Ed Darling had the hardest time tracking. One thing led to another, and then another. The problem was that it wasn’t always a straight line, and there were a lot of open cliffs that flanked whichever idea or activity he diverted from before launching onto the next. For the others in proximity to him, tracking him was tiring and even perilous. Tiring in the sense that it took a lot of energy to follow and fill in gaps when Ed Darling moved between this and that. Perilous in that to be in relationship with Ed Darling would often leave you feeling alone and unheard, because Ed Darling had moved on to the next thing so fast. He couldn’t “stand” with you, interpersonally. He couldn’t be there long enough for you to communicate or complete your meaning and then actually receive what you were trying to give him in it.

In clinical settings, this kind of pattern is often not described relationally at all, but translated quickly into symptoms.

Many patients come to me like Ed Darling, and because I don’t prescribe amphetamines, I often don’t get to work with them for very long. Amphetamines are the accepted first-line therapy for what Ed Darling suffers with, Attention Deficit and Hyperactivity Disorder, or ADHD.

I felt rather thrilled to read about a study I came across published in Cell. It was like bulbs flashing in my face. I felt seen. Smile. I may not be eager to prescribe for ADHD, but I do enjoy the medical workup of why we feel the way we feel and why we behave the way we do.

Ed Darling deserved a good medical workup rather than jumping to a psychiatric diagnosis, or any diagnosis for that matter. We all do. There’s a reason that psychiatrists still have to complete college, then four years of medical school, then four years of specialty training. They need to be able to see the whole body and mind, and what medically can look like ADHD but isn’t ADHD.

Sure enough, Ed Darling had a thick neck, high palate, and a recessed chin. And sure enough, he’d been snoring loudly since he was a teen. On top of that, Ed Darling had been a football player in high school, and although he didn’t report concussions, he was a linebacker and inevitably, I’m sure he had chronic head trauma. Both untreated obstructive sleep apnea and chronic head trauma lead to changes in the frontal lobe that look symptomatically a lot like ADHD. Ed Darling was long overdue for some laboratory studies, including a sleep study.

The study published in Cell shows that the amphetamines commonly used don’t act on the brain’s attention circuitry as had been assumed, but instead target the brain’s reward and wakefulness centers. The study supports an increasing body of research looking at sleep, or the lack thereof, as a contributor to ADHD. Reading this, I found myself thinking less about attention as a moral or cognitive failure and more about what might be interfering with sustained wakefulness and frontal-lobe function in the first place.

What would have happened if I had just referred him to a provider for amphetamines? Well, he may have felt better, because amphetamines target the reward pathways of the brain, and people generally feel good on them. Ed Darling would have felt more awake, because yes, amphetamines target the wake centers of the brain. But that would throw a veil over what really may be going on. And then if those underlying disease processes weren’t diagnosed and treated, they would continue to do damage, even if Ed Darling was feeling better in the meantime. It would be like locking down your house when there was a slow water heater leak you didn’t know about.

Self-care in this scenario is more than Ed Darling doing what makes him feel better, more awake, more focused, taking stimulants. Self-care is Ed Darling working hard to get the studies done he doesn’t really want to do, and then the treatments that target the underlying illnesses. Ed Darling has to do this for himself. No one else can do this for Ed. I can partner with him. But ultimately, Ed has to fight for this. This is self-care from a biological perspective.

What Ed Darling’s story reminds us is that feeling better is not the same as being well. Medicine that sharpens focus or boosts wakefulness can be helpful, but it should never replace curiosity about the body that is asking for attention in the first place. True care, especially self-care, often looks less like a quick fix and more like patience, testing, and humility: slowing down enough to ask what else might be going on. When we honor that process, we move closer to treating people as whole human beings rather than as collections of symptoms.

Self-care tip:
If you are struggling with an emotion or behavior, consider asking not only “What helps me function better right now?” but also “What medical or biological processes might be shaping how I feel?”

Keep on!

Question to the reader:
Where in your own life might feeling better be masking something that still needs to be understood or treated?