Why'd I take speed for twenty years? - Part 2 (classic)

Hey, everybody, it is July. We at Search Engine are taking the month to refresh and to start to think about some news stories. But in the meantime, we are re-broadcasting some of our absolute favorite episodes from earlier in our run. This week, we have part two of our two-part story about prescription stimulants. This two-parter, I think, of the work we've done. It might be the thing I'm proud of stuff, if it's not, it's certainly up there. In this story, we worked very hard to try to say something thoughtful about a topic that is both very complicated and very personal. I hope we got there. Okay. Here's part two after some ads. So, last week, we shared an episode where I was asking a question I had about my own life. Why did I take all these drugs? Adderall, 5Ans, Concerta, Ritalin, for 20 years of my life. I'd never known the story of how those stimulants were invented and marketed. The story of all the different people who had taken them for different reasons before our modern era, in which now their largest market is kids who struggle in school. When we made the first part of the story, I really only had one listener in mind, a person I knew would never hear at, myself, in the past, someone who had a straightforward, mostly unquestioning relationship to stimulants, a bit of a zealot, honestly. I wanted to make a story that, if I had heard it, might have wobbled me out of my certainty. To republish the story, I got a lot of emails, thoughtful, detailed ones, stories from people who take these drugs, but have mixed feelings and questions about them, as well as stories from people who feel like the drugs have just been miraculous for them. I've read every email I always do, please keep sending them. This week, I have a different story for you about a person with a very different mind and a very different relationship to these compounds. Yeah. Okay. Hey, can you guys hear me? Hi. Yes, although I just move to the airport and now I can't hear as well then. Bianca Harris, a trained pulmonary and critical care physician, she was connecting with us from her home studio just north of New York City. The lights are very bright, though. This is not like a stimulant switch that you see going. It's the lights. I was not aware of my assumption, but it's okay if they were. Bianca has been on either Ritalin or Concerta for the last 14 years. In Bianca's life, stimulants show up pretty late, but her story begins well before they do, in her childhood, when she's just a very small kid going through an immensely scary and confusing medical experience. Can you just tell me the story of your brain as you understand it? Sure. My story is a little bit different, I think, than a lot of people who may be listening to this. I had a brain tumor when I was eight, and it was thought to be a pretty slow growing tumor that I probably had for most of my life, but when I was probably seven and a half, I started having episodic headaches, and funny enough, nobody really took them seriously. They were very intense, but very short-lived, so I would have them and sort of clutch my head, and then they would go away, and I would be fine and go play. I don't think I thought that much about it until I remember one day being at our country house, and there was a deer or a family of deer in the backyard, and the whole family got up to go to the window to see, and I got up and I fell right down. That was very scary to me, and I could not stand without assistance, and I think that night is when I started throwing up. At that point, my father was a physician, and my mother was a nurse at the time. They were clearly fearful, but they had very different approaches to listening to me in the three months leading up to it. My dad very much did not want to see it, and my mom did, and actually, at some point later, she told me that was the beginning of the end of their marriage, so no pressure. Because of the way they reacted to what was happening to you. Yeah, she felt like she knew something was terribly wrong, and he thought I was crying for attention. Oh, wow. Yeah. Talking to Bianca, it's very clear that as a kid, a fundamental lesson she learned was that it was bad to cry for attention, which gets it something really complicated about people. When someone's in pain or they're sick, we can have two responses towards them. One is sympathy. We might offer them compassion. The other, though, is we might just feel annoyed. This pain the person is complaining about, is it real? How real is it? And Bianca, as a kid, decided very young, maybe without even realizing it, she didn't want anyone asking those skeptical questions about her, so she didn't complain. She doesn't complain. When she does describe a painful experience, she's careful to contextualize it, to hedge, to acknowledge that it only lasted for a little while, or that she knows how lucky she is in other ways. I'm saying this now because you'll hear it in this