'sstill that trigger coming from
somewhere.
Harvey (27:24):
Right.
Pen (27:26):
And, looking at it, my anxiety and my depression were
very directly caused by stress.
Yeah, there we go.
Harvey (27:35):
And my anxiety and depression are exacerbated by
stress, but even when I'm notexperiencing stress, like, if
I'm on summer or winter break,like, I still end up feeling
depressed and anxious. That'sjust an always for me.
Pen (27:48):
Yeah. And that's, like, there was no way I wasn't going
to meet the criteria forgeneralized anxiety disorder. I
don't meet that criteria now--
Harvey (27:56):
Right.
Pen (27:56):
--because of changes in my life that have made it just not
be--like, when I get stressed,it doesn't trigger into that
anymore, which is so nice.
Harvey (28:06):
I bet!
Pen (28:07):
Other side of that, my social anxiety comes from
absolutely nowhere. It's there.
This is something that I feelquite confident is not linked
directly to my ADHD because it'sjust--it just happens. It
doesn't matter what I do, like,I'm taking a medication for it
now that changes it, and that ismy big clue that it is not
inherently linked to the ADHDis, like, it was very
(28:28):
consistent, and I could, like,try and make it better, but it
was really hard, and then I tookLexapro, and it changed the
things, and I was like, oh.
Harvey (28:38):
Yeah. And I realized, you've mentioned before that you
being on antidepressants didn'tactually help your depression,
but it did for me. Sothat's--but getting on Adderall
seemed to make it better.
Pen (28:52):
Yeah. Adderall affects my depression a lot, which made
me--like, it was kind of animposter syndrome thing for a
while and like worried me alittle bit, like, oh, wow, when
I first take this, like, themood boost I get, like, I feel
like that's not supposed to bewhat happens. One, I got a
increase of dopamine. It made mefeel better.
Harvey (29:12):
Dopamine is involved in the reward center. Something
good happen, make brain go.
"Ohhh, dopamine!"
Pen (29:19):
Which is not what my brain naturally does. This is very
annoying.
Harvey (29:23):
No, you literally just, like, you took a hit of speed.
And you were like, ohhh.
Pen (29:28):
And it worried me, it doesn't know. And like, yeah, my
depression is better now thatI'm on Adderall, because
depression is linked to - waitfor it- dopamine!
Harvey (29:38):
Dopamine!
Pen (29:39):
Yeah, I have less depression because I have a
neurotransmitter. I hear thoseare good for your brain.
Harvey (29:46):
They are, generally speaking. Too much or too little
of any of the neurotransmitterscause problems,
but--because--excessivedopamine, I believe is related
to, oh...
Pen (29:56):
Schizophrenia, right?
Harvey (29:58):
Yes. Schizophrenia and/or Lou Gehrig's disease, I
think. Wait, no, not LouGehrig's... Parkinson's.
Pen (30:07):
I believe you.
Harvey (30:09):
It's--it's one of those two, or both. But there's
a--there's a thought that Iwanted to share about clinicians
and misdiagnosis. And I think--Ithink what I do want to say is
that misdiagnosis, especiallywith disorders that get so
muddy, like they do with ADHD,does not necessarily mean that
(30:31):
the clinician is doing a badjob. It can mean thatm but not
always.
Pen (30:37):
Yeah, definitely.
Harvey (30:38):
The thing about mental health is--it's--it's not like
physical health. Now--now, ofcourse, I imagine with doctors
who work in, you know, themedical field with, like,
physical bodies, physicalailments, I'm sure there is a
level of guesswork that theyhave to do, but those symptoms
are so much more visible. Like,you can--you can see a rash, you
(30:58):
can hear a cough. So that makescertain, you know, physical
illnesses a little more easy todetect. And well, there are, you
know, neurocchemical indicatorsof mental illness. The fact of
the matter is, mostpsychiatrists and most
(31:20):
therapists do not have access tothat kind of technology. And
also, we live in the UnitedStates, we can't afford it.
Pen (31:27):
It's starting with just, like, brain scans, and that kind
of thing, and testing with thatis not necessarily, like, the
first step I think most peoplewould take anyway.
Harvey (31:38):
No, and especially because, you know, a deficiency
in a neurotransmitter could havezero implications, or it could
have several differentimplications. And then you also
have to consider, well, we can'tjust look at one
neurotransmitter, because withthings like depression,
serotonin and norepinephrine areboth implicated in that
disorder. So all of this to say,I think, maybe, part of why
(32:02):
misdiagnosis happens so often isbecause with mental health care,
so much more guesswork has to bedone, entirely because you have
to take information that you getfrom self report and potentially
from peer report, and then,essentially, like, make an
educated hypothesis.
Pen (32:22):
Yeah. And that's real. And, you know, that's not to say that
everything is just simple withphysical diagnosis or that there
aren't invisible, like, physicaldisabilities and that sort of
thing.
Harvey (32:33):
Because there totally are, but there are some very
different--but there are someways in which the treatment and
identification of mental healthversus physical health is
different.
Pen (32:44):
Oh, yeah, absolutely. And like I said, like, my second
psychiatrist who diagnosed mewith bipolar disorder, she
listened to what I was saying,she took me very, very
seriously. One potential thingis, perhaps if she had been more
aware of how commonly ADHD andbipolar disorder are comorbid,
(33:04):
or how often they getmisdiagnosed. And this was
something--recently, someonethat we know was officially
diagnosed with ADHD.
Harvey (33:12):
Yes!
Pen (33:13):
She was screened for bipolar disorder and ADHD
together.
Harvey (33:18):
Oh, she was?
Pen (33:18):
Yes.
Harvey (33:19):
Oh, she didn't tell me that.
Pen (33:20):
Uh, yeah, because--I think, frankly, it was because the
psychiatrist had ADHD, so he hadsome experience with that. Like,
that is one potential way tohelp with that, is to screen
things, you know, are verycommonly comorbid together, so
you have a better idea of like,okay, so is it this, or is it
this? Like, if we're looking atall the symptoms together? Which
one of these makes the mostsense?
Harvey (33:41):
I'm just realizing, curious that I was at one point
evaluated for ADHD, but not forautism, despite how comorbid
they are. Anyway.
Pen (33:51):
You know what? How about we get into that?
Harvey (33:53):
Oh, sure.
Pen (33:54):
Um, so from the same ADDitude article - that I will
link in the description - that Igot some information about
depression and alsoanxiety--quickly on anxiety,
anxiety has passed depression asthe biggest mental health
problem on college campuses.
Harvey (34:11):
Uh-oh!
Pen (34:11):
Yeah. It often doesn't stand alone. It's a hallmark
symptom of ADHD, affecting 30%of children and 53% of adults
with ADHD.
Harvey (34:19):
Oh, wow.
Pen (34:20):
Yeah. So depression and anxiety, literally 50/50 chance
if you have ADHD.
Harvey (34:25):
Yeah. Um, and I just--I need to put that into
perspective as somebody who, youknow, studies epidemiology and
understands the rates of things.
When you start getting into the40s and 50 percents, of things
that is extremely high.
Pen (34:41):
Yeah, it's ridiculous.
Harvey (34:43):
It's dramatic.
Pen (34:43):
Like, that's the thing with depression, anxiety and being
secondary. Being caused becauseyou aren't able to deal with the
ADHD symptoms, but--
Harvey (34:53):
Which makes sense, why--why the--why.
Pen (34:55):
Why the rate is so dramatic.
Harvey (34:57):
Yes.
Pen (34:57):
Yeah, definitely. So autism, which is very different,
because you don't just--theautism is not a secondary
diagnosis.
Harvey (35:06):
Nope!
Pen (35:08):
That's--much like ADHD, and how it's just the way that your
brain works, that's where we'reat. So this-- here is
the--let's--let's talkabout--first the--the statistic:
"Studies show that 30% to 50% ofindividuals with autism manifest
(35:29):
ADHD symptoms. Roughly twothirds of individuals with ADHD
show features of autism." So,like, yeah, again, the overlap
is pretty massive there whichwe've talked about.
Harvey (35:42):
Yeah, I know I mentioned in the autism episode that
approximately a third of folkswith one are also diagnosed with
the other, and that doesn't evenconsider everyone who displays
symptoms.
Pen (35:54):
Exactly. Like, that is the thing, like, if we're just
looking at where there areoverlaps in the symptoms, that's
ridiculous. Like, you do nothave ADHD. I do not have autism.
We have a level of symptomoverlap that is sometimes just
dramatically, likem hilarious.
Harvey (36:14):
You know what we should do? We should
definitely--because myboyfriend, I think we mentioned
this in the last episode, but myboyfriend is also--my boyfriend
is autistic and he has ADHD.
So I think--I think,genuinely, it might be
Pen (36:26):
Yes.
interesting if the three of ussit down and compare
symptomology.
I would--I would love to.
We should have--we should havehim on sometime.
Harvey (36:34):
Yes, we should. I'm going to make a note of that .
