executive dysfunction

Executive function is a technical way of talking about the part of the brain that makes decisions. We decide what to do, we decide how much attention to pay our feelings, we decide what to think about. Any time we're talking about mental health, it's important to remember that we all have the same system of basic functions, which never work perfectly. In discussing mental health problems, we are not taking about a different system, but degrees of severity in a system that we're all familiar with.

We all know what it's like to consider doing something we really don't feel like doing. We know it can be worse if we're sick or exhausted. A person with serious problems of executive dysfunction might say they're having a very difficult time doing things they don't feel like doing. Knowing what that's like, we're told it sucks, but you have to just do it. Failing that is then seen as failing a trial the rest of us have succeeded.

This is where people often jump to character judgments. Such a person is lazy, misguided, not really trying. Usually, the executively dysfunctional person themselves will feel the same way. We're failures and it's obviously our own fault.

Then maybe we learn about a condition like ADHD and how it causes this. We find ourselves wading through ADHD memes and realizing lots of other people have surprisingly similar problems and they're calling it ADHD. What a relief to understand that it's not a character flaw, but a neurological condition, and we're far from alone in trying to navigate life in spite of it.

Here's the problem though. Everything about us is a neurological condition. We can label and categorize variations in neurology, we can define some of it as neurotypical or neurodivergent, but we are all the way we are for a vast array of reasons coalescing around how our brains work. Nobody should feel bad about who they are, because who we are isn't something we have any real control over. We don't exist without everything that goes into our existence. There is no self perched above it all, beyond the reach of cause and effect.

So why should having a diagnosis put us at ease? I tell myself all this, but it still feels like an excuse, when we talk about how difficult ADHD makes doing the dishes. Everyone hates doing the dishes. Over the decades, I've gotten a lot better at overcoming the problem, so I know it's not impossible. We are under the control of all these factors that go into who we are, but one big factor is what we're doing. If you're lifting heavy weights, you will get stronger.

If we rest on notions of this simply being the way we are, we will not get stronger. In order to grow, we need to do what we find difficult, but if we try to lift too much, we fail and injure ourselves. When we have a diagnosis, it can help us calibrate our expectations. We might not be able to handle what neurotypicals do, but we need to figure out what challenges we can handle. Aim low enough that we won't fail, which means facing our limitations, but don't aim so low that you don't need to try.

While I've just about conquered the dishes problem, I don't understand how people can spend ten hours a day, five days a week, doing things they don't feel like doing. I don't understand how people hold jobs. This is possibly the most fundamental way to explain why I don't work. The nature of my disability is such that I cannot even approach that level of executive functionality. My mind rebels far before reaching such an insane threshold.

ADHD alone typically doesn't stop people from working. They might be terrible workers, they might lose their jobs a lot, bouncing from job to job, with difficult stretches in between - but I've never worked. My case is different. I suspect that my endocrine problems are the other half of that equation. In addition to acute executive dysfunction, I had abysmal energy levels due to the deficiency. I could barely stay awake doing much of anything. Think about what a brutal combination that is.

A lot of what hormones do is gradual, developmental, it takes time. It's not like the time a drug might take to peak in the system, but rather time to alter the course of our ongoing physiological development. There is no peak to reach, but a whole process that's now moving in a different direction, upon supplementing a deficiency. There will be differences months out, more differences years out, and even more differences decades out.

So, having been on somatropin for seven years or so now, I've gradually been doing better in a lot of ways, but it only addresses half the problem. My excuses are good, but that doesn't make my life any less of a wreck in consequence. Excuses do not walk the dog. This is not to shame anyone, but it's a reality we have to be honest with ourselves about.