story, and because in some ways, this is a story about pain that gets acknowledged and pain that doesn't. Bianca remembers that it was months of headaches before her father took her in for a brain scan. But when he did, they quickly found the tumor. The surgeon, Fred Epstein, came down, and I did see Fred speaking to my father looking at the films, and I saw his head kind of drop. My mom had been with me, and then they switched. And my dad is the one who said, you're going to have to have a little operation, you know, to take something out of your brain. And I can only imagine what kind of guilt he probably held for not having recognized it sooner. Because at that point, it was a pretty dangerous situation. I say, and did you understand when he said, you're going to have to have a little operation, but that involved your brain? Like, did you, what was your reaction to that emotionally? At the time, my dad was a physician, and I really prided myself on being the perfect patient. And so it was scary, but without understanding the implications of what was happening, I had the opportunity to perform and be really good and make him proud at the hospital where he worked. I remember swinging my legs while I was sitting on the gurney. And in fact, we went to pick up my sister afterwards. And I remember running up turns saying, I have to have an operation. Like excited. Yeah. Like excited. Bianca remembers the day of the surgery. She remembers that the girl in the bed next to her had a brain tumor as well. She remembers the anesthesia mask being placed over her face. She remembers being afraid they would start the surgery before she was actually asleep. While she slept, the surgeon removed a golf ball-sized tumor from her cerebellum when she woke up. Her favorite unicorn puppet was at her foot, and she felt comforted by that. So what was the point, like at some point, presumably they send you home. You recover, like at some point, it's like, this is fixed. This is over. This is a thing that happened. When does that happen for you? Well, from the beginning, everybody's like, oh, you're better, you know, you're fine. You had this giant gumbah taken out, but no big deal, you're fine. I don't know what they were saying behind my back, but that was pretty much as soon as it was done. You're good to go. You just need to heal. At the time, when they removed part of the skull to get in, they didn't replace the bone. They used a wire mesh. And then the bone sort of grew over it. And so the back of my head was a little bit flat. And I guess before my hair fully grew in, I remember being at school and kids making fun of me, which was not awesome, but it's the only time that that really happened to me. Did they, was there something they would say or they would just be like, I think they called me metalhead at one point. God. Which was not so informed, but anyway, you're like, actually, it's a mesh. Yeah. Okay, so like you recover from the surgery, your hair grows back. It feels like a thing that's in your rear view. What's your first perception that like something unusual might be going on for you? I remember picking up the diary of Anne Frank. I had a sister of three years older and she was reading it and I think I was probably ten or eleven and it was very small print paperback, but I just remember I could not like focus on the words. I could only see the sort of spaces between the words come at me. And for the life of me, I just couldn't finish a sentence. And I got very frustrated and I put it down. And as the reading became heavier in middle school and high school, what it took for me to get through something and really understand critically what was being said, that was a disaster for me. At the time of the surgery, doctors believed removing the tumor would not affect Bianca's cognition. Back then, it was thought that the cerebellum only affected fine motor skills, which meant that when Bianca was a kid and she began to suspect that something was wrong with her mind after the surgery, there was no available research to support her growing suspicions. As she passed through grade school and into high school, she had difficulty concentrating. She found herself easily distracted. Most of all, she struggled with reading. She was a slow reader and felt very ashamed of it. And it wasn't just that she read slowly. It was hard for her to both hear the words of the book in her head while simultaneously having her own thoughts about those words. In fact, there was one day in class, I think, in my sophomore year, we were reading the bell jar. And I was asked to read out loud and comment on it. And, you know, there was a metaphor about peeling an onion. And she asked me to explain that. And I couldn't. I think I literally talked about her, like, making dinner. And I knew that wasn't right, but I just, I couldn't read and think at the same time. And I was anxious, of course. And I remember she really humiliated me. And I know it sounds like I've had