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.

Is there a good way at all to tackle the issues you mention? I ask because, well, I kind of recognize myself in this description.

Seeing a psychiatrist and a counselor.

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.

[0] https://www.youtube.com/watch?v=rD9qK8-sMGQ

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."

For me, I will often find the smallest actions I can do that will advance a larger task and the momentum is enough to push me.

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!

> 'Attention' is normally distributed, but the environments that smoothly manage different degrees of attention are not.

Does that mean we should be prescribing amphetamine to those who don't function well in the available environments?

That is the current basis for prescribing them:

> 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.

(DSM V: https://images.pearsonclinical.com/images/assets/basc-3/basc...)

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?

Perhaps "making available" is better than "prescribing"?

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.

Do you think that in fifty, maybe one-hundred, years people will look back at our present day understand of psychiatry and shake their heads.

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.