From the little "Sloth" wrote, it sounds like it's possible she might have undiagnosed ADHD.
As someone with ADHD myself, I instantly recognized the inability to get myself to start working on something until the last minute (even if I really, really want to do it) and the piles clothes (despite my propensity for cleanliness). Another hallmark of ADHD that many don't know about is bursts of almost manic productivity for random tasks or when under extreme pressure.
If she does have ADHD, Polly's answer is both unhelpful and somewhat dangerous.
I think that's a little extreme and reminds me of the problematic trend of giving psychiatric medication to anyone who asks for it. I mean, yes, there's a chance they 'actually have ADHD', but there's also a much higher chance they are one of the tremendous number of people who have trouble getting themselves to do things that aren't urgent. I'm on that list too. So are lots of people. Sloth sounds so incredibly normal to me.
Everyone procrastinates sometimes, the difference with ADHD is the frequency and severity. So if this person procrastinates every day of her life, and it consistently impacts her functioning and relationships, it becomes out of the norm.
ADHD is actually decently prevalent, but often missed in girls who are not disruptive in class. Often they can get by with a strong support structure (parents and partners) but struggle with the independence of adulthood, which OP described. The risks of untreated ADHD can be far more destructive than many people realize (car crashes, depression, financial insecurity) so it's at least worth evaluating for in cases like this.
I'm not sure "actually have ADHD" is a thing. (Edit: Emphasis on "actually", not on "ADHD". ADHD is a thing. In between "really do have it" and "really don't have it", though, is a huge grey area, and that's what I'm getting at.)
I mean, there are certainly people (maybe even most people) who function better on stimulants. And there are certainly people who don't function well when not on stimulants. But it's all a set of sliding scales, there's no clear line with "has ADHD" on one side and "just lazy" on the other.
The science is not on your side for this view. I suggest you read up to get a more informed view, Dr. Russell Barkley is a great resource, has videos all over youtube.
In the meantime, here's a quote from "International Consensus Statement on ADHD" (Clinical Child and Family Psychology Review, Vol. 5, No. 2, June 2002)
> We cannot overemphasize the point that, as a
matter of science, the notion that ADHD does not
exist is simply wrong. All of the major medical as-
sociations and government health agencies recognize
ADHD as a genuine disorder because the scientific
evidence indicating it is so overwhelming.
I'm not saying ADHD doesn't exist or that it's not a genuine disorder. I'm saying that there's a huge no-mans-land between "you're fine" and "woah yeah you clearly have ADHD and we should fix this."
Indeed there is, and the way psychiatry approaches it in terms of diagnosis isn't really good, either. There is a long but very insightful article on this topic that was recently featured on HN, by Scott Alexander, who's a practicing psychiatrist:
> But “ability to concentrate” is a normally distributed trait, like IQ. We draw a line at some point on the far left of the bell curve and tell the people on the far side that they’ve “got” “the disease” of “ADHD”. This isn’t just me saying this. It’s the neurostructural literature, the the genetics literature, a bunch of other studies, and the the Consensus Conference On ADHD. This doesn’t mean ADHD is “just laziness” or “isn’t biological” – of course it’s biological! Height is biological! But that doesn’t mean the world is divided into two natural categories of “healthy people” and “people who have Height Deficiency Syndrome“. Attention is the same way. Some people really do have poor concentration, they suffer a lot from it, and it’s not their fault. They just don’t form a discrete population.
(Emphasis mine - pointing out the sentence which, in original article, is basically one big collection of links to references backing it up.)
I didn't care for that article much, though there's a lot of good information in there. Why don't I care for it? Because it looks at ADHD only in terms of the capability for concentration. There are more symptoms and co-morbid pathologies associated with ADHD, and the ability to concentrate is only one of them.
The biggest one that bugs me is the inability to automatically associate actions with their outcomes if the two are separated by more than a few minutes or hours. Associating a huge spending spree with the inability to eat in the future is nearly impossible, both in planning forward and looking back. Medication doesn't directly help with this, it requires explicit thinking through of the potential outcomes (which is in turn hampered by the primary inattentivity component of ADHD).
Procrastination is, oddly enough, borne out of this, and not inattentivity. Until the consequence is imminent, the value of doing an action is so close to 0 to not matter.