some horrible school experiences with that kind of thing. I haven't had that many in terms of being treated inappropriately, but those things do stand out. Grade after grade, Bianca kept slogging through school. It wasn't that teachers or students were constantly making fun of her. It was just that she felt like a phony. On the inside, I had developed a sense of, I guess, self-loathing for lack of a better word. Because your identity was that you were a smart person and people thought you were a smart person. And then you were having this experience, which is that reading and reading comprehension felt like they required kind of, like, squinting mentally in a way that did not comport with your idea of a smart person. Yes, especially because my sister was a heavy reader. My dad was a heavy reader. And I just thought, you know, those two people are really smart. This is not easy for me. And what ended up happening was that my way of dealing with that ended up being some degree of procrastination, both out of fear. And because if I could get myself scared enough, then I could focus. Right. So I would often wait until like one o'clock in the morning of the day, an assignment was due to do the work. Right. Because the adrenaline of the fear gives you like a little boost. Yep. It's funny. Like, I had a similar, like, I didn't have a brain tumor, but I had the feeling of like, it's very confusing to get signals that you might be smart and signals that your brain might not work at the same time. And for me as a kid, it was just sort of like, why would prefer that you guys treat me as dumb? Rather than you guys sort of treating me as a person who should be capable of doing something that I'm not doing, I would just prefer you guys left me alone. Like, I think there's a lot of cultural discussion about people trying to figure out whether or not they're thin or people trying to figure out whether or not they're pretty. But like, if there'd been a mirror that you can look at your brain, I think as a kid, I would have just stared at my brain all the time because like, I couldn't figure it out, figuring it out, felt important, but figuring it out felt painful. And the adults in my life were very preoccupied with whether or not I was doing a good job being smart or whether something was wrong. And it's funny hearing you talk about it helps me remember just how painful the confusion was. Yeah. I mean, I can totally relate to that because every moment alone or in comparison to others, you try to like decide ones and for all, am I this or am I that? Yeah. What was the cruelest story you told yourself that explained it at the time? Well, I didn't believe I was smart. At that point, I was sort of almost hardwired to think that everything I had done was out of luck or charm or, you know, all the other things that people with imposter syndrome tend to do, which is denigrate your abilities and merit and basically attribute any of your successes to kind of external factors. Right. So I was a master at that, which also made me feel really bad about myself. Bianca graduated high school in 1993 about a decade before I did. The wave of stimulant medications that I would boogie board in on and not yet arrived in time to catch her. So she had to get through this without medication. She also had to get through it without a diagnosis. A diagnosis is such a tricky thing because it's both a story about ourselves we can use to understand our own minds, but it can also be a label that limits what we believe we're capable of. These days, my bias is to think more about the downside of a diagnosis and yet hearing how much Bianca struggled before she could find a name for what she felt, let alone a prescription to help her, I see how lonely that was, and at times how maddening. And Bianca says it only got worse in college, where she'd sit in the back of the class or skip class because she was convinced that she was the only person there who felt like an imposter. She felt depressed and anxious and undeserving, feelings that persisted even in the classes where she was having some success. And so when something would happen, like you would get a good grade, you were just like, you're a phony, this is fake, this isn't real. I would always have like an hour or two of euphoria that maybe I was wrong about myself, but then the crash would be even worse. And what did I do? I just tried to do harder things. I ended up doing a graduate degree in infectious disease epidemiology in the UK after college. And when I did that overseas, I had such an incredible time and I loved the science, the microbiology, and the sort of the science behind the public health and medicine. And I was like, you know what, I'm just going to do this. I'm going to go to med school. I've always wanted to go to med school. Now it's not because I want to be a neurosurgeon to sort of redeem myself from my, you know, travesties at eight years old, but it's because I'm really interested in something