Tuesday, April 6, 2010

When a "Good News" Diagnosis Means "Bad News" for the Relationship, Pt. I

 We call ADHD a "good news" diagnosis. That's because it offers not only a long-elusive rational explanation for vexing behavior but also effective treatment strategies.  So, why does diagnosis (and sometimes even treatment) mean "bad news" for some relationships? 

     The reasons run the gamut, as complex as the individuals involved and their history together. To explore this topic a bit here, let's begin with a letter (below) sent to me by a reader.  This is only one example of how the ADHD diagnosis and treatment might create new challenges even as it resolves old ones. 

Jack Celebrates His Success: Why Can't His Wife? 

Consider Jack, 42, married 12 years and diagnosed nine months ago:

"It took about six months for me to get on board with medication, and the doc and I haven't worked out all the kinks yet in that regard. But let's put it this way: Before I started taking medication, I was often criticized for being hyper, loud, disorganized and easily distracted. Since the medication, I hear myself as I sound to others and so have much more sensitivity to my own volume. I am also now more aware of my tendency to rant. A good argument used to be like food to me.  Now, I don't have to be in the ring with every discussion, and I can focus normally on a discussion that I am engaged in.   
     "So, between medication and therapy, I feel my approach to life has changed dramatically.  I'm also better organized, more focused, and doing better at work.  But has all this helped my marriage?  That's the big surprise. The situation at home has actually gotten worse in many respects. 
     "In fact, now that my 'ADHD Fog' has cleared, I'm seeing the long-running dysfunction in our relationship and wondering if my wife, Judy, could use a diagnosis. Maybe she has ADHD, too, or she's codependent. Whatever it is, it seems that she can't stand my being higher functioning; I think it's because it means she's losing control. You'd think she'd be happy for me, but she's not.
      "My psychiatrist and therapist agree that my therapy is not only working, it's a success story! With my therapist's support, I'm standing up for myself more – demanding more control over our finances, for example -- and Judy doesn't like that.  She seems lots angrier in general these days, or maybe I just notice it more because the medication  means I can't tune her out as well as I used to."
-------
     Jack's is one variation on a common theme: Newly diagnosed adults with ADHD begin treatment, often including medication, and soon the "fog" of distractibility, impulsivity, and inattention begins dissipating.  With newfound clarity, many of these adults start re-examining their choices – job and career, friendships, health habits, and sometimes even their mates.
     Frequently for the first time in their lives, adults feel solidly optimistic about their ability to evoke permanent changes; after all, they finally have the right answers and right tools. As they excitedly embrace new competencies and confidence, though, inevitably the "balance of power" in their relationship starts shifting.
     Therefore, it's understandable that adults such as Jack might feel deflated or even resentful when their partners don't share their optimism and, in fact, rain on their parade, constantly demoralizing them by dragging them back to past misdeeds. Understandably, they chafe at a partner who, as if on auto-pilot, constantly issues reminders, directives and second-guesses. It must be devastating, or at least highly irritating, to hear a partner chide, "Well, I give your latest self-help kick six weeks."
     No doubt about it. Change can be threatening, especially when a couple isn't unified in learning about ADHD and collaborating on new strategies. "Denial" about ADHD can be a problem on both sides. In other words, it might be true that Jack's wife is unwilling to accept that he can possibly change old habits. Moreover, she might be blind to her own little peccadilloes or even pathology. (We'll examine that topic next month!)
 
But Is Jack Understanding His Wife's Reactions? 

For edification's sake, though, let's ponder what Jack might be missing in this equation. Perhaps Judy has valid reasons for her reactions, reasons that might totally elude Jack, who self-admittedly spent many years in an "ADHD Fog."  Judy might, in fact, be asking herself these questions:
  • How long will Jack's "new and improved" behavior last this time?
     If Jack is typical, he no doubt has a pre-diagnosis history of "doing better" for weeks or even months at a time – improved focus at home, regular exercise, more patience with the kids, following through on agreements, and the like. Gradually, though, his attention faded or moved on to more stimulating activities. Lather, rinse, repeat. Many times over the years.
     His acknowledgement of this pattern? Perhaps rather fleeting and vague, in part because it depresses him to talk about past failures; he's trying to remain positive about the future. But Judy's more worried about the past as prologue.
  • How can I trust Jack when he won't accurately acknowledge past problems as well as show empathy for my experience over the years?
Caught up in the excitement of embracing new possibilities and seeing the past in a rather distorted rear-view mirror, Jack might not clearly remember past  patterns, much less their relevance to today. After all, he (and his therapist) consider him a success story.
     Then again, has this therapist has solicited Judy's perspective on all this? Some people with ADHD can talk a real good game during that stimulating hour of therapy (not really lying but perhaps being a bit unrealistic); therefore, how it plays out in real life is only the therapist's guess. (Hence the recommendation for couples working as a team on ADHD education and treatment strategies, as outlined in this post.)
     For her part, Judy long ago learned to protect herself from Jack's "other shoe" inevitably dropping. She's sworn to never again prematurely celebrate any positive changes he makes; it's simply too devastating when the positive changes stop suddenly, with no explanation or even acknowledgement from Jack.
     As far as him demanding more financial control, how can she possibly acquiesce when he fails to even acknowledge his old spendthrift ways and the devastating impact it had on their family, not to mention how he plans on avoiding the same predicament? It took years for her to dig them out of debt. And just the idea of his demanding financial freedom -- as if she never wanted to work together on decisions -- makes her neck veins pop. Angry? Darn straight she's angry.