The other pathology which is also little discussed is hyper focus. A seeming benefit of having ADHD, until you realize there is little conscious control over what that focus latches onto. Again, medication doesn't help much here either, other than potentially limiting the topics you can hyperfocus on.
I guess I just ask that people keep in mind that there's more to ADHD than having trouble concentrating on a particular task.
Honestly, a mental health professional is the only one who can really provide the tools which fit your needs. There's a lot of coping mechanisms which can to be employed, from making extensive use of reminders, alarms, and schedules, to setting up routines, and sometimes just to acknowledge that your brain doesn't quite work right so you don't feel bad about having to work around it.
A psychiatrist is also the one who can prescribe medication. Those meds can help with the concentration issues - can help make it possible to even invoke the behavioral modifications - but medication alone doesn't solve the problems faced by someone with ADHD. I recommend a video [0] by Jessica at "How to ADHD" to see why medication can matter. Hell, I recommend that channel to anyone curious about ADHD - her story of coming to her current point in life is a great example of how medication alone is not enough.
Feeling like a constant failure has its own costs, which is why I also mention the counselor. The right one is going to be your non-judgemental sounding board for the myriad of frustrations in life. They are also cheaper than a psychiatrist, see fewer people overall, and can help take the tools provided by a psychiatrist and personalize them even further. You can even start with a counselor and find a psychiatrist they recommend from there.
As someone who has struggled (very, very hard---high test scores, terrible grades, the whole bit) with this, I have recently taken the following approach:
1. The battleground is not a single choice or moment, but all of them.
2. There is a tendency to conflate results with character. If I have not done laundry and am wearing dirty clothes, am I a) a slovenly person, or b) a clean person who has not done laundry recently? The realization that I had no deep, abiding character flaws to address, that I could shortcut the entire "problem" of "fundamental laziness" by achieving the administrivia of life, was/is extremely encouraging.
3. The concept of "time capital" has been a good hook on which to congratulate myself, giving dopamine rewards. Basically: washed dishes are a form of wealth just as much as is money in the bank.
4. Reminding myself that no spectactular effort is reuired, that rather consistent and low-intensity effort is the key, has been helpful. I've always been good at high-intensity tasks---sports, outdoors, crunch time---and much worse at low-intensity ones. On the one hand it is something of a "life sentence" to realize that there are fewer opportunities to goof around, but it is ameliorated somewhat by realizing that the sentence is light labor, not hard stuff.
I would love to talk more about this---my life has had significant difficulties because of "laziness" and seems to be turning around at the moment---but some of those elementary tasks call right now.
Edit: Later. One of the big obstacles, I think is the ethereal nature of the problem. How does one "do" "not-laziness?" What is the momentary choice one can make that will beat the thing once and for all? And what possible paychological reward can there be for staving the spectre off for one more day, knowing that it will simply return tomorrow?
The 80-iq change of perspective, imo, is the mental action of asking oneself: "What can I do in this moment that will advance my goals?" (as opposed to: what can I do now that would match up with my mental image of what a "disciplined person" would do?) This gives you something concrete you can do now, and frames things as to offer a carrot rather than a stick.
One notable thing about this approach is that it often results in less work, as you realize that such-and-such task, while "virtuous," will not actually help you advance your station in life. This can actually be somewhat terrifying, as you worry that this is actually some trick you are playing to get out of work. I guess the sum-up is: don't fall into the trap of morally judging yourself as "industrious" or "lazy." The virtues to cultivate are judgment and efficacy, exercised consistently, not "industriousness."
I would argue that there is a discrete population with the 'disease' of ADHD, in the same way that doorways are a discrete difficulty for people who are very tall. One must either move into a house with very tall doorways, or learn to stoop. In any case, you'll probably often bang your head. This analogises to ADHD because failure to meet social and societal expectations often has real (and occasionally very painful) consequences.
'Attention' is normally distributed, but the environments that smoothly manage different degrees of attention are not.
That's a good point. A trait might be normally distributed, but (trait × some environment factor) may have a bimodal distribution (or multimodal, or something else entirely). Haven't considered it, thanks!
> A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development [...]
> B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.
> C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities).