else, infectious diseases and what have you. So when I returned to the States to do my post back, I actually had a herniated disc in my neck. And as a result of that, because I really couldn't look down at paper for too long, when I took the MCAT, I got extra time. And when I got extra time, I killed it. It's so funny because it's the kind of allowance that by the time 10 years later when I was going through high school, if you just knew to like wave the yellow flag of like, I think I've ADD, they were like extra time, extra time, but you sort of got there by accident. By accident, yeah. And I did really well in the MCAT and that changed my life. What do you mean it changed your life? Because at that point, I think I had measured so much of my intelligence and therefore worth unperformance on exams. I see. And of course, now I lost my chair and I thought, because I did not take Ritalin today. When was the first time someone, what was the first time you remember hearing about him, fed him in? Well, I don't remember paying much attention to it in my psych rotations and things like that. You know, it wasn't one of the more important things to learn about, but it came up for me when I was in residency. And then I reconnected with the therapist that I had in medical school, who by the way was apparently seeing everybody in my class. But nobody knew about it. I mean, the anxiety and the stress and all of that is exceptional in medical school. And so I was telling him more about the things that were troubling me. Yeah. And that's when he brought up the possibility of a stimulant. And what did you think? I think I took a minute and I wasn't sure because I didn't want to take anything. I just sat on it and then I was really struggling one day and I was just sort of like, fuck it. Let's try it. Bianca was a fellow in medical school. She was 34 years old. Her therapist gave her a survey to test for adult ADHD. This was a test Bianca took with complete confidence and passed with flying colors. And with this ADHD diagnosis, she got access to a stimulant medication, Ritalin. For her, this compound was a revelation. If you're someone who struggles to concentrate, taking one of these drugs for the first time, you can feel like someone has just pulled a clump of cobwebs out of your brain. It was remarkable because I never realized that there was a sort of a physical feeling behind my eyes that when I did take the stimulant, changed. So, you know, there's this sort of stereotypical way of speaking about it is, you know, the shade's going up or putting your glasses on. But I felt it behind my eyes in a way that I don't feel with coffee. What do you mean? So, like, when you say behind your eyes, you mean like the fog in the front of your brain behind your eyes? Yeah, it's almost like it's boggy back there. And it gets sort of cleared and dried out. And then I can think more clearly. But there's a real noticeable difference in how I sort of physically feel in my head. That's not a very eloquent way to state it, but it is different from something like caffeine. Yeah, I remember. Yeah, it's like sharp and it's bright. Coffee feels like the image of my head of coffee is like when you're in like a music studio and there's a board with all the levels on it, the sliders they slide up. And coffee feels like you take all the sliders and you slide them up a little bit. And for me, what And Tatumine felt like when it was good, was like three or four of the sliders that I really needed got pushed all the way to the front. - Yeah, I like that. I didn't feel high though. I just felt right. - And so what was the primary feeling when you had that experience from that chemical, like the emotional feeling of it? I mean, not the chemical feeling of it. I mean, it was love. It was like, I can't believe I've been putting myself through this, like my brain actually does work. You know, and maybe I've been replicating this kind of neurochemical activity with fear my whole life. And I chose critical care because that keeps me, you know, on the edge of my seat and that really works for me. But it was such a relief. - Did you feel upset that it had taken this long to find something that helped you? - Devastated. Yeah, first there was the relief and the love and then there's sort of like, oh, but why couldn't this have happened sooner and because I had really tried to get people to listen to me. Even in my program, I had tried a few years earlier. I went to my program director and said, listen, I'm having a really hard time keeping up with these articles. You know, I have this history. I've always wanted to get neuropsych testing. I don't really know how to go about it. And he said he would get back to me. He seemed really, you know, interested and he never did. And I was too shy and scared to go there. I thought maybe I'm the mistake. Maybe I'm the one who got into this amazing program that shouldn't have. - Right, right, right. And so if you ask more questions, you might get