Hello, everyone, and welcome
back to an all new episode of "The Financial Confessions." It's me, your host,
Chelsea Fagan, founder and CEO of "The Financial
Diet" and a woman who loves to talk about money. And when it comes to
talking about money and how we handle it, how we
deal with it, how we work, how we manage our
lives, we often run into the topic
of mental health and neurodivergence as it
pertains to all of the above. It's important to
realize that all of the habits that
we talk about, the best practices, the things
that we recommend for basically everyone to embrace when
it comes to their work and their finances is not
going to be equally accessible or equally easy for everyone. And one of the most
common obstacles that people face when
it comes to managing not just these habits
and routines but also their emotions
around them is ADHD. This is a subject
that is probably I would say one of the top
three if not the most requested subjects that we've
gotten to cover on TFC, and it's something that
I wanted to find someone to talk about with who not only
can talk about it from the more clinical and medical perspective
but also talk about it from personal experience. My guest today is someone
who actually happens to live smack in the
middle of that very particular Venn diagram. She is a psychiatrist, and
she's also a clinical specialist in ADHD, and she also was
herself diagnosed with ADHD in fourth grade
and has a book that just came out in January called
Self-Care For People with ADHD. So I honestly can't
think of anyone who would be better placed
to talk about that subject and how it interacts with
our money and our lives and all the things
we talk about at TFC than my guest today,
Dr. Sasha Hamdani. Hello. Hi, Chelsea. Thank you for having me. Thank you for being here. Yeah. And thanks to Issuu
for supporting TFC. Issuu is the all in one platform
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and use promo code TFC. So, I obviously gave a little
bit of context to who you are, but I'd love to hear in your own
words kind of the work you do and what drew you to cover
this topic and write this book. Yeah, so I knew from a young age
that I wanted to do medicine. My mom is a pediatrician
and, like, objectively the happiest person in America. She just loves her job. And so I knew I
wanted to do that. And so what I went
through medical school, I started to kind of struggle
with my own attention and focus and regulation issues, and it
became a huge challenge for me. And so that kind of led me
into thinking about psychiatry. And honestly, I ended
up doing a rotation in pediatric psychiatry,
and I loved it. And so that kind of led
me down this pathway. And then as I got into
psychiatry more and started to figure out how my
own brain was working, it led me to want to understand
ADHD a little bit better. And that's-- I mean, that's
kind of what led me to the book. Amazing. And I will note that we
got an overwhelming number of questions for-- should I call you
Sasha or Dr. Hamdani You can call me
whenever you want. Sasha is great. Well, now I want to
call you Dr. Hamdani. And I should note that we did
get an overwhelming number of questions for Dr. Hamdani. So we will be going over those. But I did want to start
with a few of my own, and probably the biggest one
that I think a lot of people watching someone like yourself
would have is, you know, you're someone who is diagnosed
with ADHD in fourth grade. So this is something
that you've been living with and managing your
entire adult life and then some. At least outwardly, you
seem like an incredibly put together, accomplished, you
know, kind of with it woman. What's the secret? How are you making it work? My god, very generous. Well, I think there's a
couple of things happening. I was diagnosed in fourth grade,
but my parents at that time-- and again, I'm not going to
disclose my age, but it's old. And so it was in a time where
ADHD wasn't really talked about and was still
extremely stigmatized. And so my parents at that time-- I was a sensitive kid, didn't
know how to bring it up. And so they proceeded
forward with the testing process and diagnosis,
but I didn't actually know it was ADHD. I didn't know that was
what was happening. So I was taking a
medication, and I knew it was going to
help me with school, but I didn't know
to what context. Did OK, got out of high school,
went directly to medical school because I ended up
doing well enough that I placed into a program. But then that was the first
time I was away from home. And so the wheels fell off. I couldn't, like,
regulate anything. I wasn't taking medication. And that's really when I feel
like I got properly diagnosed because at that time,
that's when it was like, OK, you have ADHD. I was like, absolutely not. I do not have that. And then it became me kind of
struggling with figuring out the diagnosis. So I feel like my journey really
started at, like, 18 or 19, when I actually, like,
conceptualized that and then just kind of dealing with
that a little bit at a time. And I was really
fortunate because when I got out of medical school
and entered psychiatry, I was still all over the map. And I was surrounded by
psychiatrists and therapists at that time through
my training program, and they quite literally broke
down, this is how you eat. This is how you sleep. This is how-- and they
broke down everything in very digestible chunks. And I think that helped me
build a foundation strong enough that I could start to make
my own modifications to get to where I am, which is still
very much a work in progress. Well, I mean, to
that point, when you're talking about getting
that very literal kind of roadmap for this is how you
do all of the basic functions that you need to do, can you
talk a little bit about what that looks like in practice
in terms of the tools that you use, the
practices you put in place, things that really
help you achieve at the level that you want to be? I think it boils down to
initially, before even figuring out the steps to
correct behavior, it's figuring out what your
previous behavior was-- so, recognizing your own patterns. And for me, what was
difficult is every day felt like I was
reinventing the wheel. And that's part of like what
I think a lot of ADHD people struggle with
finances and things like that is just
every day, you're trying to do something different
to stay on top of this. And you never really get
secure footing to build off of. And so I think that was one
of the most important things is learning how to
actually objectively look at what I was doing, build,
and have enough data points in order to modify behavior. And so that was
kind of the steps-- recognizing my patterns was
the important thing in terms of then figuring out, OK, I
don't sleep appropriately. This is what I need to do. I don't eat appropriately. Like, I could either go hours
without eating because I wasn't hungry at all because I'd be
distracted by something else, or I would eat all day
because it was just like mindless
eating, and I wasn't focusing on what I was doing. And it just-- you know, there
were so many different things where I felt I was
just completely unaware of what I was doing
on a day to day basis. So essentially, we
got an endless number of some version of my ADHD
makes handling money incredibly difficult in particular. What are some specific