How about you?  Was ADHD diagnosis and treatment "good news" or "bad news" for your relationship?  

24 comments:

  1. For my relationship, it was bad news, resulting in us no longer being together. Perhaps if the diagnosis had happened earlier in our relationship - like when I first started begging him to get looked at! - then we may still be together. Unfortunately, there is too much water under the bridge, too much hurt and sadness, which has left me feeling used, abused, and down right cynical.

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  2. I appreciate reading the story, as a little reality check for me. Helps me to prepare for the next steps if we get a diagnosis.

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  3. I'm sorry to hear that, Vicky.

    Sometimes, undiagnosed/untreated ADHD means the person doesn't believe in consequences until they happen.

    And sometimes, of course, the relationship can be so damaged by the misattributions and confusion.

    I hope that as time goes on you feel less "used and abused" and more educated and informed.

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  4. Hi Anonymous -- It really helps to educate yourself before you and your partner even think about pursuing an evaluation.

    Some clinicians are better than others in guiding folks along the path from diagnosis to treatment, so you want to be able to recognize a competent clinician when you meet one! :-)

    Gina

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  5. A-MEN Gina! I'm delighted that you've posted this. Yet again, while I wouldn't wish the quirks of the ADHD life on anyone, I'm delighted to know that I'm not an anomaly, and that there are patterns to these things. It's nice to have a rough idea of normal, even in a quirky situation!

    My good news diagnosis was BOTH.

    Bad news first: It was one catalyst for the end of the relationship I was in when I was diagnosed...but that relationship wasn't a good fit for me or him anyway. He was a nice guy with a little toxic caretaking streak that even pre-diagnosis I didn't need imposed upon me. And frankly, some of my ADHD quirks were a little stressful for him to live with...duh :) He was far too rigid in his routines for me to be able to accommodate. My diagnosis process made him appreciate me as someone who was working hard to take responsibility for their whole selves...but that didn't change the fact that my whole self wasn't a good fit for his whole self. Plus, he was using my eccentricities to hide behind, so he didn't have to deal with his own...! I think we're both better off having split up. I got tired of being "the person with the problem" and he got tired of stepping over the garbage can to get to the front door (hey, what can I say, I need visual cues).

    Good news: I met the love of my life (sappy, sappy, sappy...but TRUE!) after breaking up with the other dude. He has ADHD too (as you know). We absolutely adore each other, and aren't one bit annoyed with each others' ADHD quirks. Half the time we don't even notice each other's ADHD quirks, the other half of the time we're delighted with them. I find it highly amusing to watch him wandering around doing some of the exact same funny things that I do to myself all the time, it's so funny to see it from the outside! Ex: today he tore the house apart from top to bottom, looking for his W-2. He says "I just know that I put it somewhere allegedly safe, and I have no idea where that might be!". Every year I lose my W-2's, tear apart the house, and say exactly the same thing. We really need to stop putting things in safe places! I just gave him big hug :)

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  6. Thank you SO much for sharing your story, 18 Channels!

    Not only am I delighted for you (and him), but it's also a perfect setup for next month's planned installment!

    Gina

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  7. I can see how Jack has may have taken his improvement of A.D.D. symptoms (meds/therapy),and jumped too quickly into beleiving he can control and solve all the problems that were the result of A.D.D..

    It's not a cure, and his wife can't forget everthing that has happened, and feel secure yet.... Slow down Jack (Scott uh huh), and take little steps, before you start running!

    Scott.