an answer that you don't like. - Yeah, leave well enough alone. I've been dealing with this. Like, who cares if, you know, my health is deteriorating which it really did later. So I do think they're related, but yeah. - Sometimes after Bianca finally started taking stimulants, she got a full neuropsychological exam, similar to the one I had as a kid. For Bianca, it was two days of intense tests measuring how her brain processes information. It gave her a clear picture for the first time of her own mind. This part of her that had confused and bothered her for so long. And it confirmed her suspicion that something was unusual there. - The disparity between my IQ and my reading was shocking. And I remember calling my therapist after and being both relieved and really, really upset. Just, you know, he's like, look, you've had the added overlay of confusion because you are smart. And yet, there's this other thing that you've led yourself to believe to the contrary, but we have objective evidence now that like, you're really fucking smart. - Yeah. How old were you when you got the neuropsych testing? - 34. - Oh, wow. - Yeah. And if you wanna know how crazy some of these numbers can be, and you can still be successful, my IQ was in the high 90s in terms of percentile. And my reading rate for comprehension was in the second. - Wow. - Yes. - Wow. - So that means that 98% of the population can read faster than I do for comprehension. - You must have worked so hard. - Yeah. - I can't imagine what it would be like to have had that information withheld for me until I was 34. - Yeah. I mean, in hindsight, it feels like torture. I'll be honest with you. I mean, I've had a great life and opportunity, but when I think about the number it did on myself confidence, yeah. It does make me sad. Nobody wants to hear you complain about stuff like that when you're in the honor society or whatever. Like it just, it doesn't make sense to other people. It doesn't make sense to you. And you can really twist a narrative around it. That's wrong, but it's all you can do to make sense of a confusing situation. - That neuropsych report that Bianca received, at this point, it was more than a decade ago. And the science trying to understand what is happening in brains like hers has actually inched forward since then. Just last month, Bianca got in touch with a group of neuropsychontists who study the cerebellum and who are now looking into adding Bianca as a case study. We spoke to one of those neuropsychontists, Dr. Anila Damello, and she helped me see something that Bianca had been trying to articulate. When you meet Bianca in person, she looks, and this is a word I've come to understand to be extremely loaded, but she looks very normal. She looks like a doctor who lives in a nice house with a nice husband and a cute son in the suburbs north of New York, which is true. But what you can't see, you can't see evidence of her childhood tumor, you also can't see evidence of her adulthood bout with breast cancer. You can't see that a year after her child was born, she had to have surgery again. And throughout most of her struggles, her continuing preoccupation has been the problem of her own mind, fogginess, headaches, and inability to focus without the help of stimulant medication. Pretty much everything Bianca has grappled with is in some way invisible. And so not always believed or taken seriously. Women are less likely to be diagnosed with ADHD. Doctors are less likely to detect it. Even, apparently, in a case like Bianca's, where her medical history is anything but normal. This neuroscientist, though, Dr. DiMelo, actually looked at a scan of Bianca's brain and saw something closer to what Bianca sees. Dr. DiMelo said what she sees is a large lateralized lesion on one side of the cerebellum, or as Bianca's apt to put it, a giant hole in her brain. Everyone's always known that the hole was there, but for years, no one knew what it meant. Dr. DiMelo said in the history of medicine, the cerebellum has been woefully understudied. Remember, for years, scientists thought it only controlled fine motor functions, but now we know there's a connection between the cerebellum and cognition. And we know that an impact to the cerebellum can also affect cognitive functioning, which can inform symptoms that we now associate with disorders like ADHD. It'll take years to really figure out those connections, but it's exciting research. Dr. DiMelo says people like Bianca, people with highly unusual brains, are going to be part of how we begin to fit the pieces of the puzzle together. After a short break, Bianca talks about some of the downsides for her of the stimulant medications she feels so grateful for, and she turns the tables on her interviewer. (soft music) (upbeat music) Welcome back to the show. So before the break, Bianca had told me the story of her own mind and of learning to live in it. What follows is a bit different. I had a question about the downsides of stimulant