strategies about managing money when you have ADHD? So, I'll give you
a couple of them. Number one, it is-- so, a lot of times, people talk
about, like, doing a budget and figuring out what's
important to you, what's not, or figuring out, like, this
is the money I want to spend. This is what I'm going
to spend on food. This is what I'm going
to spend on rent, which I'm going to spend
on, like, utilities and just breaking it
down very categorically. I feel like that is such an
intense task for someone who's dealing with executive function,
and it's like impossible to prioritize or to plan ahead
and think about like, OK, this is where my money is going to
go and be able to maintain that. So I think reframing
your idea of a budget and using it more as, like,
income and outcome and then prioritizing what's
important to you-- like, what do I-- like, what
do I need to focus on as, like, this has to happen this
month so I need to set aside this money and the
rest of this money that I have or may not have--
but what is important to me that I'm allowed
to spend stuff on? So I mean, am I-- like, doing it in
a non-judgment way. Like, if you're, like-- I mean, don't go
into debt over it. But if you're like, I-- like, this gives me
great personal value, being able to go
to Sephora and be able to pick what
I want from Sephora and give myself a little treat. Like, that's something
that's meaningful to you. Like, spend that money. Do that. And taking away the shame
and guilt behind that because that's what's
important to you-- and it doesn't matter that
anybody else might be like, that's a frivolous purchase. You should go return it. If that's important to you, set
aside that money to do that. The second thing
that's important that is a unique concept
to ADHD is handling the impulsivity part of it. And I think financial
impulsivity-- and I can tell you this from,
like, a personal experience-- it is really, really common,
but it's also really, really hazardous, right? Because a lot of times,
with that impulsivity, what you're actually-- you're spending money. What you're actually
trying to do is kind of stimulate
your brain so you're in this, like, low dopamine
state, and you're just like, I'm a little bit bored. And you're like, this will
make me more interested. This looks fun. This is interesting. And it releases some
dopamine off into your brain. And you probably get home, and
you're like, this was stupid. Why did I do this? Now I feel guilt and shame
about things like that. So I think-- and I
do this to this day. I recognize-- I was telling you
about my TJ Max Soho experience that I want to go and
do later this afternoon. I recognize even at
TJ Maxx, I'm going to have impulsivity problems. That's just who I am, and
that's what's going to happen. And I took out cash. This is my hard limit. I can't spend on a card. This is my cash limit. This is how much-- hopefully, I won't
spend that much. But if I do, I won't
feel bad about it. So I think it's just, like,
recognizing your patterns and things like that. I also want to take a second
to acknowledge the absolutely vicious cycle of money
and mental health because speaking personally,
nothing did even remotely as much to help my anxiety,
which used to be debilitating and is now, like,
not even really that much of a consideration
than moving up several tax brackets, no longer having-- first of all, being able to
access health care in a really uncomplicated way but also
no longer having the day to day stress and shame and
anxiety of not having enough. That was completely
transformational, and I've heard a lot of other
people kind of anecdotally say that getting financially
stable really, really helped a lot of their
mental health issues on so many different fronts. But it can be a
completely vicious cycle of being unable to get
there while you're not only struggling with any
mental health issue but also the just
constant hamster wheel of not having enough. Yeah, it's true. It's true. It's such a-- it's an
important consideration for mental health,
for sure, because I think it bleeds into every
aspect of accessibility possible, right? Like, you can't access
behavioral modification. Most of the time, you
can't access medication. You can't access eating better,
sleeping better, because you're just chronically stressed out
and releasing neurochemicals telling you you're stressed out. And it just continues to worsen. So I think it's such a
good thing to talk about. Totally. In your clinical practice,
when people come in and they're
struggling with ADHD, are there really broad
patterns that you see in terms of the
things that they're struggling with and also
sort of maybe easier wins that they could be putting
in place in their own lives that they're often not when
they first come to you? How much time have you got? All the time you need, babe. We are seated and ready to
listen to these anecdotes. Well, I think that
there's-- like, if you're talking about
easy wins, right, so-- and I'll kind of
back up a little bit. Even prior to
writing this book, I was looking for what are
behavioral modifications that I could-- like, to regulate my own
life but to also help-- by that time, I had
gotten on to social media. So, to help my social
media following and help my patients,
what are things that, outside of medication
behaviorally, I could put into place
in an organized fashion so that people could get
those easy wins, right? And so that's what got me
on this path of creating an app for ADHD
behavioral modification to help educate you
about your brain and then lead to just
slow, progressive changes to optimize your life. And that's called-- still on
the tail end of development, but it should be out in
the next couple months. And it's called Focus Genie. But some of the
things that it does is it helps you
recognize your habits. So in terms of-- like, it tracks
how are you-- how did you feel like
your focus was doing? How did you feel like your
impulsivity was doing? How much did you drink today? How much did you eat today? What was your sleep like? So it tracks that so you
get this personalized kind of thing. And then with that, you have
these easier productivity hacks which I feel like
are really effective for those attainable wins. So instead of for me, I
was having a hard time getting tasks started,
getting tasks done, getting overwhelmed with just
the sheer volume of tasks coming my way. And so it would-- but the thing that's
nice about this is that it has ways
of breaking down tasks, of putting in tasks in
just an easy, attainable way. You can voice record it. You can jot it down. You can put all these things. And then it's incentivized. So you want to keep
achieving more. So I think it's about, like,
in terms of once you figure out here's where the
deficit is, what is the pathway that's
going to get you to correcting that problem? And often times, it's what's
the most interesting route to get there, or what's the
easiest route to get there. So, things that are stimulating
dopamine for your brain because you're going to
be more likely to continue those pathways. Now, in terms of
being in these, let's just say, like, not
optimal patterns where as you
mentioned, oftentimes, it can feel impossible
to start, it can feel impossible to take a
first step toward whatever it is no matter how kind of
small the thing might be, for a lot of people, we hear-- and this is definitely,