Anyway.
Pen (36:37):
You should, 'cause I'll forget. I'm well-meaning but,
oof. Okay, so here's the quotefrom ADDitude, that proves that,
you know, one, there's a lot ofdifferent authors of the
articles, and some of them are,like, you know submitted from a
lot of different sources, andalso that bias comes in pretty
much everywhere.
Harvey (36:57):
Yeah.
Pen (36:58):
And that ableism is a complex thing, and--so here's
the quote.
Harvey (37:05):
Yes.
Pen (37:07):
"Trouble reading social cues and acting appropriately in
social situations are hallmarksymptoms of autism spectrum
disorder (ASD). With autismrates on the rise, parents may
fear the worst when their childstruggles socially." Harvey's
pointing a finger gun at mylaptop, and they're right to do
it. "But this is a big one forchildren with ADHD, too, though
(37:27):
it usually isn't considereduntil a diagnosis has already
been made." That's real. Socialsituations being an issue, like,
where that is, that's real. Theother part what do you... "If
your child has trouble makingfriends, ask yourself: is it
because they're overly fixatedon an unusual interest, or is it
because they're alwaysinterrupting and speaking over
(37:48):
others? The former may be due toASD, the latte, ADHD. An
individual can have bothconditions."
Harvey (37:54):
Bite, bite, bite, bite, bite, bite, bite, bite!
Pen (37:58):
One, the bias in that and portraying autism as a worst
case scenario is incrediblymessed up. I put this in here as
an example of, like, yeah, Ilove ADDitude, like, a lot of
their stuff I'm very into. Isource it for a reason. This
article? I do not trust theperson writing this. This is a
(38:20):
bad take about autism. That'snot--
Harvey (38:23):
Like, okay, sorry for being a retard, I guess, like...
Pen (38:26):
That is--
Harvey (38:27):
We can cut that out.
Pen (38:28):
That is a horrible take. It is not--this is not how we
should be talking about autism.
It's also not the reality.
Harvey (38:36):
Yeah. If we--if we do keep that bit in, do want to
clarify i'm allowed to reclaimthe r-slur. Anyway.
Pen (38:43):
Yes, like, that's--that's real. And then I really don't
like the, like, "Is it becausethey're overly fixated on an
unusual interest, or is itbecause they're always
interrupting and speaking overothers?" and portraying those
as, like one of them is onlyautism, and one of them is only
ADHD, and the only reason theywould overlap is because your
kid has both." What are youtalking about?
Harvey (39:06):
Yeah, because i was gonna say, hyperfixation is a
hallmark of ADHD, and notknowing how to take your turn in
a conversation is a hallmark ofautism. What on earth are they
on?
Pen (39:20):
Yeah this--I put this in here and--here's the kind of
miserable thing (39:25):
that article is the same one that I got the
stuff from depression andanxiety from.
Harvey (39:32):
Bite, bite, bite, bite, bite, bite, violence, bite.
Pen (39:35):
So it's--like, kind of--it's incredibly unfortunate,
especially because we're runningout of time, that I don't have a
better one in talking about ADHDand autism and how they've
overlapped, and i'm very sorryabout that.
Harvey (39:45):
But this is useful for doing a critique.
Pen (39:48):
Exactly. And, luckily, we have talked about ADHD and
autism overlapping before in away that isn't riddled with bias
and bigotry.
Harvey (39:58):
Yeah. Jesus Christ, that is--
Pen (40:00):
Yeah, that's--that's...
Harvey (40:04):
Like, I feel like i've been hit by a car.
Pen (40:06):
I'm very sorry to blindside you with that. Like, that is a
really crappy thing to say. It'salso straight up inaccurate.
That is not--a commonalitybetween ADHD and autism is not
being good at reading socialcues.
Harvey (40:27):
Right.
Pen (40:29):
That doesn't mean something's wrong with you.
Also, let's not paintneurodivergence as something
that is wrong.
Harvey (40:38):
Listen, I can make friends. I have plenty of
friends. They just have to letme talk about Sonic the
Hedgehog.
Pen (40:44):
I love it when you talk about Sonic the Hedgehog.
Harvey (40:45):
Thank you.
Pen (40:46):
And that's--that's also things, like, trying to diagnose
either ADHD or autism by whetheror not your kid is good at
making friends is, like, let'stake that carefully, because
that tends to fall into a blamething, or looking at your child
as having something wrong withthem.
Harvey (41:06):
And then you're also--you're also legitimizing
kind of the --the bias and thediscrimination that children are
taught because we live in aninherently ableist society,
rather than questioning sort ofthe source.
Pen (41:23):
Yeah. Like, it's pointed out as, "Oh, well, there's
something, like, going wrongwith this kid, because they're
not making friends," instead of,"So this is how this kid exists,
and the children around themdon't understand that." These
are very different ways oflooking at it, and that is a
very, very big problem withsociety, with parents and
(41:44):
teachers, with clinicians,like--this is the source of a
lot of where the bias can comefrom, especially because we tend
to look at ADHD and autism asthings that are diagnosed in
childhood, and not consideringsome of the implications of
that, and, particularly, whenyou are diagnosed as an adult,
and it's like, "Oh, okay. So mywhole, like, antisocial thing,
(42:06):
where everyone said I hatedpeople. Really?
Harvey (42:09):
Really now?
Pen (42:10):
Is that--cool. Cool. Good to know that none of you knew
what you were talking about.
Harvey (42:14):
So we're just not gonna examine that one, huh?
Pen (42:16):
So we're not gonna think about that one? We're just gonna
let y'all get away with that?
The answer is no.
Harvey (42:20):
Now, we don't have time [Harvey and Pen, in unison] to
unpack all of that.
Pen (42:24):
John Mulaney, Kid Gorgeous.
But, yeah, yeah. If we had moretime, I would talk more
positively about the--about someof the comorbidity in ADHD and
autism. But--and also, like, alittle bit more on some of the
diagnoses and misdiagnoses, butI think as, like, a broader
overview of where there'scomorbidity, and also how this
(42:48):
misdiagnosis happens and sofrequently, I think i've hit
most of what I was going for.
Harvey (42:56):
Great!
Pen (42:57):
Do you have any thoughts, Harv-and-a-half?
Harv (43:01):
Harv-and-three-quarters...
Pen (43:01):
But not two Harvs.
Harvey (43:03):
Aw. Well, I don't have anything, like. substantive to
say, so to put a positive spinon the--
Pen (43:10):
Please?!
Harvey (43:11):
To put a positive spin on the ADHD-autism comorbidity
thing, if you are autistic andyou have ADHD, you are so sexy,
and swag, and epic, and cool.
Pen (43:25):
You--you are two times as funny as anyone else. That is a
thing that we've legitimatelytalked about, is like
neurotypical people arevery--neurodivergent people are
very good at being funny.
Harvey (43:35):
Yes, because--I think because my--you know, my amateur
opinion of that is probablybecause we have to question
social norms so it's easier forus to break them.
Pen (43:46):
Exactly. I was just thinking about this earlier, is
like, you know, the thing where,like, humor comes from breaking
expectations and it's likethat's all i'm allowed to do.
Harvey (43:53):
Also, bonus points if you're gay.
Pen (43:57):
Yeah, like, Harvey and I have a lot of, like I just said
Harvey, and I have a lot ofoverlaps in our symptoms. I
think that's very cool of us.
Harvey (44:05):
We're very sexy and cool and--no, I can't say that on the
podcast. Anyway.
Pen (44:11):
I think we're pushing it with saying sexy twice. Oh, no!
Three times!
Harvey (44:15):
Oh, no!
Pen (44:17):
Yeah, no, and honestly, like, I think that you are a
very, like, you get--you getalong with people really well,
as a general rule. Like, I wouldsay you're a very charming and
charismatic person.
Harvey (44:26):
Some of it is because i've been masking my entire life
but we don't have time to unpackthat.
Pen (44:32):
And that's--that's stuff.
Harvey (44:35):
But, yeah, I do get along pretty well with people.
Pen (44:37):
You are a very cool person.
You're also, legitimately, thefunniest person I've ever met in
my life.
Harvey (44:42):
Which--it makes me very happy every time you say that.
Pen (44:45):
I say it a lot.
Harvey (44:47):
They do, and it makes me very happy.
Pen (44:49):
But yeah, like, the ways that our symptoms overlap, I
think, really help ourfriendship along, and make it,
like, a very cool thing and,like, I've heard from other
people that our friendship isjust nice for them to like, see,
and that it's cool. So you know,those kind of symptoms that are,
like, "concerning" to see inyour child, don't start with
(45:13):
that kind of take, you're notgoing to be treating your child
well as a result, if that'swhere you're coming from. And
also, sometimes it means thatyour child makes really, really
good friends.
Harvey (45:23):
Yeah. God forbid your neurodivergent kid becomes
friends with otherneurodivergent people.
Pen (45:29):
It's improved my life dramatically.