medication for Bianca, but from there our conversation went in a direction I really didn't expect. She actually ended up gently challenging some of my ideas about my own story. I'll just play you what happened. Did you feel then or now that there were trade-offs to stimulant medication for you or were there downsides? Yes, I felt a little edgier. I remember if I were arguing with my husband, I just knowing how it is to have a mature argument. I was a little quicker to sort of snap. A few times I sort of I think used it for the wrong reasons, like if I just wanted to stay up late or socially, I might take it, but not for the purpose of work. That was a slippery slope, but I never really gotten to trouble with that. But if you feel good on it, why wouldn't you take it? I guess there's one way to look at it, but I think the biggest negative for me was, as much as it felt like I was more me than I've ever been on the stimulant, then there's that question of what is natural and what is me. And so there were moments when I thought, is this cheating, is this really me, is this fair? I would let that get to me because what I valued was sort of natural genius. And I wasn't sure that that counted. So I always found other ways to put myself down as part of it. But for me, and I know it's not true for everyone, the net was positive and life changing, right? Also that I was no longer depressed, and I did not need to be on medication for that. So that I think is hard for me to forget about when I speak about some of the negatives. 'Cause that was so overwhelmingly positive. It's funny, you know, one of the personality traits I'm trying to correct myself as I get older is not to just be like a zealot for whatever my new opinion is. Anything like five or 10 years ago I was kind of like a pro stimulant zealot. And then like when I stopped taking stimulants, I was like kind of an anti-stimulant zealot. And now I just feel like a confused person, which is a more honest position to be in, I think. But sometimes my critique of these drugs is that for some people, boredom, some of the time can be really useful. That, like, it can tell you that you don't like what you're doing and maybe you shouldn't do it. And that there's people I know, and a person I've been at, like, a long time ago, where, like, I had jobs that I found unfulfilling where it was hard for me to do the work. And I think what I ended up doing was, like, taking a medication to be able to do the work, but, like, in retrospect, it felt kind of dystopian to be like, oh, the job you don't like, like, there's a medication for that that'll keep you there longer, and it'll turn off the parts of your brain to tell you not to. And so sometimes, when I would think about this stuff and I would think about friends who are still taking it, I think, like, well, maybe there's a cultural message around this drug, which is telling you, you need to take a drug or a medicine or whatever, a molecule, but maybe you should just choose a different life than the one that you would only have assisted by this. But then when I hear your story, I'm like, well, you should be doing what you want to do. And if you feel like there's ways in which you love your brain, and there's ways in which your brain makes you suffer, and your brain sometimes is an obstacle to the things you want to do, and that this medication helps you, like, when you say, like, oh, it helped me love my brain more. That's like a really, that feels really meaningful in a way that I don't know what to think of. Well, it doesn't have to be binary, I guess. Like, all these things can be true. You can be conflicted about it, and you can make choices around it, and it's so individualized, right? You can have some days where it's working for you, other days where it's not, you know, keeping yourself in check, and staying authentic, and making the right choices. But to your point earlier, I mean, it is challenging. Everybody would like to feel the best that they can feel without taking something. I think that's probably true, because their side affects to everything. Yeah. But I can tell you, since I was 34 when I was diagnosed at 36, my husband and I started to try to have a family, and it was gut-wrenching for me to go off of it. I had just been given this toy that I had been yearning for my whole life. So to have to go off of it, we had to do IVF, unfortunately. I mean, a lot of people do, but it was definitely a struggle, and then to be pregnant off of it and have your brain go to mush in all these other ways, it was a really difficult decision. It's one that I knew I wanted on the other side, but it was one of the more painful things I've gone through. God, that seems really hard. I still, I miss it all the time, but I don't know. I think for me, everyone has to make these choices, and like, for me on balance, I think, the trade-offs are bad, but I still miss it. But what do you think your life would have been like if you hadn't taken