I think, very acutely the case with money-- there becomes a really
intense negative feedback loop of shame and
feelings of inadequacy and what's wrong with
me and all of that. And it can be very hard, I
think, for a lot of people to separate out the emotion
and the character judgment and things like that. In terms of both,
you know, what you've put into practice
yourself-- obviously, your book is a lot
about self-care and having that really positive
relationship with self. But when it pertains-- as
it pertains to the emotional aspect in particular, what are
some recommendations that you have for people to at
least, at minimum-- like, not even dealing
with the habits. Like, let's remove
that part of it. So, that's actually a
really great question because I think with
shame in general, it's so pervasive, right? Once that process starts,
it's really difficult to get on top of it and pull
yourself out of that hole. So I think with
one of the things that-- you know,
clinically, is helpful. But also personally,
very poignant for me was understanding
how my brain worked and understanding that my
brain is uniquely wired. Like, I'm just never going to
be in the same mental computing sphere as a neurotypical person. I just don't think
in the same way. I can achieve similar results,
but it's in a different way. And so once I
understood like, OK, my brain works in a different
way, it's just a different-- it's hard to-- it's not hard to, but it helps
remove some of that shame because you're like, I
am not the only person going through this. I am built and
wired differently. I can do what I need to do. I just have to handle
it a different way. I have to be smarter than
this extrinsic system and figure out my own way. So then it becomes a
question of problem solving. So I think just giving
yourself grace on that front is really important. In terms of people who,
for whatever reason, let's just say that diagnosis
is not available to them right now, so they have no real
way of knowing whether or not they have ADHD or ADHD. Are there common patterns that
you encourage people to look at in their lives to, you
know, not even necessarily self-diagnose but to sort of-- because obviously,
if you're saying that part of the lifting
of the emotional burden comes from accepting
that this is, you know, a neurodivergence
that is just as banal as having a
physical difference, if someone doesn't
necessarily have access to the diagnosis that might give
that neutrality to it, at least to kind of give them a sense
of, like, this is not normal. Yeah, so I think that,
first of all, let's back up and talk about the
term neurodivergent. So, neurodivergent
and neurodivergence isn't actually a clinical term. It's something that came
about in, like, the '90s. And it was talking
about this wide spectrum of brains that just
behave differently for whatever reason. It could be ADHD. It could be autism. It could be a wide spectrum
of mental health phenomena. And so I like that umbrella. I like not limiting it to,
like, it's a formal diagnosis. A lot of times,
what I tell people is you are the expert
on your own brain, and if you feel like something
is not working appropriately-- where I draw the
line in terms of, like, trying to treat
yourself, because I think that can get dicey,
but in terms of, like, understanding your own
environment and recognizing, hey, I think something is off,
I don't think you necessarily need that formal
diagnosis in order to be able to give
yourself some leeway. OK. If you feel like your brain
is working differently, it probably is. Right. Yeah. Yeah, and also, I mean, in
terms of the benefit, obviously, there can be a lot of structural
benefits to a formal diagnosis. Absolutely, yeah. But there are plenty of people
who have a formal diagnosis and aren't making progress
or who are not, you know-- their situation
is not improving. So it's certainly
not a guarantee that things will get better. And you know, Chelsea, to be
honest with you, access to care is just such a nightmare. It's like such a mess. It's such a mess, and it's so-- like, our system is so flawed
in so many different ways in terms of serving just
mental health in general that I think that it's
important for people to be able to find ways
to pacify this guilt and shame without
necessarily needing to lean on a formal diagnosis. No. I mean, very well-said. So, as I alluded to, we
have an overwhelming number of questions from our audience. I'm going to start
with some questions from our society members. Do not forget. If you're not a society
member, hit the Join button or join the Patreon in our
link, and you will always be prioritized as these
ladies and gentlemen are. OK, how do you handle a career
change when masking no longer works, and you can
explain masking, and burnout has set in? Or another way to ask-- how
do you build a career that's compatible with your ADHD
when you can no longer fake it mainly for other health
reasons, specifically an autoimmune disease
that impacts my thyroid? That's such a good question. And thyroid stuff is miserable. I have thyroid stuff going
on too, and it's just like-- it's a mess because it makes
you so cloudy and foggy, and it just, like-- it lowers your
baseline automatically, and so many things
can throw it off. But I think-- the
concept of masking is conscious or
unconscious-- a lot of times, it's unconscious--
behaviors to help integrate into society a
little bit better, and people do that in terms
of mimicking other behavior. They do it in terms
of suppressing their own behaviors
that might be not optimal for the
certain situation. So a lot of times,
people see, like, suppressing fidgets by
aggressively crossing their legs, things like that. But when you're looking at
in a work environment where maybe that masking that has
previously gotten you thus far in whatever setting you're at,
if you can't do that anymore, if you're so fatigued from
this autoimmune or thyroid dysfunction that
you literally do not have the spoons to
continue doing that, then it really
becomes an issue of-- I mean, clearly, this person is
talking about a career change. Do I find something that's
more compatible with this spot in life that I'm in? And that's what
becomes really tricky. It's navigating those
waters and figuring out because at the
end of the day, we need to find a way to
finesse our lives financially that we're comfortable or
possibly more than comfortable, right? But how to do that is
you need to accommodate your specific brain
functionality. So for example, with
ADHD, a lot of times, maybe, like, getting into
a career pathway that is more native to
you-- so for example, something maybe
a little bit more creative or something with a
little bit more flexibility. Maybe that's not
attainable, or maybe that there's no big
financial payout with that, which is what we hear a lot. Sometimes, then, it's a
matter of, like, well, how can I optimize this
situation that I'm at to accommodate this? So, asking for specific
work accommodations-- like, can I take breaks
throughout the day so I can, like, relieve
some restlessness or so I can kind of
gather my thoughts and so I don't feel as
chained down to the system? Can I listen with headphones,
or if I'm getting really like overstimulated and I can't
really mask or be sociable in those settings, can I sit-- can I start a little