> D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
In one form or another, person X environment has been central to the definition of mental health for most of modern psychology, going back at least as far as Freud(maybe)'s "to love and to work".
Or, to put it another way, does that mean we should be prescribing glasses to those who don't see well in the available environments?
This isn't a problem specific to ADHD or psychiatry. Many conditions are similarly defined by an arbitrary cutoff of symptom severity, or where a given quantity falls in terms of percentile or standard deviation in some reference population. I think the underlying problem is the orthodoxy of medical billing/insurance that says every treatment has to be associated with a distinct condition indicated by a particular diagnostic code.
I don't know how we'll view psychology, but I believe we'll look back at a number of psychological illnesses and realize that they're a result of our environmental factors much more so than they are naturally-occurring diseases. ADHD is a prime example. I believe modern life is highly over-stimulating us and a sizable subset of our society has trouble coping. Was ADHD a problem before the advent of TV, cell phones, the internet and our 24/7, immediately-available society? It's possible that people used to just go undiagnosed, but I believe it just wasn't as much of a problem as it is today.
Concentration is a skill that can be practiced. I've struggled with it myself and have found that meditation is far more effective than medication in dealing with it. Moreover, when I do retreats or backpacking trips where I'm cut off from the digital world, all my concentration issues disappear. It's made me believe that modern psychiatry is myopiclly focused on identifying and treating symptoms and largely ignores the avoidable causes of those symptoms.
> It's made me believe that modern psychiatry is myopiclly focused on identifying and treating symptoms and largely ignores the avoidable causes of those symptoms.
I disagree with that, even though I agree a lot of mental issues are heavily environmental. The reason psychiatry tries to work around them is that the environment of modern civilization is what we have, it's not going to change (easily), and in the meantime, people need to live somehow. Backpacking retreats are a cool hack if you can afford it regularly, but most people can't - they get maybe one longer stretch of free time a year.
The environment we live in is wholly unlike the environment we're adapted to. I'm not sure if we can or want to get meaningfully closer to the old days to alleviate our mental pains - for all our adaptations, the ancestral environment sucked hard compared to today, and modern civilization fixed at least as much as it broke.
Maybe. But it seems to me that the problems in psychiatry (and many other disciplines) have less to do with understanding, and more to do with incentives within the system. Nonsense reigns between populist regulators, greedy companies and individuals just trying to cover their asses while they go through their day.
Kind of a given. Can you think of something from the 1960s (let alone 1910s) that we look back on and think "wow, yeah, they had that figured out"? Even if it was mostly understood, the difference between "mostly understood" and actually understood is huge.
It is. Sure there is a spectrum, like autism is a spectrum, but if you're insinuating that ADHD isn't real you're wrong. The medical field has a pretty good consensus about this one.
That's just normal, not ADHD (which is way too overdiagnosed at this point and would fit 90% of people I meet).
People are lazy, but they also do not want to completely ruin their life, so they will wait until they realize they cant wait anymore, doing the minimum amount at the last minute to meet the goal.
What do you think ADHD is? It's defined by its diagnostic criteria, and those are very vague. There's certainly no consensus that ADHD is anything other than a term to describe the lowest performers on the metrics which Adderall improves. ADHD is definitely not some kind of genetic defect of the prefrontal cortex or anything of that sort.
Being lazy is not an attention deficit or hyperactivity. Most people can focus just fine, as they do when the deadline approaches. The situation described in the parent post is an issue of motivation and discipline, not attention.
To be more clear as to the diagnosis: there is a definite difference between people who don't want to pay attention to certain tasks (the vast majority) and those who cant (the minority that do have legitimate ADHD).
You're all wrong wrt. the scientific consensus :). The current consensus is that the ability to concentrate for longer periods on all the bullshit our modern lives are throwing at us is a normally distributed trait in the population, and ADHD is an arbitrary cutoff on that distribution. See https://news.ycombinator.com/item?id=16090523 for details.
I'm not sure where I was off - having the ability to concentrate is different than using that ability, and many people are really in the latter group because of a lack of proper discipline and priorities but end up getting diagnosed all too easily as the former.
You're making a moral judgement here, which is both unproductive and hinges on a convenient separation between "ability to concentrate" and "proper discipline and priorities" as if they were orthogonal.