Harvey (45:31):
Oh, God, me too.
Pen (45:32):
Night and day.
Harvey (45:34):
Do you have any last thoughts you want to share
before I wrap us up here?
Pen (45:36):
Um, just generally that, like, though this is a
frustrating thing, the commonmisdiagnosis, it comes from a
lot of different places, and itis genuinely a complicated
thing. And also, if you aresomeone like me, who has ADHD
and has been misdiagnosed in thepast, and would have really
benefited from being examinedmore properly, and, like, you
(45:59):
feel that, because I certainlyfeel it, that's okay, and you
are valid in that, and I hopethat this gives you, like, some
vindication, because I know thatthat can feel really good. And
if you're someone, like, again,as always, if any of this kind
of echoes in you, like,you're--you're kind of feeling
it and you haven't beendiagnosed with anything or
(46:20):
whatever, I absolutely encourageyou to do research, if that's
the kind of thing that helpsyou. If you have a therapist or
psychiatrist, to talk to themabout it. If you don't, I
recommend therapy to pretty mucheveryone. So yeah, by all means,
like, you get to take yourselfseriously, and whatever you're
feeling, you're feeling it, nomatter where it comes down to.
Harvey (46:41):
Very nice way to wrap that up.
Pen (46:43):
Thank you, I do my best.
Harvey (46:45):
So, let me first say, we really appreciate the audience
that we have here. Those ofyou--we notice those of you who
listen consistently, and itmakes us really happy. So--so
we're glad to have y'all. We'veseen the really tangible ways in
which we can make an impact, andwe want to keep doing that. So
(47:06):
what I want to ask, as one ofthe cohosts of this podcast is,
if you've got some time, in thenext week or so, share this
podcast with a friend of yours,just one. That would mean a lot
to us, and it would be great toget some more reach for more
folks to know who we are and formore--for more folks to possibly
(47:27):
find themselves.
Pen (47:28):
Yeah, and--and with that, it would be really, really
awesome if you have the time andinclination for you to send us a
message on social media or emailus, so that, like, one, if you
have any questions or anyfeedback, or, like, a particular
thing you would like us to talkabout, that we know that because
we want to be able to do thingsthat are beneficial and that our
(47:51):
listeners would really enjoy.
And also because you know, thisis something--this is a labor of
love. This is a passion project.
We do have other things going onin our lives, and we both love
doing this. We don't need praiseand adoration in order to do it,
but it really does help to havethat engagement from people.
H (48:10):
if you want to make me in Pen happy stim, send us a message.
Pen (48:15):
That's a good way to put it. I love that.
Harvey (48:17):
So, stick around for just a few moments, we'll tell
you a little bit more about howthis podcast is run and our
Patreon Woo! Say wahoo.
Wahoo!
Pen (48:26):
Thank you!
Harvey (48:28):
Beyond Introspection is an independently-run podcast by
Pen Novus and Harvey LaFord.
Music by Girl Lloyd. You canfind us on Twitter and Instagram
at ByndPodcast or you can emailus at
beyonddotpodcast@gmail.com.
That's beyond d-o-t podcast, nospaces. We publish on
Buzzsprout, iTunes, Spotify orwherever you get your podcasts.
(48:49):
You can find the links to oursocial media and email in the
podcast description.
Pen (48:54):
We also have a Patreon. You can find us at
patreon.com/beyondintrospection.
That's all one word. We alsohave links to it on our site and
on our social media. Our podcastis entirely independent, so we
pay for hosting fees andtranscript service subscriptions
out of pocket. This is a passionproject that we're really happy
to do, and any support you'reable to give us would really
make a difference. On our
P (49:13):
$2, which gives you access to test audio and other bloopers;
$5 which will give you access tobonus episodes that will make in
the future, on topics like howangry we are Freud, our
frustrations with our respectivefields of studies and even guest
episodes; $10 will get you adirect line and priority access
to request episode topics andnew bonus content; and $15,
(49:34):
which will give you access tomonthly AMAs--that's ask me
anything for those who don'tknow--where we can answer
questions ranging from thepodcast process and we figure
out what to record, more indepth questions about our
neurodivergences, and more. Allof those tiers will include
benefits from lower tiers ofcourse. And also just to note,
unlike our regular episodes,Patreon bonus content is likely
(49:56):
to include swearing, so ifthat's not your vibe, please
know that ahead of time. We'dalso love it if you're able to
share this podcast with peopleyou know. Our only advertising
is word of mouth and we want toreach as many people as
possible.
Harvey (50:10):
Got feedback for us?
Want to request an episodetopic? Just feel like saying
hello? Feel free to reach out onsocial media, or via email. We'd
love to hear from everyone. Takecare of yourselves.
Hi, friends. Among other things, this episode addresses
the comorbidity between ADHD andautism, and also some of the
ways that that gets reallycomplicated. It should be noted
that, around the 38 minute mark,I reclaim the r-slur. Now, this
is something that I am allowedto do because I am autistic,
(00:20):
however, if hearing that slurmakes you feel uncomfortable or
upset, which is totallyunderstandable, just be
forewarned that that's going tohappen, and feel free to skip
past that point. Enjoy theepisode!
Pen (00:46):
Hello, and welcome to Beyond Introspection
where we talk about mentalhealth, neurodivergence, and how
it impacts literally everyaspect of our lives.
Harvey (00:53):
All of them.
Pen (00:54):
I'm Pen.
Harvey (00:55):
And I'm Harvey.
Pen (00:56):
And in this episode, we are going to be talking about ADHD
and misdiagnosis.
Harvey (01:02):
Which to my understanding is very common.
Pen (01:05):
Yes, yeah, it's actually--it's really, really
common, much like comorbidity iscommon. Which, those two, as you
might be able to imagine arelinked.
Harvey (01:15):
Hmm, who'd'a thunk it?
Pen (01:16):
Yeah, who would have thunk it? Apparently not a fair number
of clinicians, which... weirdtake, but okay.
Harvey (01:25):
That seems concerning.
Pen (01:28):
It's, uh--some of this is, like, it's not that i've seen a
lot of things where cliniciansare like, "No, actually, I don't
think that there's muchmisdiagnosis," it's just that
the misdiagnosis happens soconsistently in the first place,
that it's like, okay, maybe theunderstanding that you are
working off of for what ADHD isand how it looks is flawed, and
(01:51):
y'all need to take a minute toreexamine that.
Harvey (01:54):
Maybe you're doing a bad job
Pen (01:56):
Sometimes, even when you're well-meaning. But--ooh--ooh,
that's... yeah, that's a lot ofthings, huh?
Harvey (02:03):
Impact versus intent applies to a lot of things, but
I think, before we get into thisemotionally exhausting,
probably, episode, Pen.
Pen (02:15):
Harvey.
Harvey (02:15):
Tell me about your Wahoo! Moment of the Week.
Pen (02:19):
You...
Harvey (02:20):
Me?
Pen (02:20):
You know I'm gonna make you redo that so you say "wahoo" in
the fun voice.
Harvey (02:24):
Oh. Tell me about your Wahoo! Moment of the Week.
Pen (02:27):
Thank you so much. Yeah, I literally only remembered we
were gonna do this when we weretalking before I hit record. So,
give me a second to think.
Harvey (02:38):
I have--oh! Go ahead.
Pen (02:41):
The library that I work at, we are in the process of weeding
the nonfiction, getting rid ofthings that haven't been checked
out in ages, or just areirrelevant. And for one reason
or another, comics and comicbooks, a lot of them are in
nonfiction. In part, I thinkjust because, like, the Dewey
Decimal System doesn't actuallyhave a fiction versus nonfiction
(03:04):
category. Like, just, fiction iskind of in the 900s, we just put
it in a different place becausethat does make more sense.
Harvey (03:10):
Sure.
Pen (03:11):
So comics just fall into being in the nonfiction section,
which I imagine is part of thereason that they don't always
get checked out.
Harvey (03:16):
That is sort of bizarre, yes.
Pen (03:19):
But one of them that we were getting rid of is a Calvin
and Hobbes anthology that isactually a copy of the same one
I used to read when I was a kid.
The original one that I got intoCalvin and Hobbes with, so I
took it home, and now I have it,and i've been rereading it, and
it--it's cool
Harvey (03:35):
So that's why you mentioned Calvin and Hobbes in
the Discord the other day.
Yeah. I understand so many moreof the jokes now in my 20s than
I did when I was eight.
That seems about right. Iremember my mom also reading me
Calvin and Hobbes books when Iwas a kid. I have a very clear
memory of being, I think, sevenor eigh,t and having
heatstroke...
Pen (03:55):
Oh! Oh, no.
Harvey (03:56):
...the day before school started, and laying on my couch,
and my mom reading a Calvin andHobbes anthology to me. And I
fell asleep and woke up fine thenext day.
Pen (04:07):
I'm glad you woke up fine.
Harvey (04:08):
But I would--well, yeah, I didn't die, as you can see.