it, you know, it sounds like you really needed it at the beginning. I guess, how do you think back on your life and how it might have been without it? I don't know. I think there's a version of my life where I'm like really frustrated, because for you, the way you handled the mixed messages you were getting about your own worth or potential was to just force yourself to try and to excel, and to just sort of make up the difference with hard work. And the way I handled those things was to not try. My college GPA at one point was 1.9, which is kind of astounding. It's kind of hard to get a 1.9, and I think there's a version where I would have ended up in a job that I didn't find terribly fulfilling and suspected that I could have done something I found more fulfilling. And I think, like, I know a lot of bright people who have not gotten to exercise their intellect in the most rewarding way, and some of them, anyway, have a really hard time with bitterness, and I understand why. And I think I can imagine all sorts of stations like that for myself. And I was in a lot of them for a while, you know? I feel like now, if my brain is kind of like, this is such an obnoxious thing to say, but you've been really candid, so I'm not going to worry about being candid myself. Sometimes I think my brain is like a fussy, imported sports car where it could go really fast some of the time, but it's usually in the shop. And I think now I figured out how to use my brain in a way that mostly works. And I figured out how to make peace with the ways in which it doesn't work the way I wish you would work. And that it's like not a computer. It's like a living thing. For me, the hard thing is what I've gotten here. I've like sworn the stuff off, but I did a lot of work that I'm proud of on it. And like, did the drug help me learn how to not take the drug? Like, I don't know. I know that I was taking it past a point where it was useful. I know that I was taking it with a lesser strength than you were. And I know that it was part of a larger constellation of like how I was medicating and self-medicating that didn't work for me. But it kind of feels like the humility you have to have about your own life and about not knowing what the choices you didn't make where they would have led you. I can't say like, oh, I wish I'd never found it. I wish I'd never touched it. It was all bad. Like, it was just complicated. Yeah. And like, it never occurred to me that I could not take it or that I could think about how I was taking it. I only ever saw therapists who were either like, would you like to have more? Or do you want to just try a different drug? But yeah, I think my regret is not whether I took it or not took it. My regret is that I didn't take it mindfully. Like, I didn't take it thinking very hard about what taking it correctly would mean. I just thought like, I'm tired of feeling stupid. This makes it easier. It makes me feel better. And anyone who tells me that I should think about this harder is like not getting it and offending me. And I wish I'd been able to have a more thoughtful conversation about it. But I wasn't. I stopped taking it about the time in my life where you started taking yours. And like, I feel grateful for what I got from it. And I feel grateful that I stopped it. And I think I wish that you got to run your life more times so you could see what other choices would look like. It sounds like you're also missing agency a little bit. I mean, I think that happens to kids who are put on it. And maybe it has to be that way. But that becomes confusing. And it's how could you not go down the what if rabbit hole? So I could see myself in the position that you're in now had I been diagnosed as a teenager to be asking those questions and taking a break from it to really see what I was all about. I think it's okay to change. And part of that change is based on the experience that you had. It's just different for everybody. And you can't separate from fads and trends. And of course, there's overuse. And of course, there's sort of unscrupulous providers and uninformed parents. But the individual cases can be made in ways that can't be refuted. And your sounds like it probably did help you in a way that was right for that time. And you've explored it. And since realized that it's not right for you now, I mean, that's great. I mean, that's maturity and reflecting on your life experience. Yeah. I think so. It's funny to be in the position of doing this job where I sometimes feel torn between wanting to be like, here's my collected notes of being a human being up until this point. And here's everything I figured out. But please don't listen to me too much because I've written them in pencil. I've changed them a lot. Five years ago, I have a really different opinion. Yeah, it's scary because they're individual choices, but they're made in the context of a culture. And when I was on, I mean, I would have friends who were smart but frustrated by their own