bit earlier so I'm away from the hustle bustle? Can I end a little bit later? Can my deadlines be a
little bit more flexible? So there's a lot of
different modifications within your environment
you could do. There-- and then also,
there's career choices, which are just like, is this-- like, even if I make
those accommodations, is this going to be
compatible for me? I also-- I mean, as a
business owner and an employer of a decent number
of people, I think-- not all business
owners are this way. Not all managers are this way. But I do think more than
a lot of people expect-- there is a huge value in
being really proactive with your employer and saying-- you know, having a conversation
along the lines of I love what I do here. I want to be here long term. You know, this is a really great
job for me in a lot of ways. There are a few
things that I think are preventing me from
necessarily doing my best work because I think
a lot of people underestimate the value
that having an employee stay at a job is-- the value that it
has for an employer. It's very expensive
to replace someone. It's very expensive and time
consuming and unpredictable to train a new person,
to switch, you know, a whole rollout,
especially if you are, you know, a key
person in a structure. So, really kind of being
preemptive about this is-- these are the changes,
like some of the ones that you mentioned, that would really
help me not just do my best work day to day but also
be able to stay here as long as I would like to. I think, you know, there's no
harm in at least attempting to have that conversation
with employers, and I think a lot
more than people would expect are willing to
have some kind of conversation. And I think it's important
to note in that-- and that's-- I go through this
in-- there's a specific chapter in my book about this
because it's important enough to warrant that you deep
dive into some of those accommodations you can ask for. But also, there's a
huge subset of people that, one, don't have that
formal diagnosis or, two, aren't super comfortable
disclosing it at that point just because
of they're afraid of, like, the cultural thing. So it's nice to be able to
have the verbiage to be like, you don't have to
say I have ADHD, and so I need these
accommodations, but spinning it in a
way, like, you know what? I've noticed that I do
better work when I'm away from more chaotic environments. Is it OK if I tilt my desk
away from the situation or if I listen with
headphones so I can focus a little bit better? So you're not actually
saying, I have ADHD, so we have to do these things. But you're kind of soft
stepping into that. So if you don't necessarily
want to disclose, there are also other ways to
make it more accessible to you. Well-said. OK, reading, watching
slash listening recs for parents of children with
ADHD and/or autism, especially parents who are realizing
that they may have been diagnosable themselves
but never were. Yeah. I would also to add
on to that question, I would love to hear you explain
a little bit kind of some of the connections
between ADHD and autism for people who might
be wondering why they would be in the same question. So, I'll start with that. So I'm not, by any means, an
expert on autism specifically, and I feel like the
distinction there is because autism
generally, generally-- and there's late diagnosis
of autism now and especially becoming more and
more prevalent. But historically, it's
something that you would notice at early
developmental stages, which is kind of what you
hear about ADHD as well. And it has moved from, like,
discrete diagnoses to, like, a big, wide spectrum of
neurodevelopmental behaviors and not predictable but like a
range and spectrum of disorder. Why ADHD is different
or similar-- I mean, I really could
answer this question a bunch of different
ways, but I'm going to choose this way
because I'm feeling spicy. I don't love the DSM, to
be totally honest with you. DSM is the diagnostic
criteria that we use to outline what meets
criteria for certain diagnoses. I don't love it because
I feel like it's way too narrow of a scope for ADHD. So at this point,
in terms of, like, what's the difference
between ADHD and autism, there are many, many
different differences, and there's some key
similarities in terms of, like, they're different
shades of neurodivergence. But I feel like we
need to learn more, and we need to expand our
scope of ADHD a little bit, and then we might see more
similarities or differences with autism. I forgot the original question. What was it? The original question was
recommendations for parents who have a child who's diagnosed
and especially if they may have been diagnosable
themselves but weren't. Yeah, so I will give you
a couple of resources that I absolutely love. One of them which I don't
feel like we talk about enough is understood.org. It is an absolutely free
resource for parents, for kids, for students. And the thing that's
amazing about this is that I love how they
lay out the information. So they have
scripts for parents. So for parents that
are wondering, like, how do I navigate
this-- what is an IEP? What is a 504? How do I get through
this school system? And even above and
beyond school system, there's scripts that the
parents can, like, read through. These are the questions
I need to be asking. These are the-- and it's free. It's free. We love free. I'm telling you. So-- and I've worked
with them in the past, and they're an incredible
nonprofit resource. I love them, love them. And my-- I talked about her
before, my pediatrician mom. I got her hooked on
to that, and that's just part of her resources now. So that's one of them. The other place you could go-- the problem is that there is a
lot of really good information. It's just-- it's hard to
figure out what is reliable. So usually, if I'm
like, OK, we'll go to-- and let's figure out in
terms of, like, social media, good sites to go to. It's hard because you're at
the whims of the algorithm. So you could get a lot
of good information. You could get a lot
of bad information. But if you are following
someone on social media-- I can't think of anyone off the
top of my head for good autism information. But if you're following someone
for clinical information, I would double
check and make sure that they have the
criteria to be able to be sharing that information. And what's helpful is that
YouTube is now rolling out, like, health
badges, and that's-- Good. --a slow, ongoing
process which was, like, this thing to cultivate
and make sure that this is good sound information. And I hope a lot of the
other platforms adopt that. I want to take a quick
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with promo code TFC. Man, I have to say I always
kind of go back and forth. It's kind of the same thing
in the financial space as well, but to-- I think it's even more dangerous
with the medical and mental health space is like,
on the one hand, everyone's talking about it. That's great. But on the other hand,
you have, I mean, everyone's talking about it, and
the amount of misinformation, the amount of bad information--
you know, you often see-- like, sometimes, you'll
see, like actual therapists or it appears to be
clinicians talking about their own patients. I'm like, is this even legal? Like-- but also a lot of
people who really don't have any expertise or credentials