Pen (04:12):
I do, I see. I see you, alive.
Harvey (04:15):
Yeah!
Pen (04:16):
There's a picture in one of my mom's scrapbooks of me age,
like, seven or eight sitting ina toy box that one of my mom's
friends, like, made when I wasborn. So, you know, big enough
for me to sit in, which I waskind of laying it in my
carebears one--nightgown, sothat's how you know it was a
while ago, just reading thisanthology.
Harvey (04:39):
Yeah, that'll do it. All right.
Pen (04:41):
What's your Wahoo! Moment of the Week?
Harvey (04:44):
I have several.
Pen (04:45):
W-hey! That's nice! I think last time we did this, you were
like, "I'm depressed."
Harvey (04:50):
I'm still depressed.
That hasn't changed.
Pen (04:52):
I mean, me, too.
Harvey (04:53):
I missed a dose of my antidepressants last night, so
I'm extremely tired, but, youknow, like, good things have
happened, and I'll just--sincethere are several, I'll go
through them real quick. I gotmy first dose of the COVID
vaccine.
Pen (05:08):
Yeah!
Harvey (05:09):
Because I have a [snapping] underlying condition!
Pen (05:12):
Congratulations on vaccination. We believe in
science here.
Harvey (05:15):
We do believe in science here, to a degree. We take
science with a grain of saltbecause science is more biased
than people give it credit for.
Pen (05:22):
We absolutely consider the ways that science can be flawed,
but we aren't antivax.
Harvey (05:27):
No. Vaccines are safe and effective.
Pen (05:33):
Please.
Harvey (05:34):
That is not debatable.
Pen (05:35):
That's not--this is not a debate that we're gonna have.
Harvey (05:37):
Um, I just got back, today, actually, from seeing my
boyfriend, which was nice,because I hadn't seen him in
about a month and a half, so Iwas like, oh, boyfriend time. So
I got cuddles, and that wasnice. I've also been talking to
this guy. I'm polyamorous, bythe way, I don't think I've ever
(05:57):
mentioned that on the podcast.
But I'm poly. And there's thisguy I've been talking to named
Devyn, who is very, very cool.
We're having a virtual date onFriday.
Pen (06:09):
Oh, fun!
Harvey (06:10):
Yes. And I--I'm probably going to be meeting up with him
at the end of April, because bythat time, I will--we will both
be both fully vaccinated.
Pen (06:21):
That's radical.
Harvey (06:22):
And the last thing. I've been having a bit of a rough two
weeks, as Pen knows. I'mintentionally being vague about
this, but something happened inmy life that was just really
rough on me. It was somethingthat I really hoped would go
well, and it just didn't go theway that I wanted it to. But I
did learn through thatexperience that I have more
(06:44):
people that I knew in my lifethat are going to be here for
me. So even though I am, like,wildly depressed right now,
like, at a lower low than I'vebeen in a long time, there are a
lot of good things to thinkabout.
Pen (06:56):
Oh, that's great, buddy.
Love that. Love that for you.
Harvey (07:00):
Okay! [clap] Let's get sad.
Pen (07:02):
It's not sad. I'm gonna be frustrated. You can believe
that. But it's not necessarily asad--a sad one.
Harvey (07:11):
"Sad" as an umbrella term. Thank you!
Pen (07:14):
Seasonal Affective Depression as an umbrella term.
[Laughter] Thank you forlaughing. Okay, so ADHD and
misdiagnosis. I--this is stuffthat I have been kind of
learning about more in the pastyear or so. I remember it was
last spring when I first learnedthat it's actually pretty common
(07:35):
for ADHD and bipolar disorder tobe misdiagnosed as each other.
Harvey (07:41):
Yeah.
Pen (07:41):
And I remember learning that and being like, are you
kidding me right now? Are youokay?
Harvey (07:46):
Oh, right, because at the time, didn't you have both a
diagnosis of bipolar II andADHD?
Pen (07:50):
Yep. I was originally diagnosed with bipolar type II
by my second psychiatrist, whowas better than my first
psychiatrist.
Harvey (07:58):
Didn't prescribe you any, you know, life-threatening
medications without the propertests.
Pen (08:03):
Yeah, she was actually the one who brought up like, "Oh, so
you've been getting the bloodtests?" And I was like, what?
And she was like, "So we'regonna get you off that
medication. That's some messedup stuff." And I was like, yeah,
it is, ma'am. Thank you. She,you know, we talked and she
listened to me about like, themood instability that I had and
brought up, "Hey, has anyoneever talked to you about
(08:26):
potentially a bipolar diagnosis,specifically type II?" and she
like, talked me through that andtalked me through the different
medications that could be used.
And legitimately, like, that wasvery good. She listened to me
and told me what was going on.
We had conversations about themedication and everything. Like,
that was very useful.
Harvey (08:44):
Alexa, play "Lithium" by Evanescence.
Pen (08:47):
Yes. The problem is that she was wrong.
Harvey (08:53):
Yep.
Pen (08:54):
And it was not because she wasn't listening to me. It's
because of a lot of complicatedfactors.
Harvey (09:00):
So many. So, so, so many.
Pen (09:02):
But yeah, it was only last year that I learned that things
like, you know, mood shiftsthat, honestly, it was me
learning about some of thesymptoms of ADHD that I had
never heard of before, primarilythe ones that have to do with
emotional regulation. Because,surprise, surprise, they're not
the ones that people talk about.
Harvey (09:22):
Which, like, if you know anything about the brain, if you
are into neurobiology, biology,psychology, it's not a hard leap
to be like, oh, yeah, no, thatmakes sense, why ADHD would
result in emotionaldysregulation. But good God,
the--the fact that it just nevergets talked about.
Pen (09:42):
Like, here's the thing, and we've talked about this on this
podcast before, that ADHD isliterally caused by, like,
there's some things that are upin the air, but it is a
deficiency of dopamine.
Harvey (09:53):
Right. And really, you can reverse engineer that from
figuring out what Adderall does,but--
Pen (09:58):
Like--the wild thing? it's caused by lack of dopamine.
Harvey (10:05):
Right.
Pen (10:05):
That's not how we talk about it. We don't say, like,
"ADHD (10:08):
a brain condition that's caused by a lack of dopamine."
And, like, from there, like, alack of dopamine, does that
affect your emotions? Of courseit does.
Harvey (10:17):
Yeah.
Pen (10:17):
That is not even close to a logic leap, but we don't talk
about it like that's the case.
Harvey (10:22):
So much of ADHD is just kind of predicated on effects on
the frontal lobe. and a largepart of what happens in--a large
part of emotional regulation, ithappens in the midbrain, and
then also parts of theforebrain, the frontal lobe. And
all of those are dependent ondopamine. But to your point,
Pen, I'm realizing--I had neverthought about it that way, that
(10:44):
it's not talked about as, like,a brain thing. I think ADHD is
definitely, now that you pointedit out, more and more talked
about in behavioral terms. Andthe behaviors do matter. But
that doesn't mean that we canjust, like, eschew the source.
Pen (11:01):
I think that's--that is my issue with a lot of it, is like,
yeah, we should absolutely talkabout behavior in ADHD, because
that's how it manifests.
Harvey (11:09):
Right.
Pen (11:09):
We don't talk about it like there's an underlying reason,
though. We talked about thebehaviors like they're all
separate things that just, like,pop up, and we can deal with
them one at a time. Like, wedon't really discuss it like,
okay, so all of these behaviorsare caused by the fact that this
is a brain condition that youare born with.
Harvey (11:28):
The behavior is posited as the problem, rather than a
symptom of the problem.
Pen (11:33):
Yeah. And that's just--that is a fundamentally flawed way of
discussing ADHD.
Harvey (11:38):
And it's also going to lead straight into victim
blaming. And in my mind, it'sdeeply rooted in that "pull
yourself up by your bootstraps"Western ideology,
Pen (11:46):
Which is a--something that is so messed up, and also so
common that, you know,neurodivergent people here is
like, you pull yourself up byyour bootstraps thing, and it
has been, you know, veryvalidating, and in some ways,
kind of liberating to learn,like, yeah, I can put in all the
(12:06):
effort that I want. There'snothing I can ever do to force
my brain to produce moredopamine, so some things are
just going to be harder for methroughout my entire life.
Pretty messed up that that was aliberating and validating
realization.
Harvey (12:20):
Yeah, that should sort of just be, like, the basis
for--for how one experiencesADHD.
Pen (12:28):
Yeah, but because it's not, and because we don't talk about
ADHD like it's something that'sinherently going to affect your
mood. Even though, if you lookat the underlying thing, there's
literally no way it wouldn't.
Because of that, I didn't know.
Despite, like, I brought up ADHDto my psychiatrist, Jada--
Harvey (12:53):
Jada Butler!