A premise for Adhd is that, for some reason, developement of the latter is delayed causing an apparent lack of the former. The inpairment is in executive control itself, which is why your argument actually is in favour of diagnosis.
I don't think I believe in the distinction. "Lack of discipline" is a good descriptive synonym of not being able to focus on unpleasant tasks, yes, but as a way of pointing out a perceived flaw of character, it doesn't feel very useful. After all, a person that "lacks proper discipline" isn't usually able to fix it themselves. You can't "just get" disciplined.
Also having the capacity to concentrate but refraining from using it is an active choice; people doing that won't be complaining that they can't focus.
What do you think ADHD is? You say it's "definitely not some kind of genetic defect of the prefrontal cortex or anything of that sort," but there's been growing evidence of exactly that for a long time now:
> New high-resolution, three-dimensional maps of the brains of children with attention-deficit/hyperactivity disorder (ADHD) indicate significant and specific anatomical differences within areas of the brain thought to control attentional and inhibitory control systems, compared with brain scans of children without ADHD... The reductions in size of prefrontal regions observed by Sowell and her colleagues are consistent with other reports of reduced frontal lobe volumes in children with ADHD. The more advanced imaging methods and analysis used in the current study, however, suggest that those reductions are localized to more inferior aspects of the prefrontal regions than was previously realized.[1]
> In instances where heredity does not seem to be a factor, difficulties during pregnancy, prenatal exposure to alcohol and tobacco, premature delivery, significantly low birth weight, excessively high body lead levels, and postnatal injury to the prefrontal regions of the brain have all been found to contribute to the risk for ADHD to varying degrees.[2]
> Recently, neuroimaging has led to several important advances in the understanding of the neurobiology underlying the clinical picture of ADHD, and demonstrates a clear brain basis to the disorder in regions involved in attention, and executive and inhibitory control. Furthermore, transcranial magnetic stimulation (TMS) has provided evidence that intracortical inhibition, as indexed by the immature ipsilateral motor cortex, normalises with psychostimulant treatment. There is an exciting confluence between emerging studies in basic neurobiology and the genetic, neuroimaging, and neuropsychological analyses of ADHD.[3]
> ADHD is definitely not some kind of genetic defect of the prefrontal cortex or anything of that sort.
Not in the sense that it's definitively tied to a specific pathway disrupted by this or that SNP, but it appears to be heritable in much the same way that height is heritable.
I didn't see your comment when I posted mine, but that was my take as well (another ADHD person here). I hope she doesn't though, because if so she will be terribly disappointed in herself when she loses enthusiasm and is back to square one 2 weeks later. She's already beating herself over what she perceives as a flaw of laziness (despite being educated, employed and mostly functional).
At a point the bigger problem with adult ADHD is how much you end up beating yourself up. It's a good thing to try to keep yourself honest and accountable for your actions as an adult, but when your brain just doesn't cooperate you need to learn to forgive yourself and depend on external systems where possible. I dont think this advice will help much with that.
> I instantly recognized the inability to get myself to start working on something until the last minute (even if I really, really want to do it) and the piles clothes (despite my propensity for cleanliness). Another hallmark of ADHD that many don't know about is bursts of almost manic productivity for random tasks or when under extreme pressure.
This also describes a lot of people's normal behavior. I don't have ADHD and do everything you describe and my wife does too.
Huh. As someone with diagnosed ADHD and who has (in the past) taken appropriate medication, I still thought the advice rang true.
How you conceptualize your identity is a huge factor in addressing behavior pattern ambivalence. For me it somehow dovetails perfectly with a neurochemistry explanation because there's no bright line separating this stuff.
As a kid I coped with my inability to complete school assignments on time by not identifying with success in school. This reinforced my existing faults.
Learning to crush that coping mechanism out of existence was one of the best things that ever happened to me.
As someone with ADHD myself, I instantly recognized the inability to get myself to start working on something until the last minute (even if I really, really want to do it) and the piles clothes (despite my propensity for cleanliness). Another hallmark of ADHD that many don't know about is bursts of almost manic productivity for random tasks or when under extreme pressure.
If she does have ADHD, Polly's answer is both unhelpful and somewhat dangerous.