and are just kind of, you know, saying any old thing on TikTok. Yeah, I mean, there
is absolutely-- I won't discredit the validity
in terms of lived experience. I think that that's an
important part of the story to tell, for sure. But I think once you start
moving into, like, hey, this is part of the
diagnostic criteria, or this is how to
treat, or this is how you can move
forward safely, I think it's really important
to make sure you're just more cognizant of who you're
following because I think that can get dicey. Oh, totally. But I mean also, there's-- I mean, there are
huge overlaps with, like, for example, you know,
there's massive popularity. We have another podcast
we do where we deep dive into a lot of scams and
the prevalence of things like, you know, essential oils
and, you know, aromatherapy and all of this
stuff that, you know, is snake oil in a big way. But also, I think, there's a-- we're at a sort of
strange moment, I think, culturally where on the one
hand, I think for a lot of us, we're becoming more aware in a
more nuanced and thoughtful way about a lot of mental health
issues than we were before. But on the other hand,
there's, I think, an increasing
prevalence of this idea that, like, this is
a modern phenomenon, that it only exists because of
whatever modern culprit they kind of want to identify
rather than what I think is the more obvious
answer, which is that this has
likely always existed. It just was not
diagnosed or diagnosable. And it can lead to a lot
of really dangerous places. Yeah, I think you are right. I think this has been
around for forever. We just didn't talk about it. We didn't talk about it. We didn't explore this. We didn't understand the-- we didn't understand,
like, what are the impacts of mental
health in the scope of just health in general. And I think that
that is something that is so incredible that's
coming out of the past 10-- like 5, 5 years-ish. Really, it's really started-- I mean, this is the first time-- when I was working
with the white house and with the surgeon--
the surgeon general just came out with
an advisory yesterday about the impact of loneliness
in terms of, like, it's health concerns, in terms of
like dementia and stroke risk and cardiovascular health. I've never seen
anything like that. I've never seen someone
that high up talking about mental health
in that sphere. So I think this is incredible
that we're talking about it. But I also think it makes it
this huge market for, like, very predatory behavior, right? It's just absolutely
people cannibalizing like this very vulnerable
population in order to make money and
profit off of it. So there's a lot of garbage. There is a lot of garbage on the
internet in really all domains. Yeah. OK. How do I handle
friends and family who say you're just lazy,
or you just need to focus? And also, how do I
handle people who think that all medication
is inherently bad? Oh, those are two super
long, juicy questions. Well, I will tell you that in-- literally, because
this is something that I get asked about
all the time, I am-- well, now I can't find it. There's a whole
chapter about how to talk to people
you love about ADHD. How do you disclose it? How do you talk
about it clinically? How do you let them know within
your circle and even outside of your circle how what
you're dealing with and how to support
you and how you can-- you can modify your
behavior, but I think a lot of that comes
down to dialogue, right? Being able to communicate
because doing that-- just like you were talking
about with your employer, being preemptive about that. Being able to speak
in an open fashion, in a way that both parties
are truly listening, that's actually a really-- it's a really nice and
privileged situation to have. A lot of people don't have that. You know, their support systems
aren't willing to hear that. You should study more. You should pray more. Just put it on a to do list. Like, that-- OK, cool. It's not going to help me. Right. So I think that there
is, you know, just-- for me, what I have found
to be really helpful is to broach things in
a very clinical fashion. And I don't mean
clinical in the way of, like, you have to go
to school and become an MD and then talk about it. I mean talking about it
in a way that separates the emotional component of it. Like, instead of being very
reactive and being like, I'm not lazy, you
keep calling me lazy, this is just really hurtful,
you might start with, you know, my brain
works really quickly. It's a dopamine-based circuitry. I have a dopamine
dysregulation problem. And again, this might be
a little bit too clinical. But even, like, if you
boiled it down even more, my brain is firing
really quickly. And what happens is I utilize
my resources really quickly, and I burn out fast. And so when you see me
in these points of time, I either have expended
so much energy doing other things that
I need time to reset-- and that's what you're
perceiving as laziness. But I'm just kind of
starting my process up again. And I feel like when you phrase
it like that, instead of, why do you always call me
lazy, you don't understand what I'm going
through, it moves away from being a confrontation
more to a conversation. Oh, I think also at
some level-- and I think this is just, like, kind
of the growing up of it all is like, you have to come
to peace at some level, I think everyone does,
about different things, not always necessarily something
like a mental health issue. Could also be life choices. It could also be profession,
whatever it might be. Like, everyone, I
think, at some point has to come to terms
with like, there's just going to be
assholes in your life who say ignorant things and
don't believe you and ask judgmental questions
and insinuate things. And you really, I think-- like, no one will be free until
they release those people. And it doesn't mean you have to,
like, go no contact with them. Like, sometimes maybe you do. But like, you can also just say
like, this person is going-- like, I have
certain life choices that certain people
in my life say really not nice, very judgy,
very dismissive things about. And now, it's like, I mean,
truly water off a duck's back. I don't give a [BLEEP]. I really don't give a
[BLEEP] what they think. And I think if you're
in a situation where-- like, I think it's always
really important to ask yourself on a really sort
of practical level, does this person's opinion
matter on this subject? Because, like, for example, if
you have an employer who is not respecting a diagnosis and is,
like, not taking, in this case, your ADHD seriously, and that's
impacting your job, like, that person's opinion does
matter in this context. And like, you may need
to get a different job or to radically change that. But if it's just like your
mother or something that you don't live with and haven't
lived with for 10 years, and she's not paying your
bills, and she's-- like, does her opinion on
this subject matter? It might feel bad, but are
there real consequences to just saying, OK,
I mean, I disagree, but we just don't have to
talk about it, you know? So, I'll add one layer
of complexity to that. So, with ADHD, there's
a concept called rejection sensitive
dysphoria, which is not-- I mean, again, this isn't in
the DSM, but like, almost 100% of people with ADHD has this
specific phenomenon, which is a just an intense emotional,