Pen (12:54):
Yeah!--as a potential thing to get screened for a year
before I learned this. Like, Ilooked into it, I looked into
ADHD, I saw the way thataffected me, and I didn't come
across any information that mademe--like, that was based on how
ADHD and bipolar disorder getsmisdiagnosed each other until
(13:17):
another year had passed, whichtells you a lot of things,
including that, even if you takethe research into your own
hands, that doesn't mean thatit's going to be good
information that's readilyavailable.
Harvey (13:30):
Well, yeah, I was gonna say, I mean, somebody has to
produce that knowledge and--
Pen (13:34):
Make it accessible.
Harvey (13:35):
Make it accessible. And the accessible information about
ADHD is so just based on thatbehavioral view of it.
Pen (13:46):
Which is flawed. But all of that to say, when I learned that
ADHD--it--it was a fundamentalchange in how I viewed my own
ADHD as well. Because I hadthought of it as something that
is more based in, like,executive dysfunction and just
kind of how my brain works anddifferent from like, my anxiety
(14:06):
and depression that, you know,just hurt me. Like, I didn't
think of my ADHD as somethingthat hurt me in that way. But
learning that the mood swingsthat categorized a lot of the
stress and pain of my,especially later, teenage years
are far more than likelydirectly linked to my ADHD was
(14:30):
really--like, that hit kind ofhard. Like, oh, okay. So I don't
think that my bipolardiagnosis--I'm not 100% sure
that it has been removed exactlyfrom my file. I have no idea how
all of that fits. But, like, Ihad that conversation with my
psychiatrist, and I was like,hey, I learned this, and she was
(14:52):
like, "Oh, yeah, that totallymakes sense. And especially when
you're in--like, you're incollege, and you're under a lot
more stress, your mood, like,shifts a lot." I was like, you
right, though, Jada.
Harvey (15:01):
Yuh.
Pen (15:03):
And like, regardless of whether or not I have bipolar
disorder, she didn't take me offof lamotrigine, which I had
originally been put on becauseit helps treat bipolar disorder,
because it's a mood stabilizer,and an anticonvulsant. Brains
are so weird.
Harvey (15:18):
Right? It's got to be a neurotransmitter thing.
Pen (15:21):
Probably. She didn't take me off of that because, like,
one, there's no real need to.
Like, lamotrigine doesn't messwith you, really. It's pretty
lowkey kind of medication, notmany side effects, thank God.
Harvey (15:37):
And given that, probably, if she took you off,
you know, your body might havehad a worse reaction to, you
know, just not taking it coldturkey, which I doubt she would
have done, like--
Pen (15:49):
No, I don't--
Harvey (15:50):
Jada Butler is a good psychiatrist, from what I
understand. But it's probablystill easier on your body and
brain.
Pen (15:57):
And if nothing else, like, even if it's not treating
bipolar disorder, it is a moodstabilizer. That's--like, yeah--
Harvey (16:04):
Like, those are helpful.
Pen (16:05):
I don't know exactly how much it's doing for me, but if
it's stabilizing my mood, evenlike 5%, that's--thanks. Because
my mood is very unstable. I havea lot of mood changes, and they
are fast. And that's actuallyfits in really easily with going
over to how bipolar and ADHD getmisdiagnosed as each other.
(16:27):
Because we all kind of have anunderstanding that bipolar
disorder is categorized by moodswings.
Harvey (16:35):
And really dramatic ones, too.
Pen (16:37):
Yes.
Harvey (16:39):
I think we've done a pretty good job talking about
sort of the scope of mentalillness and just, like, how
significant it can get. So whenwe're talking about mood swings,
we're not talking about just,like, you know, like your
average day--like, everybodyexperiences mood swings. That is
something that happens, or eventhe mood swings that you
experience with depression.
Bipolar, whether it is type I ortype II is really characterized
(17:00):
by those super intensedepressions. And in the case of
bipolar I, those high maniasand, in the case of bipolar II,
something called hypomania,which is still mania but less.
Pen (17:15):
Yeah, but it's, like--it is extreme. And it's also
prolonged.
Harvey (17:20):
Yes.
Pen (17:21):
And, very, very importantly, often is not
triggered by anything inparticular, except just your
brain.
Harvey (17:29):
Just happens. Also runs in families.
Pen (17:31):
Yes. And that's like, those are all very significant things
about bipolar disorder, and verysignificant in differentiating
it between ADHD. With ADHD, yourmood can swing in really intense
extremes. And this does happento me. Yeah. But it is one
always triggered by something.
There is always something thathappens. And we've talked about,
(17:51):
like, RSD - rejection sensitivedysphoria - before. That is one
example of ADHD mood swinghappening.
Harvey (18:01):
Yeah. And those mood swings happened with me and RSD
as well.
Pen (18:04):
But, like, that, something happens when you have a really
intense negative reaction to itthat is not necessarily--what,
equivalent to or appropriate to?
Harvey (18:15):
It's disproportionate.
Pen (18:16):
Yeah, disproportionate.
Harvey (18:17):
Possibly irrational.
Pen (18:18):
Yes. And that is triggered by something specifically. And
also with ADHD, sometimes after,like, a very small change
happens, like, maybe you listento one song or just a little bit
of time passes, or you just,like, sit somewhere comfortable,
it can be pretty much anything,your mood can change right back
(18:39):
to feeling good, very, veryquickly. That, like, positive to
negative thing can happen almostinstantaneously, which is not at
all what bipolar disorder islike.
Harvey (18:51):
No, to my understanding, you don't really go straight
from intense depression tomania. It's sort of like, you
have those intense depressiveepisodes, you kind of stabilize
for a little bit, and then youstart working your way up into
that mania.
Pen (19:06):
And they last for quite a while.
Harvey (19:07):
Yeah, that's--that's my understanding, that those
periods--like, I believe, withhypomania, like, you need to
experience at least one periodof mania for, like, a week or
more.
Pen (19:18):
Yeah, it has to be, like, minimum several days of
experiencing this thingconsistently. That's not what
ADHD mood swings are like. No.
It can be like half an hour, itcould be several hours. Probably
isn't going to be more than aday or so, except in the cases
of how ADHD can kind of mimicdepression.
Harvey (19:38):
Yeah, real--real--real quick aside. I was just gonna
say, if you've heard about thesymptoms of mania or hypomania,
and they sound familiar to you,what I will say is that
experiencing hypomania does notnecessarily mean that you have
bipolar. I experience occasionalperiods of hypomania, but
(19:59):
they're usually pretty shortlived. In any case, I'm--like, I
don't believe I have bipolardisorder. But yeah, just so you
know, hypomania is--is a symptomyou can experience without
having bipolar.
Pen (20:11):
Yeah, totally. Some of my ADHD, mood swings that have been
characterized more heavily byirritability, and like, kind of
this... feels like sort ofitching under my skin a little
bit, like, just very--it'sintense, and it's not quite
distress. It's not happy. It'sjust a lot.
Harvey (20:33):
Bothersome.
Pen (20:34):
Yeah. that I thought was hypomania. Turns out it doesn't
last nearly long enough to becategorized for bipolar type II.
But that was something that Idid experience, and was part of
the reason that I was diagnosedwith that. So, you know, if that
sounds familiar to you, it's notnecessarily bipolar, but I would
(20:55):
definitely encourage you to,like, if you have a psychiatrist
or therapist, to talk to themabout it. Do your own kind of
research, if that would help youout, like, whether or not--like,
whatever diagnosis, it ends upbeing. I think it's great to
know these things aboutyourself, and to also figure out
ways to help deal with that.
Harvey (21:14):
And at the end of the day, like, regardless of the
diagnosis, like, those symptomsare still happening to you, and
they still matter.
Pen (21:20):
Absolutely. Whether or not you perfectly fit in with the
DSM requirements for aparticular diagnosis doesn't
change how you're actuallyfeeling and what you're
experiencing.
Harvey (21:30):
Yeah, I mean, DSM requirements are bull hockey,
Pen (21:34):
Yeah, there's a lot of messed up stuff in DSM
requirements.
Harvey (21:37):
Anyway, do you want to talk about ADHD and depression?
Pen (21:39):
Yeah. I actually have some fun--well, I say fun--I have
some facts--
Harvey (21:46):
Facts.
Pen (21:48):
--that I got from ADDitude.
Harvey (21:50):
Yes, we love ADDitude.
Pen (21:52):
Oh, I'm gonna get somewhere with it. Give me a minute to get
to--I'm gonna get there in aminute with autism and ADHD.
Harvey (22:03):
Ope.
P (22:04):
here's a quote from ADDitude.
"Clinical depression is commonin adults with ADHD. Experts
estimate that depression existsin approximately 47% of adults
with ADHD, and 14% of children,but depressive symptoms don't
always indicate a full blowncomorbid condition." And that.
(22:24):
That is the part I want to talkabout. That was something that I
realized very recently aboutmyself. Way back when I first
got into therapy, I wasdiagnosed with major depressive
disorder. I was doing verybadly. My therapist,
Charlie--remember Charlie? Thetummy guy?
