[evol262]

> My personal opinion is they have untreated PTSD following a violent animal attack in early 2020 that caused life-long damage to their dominant hand. This in turn led to them suffering panic attacks around animals, anxiety due to the Covid lockdowns making treatment/physio complicated, furlough leading to isolation at home and being unable to do many of their hobbies from the physical injury (unable to play video games, the guitar, drums, etc)

You answered your question. I was diagnosed later in life, as a successful engineer. I am not and never was at the "unable to concentrate on a crossword" level, but you seem to have some misunderstanding about what ADHD is. It is not the inability to concentrate on things. It is the inability to concentrate on _appropriate_ things. It's perfectly possible for them to just be completely disinterested in the crossword, yet able to be engrossed for hours in something which interests them. The medication levels this out so you are able to keep your attention on mundane tasks and complete them after the "interesting" part is over, or to start on mundane tasks at all instead of procrastinating until it's do-or-die.

Fundamentally, there's a strong intersection with the dopamine reward system, and a "history of drug misuse" and poor impulse control is completely in line with a diagnosis.

Personally, I went through a close family member's suicide, followed rapidly by moving across the country to an isolated town where my spouse developed a problem with alcohol, a couple years of abuse, a divorce, another move to a different area of the country, then all of the lockdown stuff. All of my (and their) unconsciously constructed support structures, reward activities, and safety nets evaporated. Stop.

[satysin]

> but you seem to have some misunderstanding about what ADHD is. It is not the inability to concentrate on things. It is the inability to concentrate on _appropriate_ things.

I appreciate you taking the time to reply and clarify things but I would like to say I have a pretty good understanding of ADHD. As I have mentioned my son was diagnosed with ADHD a couple of years ago. I go with him to every appointment and support groups we are in. I have spent dozens of hours with his doctor, psychologists, etc. to try and learn as much as possible about ADHD to support him as best I can and to ensure I can get the support he needs in school.

My comment about the other family member not being able to concentrate on a crossword was more a summation of the issue not a specific example. He has always been an intelligent guy, he wasn't gifted nor did he need to push himself extra hard to succeed. He never had issues concentrating on "boring" tasks for all the time I have known him (30+ years at this point). Sure he was never super engaged with them (who would be?) but he didn't get lost in procrastination.

What I mean is these are all very new things for him. Even for things he used to love such as games he cannot find the "mental energy" (as he puts it) to play. To begin with I put this down to his injury and while his hand will never be as good as it was he can use it "fine" for such things now. He just has no interest. No interest in anything. Basically all he wants to do is just sit on the computer and mindlessly consume. He stopped coding, stopped playing games, stopped reading, not taking his drone out, stopped doing some 3D stuff in Blender, stopped watching the kind of shows he used to love, etc. Pretty much the only thing he does still do that he did before is go to gigs. And perhaps this is unfair of me but I suspect that is because he always takes some drugs while there.

What I mean is he had a large change in personality over the past two years since the attack, not just his executive functioning.

Now it is very possible he always had ADHD but like many he managed to cope with it via systems he developed and perhaps the attack (or the pandemic) caused those systems to fail him and maybe just medication will help him. My worry is that he has some other issues and for one reason or another he convinced himself it is ADHD and only ADHD.

This is a concern his wife also shares and we have discussed. When she has suggested therapy he dismisses it as "not something that works for him" (even though he has never actually had any to validate that claim). It is a tricky subject and he is now sure he is "fixed" as his concentration is indeed better as he is taking some kind of amphetamine 4 times a day, however his wife has told me there is no improvement in any other areas which she is worried will lead to a crash at some point.

[evol262]

I understand that, but adult ADHD and childhood ADHD are very different.

The energy level in childhood, brain development, behavioral expectations in school, and everything else is very different. I'm old enough that ADD (now ADHD) wasn't really a thing when I was growing up. People had to learn to manage, without medication. Doing it with medication is different, but being a functioning adult is not the same, and the same knowledge should not applied.

Everything you are saying is from an outside point of view. He sounds depressed, but he went through a traumatic incident. That doesn't mean he cannot have both.

