Meet the 'PARPs' (coming soon)

Next in line at SymptomSleuth... 

Meet the PARPs (paradoxical patients)

The next post in our idea hatchery will be for all you round pegs facing square holes out there.

[image courtesy of Allie Bosch of Hyperbole and a Half.]

Nature and Nurture Trading Spaces

I ended my last post (about forms of Denial recently seen at our house) with a remark about my own 'rotating frames of reference' on matters of mind. 

As a student of psych decades ago at a large university, I was given a wide range of  models to learn from, but they were almost all environmentally-driven. Psychiatry and psychology both seemed to think that how you were built was much less important than how you were molded by your environment.

Even then, it seemed to me that we focused on belief and behavior to the exclusion of genes and anatomy, and that those inborn aspects had to matter at least as much. But we just didn't know very much yet about the rest. The biological side of behavior was still a 'black box' to most scientists.

All of this changed in the 1990s, a "Decade of the Brain," with an explosion of clues.

Adding the "Bio" Frame

The '90s were full of headlines about mind-body connections. We were rapidly building new mental maps dotted with scores of physical correlates for symptoms and syndromes that had been long been puzzling.

The River in Egypt That Starts With a 'D'

Denial may be one of the most paradoxical parts of psychology since the very act of rejecting the notion appears to suggest its presence.

Someone says you are "in denial" about Topic X , Y or Z. You see it differently. But before you open your mouth, you know that the very act of objecting makes it seem you are guilty as charged.

It's a classic cant-win-for-losing Catch 22.

My son (I call him "Trey" here) probably feels caught in exactly that kind of double-bind right now. Most of the older heads around him agree about things that we don't believe he sees. But both his pride and his plans make him extra-invested in thinking that the rest of us are wrong.

We think he is ripe for all kinds of denial right now, while in his better moods he thinks he's the only cool head in the room.



The Biggest D on Our Family Tree?
Since last week's post (about ADHD Awareness Week) I have been reminded that one of the D's in "ADD" can sometimes stand for Denial too.

ADHD: The "A" in Our Alphabet Soup

It is some kind of karmic irony that I picked this particular week to launch a blog meant to help with a mental health puzzle that is up close and personal.

This also happens to be "Awareness Week" for ADHD, which I first found out on Twitter. (If you are new to the topic, there is an informative site at adhdawarenessweek.org involving the partners shown in the graphic below.)

We are not new to this topic at our house. Quite the opposite. Until recent events (see first post on this blog) ADD appeared as the largest ingredient in the mental health brew spawned by our gene pool.

The coincidence makes me feel as if it was not a coincidence. Perhaps I needed a vivid reminder of what could still be our most relevant theme.

My husband and I have almost 20 years of experience with ADHD. Our family contains a boatload of relevant genes, three impacted offspring and two affected mates. To say that I have more than a few opinions would be to put it mildly. 

However to say much about my own story would build a bigger trail of bread crumbs than our current need for privacy permits. Since our situation is still unfolding, I can't write frankly without a cloak for my now-adult offspring. 

So for now, I will simply weave my current impressions about ADD into the larger story I was already planning to share.


A Launch Pad Lacking Ignition

Like many a parent before me, I wanted to think our own needs for added awareness of ADD were largely behind us once the youngest finished college.

That physics degree of his seemed like some kind of finish line to us, his own 'Mission Accomplished' banner. That banner said he had made it over the hurdles and through the gates that met his needs for self-pacing high-level engagement from elementary through college. For that we credited many things, including good advisors, good meds, and flexible educators. 

At that point, we all hoped that his launching pad was complete. None of us really looked at the question of fueling the engine. He was living with friends two hours away, happily attached to a very nice girlfriend and full of "gotta do it myself" energy. It was the peak of his 20-something pride and all of the adults in his orbit, including me, were happy to second the motion that he was now well-equipped to execute.

Today, I am left to wonder how many ways there are to spell 'wishful thinking.'

But I would digress to serve up the rest of that story yet. Let me confine my first ADHD posting here to my first take on Then & Now.

(continued past the jump below)

Treading Water in Limbo

There are few things in life more unsettling than watching one of your kids lose most of his marbles.

At times like that it doesn't matter what you already know about mental health, neuroscience or genes, or even how many personal histories you've seen. For now you are just a parent quivering, as any parent would, groping for answers, grasping at straws, trying to prepare for the worst while deeply hoping it isn't as bad as it seems.

A few weeks later and all of that feels like a dream, outwardly everything seems so normal once more.

What was that train wreck and how likely is it to happen again? Nobody yet has a guess.

On the surface, what we are seeing does not compute. An extra-bright, yet extra-relaxed, late twenty-something whose only known prior is the non-hyper form of ADHD, went around the bend for a few weeks, then returned to almost-normal (emphasis 'almost') amazingly fast.

Meanwhile everyone else is wondering if another shoe will be dropping soon, uncertain which events are more and less significant.

Watchful Waiting
For the time being, family, friends and the pros (MS, MD, and a PhD) watchfully wait to see, while he insists that he now feels fine and thus needs no meds. This may or may not be a pivotal issue. For now, things seems so normal again that we want to believe that Trey is right not to fret, especially given some recent headlines about neuroleptic meds. (This sets off his mother into a flurry of web surfing and fast-forwarding updates, consulting sources from NAMI to patient groups while reading memoirs, studies and journals.)

Could it really be "only" a very odd burp in an ADD brain? Or might it be some chronic disorder kindling despite his "what me worry?" temperament that rarely tips to extremes? Was there more of a substance history than he admits or anyone knew? Or did he minimize a scary encounter that happened aways from home, and might it have been a PTSD-ish event that shut him down for awhile? And how would these pieces fit with a brain that may also contain at least a few flecks of ASD?

None of the standard labels really fit the visible history and no one yet has more than a half-guessing theory.

This leaves us to mix and match from a long list of hints until a pattern becomes compelling.

First-time psychosis is like that. It could be a one time event, akin to what they used to call a 'nervous breakdown'. Or it could be quite the opposite, something chronic just now coalescing into some form of repeating distress. So here is the mom unit sleuthing the heck out of it, applying a sieve to the alphabet soup of diagnosing codes, seeking patterns that make more sense.


Meanwhile, we get to keep treading water in limbo, not knowing how to orient.


Sit tight and stay tuned while we try to help ourselves. Perhaps some of you who are reading this will be helped  or help us along the way too.