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  8. it takes a while for the meds to work. the most hurtful thing ive dealt with was when my fiance would say. i think we better have your meds checked.. now it was during an argument..and to me more of a low blow.. so i ignored it.. but im back in college at 40. im on the honor role, host study groups, and tutor on my off days.. im going for a dental assisting license.i was also voted student of the semester by my peers. But recently, a program director has labled me a problem student to teachers ive yet to have, for being "too helpful" in class, asking questions, and being disruptive. The instructer i currently have has no idea what she is talking about. i was very hurt, embarrassed, and humiliated by this. This was never mentioned until after they found out i had adhd. A student in my class was making fun of people with ADHA on a regular basis and i said.. "you know,? I have ADHD and am on medication for it, we dont all act how you are portraying it" i was told by the dean that if i wanted to not be accussed of this behavior that it was best i write any questions i have over the material down and see the teacher after class. It is also best that i dont help other students. School used to be the best 5 hours of my day and now its the worst. Im so afraid that my adhd is out of control that im actually stressing myself out by being someone im not. im actually feeling paranoid that at any moment i could be a distraction... Ive told my instructor about the question thing, and to please not call on me in class as any move i make can be seen as a distraction to others. She thinks the whole thing is crazy. She also believes the entire complaint was from this problem student that is in our class, the one that makes fun of adhd.
    What do i do? ask the doc to increase my meds?> I mean..when you have this.. the asumption is that your guilty. but what if this IS just a problem student causing trouble, and some advisers that didnt research for any proof? As i said before..my current instructer has said..had they not told her i had adhd,..she wouldnt have known. And i show none of these mannerisms during class.

    frustrated,
    Angela

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  9. HI Angela,

    Wow, just when I think I've heard of every possible ADHD-related scenario, I read a new one.

    If I were in that situation, not even having ADHD, I too would be confused at the conflicting information. Who to believe???

    So, when you have ADHD and you are aware (as it sounds like you are) that you might not always be the most accurate self-observer, well, that could really mess with your mind.

    A hunch tells me that you are right, that this problem student is the trouble-maker. Why do I suspect this? Because I've seen how vicious and persistent some people can be when they are determined to spew misinformation about or deride ADHD. And how even more vicious they can turn when they are called out for it and publicly corrected. (Good for you for standing up for yourself and all people with ADHD, by the way.)

    All that said, you probably owe it to yourself to be a little more methodical in checking out how you are perceived by your teachers. (Some people with ADHD do tend to talk a lot in groups and try to help others to an excessive degree --perhaps partly as a subconscious effort to stay stimulated and engaged.)

    1. Do you trust the teacher who gave you the positive feedback, or is it possible she just didn't want to hurt your feelings or get in a conflict with you?
    2. Can you get reliable feedback from others who are around you on a regular basis -- friends or family members?

    Reliable feedback from people you trust might provide helpful information towards tweaking your medication or changing some habits.

    As for your partner mentioning the medication dosage during an argument, in general I'd see that as unfair. After things have cooled down would be a more appropriate time to broach the topic, and only in a non-intrusive way.

    When working to establish a good dosing strategy, a partner's input can be very helpful. But it should be as part of a cooperative team effort, not a "gotcha" in the heat of battle.

    I hope this helps. Maybe others will weigh in with advice.

    Gina

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  10. Thanks for your post Gina. I can relate to Jack's wife. I have developed coping strategies over my 10 year relationship and now for the last year or so my partner has been in therapy and on medication which is making major improvements. Sometimes I am frustrated with myself because I struggle with the trust issues and wondering if the "new" version of my partner is here to stay or if I'm opening myself up to disappointment (again). It's complicated.

    Some of my partner's changes and new behaviors are not the priority things that I feel like need to be changed now. Does that make me a control freak? Maybe. Or maybe I'm just a person emotionally worn down by years in a relationship that had some disfunctions that are now coming to light.

    In reading Angela's post I agree that the comment seems to be from the problem student. Angela, don't let that one person deter your happiness in school. As far as the medication comment during your argument... I had my partner say that once to me. I wasn't offended - I think in an effort of trying to fix things and knowing how much medication has helped my partner, he felt like he was trying to help rather than be critical. Gina is right in that your partner's timing wasn't right but I think the intention might not have been malicious.

    With my partner I do get to give feedback with dosing of medication and it seems to be good for me to track how things are changing compared to how my partner perceives the changes.

    It's unfortunate that ADHD is still misunderstood by a lot of people and folks out there are throwing the word around in judgment without knowing anything about what it's really all about.