Pen (22:39):
Yeah, tummy man. He did not do a bad job in diagnosing me
Harvey (22:39):
Tummy man! with depression. I was doing
horribly. And like, probably, Idid qualify for the diagnosis.
Here's the thing in ADHD and
comorbidity (22:53):
difficulty dealing with ADHD symptoms can cause
secondary depression andGeneralized Anxiety, as well as
some other things. Obviously,some of the comorbid diagnoses
like bipolar disorder or autism,those are [not] caused secondary
because that's not really howthose work.
Harvey (23:11):
Right.
Pen (23:12):
You don't just develop autism. That's not--that's not
really how it go.
Harvey (23:19):
Nope, nope, nope.
Pen (23:20):
But things like depression and anxiety, oart of the reason
that they're so comorbid withADHD is, when people with ADHD
don't have the tools or thesupport to deal with their
symptoms, it's--it's incrediblystressful, and it's compounding.
Like, the mood instability thatis just a part of ADHD, as well
(23:43):
as, like, society's inherentableism that means that, like,
the way my brain works doesn'tfit with any of the models that
I'm expected to be a part of. Ican't consistently pay attention
like I need to. My sensoryprocessing issues are just going
to exist no matter what, andsome of the adjustments that I
(24:04):
need, like, sometimes wearingheadphones, or having lights be
lower, or being able to takebreaks, or juggle like three
different projects at once, orget up and move around. When I'm
not allowed to do thosethings--just--good luck.
There's--there's nothing I cando to make myself not feel
depressed and anxious, and thenpotentially qualify for these
(24:24):
disorders that are, in reality,linked to my ADHD. And if I was
being treated well andrecognized for my ADHD, which
did not happen until I was 20,and I was originally diagnosed
with generalized anxiety andmajor depressive when I was 14
or 15, so going five to sixyears without any of my ADHD
(24:46):
symptoms being properlyrecognized for what they were,
and certainly not being treatedfor ADHD, meant that those
things got more intense.
Harvey (24:56):
Ee-yup.
Pen (24:56):
Would I have been diagnosed with those things if I'd been
diagnosed with ADHD at thebeginning? I think so. If I had
been diagnosed with ADHD andproperly treated when I was much
younger, then maybe not. I'llnever know. But as it is right
now, I definitely havedepressive swings. I'm in one
right now, folks. I don't thinkit is depression so much as it
(25:17):
is linked to ADHD and how thataffects my mood, and
particularly, its instability.
Harvey (25:24):
Yeah, no. And that makes sense. And I think maybe the way
that you would figure that outis just trying to identify,
really, the source of thedepression. Like I know, in my
case, you know, autism anddepression have some
comorbidity, not a lot, butsome. But in any case, even if I
wasn't autistic, like, I havedepression, I totally do. Um,
(25:46):
and the thing about that isthat, yes, there are triggers,
but also my depression comesapropos of nothing, sometimes.
My anxiety, in particular, justcomes apropos of nothing. I
actually don't know if I stillmeet the criteria for GAD, but I
know that I experience panic.
And kind of the crux of panicdisorder is that the panic
attacks come from nowhere, andthen also, it's a vicious cycle,
(26:10):
because you become afraid ofhaving another panic attack and
whatnot. All of this to say, mydepressive symptoms are more
identifiable as depression, Ithink precisely because of the
lack of cause.
Pen (26:25):
Yes, that is-- that is huge thing, like, some of the
intensity and instability thatcomes with ADHD, there is still
a trigger for it. It's becausemy brain does not have the tool,
dopamine, to deal with thingssometimes. And so it's a lot
more intense for me to try andprocess it, because I'm just
lacking the tools for something.
But I'm still trying to processsomething. Or it's not a direct
(26:48):
trigger, so much as it is,things just stacked up on top of
each other. Eventually, when youare stressed by so much of your
life - because of society'sinherent ableism - and also just
because things are hardsometimes, like whether or not
the society was inherentlyablest, I still don't have to
dopamine, that's stillgonna--that's still gonna do
something to me. And when thatstacks on top of each other,
(27:10):
sometimes you get into a moredepressive state. Maybe you
can't figure out the one thing,but if you've been feeling
stressed for quite a while, andthat follows through to a more
depressive episode, there'sstill that trigger coming from
somewhere.
Harvey (27:24):
Right.
Pen (27:26):
And, looking at it, my anxiety and my depression were
very directly caused by stress.
Yeah, there we go.
Harvey (27:35):
And my anxiety and depression are exacerbated by
stress, but even when I'm notexperiencing stress, like, if
I'm on summer or winter break,like, I still end up feeling
depressed and anxious. That'sjust an always for me.
Pen (27:48):
Yeah. And that's, like, there was no way I wasn't going
to meet the criteria forgeneralized anxiety disorder. I
don't meet that criteria now--
Harvey (27:56):
Right.
Pen (27:56):
--because of changes in my life that have made it just not
be--like, when I get stressed,it doesn't trigger into that
anymore, which is so nice.
Harvey (28:06):
I bet!
Pen (28:07):
Other side of that, my social anxiety comes from
absolutely nowhere. It's there.
This is something that I feelquite confident is not linked
directly to my ADHD because it'sjust--it just happens. It
doesn't matter what I do, like,I'm taking a medication for it
now that changes it, and that ismy big clue that it is not
inherently linked to the ADHDis, like, it was very
(28:28):
consistent, and I could, like,try and make it better, but it
was really hard, and then I tookLexapro, and it changed the
things, and I was like, oh.
Harvey (28:38):
Yeah. And I realized, you've mentioned before that you
being on antidepressants didn'tactually help your depression,
but it did for me. Sothat's--but getting on Adderall
seemed to make it better.
Pen (28:52):
Yeah. Adderall affects my depression a lot, which made
me--like, it was kind of animposter syndrome thing for a
while and like worried me alittle bit, like, oh, wow, when
I first take this, like, themood boost I get, like, I feel
like that's not supposed to bewhat happens. One, I got a
increase of dopamine. It made mefeel better.
Harvey (29:12):
Dopamine is involved in the reward center. Something
good happen, make brain go.
"Ohhh, dopamine!"
Pen (29:19):
Which is not what my brain naturally does. This is very
annoying.
Harvey (29:23):
No, you literally just, like, you took a hit of speed.
And you were like, ohhh.
Pen (29:28):
And it worried me, it doesn't know. And like, yeah, my
depression is better now thatI'm on Adderall, because
depression is linked to - waitfor it- dopamine!
Harvey (29:38):
Dopamine!
Pen (29:39):
Yeah, I have less depression because I have a
neurotransmitter. I hear thoseare good for your brain.
Harvey (29:46):
They are, generally speaking. Too much or too little
of any of the neurotransmitterscause problems,
but--because--excessivedopamine, I believe is related
to, oh...
Pen (29:56):
Schizophrenia, right?
Harvey (29:58):
Yes. Schizophrenia and/or Lou Gehrig's disease, I
think. Wait, no, not LouGehrig's... Parkinson's.
Pen (30:07):
I believe you.
Harvey (30:09):
It's--it's one of those two, or both. But there's
a--there's a thought that Iwanted to share about clinicians
and misdiagnosis. And I think--Ithink what I do want to say is
that misdiagnosis, especiallywith disorders that get so
muddy, like they do with ADHD,does not necessarily mean that
(30:31):
the clinician is doing a badjob. It can mean thatm but not
always.
Pen (30:37):
Yeah, definitely.
Harvey (30:38):
The thing about mental health is--it's--it's not like
physical health. Now--now, ofcourse, I imagine with doctors
who work in, you know, themedical field with, like,
physical bodies, physicalailments, I'm sure there is a
level of guesswork that theyhave to do, but those symptoms
are so much more visible. Like,you can--you can see a rash, you
(30:58):
can hear a cough. So that makescertain, you know, physical
illnesses a little more easy todetect. And well, there are, you
know, neurocchemical indicatorsof mental illness. The fact of
the matter is, mostpsychiatrists and most
(31:20):
therapists do not have access tothat kind of technology. And
also, we live in the UnitedStates, we can't afford it.
Pen (31:27):
It's starting with just, like, brain scans, and that kind
of thing, and testing with thatis not necessarily, like, the
first step I think most peoplewould take anyway.
Harvey (31:38):
No, and especially because, you know, a deficiency
in a neurotransmitter could havezero implications, or it could
have several differentimplications. And then you also
have to consider, well, we can'tjust look at one
neurotransmitter, because withthings like depression,
serotonin and norepinephrine areboth implicated in that
disorder. So all of this to say,I think, maybe, part of why
(32:02):
misdiagnosis happens so often isbecause with mental health care,
so much more guesswork has to bedone, entirely because you have
to take information that you getfrom self report and potentially
from peer report, and then,essentially, like, make an
educated hypothesis.
Pen (32:22):
Yeah. And that's real. And, you know, that's not to say that
everything is just simple withphysical diagnosis or that there
aren't invisible, like, physicaldisabilities and that sort of
thing.