sometimes physical pain or discomfort when it comes
to real or perceived rejection or criticism. So when you're talking about
water off a duck's back, I mean, I think
I've worked really hard to get closer to that. But I give a [BLEEP]
about everything. You do. I give a [BLEEP]
about everything. I mean, I care so much about
what people are saying, what people are
thinking about me. I think about it constantly. And the thought of, like,
being able to roll stuff off my back, I'm like,
what's that like? That would be awesome. So I think that for people
experiencing that where they're like, I just-- I can't do that, I think
exactly what you're saying. I think if you get
to a spot where you're able to weigh how much
does this opinion matter-- so not necessarily-- because
I think they're are always going to feel like
that opinion matters. But like, if you can weigh, and
if you have a scale of things like, is this going to impact
my life significantly or not impact my life
significantly, you can work on getting past it. But I don't think
I've ever gotten to a point where I don't care. I can't. I care about everything. I care-- I am literally
distracting myself because I think I offended
my Uber driver this morning. Maybe you did. I think I did. Maybe you did. I didn't hear the question. He asked where I was from,
and I didn't hear it. And it felt like I was
ignoring him, but I wasn't. I wasn't. If you're listening, I wasn't. Hey, she wasn't ignoring you. She's doing-- Please. No, that's-- I mean, that's
a good-- honestly, this is-- I'll leave this in
the cut because this is a good thing for me to
remember is that there-- my orientation on this
channel and in life is trying to be extremely
pragmatic about, like, sort of weighing down,
like, you do a cost benefit analysis, and you draw a line. And anything under
that line, who cares? And I don't know why. That's always been really
relatively easy for me to do. But I do think it's
worth remembering that for a lot of people,
even if rationally, they know that it has absolutely
no bearing on their life, that it's very, very
hard for them to let go. However, I will say--
and this is something that I didn't use to do, and I
know many people don't do it. I don't think enough
people even take that first step of trying to-- and I think you can
do it quite literally. I think you can
actually write it down. I think not enough people
take the step of saying, like, what is the actual--
and for me, a lot of it comes down to going to the
very logical conclusion of what is the worst possible outcome
and really forcing myself to you visualize it. Sometimes, you write
even a game plan out for what that worst
possible outcome is because as those of you
who have been long time viewers of the channel,
I was diagnosed with generalized anxiety
disorder several years ago. And I would not
say I feel like I'm cured or anything like that, but
I do think I manage quite well. And although that particular
thing was never, like, my biggest issue,
I do think there were a lot of, back to the
conversation of easy wins, relatively low hanging fruit
that I was not at all doing. And I think that's
also part of what makes this topic
so complicated-- because the line between what is
within your control to improve and the things that you are
doing to sabotage yourself in some ways and what is out
of your control to change can feel so blurry. And there was a time-- there was a time when
it felt impossible for me to not stay up
until 4:00 in the morning every night, like, working
on small things that I like did not need to be doing. And for a lot of people,
I think the first step has to be trying
to, at minimum, do the sort of purely
cognitive work of, like, what are the actual
potential consequences here, what am I-- like, what is even
remotely within my control? And I think that
eventually boils down to exactly what we were
talking about, recognizing your own patterns, right? So, being cognizant
of your own patterns helps you recognize, like, OK. If I'm doing this, this might be
something that comes up a lot. So, being able to go
through and take away the emotional part
of it so you can see it just black and
white for what it is, I think there is a
huge value in that. It's a huge value. But it's also-- you know,
it's a skill set that has to be practiced and
learned and developed because I think for
a lot of people, it doesn't come naturally. No, I don't think it does,
and I also think, again, like, some of the things
that can be-- like, for me, for example, my use of
technology was terrible. And that's a question that
has come up several times. And so I'll just sort
of amalgamate them. But one thing that I think-- and
it's, as we discussed earlier, like, a lot of this
stuff has clearly existed for a long time. But one thing that has not
existed for a long time is our phones, is our
computers and the ways in which our access
to not just technology but, in the case
of social media, a million people on the
opposite side of our phone that we now have unfettered
access to, that is new. And that is, I think,
for a lot of people, really difficult
for human brains. I know for me, when it pertained
to anxiety, like, certain ways that I was using social media,
that I was using my technology, even just the light itself was
really, really harmful for me. But it's also not
something a lot of people can totally opt out of. So, the questions from
the ADHD perspective are, like, for people who
know that technology plays a role in their symptoms
and in their management of those symptoms, what are
some relatively low-hanging ways to improve your
relationship with and your use of these things? OK, so at that point,
they've already recognized, yes, social media
and my exposure to social media is causing dysfunction,
whether it's increasing distractibility,
whether it's increasing FOMO and increasing
just emotional dysregulation that comes with that. They've already recognized
that that's a problem. At that point, it's how
big of a problem is it. So, is this something that once
you dip your toe in, it's just, you know, the floodgates
open, and then it's impossible to pull
yourself away from? If that's the case,
then maybe this isn't for you because
maybe the risks of it far outweigh the benefit. Is it something that I am going
to set limited times where I can use it, and then I can
use it to kind of decompress, and then I can pull
away from it easily? OK, well, then maybe, it's just
taking those steps to set-- like, for me, I cannot
be on social media during the workday. I will not get work done. Won't happen. And so I need to set,
like, that aside for me. Like, I'm not going to do this. So, like, when I'm posting
on social media or things like that, it's all scheduled
and, like, things like that. So if if I have a day off, OK,
maybe I can do that in between. But if I'm at work,
I can't open that. And that seems like such a
dumb thing and a no brainer. But for me, that was,
especially during COVID, where everything moved
telehealth, I was on my phone all the time. And so it became
like muscle memory. I would be, like on a screen
doing my telehealth appointment and, like, checking
my VPN or whatever. And then, like, my thumb would
just take me to Instagram or take me to YouTube or-- you know? And so it was a-- again, this was another example
of not knowing my patterns until later. So recognizing how