It's not even a little surprising that he had a change in personality. You sound extremely judgmental, to be honest. Your friend went through trauma. He may not have PTSD (that word is used a bit too freely these days), but it was a traumatic experience which sounds like it literally crippled his ability to do half of the things your'e saying he doesn't "want" to do.

He suffered "life long damage to his dominant hand". The hand he presumably uses to help fly the drone, to play music, to use the controller playing games, to use the mouse in Blender (maybe). It may be painful constantly, especially if the rehab/physio was hard to manage during lockdown. You would also have a "large change in personality".

There isn't a lot of psychiatric care which can be done in isolation. People who have ADHD/ASD are also more likely to be depressed, but you can't "root cause" this to a single issue, and saying "well, he's depressed/has trauma, so he should deal with that" doesn't mean he does not also have ADHD.

He is trying to tell himself to "fake it until he makes it" after a traumatic experience, and he does not want to relive the trauma in therapy, he does not want to risk whatever potential side effects from antidepressants.

He is trying to accept that this is his life now. This life of lifelong damage in his dominant hand which has forever put the thing he loves out of his reach, and _maybe_ dragging him out of the house to do new things would introduce him to something new he loves which does not remind him of the life he cannot have anymore. _Maybe_ doing that instead of gossiping with his wife about it and wondering why he no longer does his old hobbies would help.

It sounds as if he is living in limbo between a life he lost and finding new fulfillment. The thing about very traumatic experiences as an adult is that the medication he is currently on (and again, which he probably needs) has made his life somewhat bearable again. He doesn't sound happy, and he doesn't sound like he knows what will make him happy, but the current state of things is so much better than it was two years ago that he doesn't think it's bad, or he worries that making more changes would make it worse again.

Be your friend's friend instead of whatever you're doing now. Monday morning psychiatrist on HackerNews is definitely not.

[satysin]

I just wanted to clear a few points up. This person is not just a friend they are family. I have known them since they were born while I was a child. We grew up together and have always been very close.

He and his wife are childhood sweet hearts, they have been together since they were teenagers. I have known his wife since they first started dating so more than 15 years now. His wife and I are not "gossiping" about him behind his back as you put it. We are concerned for him and worry he is fixating on one possible problem while dismissing outright every other possibility.

One thing I would like to clarify a bit is when you say "forever put the thing he loves out of his reach", this is not true. While he may never play the guitar quite as well as he used to he can still play, far better than anyone else I know personally. When I said life long damage to his dominant hand I was referring more to visual scars than anything else. He did struggle for about a year but he is perfectly able to play the guitar and use his hand much as before. Perhaps not quite as good as before but it is not like he lost his hand or it was horrifically damaged to the point it is useless.

Unfortunately I am unable to edit my previous comment. When I wrote "unable to do many of their hobbies from the physical injury (unable to play video games, the guitar, drums, etc)" I meant they were unable to do those hobbies at the time (i.e. in the 6-12 months post injury) due to them being in recovery not that they were permanently unable to do those hobbies for the rest of their life.

>Be your friend's friend instead of whatever you're doing now.

We are all trying to be there for them. Me, his brother, his wife, his parents. We're all worried about him and while I may come across as being judgemental I promise you that is not the case.

[chrsig]

> I just wanted to clear a few points up. This person is not just a friend they are family. I have known them since they were born while I was a child. We grew up together and have always been very close.

How many of those years have you been a mental health professional?

> We are all trying to be there for them. Me, his brother, his wife, his parents. We're all worried about him and while I may come across as being judgemental I promise you that is not the case.

No, you're on the internet invalidating his diagnosis.

[zozbot234]

> he does not want to relive the trauma in therapy

AIUI, therapy is not really about "reliving trauma". It certainly sounds like this person could benefit from assistance by a professional wrt. managing his stress reactions. Medication is a crutch.

[fao_]

> Medication is a crutch.

The only people I've ever known to have said this, were not qualified therapists, councillors, or psychologists. Isn't that interesting?