Harvey (32:33):
Because there totally are, but there are some very
different--but there are someways in which the treatment and
identification of mental healthversus physical health is
different.
Pen (32:44):
Oh, yeah, absolutely. And like I said, like, my second
psychiatrist who diagnosed mewith bipolar disorder, she
listened to what I was saying,she took me very, very
seriously. One potential thingis, perhaps if she had been more
aware of how commonly ADHD andbipolar disorder are comorbid,
(33:04):
or how often they getmisdiagnosed. And this was
something--recently, someonethat we know was officially
diagnosed with ADHD.
Harvey (33:12):
Yes!
Pen (33:13):
She was screened for bipolar disorder and ADHD
together.
Harvey (33:18):
Oh, she was?
Pen (33:18):
Yes.
Harvey (33:19):
Oh, she didn't tell me that.
Pen (33:20):
Uh, yeah, because--I think, frankly, it was because the
psychiatrist had ADHD, so he hadsome experience with that. Like,
that is one potential way tohelp with that, is to screen
things, you know, are verycommonly comorbid together, so
you have a better idea of like,okay, so is it this, or is it
this? Like, if we're looking atall the symptoms together? Which
one of these makes the mostsense?
Harvey (33:41):
I'm just realizing, curious that I was at one point
evaluated for ADHD, but not forautism, despite how comorbid
they are. Anyway.
Pen (33:51):
You know what? How about we get into that?
Harvey (33:53):
Oh, sure.
Pen (33:54):
Um, so from the same ADDitude article - that I will
link in the description - that Igot some information about
depression and alsoanxiety--quickly on anxiety,
anxiety has passed depression asthe biggest mental health
problem on college campuses.
Harvey (34:11):
Uh-oh!
Pen (34:11):
Yeah. It often doesn't stand alone. It's a hallmark
symptom of ADHD, affecting 30%of children and 53% of adults
with ADHD.
Harvey (34:19):
Oh, wow.
Pen (34:20):
Yeah. So depression and anxiety, literally 50/50 chance
if you have ADHD.
Harvey (34:25):
Yeah. Um, and I just--I need to put that into
perspective as somebody who, youknow, studies epidemiology and
understands the rates of things.
When you start getting into the40s and 50 percents, of things
that is extremely high.
Pen (34:41):
Yeah, it's ridiculous.
Harvey (34:43):
It's dramatic.
Pen (34:43):
Like, that's the thing with depression, anxiety and being
secondary. Being caused becauseyou aren't able to deal with the
ADHD symptoms, but--
Harvey (34:53):
Which makes sense, why--why the--why.
Pen (34:55):
Why the rate is so dramatic.
Harvey (34:57):
Yes.
Pen (34:57):
Yeah, definitely. So autism, which is very different,
because you don't just--theautism is not a secondary
diagnosis.
Harvey (35:06):
Nope!
Pen (35:08):
That's--much like ADHD, and how it's just the way that your
brain works, that's where we'reat. So this-- here is
the--let's--let's talkabout--first the--the statistic:
"Studies show that 30% to 50% ofindividuals with autism manifest
(35:29):
ADHD symptoms. Roughly twothirds of individuals with ADHD
show features of autism." So,like, yeah, again, the overlap
is pretty massive there whichwe've talked about.
Harvey (35:42):
Yeah, I know I mentioned in the autism episode that
approximately a third of folkswith one are also diagnosed with
the other, and that doesn't evenconsider everyone who displays
symptoms.
Pen (35:54):
Exactly. Like, that is the thing, like, if we're just
looking at where there areoverlaps in the symptoms, that's
ridiculous. Like, you do nothave ADHD. I do not have autism.
We have a level of symptomoverlap that is sometimes just
dramatically, likem hilarious.
Harvey (36:14):
You know what we should do? We should
definitely--because myboyfriend, I think we mentioned
this in the last episode, but myboyfriend is also--my boyfriend
is autistic and he has ADHD.
So I think--I think,genuinely, it might be
Pen (36:26):
Yes.
interesting if the three of ussit down and compare
symptomology.
I would--I would love to.
We should have--we should havehim on sometime.
Harvey (36:34):
Yes, we should. I'm going to make a note of that .
Anyway.
Pen (36:37):
You should, 'cause I'll forget. I'm well-meaning but,
oof. Okay, so here's the quotefrom ADDitude, that proves that,
you know, one, there's a lot ofdifferent authors of the
articles, and some of them are,like, you know submitted from a
lot of different sources, andalso that bias comes in pretty
much everywhere.
Harvey (36:57):
Yeah.
Pen (36:58):
And that ableism is a complex thing, and--so here's
the quote.
Harvey (37:05):
Yes.
Pen (37:07):
"Trouble reading social cues and acting appropriately in
social situations are hallmarksymptoms of autism spectrum
disorder (ASD). With autismrates on the rise, parents may
fear the worst when their childstruggles socially." Harvey's
pointing a finger gun at mylaptop, and they're right to do
it. "But this is a big one forchildren with ADHD, too, though
(37:27):
it usually isn't considereduntil a diagnosis has already
been made." That's real. Socialsituations being an issue, like,
where that is, that's real. Theother part what do you... "If
your child has trouble makingfriends, ask yourself: is it
because they're overly fixatedon an unusual interest, or is it
because they're alwaysinterrupting and speaking over
(37:48):
others? The former may be due toASD, the latte, ADHD. An
individual can have bothconditions."
Harvey (37:54):
Bite, bite, bite, bite, bite, bite, bite, bite!
Pen (37:58):
One, the bias in that and portraying autism as a worst
case scenario is incrediblymessed up. I put this in here as
an example of, like, yeah, Ilove ADDitude, like, a lot of
their stuff I'm very into. Isource it for a reason. This
article? I do not trust theperson writing this. This is a
(38:20):
bad take about autism. That'snot--
Harvey (38:23):
Like, okay, sorry for being a retard, I guess, like...
Pen (38:26):
That is--
Harvey (38:27):
We can cut that out.
Pen (38:28):
That is a horrible take. It is not--this is not how we
should be talking about autism.
It's also not the reality.
Harvey (38:36):
Yeah. If we--if we do keep that bit in, do want to
clarify i'm allowed to reclaimthe r-slur. Anyway.
Pen (38:43):
Yes, like, that's--that's real. And then I really don't
like the, like, "Is it becausethey're overly fixated on an
unusual interest, or is itbecause they're always
interrupting and speaking overothers?" and portraying those
as, like one of them is onlyautism, and one of them is only
ADHD, and the only reason theywould overlap is because your
kid has both." What are youtalking about?
Harvey (39:06):
Yeah, because i was gonna say, hyperfixation is a
hallmark of ADHD, and notknowing how to take your turn in
a conversation is a hallmark ofautism. What on earth are they
on?
Pen (39:20):
Yeah this--I put this in here and--here's the kind of
miserable thing (39:25):
that article is the same one that I got the
stuff from depression andanxiety from.
Harvey (39:32):
Bite, bite, bite, bite, bite, bite, violence, bite.
Pen (39:35):
So it's--like, kind of--it's incredibly unfortunate,
especially because we're runningout of time, that I don't have a
better one in talking about ADHDand autism and how they've
overlapped, and i'm very sorryabout that.
Harvey (39:45):
But this is useful for doing a critique.
Pen (39:48):
Exactly. And, luckily, we have talked about ADHD and
autism overlapping before in away that isn't riddled with bias
and bigotry.
Harvey (39:58):
Yeah. Jesus Christ, that is--
Pen (40:00):
Yeah, that's--that's...
Harvey (40:04):
Like, I feel like i've been hit by a car.
Pen (40:06):
I'm very sorry to blindside you with that. Like, that is a
really crappy thing to say. It'salso straight up inaccurate.
That is not--a commonalitybetween ADHD and autism is not
being good at reading socialcues.
Harvey (40:27):
Right.
Pen (40:29):
That doesn't mean something's wrong with you.
Also, let's not paintneurodivergence as something
that is wrong.
Harvey (40:38):
Listen, I can make friends. I have plenty of
friends. They just have to letme talk about Sonic the
Hedgehog.
Pen (40:44):
I love it when you talk about Sonic the Hedgehog.
Harvey (40:45):
Thank you.
Pen (40:46):
And that's--that's also things, like, trying to diagnose
either ADHD or autism by whetheror not your kid is good at
making friends is, like, let'stake that carefully, because
that tends to fall into a blamething, or looking at your child
as having something wrong withthem.
Harvey (41:06):
And then you're also--you're also legitimizing
kind of the --the bias and thediscrimination that children are
taught because we live in aninherently ableist society,
rather than questioning sort ofthe source.