big of a problem is it and controlling
your consumption. Yeah. And I'm sure that applies
to a lot of things as well. Mm-hm. Also another thing
that can be easier said than done, unfortunately. All of these things are. OK, is it possible to
manage ADHD symptoms without medication or caffeine? Yes. Yeah. Yes, yes. But let me tell you-- let me tell you a
little bit about, like, a personal anecdote,
and then I'll go into why that's possible. So, when I was in-- so, growing up, diagnosed
in fourth grade, was on medication. Do you mind sharing
what medication? It was methylphenidate--
so, the generic of Ritalin. OK. So I took that same dose
4th grade to 12th grade. And then I entered
medical school. Things were really hard. I didn't want to
believe I had ADHD. I skipped-- like, when
I finally was like, OK, I made my peace-- like, this is
way harder than it has to be. Let me try medication again. I tried probably every other
medication in the world. Like, I tried Ritalin again. It didn't work. I wasn't sleeping. I wasn't eating. I wasn't like-- it
was just a mess. And then I finally found a
combination of medication that worked, and it got
me through the tail end of medical school. And then I got into residency. And then when I was in
residency doing stuff I liked, doing psychiatry, doing stuff
I really immersed myself in, and when I was surrounded by
people that wanted to help me with my habits and break
down things to be accessible, I started to need
the medication less. And again, I'm a psychiatrist. I'm not pro or anti-medication. Like, if you need
it, you need it. If I need it, like,
I will take it. Like, at that point
in my life, it was getting harder for me to
take the medication because I was getting headaches,
and I wasn't eating again, and I was like,
what is happening? And then when I got out of
residency, I got married, and I was trying to
have my first kid. And so I was like,
OK, well, this might be a good time to try
not being on medication. And since that time,
since that trying period-- so that was about
six-ish, seven years ago. I haven't been on
medication since then, and it's because I relied
so heavily on that time where I was on
medication and working on those behavioral techniques. So what I tell my patients
is that you can address this in whatever way works for you. You can do medication if that's
appropriate and working through with your physician and
figuring out what works. But also, if you get
down to the nitty gritty and you work on, like,
behavioral techniques-- and I mean, that's part of the
reason why I wrote that book. That's part of the reason why I
love this app is because that's what it's cultivating because I
think the behavioral component, even if you're on medication,
I don't think you're going to feel like you achieve success
or, like, that you feel on top of it without that part of it. I will also say-- again, not ADHD, but
I similarly to you cycled through a
lot of medications for anxiety and sleep
issues, some of which are-- it's shocking to me that
they are not more-- like, looking back, I'm
like, some of these were prescribed a little
lightly for as crazy as they are, especially sleep aids. Like, they don't tell you
that if you don't fall asleep on those drugs for whatever
reason, I'm not exaggerating. Like, you're actually
hallucinating. Like-- You will trip balls. You are-- listen. I'm not going to talk about
other drugs I might have done. But suffice to say,
there were some overlap. But anyway, and I have not taken
any kind of pharmaceutical for, I don't know-- like,
I mean, obviously, like, over the counter stuff,
but nothing for, similar to you, like, six, seven years. And I would say I
feel infinitely better now than I did even when I
was on stuff that was working the best, which is, it's hard to
even say that without sounding like you're insinuating
that everyone should do it, which is totally not the case. I think there are a lot
of people who, you know, every person's
situation is different. However, I used to-- I genuinely used to live my
life thinking that I would never be able to sleep like a
remotely normal person unless I was like on
some kind of, you know, constant drug cocktail. And that hasn't been
the case for years. So it definitely is possible. It's possible, and
I think that when you focus on that
behavioral component and you actually
break down-- when you have an understanding
of your brain, when you break down
those kind of things, I think that's the part of it. Medication can absolutely
help, absolutely help. And a lot of people need it,
and I have definitely needed it. And if I need it in the
future, I will absolutely look into it again. But I think it was
actually nailing down the behavioral part that changed
my life, changed my life. Same, yeah. Slay. OK, all right. We have time for just a
couple more quick questions. Yeah. Oh, interesting. You're very well
positioned to answer this. Do you think that children
should be prescribed Ritalin? Because I've noticed it
heavily disrupting sleep cycles and eating habits
for my little one. I know. I mean, so here's the deal. It's hard to answer
that question because I think true patient
care is personalized, right? I can't make a blanket
statement because it depends on the patient. What is best for the patient? So, what I tell
people is when we're having that initial
conversation about medication, right, I tell them
that the initial-- 100 times out of 100
times, I would rather underdose the patient and
have them not be taking, like, the full amount that they
should be taking because I think you can make up the rest of that
with behavioral modification rather than give
them more medication and have them now have
to deal with other things that they have to
behaviorally modify. Now I can't sleep. Now I can't eat. Now I can't do this other stuff. So, I think if you're
getting into a spot, the right medication should
make you feel like you just on a good day. So you're not going
to be at 100%. You're not going to be, like,
super laser-focused 24 hours a day because I don't
think that's part of the human condition. I think you should just feel
a little bit more capable and more confident and feel like
your skill set is more reliable and then use that behavioral--
use the medication, if you're on medication, to
build habits to sustain you. I personally feel that I was
overprescribed, anecdotally. And I also think that for
a lot of people-- now, chances are if you're-- who knows? Everyone's different. But like, for a lot
of these drugs-- like, for example,
benzodiazepines, which are prescribed for people
with anxiety frequently-- like, I personally didn't
realize, for example, how easily addictive they are. And I feel very lucky that
I just really never liked the feeling that it
gave me whatsoever. So I stopped using them
almost immediately. I never even used the
first prescription I had filled of the
two that I was trying. But so many people get
addicted to pharmaceuticals-- So fast. --so quickly. So fast. And it can happen in a
matter of weeks, I've read. Days. Days. 10 days. 10 days. And I've also read-- and this
is something you could probably confirm-- that benzodiazepines
are some of the hardest drugs to come off of. Yeah, you'll seize. It's a seize. And so I do think-- and I mean,
every doctor is different. But I do think that
it is, like you said, from the perspective of the