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  11. Im 45 and diagnosed with ADHD last week. Im not dealing with daniel, but excitement. My diagnosis has provided me with an answer to why I behave and think the way I do. My wife is very supportive but Im concerned with past behaviors that I cannot remember? Im also concerned about my impulsiveness, and weather or not I can now "justify" (for lack of a better word) my impulsive behaviors. Im just beginning to understand the impact this disease has had on my partner and children. I have 1 child (of 4) that was diagnosed with ADHD last year. Her on-going therapy (and progress) motivated me to seek an evaluation. Im reading everything I can find (Im not a fast reader so have plenty of material for a while), but I wonder about support groups, and how much I need to continue to look back at my life. How much of my life do i have to evaluate to understand how ADHD has impacted me? Isn't it better to continue cognitive therapy and learn how to effective manage my life going forward, rather than looking behind? Do I really need to "stir the pot" to move forward?

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  12. Good for you -- "excitement" is the logical reaction, in my opinion, when you are given the explanation of ADHD and, more importantly, a clear path for elevating your life.

    As for your question -- isn't it better to continue cognitive therapy and learn how to effectively manage my life going forward, rather than looking behind? -- that's a tricky one.

    You are at the crossroads, it seems, between the past and the future, and it's important to nurture optimism. That means focusing on doing things differently and being confident that this is possible.

    Trying to focus on that while at the same time acknowledge problems in the past....well, until your ADHD symptoms are stabilized, you risk having all the optimism knocked out of you.

    This will greatly depend on the person, but one of the key challenges of ADHD is emotional dysregulation.

    In short, if you overly focus on past problems, you risk getting stuck there, emotionally and behaviorally.

    It is important to acknowledge past problematic behaviors, so that you can avoid them the future (you can't change what you can't see). And also so your family can be assured that you "get it" and are focused on doing things differently.

    I hope that makes sense.

    By the way, plenty of people with ADHD prefer audio or visual materials to written ones. If they're humorous and well-done, so much the better.

    Check out the great videos at Totally ADD:

    http://totallyadd.com/welcome#/treatment/

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  13. After a 12 1/2 year marriage, I finally left my husband. I asked him to seek help so many times over the years and had that erupt in anger. Three children, two bankruptcies, and 12 years later I walked out the door.

    A few days after I took the kids and left (I threw a little bit of clothes in the car, grabbed some cash, and drove to my moms a few states away while he was at work to avoid having a gun pointed at my head for trying to leave him again) he finally went to counseling and was diagnosed with Adult ADD.

    Under threat of being charged with kidnapping for leaving the state with the kids and his promise he would live with his mom and let us have the house (my son also has ADHD and learning disabilities. It was important for him to return to his old school for his special teachers), I returned to our home.

    He is on medication but has yet to move to his mothers as promised. I have no where else to go in this state. If I cross the state line I risk losing my children. We co-exist in the home at best.

    He is determined to win me back, prove to me he has changed, yet still refuses to acknowledge a lot of past hurts.

    He somehow thinks that having a diagnosis makes everything "all better" and we can just pick up where we left off.

    I was at my mom's for 6 weeks. Coming back here was one of the worst mistakes I made (next to believing his promises to change before, having married him in the first place, and staying through the abuse).

    I am at a loss, but reading your blog helps me to know I am not alone in this battle. I know my comment is more of a vent than a helpful comment, but I need to let this frustration out.

    Throughout our marriage I often joked about having four children, one of which I was married to. Having both a husband and a son with ADHD is not easy.

    I just hold onto the hope that eventually he will get distracted with something or someone else and leave me alone and that I can break the cycle by helping my son not turn into his father.

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  14. Hi there,

    I am so sorry to hear of your family's situation. It's hearing too many stories like this that resolved my commitment to taking ADHD seriously and doing my best to make sure others do, too.

    Yes, yours might be a more extreme situation but it is not uncommon, not by any means. And people who try to minimize ADHD's potential challenges aren't helping anyone.

    Getting support for yourself, getting education on the many ways in which ADHD manifests...these are important steps you can take to strengthen your resolve to take care of yourself and your children.

    That said, once a person has acknowledged the diagnosis and sought help, it often does little good to keep living in the past. Yes, it is important to ensure that the past events do not repeat themselves, and recognition of the hurt is helpful. But in order to get on with the future, sometimes it's best to focus on that.

    Your husband failing to abide by his promise doesn't seem like a great way to start afresh or engender new confidence in his "hearing" you.

    I hope 2011 holds in store happier times for you.

    g

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  15. Since I was diagnosed with ADD last fall, my husband has even less tolerance for my 'quirks' (disorganization, absent mindedness, etc., lack of ability to clean, or keep things as tidy as he wants) I have given him a lot of literature explaining why I am the way I am and he thinks I should now just 'fix it' and stop being that way. I am taking medication but it doesn't help as much as I would like. My husband is very 'type A' and seems to just resent me now and tells me not to use my ADD as an 'excuse'.