Pen (41:23):
Yeah. Like, it's pointed out as, "Oh, well, there's
something, like, going wrongwith this kid, because they're
not making friends," instead of,"So this is how this kid exists,
and the children around themdon't understand that." These
are very different ways oflooking at it, and that is a
very, very big problem withsociety, with parents and
(41:44):
teachers, with clinicians,like--this is the source of a
lot of where the bias can comefrom, especially because we tend
to look at ADHD and autism asthings that are diagnosed in
childhood, and not consideringsome of the implications of
that, and, particularly, whenyou are diagnosed as an adult,
and it's like, "Oh, okay. So mywhole, like, antisocial thing,
(42:06):
where everyone said I hatedpeople. Really?
Harvey (42:09):
Really now?
Pen (42:10):
Is that--cool. Cool. Good to know that none of you knew
what you were talking about.
Harvey (42:14):
So we're just not gonna examine that one, huh?
Pen (42:16):
So we're not gonna think about that one? We're just gonna
let y'all get away with that?
The answer is no.
Harvey (42:20):
Now, we don't have time [Harvey and Pen, in unison] to
unpack all of that.
Pen (42:24):
John Mulaney, Kid Gorgeous.
But, yeah, yeah. If we had moretime, I would talk more
positively about the--about someof the comorbidity in ADHD and
autism. But--and also, like, alittle bit more on some of the
diagnoses and misdiagnoses, butI think as, like, a broader
overview of where there'scomorbidity, and also how this
(42:48):
misdiagnosis happens and sofrequently, I think i've hit
most of what I was going for.
Harvey (42:56):
Great!
Pen (42:57):
Do you have any thoughts, Harv-and-a-half?
Harv (43:01):
Harv-and-three-quarters...
Pen (43:01):
But not two Harvs.
Harvey (43:03):
Aw. Well, I don't have anything, like. substantive to
say, so to put a positive spinon the--
Pen (43:10):
Please?!
Harvey (43:11):
To put a positive spin on the ADHD-autism comorbidity
thing, if you are autistic andyou have ADHD, you are so sexy,
and swag, and epic, and cool.
Pen (43:25):
You--you are two times as funny as anyone else. That is a
thing that we've legitimatelytalked about, is like
neurotypical people arevery--neurodivergent people are
very good at being funny.
Harvey (43:35):
Yes, because--I think because my--you know, my amateur
opinion of that is probablybecause we have to question
social norms so it's easier forus to break them.
Pen (43:46):
Exactly. I was just thinking about this earlier, is
like, you know, the thing where,like, humor comes from breaking
expectations and it's likethat's all i'm allowed to do.
Harvey (43:53):
Also, bonus points if you're gay.
Pen (43:57):
Yeah, like, Harvey and I have a lot of, like I just said
Harvey, and I have a lot ofoverlaps in our symptoms. I
think that's very cool of us.
Harvey (44:05):
We're very sexy and cool and--no, I can't say that on the
podcast. Anyway.
Pen (44:11):
I think we're pushing it with saying sexy twice. Oh, no!
Three times!
Harvey (44:15):
Oh, no!
Pen (44:17):
Yeah, no, and honestly, like, I think that you are a
very, like, you get--you getalong with people really well,
as a general rule. Like, I wouldsay you're a very charming and
charismatic person.
Harvey (44:26):
Some of it is because i've been masking my entire life
but we don't have time to unpackthat.
Pen (44:32):
And that's--that's stuff.
Harvey (44:35):
But, yeah, I do get along pretty well with people.
Pen (44:37):
You are a very cool person.
You're also, legitimately, thefunniest person I've ever met in
my life.
Harvey (44:42):
Which--it makes me very happy every time you say that.
Pen (44:45):
I say it a lot.
Harvey (44:47):
They do, and it makes me very happy.
Pen (44:49):
But yeah, like, the ways that our symptoms overlap, I
think, really help ourfriendship along, and make it,
like, a very cool thing and,like, I've heard from other
people that our friendship isjust nice for them to like, see,
and that it's cool. So you know,those kind of symptoms that are,
like, "concerning" to see inyour child, don't start with
(45:13):
that kind of take, you're notgoing to be treating your child
well as a result, if that'swhere you're coming from. And
also, sometimes it means thatyour child makes really, really
good friends.
Harvey (45:23):
Yeah. God forbid your neurodivergent kid becomes
friends with otherneurodivergent people.
Pen (45:29):
It's improved my life dramatically.
Harvey (45:31):
Oh, God, me too.
Pen (45:32):
Night and day.
Harvey (45:34):
Do you have any last thoughts you want to share
before I wrap us up here?
Pen (45:36):
Um, just generally that, like, though this is a
frustrating thing, the commonmisdiagnosis, it comes from a
lot of different places, and itis genuinely a complicated
thing. And also, if you aresomeone like me, who has ADHD
and has been misdiagnosed in thepast, and would have really
benefited from being examinedmore properly, and, like, you
(45:59):
feel that, because I certainlyfeel it, that's okay, and you
are valid in that, and I hopethat this gives you, like, some
vindication, because I know thatthat can feel really good. And
if you're someone, like, again,as always, if any of this kind
of echoes in you, like,you're--you're kind of feeling
it and you haven't beendiagnosed with anything or
(46:20):
whatever, I absolutely encourageyou to do research, if that's
the kind of thing that helpsyou. If you have a therapist or
psychiatrist, to talk to themabout it. If you don't, I
recommend therapy to pretty mucheveryone. So yeah, by all means,
like, you get to take yourselfseriously, and whatever you're
feeling, you're feeling it, nomatter where it comes down to.
Harvey (46:41):
Very nice way to wrap that up.
Pen (46:43):
Thank you, I do my best.
Harvey (46:45):
So, let me first say, we really appreciate the audience
that we have here. Those ofyou--we notice those of you who
listen consistently, and itmakes us really happy. So--so
we're glad to have y'all. We'veseen the really tangible ways in
which we can make an impact, andwe want to keep doing that. So
(47:06):
what I want to ask, as one ofthe cohosts of this podcast is,
if you've got some time, in thenext week or so, share this
podcast with a friend of yours,just one. That would mean a lot
to us, and it would be great toget some more reach for more
folks to know who we are and formore--for more folks to possibly
(47:27):
find themselves.
Pen (47:28):
Yeah, and--and with that, it would be really, really
awesome if you have the time andinclination for you to send us a
message on social media or emailus, so that, like, one, if you
have any questions or anyfeedback, or, like, a particular
thing you would like us to talkabout, that we know that because
we want to be able to do thingsthat are beneficial and that our
(47:51):
listeners would really enjoy.
And also because you know, thisis something--this is a labor of
love. This is a passion project.
We do have other things going onin our lives, and we both love
doing this. We don't need praiseand adoration in order to do it,
but it really does help to havethat engagement from people.
H (48:10):
if you want to make me in Pen happy stim, send us a message.
Pen (48:15):
That's a good way to put it. I love that.
Harvey (48:17):
So, stick around for just a few moments, we'll tell
you a little bit more about howthis podcast is run and our
Patreon Woo! Say wahoo.
Wahoo!
Pen (48:26):
Thank you!
Harvey (48:28):
Beyond Introspection is an independently-run podcast by
Pen Novus and Harvey LaFord.
Music by Girl Lloyd. You canfind us on Twitter and Instagram
at ByndPodcast or you can emailus at
beyonddotpodcast@gmail.com.
That's beyond d-o-t podcast, nospaces. We publish on
Buzzsprout, iTunes, Spotify orwherever you get your podcasts.
(48:49):
You can find the links to oursocial media and email in the
podcast description.
Pen (48:54):
We also have a Patreon. You can find us at
patreon.com/beyondintrospection.
That's all one word. We alsohave links to it on our site and
on our social media. Our podcastis entirely independent, so we
pay for hosting fees andtranscript service subscriptions
out of pocket. This is a passionproject that we're really happy
to do, and any support you'reable to give us would really
make a difference. On our
P (49:13):
$2, which gives you access to test audio and other bloopers;
$5 which will give you access tobonus episodes that will make in
the future, on topics like howangry we are Freud, our
frustrations with our respectivefields of studies and even guest
episodes; $10 will get you adirect line and priority access
to request episode topics andnew bonus content; and $15,
(49:34):
which will give you access tomonthly AMAs--that's ask me
anything for those who don'tknow--where we can answer
questions ranging from thepodcast process and we figure
out what to record, more indepth questions about our
neurodivergences, and more. Allof those tiers will include
benefits from lower tiers ofcourse. And also just to note,
unlike our regular episodes,Patreon bonus content is likely
(49:56):
to include swearing, so ifthat's not your vibe, please
know that ahead of time. We'dalso love it if you're able to
share this podcast with peopleyou know. Our only advertising
is word of mouth and we want toreach as many people as
possible.
Harvey (50:10):
Got feedback for us?
Want to request an episodetopic? Just feel like saying
hello? Feel free to reach out onsocial media, or via email. We'd
love to hear from everyone. Takecare of yourselves.
Popular Podcasts
United States of Kennedy
United States of Kennedy is a podcast about our cultural fascination with the Kennedy dynasty. Every week, hosts Lyra Smith and George Civeris go into one aspect of the Kennedy story.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com