person who is being prescribed, like, always worth it to, if
you're getting prescribed right away without too many
questions, without like a ton of experience with
that doctor, like, that maybe should be
a bit of a red flag. And I also think that
your doctor should be talking to you about-- and you know, to be totally,
totally candid with you, ADHD is, even in psychiatry,
not talked about a whole lot. Like, I feel like this wasn't-- I kind of niched down
into a clinical specialty because I had that
personal interest because I wanted to know what
was happening in my own brain. So that's what kind of led me
down this pathway of, like, research and looking into
alternative mechanisms to treat things. But within medical school
and within training, like, it's something that kind
of comes up peripherally. But there's not a lot
of dedicated time to it. So it might not be
the clinician's fault, but I think mental
health is something-- addressing mental
health effectively can ever be done
with just medication. I think that therapy part of
things and that understanding and that-- even just, like,
personal understanding. It doesn't need to be
formally through a therapist. But like, behaviorally
and understanding from a fundamental level what
am I actually dealing with is so pivotal in that. Agreed. Well, kind of on
the opposite side, though, so we have a lot of
questions along these lines. So, what is the
difference between ADHD and other executive
function disorders? Because I feel like everyone
I know has ADHD right now, and I'm wondering if it's being
conflated with other disorders that impact executive function. And on that note, do you think
that we're overdiagnosing ADHD post-COVID
slash work from home slash global TikTok addiction? That's such a good question. I'll start with that. There was a couple of
questions in there. So I'm going to start
with the last question. Last question is, do I feel
like this is overdiagnosed? Yes and no. So, I feel like it's a
population issue kind of thing. There's some
patient groups where I feel like it is not
talked about enough. I think it's skipped over. It's not an
accessible diagnosis, and people don't go to ADHD. And they immediately assume
it's a behavioral issue, and they think it's
something else, and it's oppositional defiant,
and it's-- and they're taken through these completely
different wrong pathways. Whereas I think there are other
populations where it's like, this is not ADHD. This is normal. Like, someone can't
focus, and you're having a little bit
of difficulty focusing for an exam, but it's
not bleeding over into the rest of your life. This is totally
functionally normal, but you're being given
ADHD medication for. So it's like-- and you
can break that down by race, socioeconomic status. There's so many different,
like, ledges where you can kind of pinpoint data. So yes, it's
overdiagnosed sometimes, it's underdiagnosed sometimes. Yeah, and I mean, I think,
not to be a broken record on this channel, but I
think we underestimate the role of capitalism in the
sense that, like, you know, young to middle aged-- young adult to middle aged women
are really disproportionately-- especially, I think,
white, more affluent, et cetera-- are really
disproportionately diagnosed with things like anxiety,
depression, et cetera. And there's a whole
lot to unpack there, but, like, one of
the key things is that, like, when you look at a
lot of those same demographics, these are people who
on aggregate, like, are working full time, also
have the responsibility of being the full time primary
caregiver to children, are living in conditions
which are pretty unprecedented and pretty-- like, it's no
surprise that people would feel really unable
to cope in a lot of ways. And they're-- you know, whatever
the actual sort of outcome is of that-- for example, a lot of people
end up self-medicating. A lot of people end up forming
really, really bad habits out of this stuff. But to me, there
are a lot of-- when you look at a lot of
the ways that people have to live under
our current system, especially compound that
with how inaccessible health care is, it's not shocking
at all that tons of people would be breaking
down a little bit. Yeah, and I think when you-- like, the first part
of the question, where it was talking about
executive function, right? Executive function is--
well, executive dysfunction is a breakdown in that skill
set in goal-oriented activity, the planning steps that
take to get a task started, to complete a task, to do all
of those other things wrapped up in that. So, included in that is
time planning and budgeting, stuff like that. So, so much is involved in
executive function breakdown, and you can see that
in a lot of things. You can get that in, like,
other medical conditions. Thyroid stuff is
notorious for that. Autoimmune stuff, notorious
for that, chronic pain. A lot of different things
you can see have that issue. I think what we need
to kind of remain in the scope of is
that ADHD is not just this I can't focus sometimes. It is this longitudinal and
pervasive pattern of behavior. This isn't-- there's
not an off switch. It's just, over the
course of your existence, you've had this. And it's chronic in nature,
and it's a disorder. A lot of people shy
away from the term-- they don't like the
disorder part of it. But I think it's really
pivotal in understanding, like, this is something that
impacts your life negatively. And what I think-- this rhetoric of, like-- and you hear it all the time. I don't know if you hear it. I'm on a very weird
part of TikTok. But like, you hear ADHD is
my super power, like, all day long. And it is the most-- I hate it because I
feel like it is so-- like, it marginalizes everybody
else that's struggling. Like, 100 times out of
100 times, I would not-- if you gave me the option
of do you want ADHD and you'll have these positives
that intermittently come about, or would you rather not
have it, I'd be like, I would rather not have it. That is where I would rather be. And so I think that learning
how to cope and to function, you can get some great
positives out of it. But I don't-- I think that it's
important to keep that emphasis on the disorder part because
it is a-- it's not just like, I can't focus one time,
and now I have ADHD. No. This is something that
has followed you around, and it's impacted your life. Man, I guess that's the
one upside to anxiety is nobody's out there
being like, wow, having anxiety is my superpower. I love this. Like, I'm so glad that this is
the way that my brain works. Well, it has been such a
pleasure having you here. Yeah. I'm so excited that I was
able to see you in person. I know! This is very cool. So, please remind everyone where
to go, what the book is called. Yeah, so, Self-Care For People
with ADHD released by Simon and Schuster this
January, and it is-- you can get it really anywhere. It's on Amazon, Barnes
and Noble, the Simon and Schuster site. I saw it in a Target. It was a big day for me. Tar-jay! My goodness! And then the app Focus
Genie will be out hopefully in the next month or two. We're doing our last bit
of performance testing. And then we're good to go. Amazing. Yeah. Well, thank you so
much for being here. Yes! And thank you guys
for tuning in, and I will see you next
Monday on an all new episode of "The Financial Confessions." Goodbye!