minds. And I wouldn't tell them to take it, but I'd tell them how much it was helping me. And now, I have friends who take either similar medications or other medications where I'm like, oh, I see my struggles in you. And I'll tell them my story conspicuously, like the desire to what's other people, unfortunately, is very strong in me. Even though I hopefully have like more intellectual humility than I use. But that's a good trait. I mean, it's a trait. It's a trait. Part of me hearing your story where I think I know more about this person than they do and they should do anything other than what they're doing. I find your story powerful for that reason. Well, I appreciate that. But I mean, I do think about it a lot. I sort of check in with the balance on many days. And I like taking breaks from it. And I don't use it all the time. But sometimes, it bothers me that I need it. The fact of needing it reinforces the fact that something is wrong with me, which is not something that I would let slide if a patient were telling me this. I mean, this only applies to me that I can still say, but my brain's broken. I don't love that about myself. I don't necessarily see it even as I did as a kid as like this incredible thing that I endured. And so it's forcing me to sort of look at it and start to be okay with the fact that There's this thread throughout my life of my brain. doing its own thing. And I think leaning into it a little bit more is going to serve me better than wishing it weren't so. Dr. Bianca Harris. That was her story. I know there are so many more. You can email us at [email protected]. We read every email. Bianca has taken a break from practicing medicine that she and her husband can race their son. She's also working on a book about imposter syndrome, although she really the right person right now. Just kidding. We're very excited to read it. And I want to thank her for her vulnerability in sharing her story. We have a tiny bit more show after some match. [Music] Okay, so sometimes on the show we have recommendations. Usually they're from the internet. This week I have a very specific recommendation that is only really useful if you live in Brooklyn, New York. I'm sorry. This is unpaid. There's a sandwich shop that I really like that just opened called Sea and Soil. It's at President Street and Columbia. I really love this place. Part of the reason I wanted to mention them on the show is because they told me that people keep coming into the store and telling them that they have opened in a cursed location where every business closes and that they would like people to stop saying that to them because it's scary. But basically they're a worker-owned sandwich shop, which means when they hire someone that person after I think a year becomes a full-voting part owner of the shop. They also do sliding-scale prices, which I think is cool. But the main thing that I really like about the sandwich shop is just the quality of the sandwiches, which are extremely delicious. I keep going in and ordering the sandwich called the "Ren". It's just like a really really good chicken sandwich. It's, I can't pronounce any of these ingredients, Cuban paprika roast chicken. I could already be off. Aji Verde that sounds like a person. I don't know what it means. Please don't email me and tell me how wrong I am. Aoli, which I can say, red, onion, which I'm familiar with, and greens on SNS, Faccaccia. SNS, like Sea and Soil Faccaccia, they make it on-site. It's really good. They keep telling me to get stuff that's not the chicken sandwich. I keep getting the chicken sandwich. You can do what you want, but I would get the chicken sandwich. That is my recommendation this week. Sea and Soil in Brooklyn. Go get a sandwich. Pay what you can. Surt engine is a presentation of a Odyssey. It was created by me, PJ vote, and truthy opinion. This episode was produced by Garrick Graham and Noah John. Theme original composition and mixing by Aaron Bizarreon, fact-checking by Sean Merchant. Special thanks this week to the many people who listened to drafts and game notes, including Vlad Gittuck, Dr. Eli Wilder, Dr. Colin Reef, and General Air, and Matthew Smith, author of the book Hyperactive. Thanks also to Dr. Anila Damello, assistant professor at UT Southwestern in UT Dallas, and to Dr. Catherine Stutley, associate professor in the Department of Neuroscience at American University. At Odyssey, our executive producer is Leah Restennis, and thanks to the rest of the team at Odyssey. Rob Morandi, Craig Cox, Eric Donnelly, Colin Gainer, Laura Curran, Josephina Francis, Kurt Courtney, and Hilary Schuff. Our agent is Orrin Rosenbaum at UTA. If you'd like to support our show, get mad free episodes, zero reruns, and to my additional audio. Please consider signing up for incognito mode. You can learn more at search engine.show. Follow and listen to search engine for free on the Odyssey app or wherever you get your podcasts. Thanks for listening. We'll see you next week.