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  16. My husband recently lost his job so I cannot wait for his diagnosis. He and I both need stability and happiness. It never occurred to me our marriage could be affected in a negative way. This has been very helpful.

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  17. Hi there,

    Yes, this tougher economy has meant many people with unrecognized ADHD are suddenly feeling their challenges more severely.

    I know this is a mixed blessing, but I hope it means that you and he find the stability and happiness you are seeking.

    best,
    g

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  18. First of all, I am SOOOOOOOOOOOO thankful that I finally started looking into finding people more like me...all these stories are so comforting!

    Until this year, I always ended up in relationships that were abusive and the guys were extremely controlling and I now realize after meeting my therapist who officially diagnosed me with ADD that I was probably just seeking structure because my brain was so out of control.

    This year, I met a wonderful guy! He was a total party animal and extremely impulsive (which is probably a large part of what attracted me to him) and I was kind of trying to hide from my impulsive, distractable, disorganized self. Over the last year, we have come to understand each other and he's become more open about his ADHD now that I've finally been diagnosed and am getting some help. It's so comforting to have someone who understands me! We do get frustrated with each other because I'm more reactive and he's a little more impulsive...we're still different even though we share a lot in common. It's great to be with someone who gets how it works!

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  19. Congratulations! Knowledge is power. I'm glad you are finding mutual understanding with your wonderful guy.

    Gina

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  20. My good news is that after years of my own mental suffering I finally found that answer. I have been 2 months into discovery mode and fixing myself mode and while sometimes the progress is slow, I know that it will be better for myself in the end. What has helped the most was the correct medicine and finding a caring life coach. The bad news is that my discovery seems to be too late to save my marriage. My wife wants a separation stating that she is no longer attracted to me. I went downhill 5 years ago after the birth of twins and already caring for a 2 1/2 year old. The wife got tired of telling me that she was unhappy and me not pursuing it enough. I am not sure what to do next to save this marriage. She is pretty adamant about divorce. We started seeing a relationship therapist but he told her that he has never met anyone who already knew what she wanted, out of the relationship. Can I save this or should I just move on?

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  21. Well, congratulations on the good news. ;-)

    As for your wife being adamant of divorce and the therapist's response to this, I'm sure you know that no one can really tell you what to do. Especially given only one paragraph.

    The sad truth is that the ADHD diagnosis comes so late for many people, after compounded hurt and distress. The relationship simply might be beyond repair.

    Another truth is that some couples therapist will take their cues from the couple. If your wife sounds set on divorce, that's what the therapist will go with. Many people simply will not believe that "people can change," and do not understand the dramatic impact of effective treatment for ADHD.

    Two months post-diagnosis is not a long time. Perhaps a trial separation is in order - a time for your wife to de-stress and regain a happier foothold in life and a time for you to continue optimizing treatment strategies.

    Perhaps after a few months or even a year, you two can try sticking your toes into the water of the relationship again.

    Good luck!
    g

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  22. Meu companheiro tem TDAH. Como posso fazer para ajudar ou conviver com ele?

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  23. Hello Gina ... I am so thankful for you and your book .. The incites and stories from your book have provided the only support for my, in the "last day's of my 14 year relationship. Now, I am so very sad to say that despite all that I've read, all that I've lived and all that I know ... my partner with 43 yr old partner with a life of untreated and only 3 mos diagnosed ADD, decided on the ride coming back from the therapist that she no longer wanted to try and work on a relationship anymore! ... I am devestated! ... It was me who wouldn't stop advocating because I knew something wasn't right ...for years in couples ... with psychiatrists that were treating for anxiety and depression, even Psyd's that were not getting it ...until 3 mos ago ... they got it right and now ... even before the fog has had a chance to clear, my partner is walking out! I'm guessing the push was to much and all I can do is cry. What's most frustrating is how difficult it has been to find a couples' therapist her in the SF Bay Area that really does understand ADHD ... and a good support group that partners can turn to. It's really hard to see the love of your life in pain and not be able to do anything but say good-bye!!!!

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    Replies
    1. HI Roz,

      I'm so glad that my work has been a support to you.

      Perhaps your partner needs some time to sort through her feelings and her reaction to the diagnosis. It sounds like a very impulsive thing to do, and perhaps she doesn't mean it. She just doesn't know what else to do with her feelings.

      At the same time, maybe you can use this as a breather, to detach a bit, take care of yourself, and re-assess if this relationship is worth pursuing.

      At some point, it's her choice. She might not be ready to accept the diagnosis now. It might take a few more relationship breakups, as it has taken for many people with late-diagnosis ADHD.

      Please take care of yourself and do some good things to charge your batteries. One day at a time!

      g

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