magine this: you have a task to complete and it is all you can think about. It occupies your mind every waking hour, you have everything you need at hand, and you are motivated. Yet for some reason, you just can’t get yourself to begin. Days pass and the work starts to pile up, your frustration and anxiety only multiply, being fully aware of the consequences. Yet no matter how hard you try, you find yourself stuck in the same loop every single day, barely getting through. Before you know it, you find yourself crumbling under the weight of years of pent-up expectations and responsibilities, unable to meet them even halfway.

This has been an everyday reality for Zain Ali, an MPhil scholar and countless other adults who struggle with ADHD.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes ADHD as a persistent pattern of inattention or hyperactivity - impulsivity that hinders day-to-day function. A person with ADHD will struggle to meet the expectations of everyday life. People with ADHD often have trouble staying organised, initiating and completing tasks along with engaging in impulsive and thrill-seeking behaviours. ADHD typically manifests in childhood but the symptoms can be missed if close attention is not paid, giving rise to the phenomenon of late-diagnosed ADHD in adults. For many years, it was only believed to be diagnosed in children, a notion that has done more harm than good. In Pakistan, the situation is made worse by the country’s underdeveloped psychiatric infrastructure which cannot provide adequate care, sometimes even diagnostic services. Additionally, the stigma surrounding mental health in the country quells all hope for any improvement.

Left behind

“Growing up, I always thought I was different from the rest of the children in my class, but I could never tell why,” says Zain. He recalls always lagging behind in academics as a child despite trying hard. No one around him seemed to understand that he needed help. “I became the scapegoat child in my family. I was bullied throughout my childhood. I always felt left behind- a feeling that still gnaws at me,” he says.

As Zain transitioned into adulthood, this sense of isolation persisted. Struggling with a distorted sense of self and low self-esteem, he turned to Laxotanil, an anti-depressant, to cope.

“Looking back, the addiction was a result of my ADHD because it would give me the dopamine hit I needed,” he reflects.

Research suggests that addiction often runs hand in hand with ADHD as it can fulfil the brain’s need for stimulation given that ADHD brains are associated with lower levels of dopamine. Dopamine is a hormone responsible for producing feelings of pleasure and motivation. At the core of ADHD lies severe dopamine dysfunction.

Sara Ahmed, a recent university graduate, shares similar experiences of feeling isolated in her life. Sara was recently fired from her job due to her struggles with ADHD.

“I have always wondered how people just wake up and function normally. It feels like an alien concept to me,” she says. Living with years of untreated and undiagnosed ADHD has left Sara with chronic depression and apathy towards people around her. “Everything feels pointless. I feel like I’m stuck in a never-ending loop,” she adds.

ADHD is more than just losing your keys or wallet; it’s about losing yourself under the weight of wasted potential and unfulfilled dreams. 

For Zain, the full extent of his ADHD is reflected in his academic life. He has quit several degrees halfway, with the same old fear of failure creeping in every time he starts something new. Sara had to give up on her dream of pursuing fine arts as her attention issues got worse. This is a common experience for people with ADHD who struggle with executive dysfunction - an impairment in one’s cognitive processes that help them initiate, manage and complete tasks. This dysfunction can often manifest in an inability to achieve long-term goals.

For Sara, it has come at the cost of her dreams and her personhood. For Zain, it came at the cost of losing touch with his family for failing to meet their expectations.

“They do not know about my condition. At this point, I prefer to keep it that way,” he says.

Diverging from the norm

“A majority of brains are wired typically, but then there are those of us who have neurological variations,” says Surhan, a coach for people with ADHD and autism who has both these conditions herself. Neuro-divergence or neuro-diversity is a phenomenon where a person’s brain functions differently, as seen in conditions such as ADHD or autism. Surhan does not view these differences as an illness but rather a natural variation.

“It can however be disabling because the world does not accommodate or understand the needs of neuro-divergent people,” she says.

Surhan employs a social model of mental health rather than a pathologising one for helping her clients. “I do not slap them with a label. Rather, we work together to find ways to make their life more manageable,” says Surhan.

“For neuro-divergent people, blending in comes at a cost. As children, we are taught to hide our traits that are out of the ordinary and force ourselves to be ‘normal.’ The fact is that you can only hide so much. So as adults, we grow into depressed individuals, always at the brink of burnout,” adds Surhan.

Quest for a diagnosis

“I had to put up a fight to get a formal diagnosis for ADHD,” says Ramisha Chaudhry, a psychiatry resident. When she went to a doctor seeking help, she was misdiagnosed with bipolar disorder within the first ten minutes of the appointment.

“I have been in my body for over 20 years but they could not even spare a few minutes to hear what I had to say,” Ramisha recalls. “The problem continued with more doctors, but by then, I had learnt to advocate for myself,” she adds. Sara says she had similar experiences. Her concerns were dismissed by a doctor who turned her away diagnosing her with depression in less than minutes. In fact, she was told by a doctor how ADHD is just another “fashionable” condition. It took Sara four years to get a formal diagnosis and get the help she needed all along.

Zain recalls: “My addiction often made the doctors judge me. At the mention of ADHD, they assumed I was looking to get stimulant drugs,” says Zain. It took him over a year of a series of disappointing doctor visits before he was able to get a formal diagnosis.

“There is a lack of capable psychiatrists in Pakistan,” says Surhan. “Most people I know are scared of going to psychiatrists fearing that they will be dismissed and gas-lit. Instead, they go back inside their shell. Even the best in town will find a way to disregard your experiences as an ADHD adult,” adds Surhan.

According to the WHO, Pakistan has 0.19 psychiatrists for every 100,000 people. These statistics paint a bleak picture for the state of mental health infrastructure in the country.

When faced with limited diagnostic options and the looming threat of misdiagnosis, one is compelled to think if self-diagnosis can be a valid tool for finding support and community. Surhan seems to think so. “I do not ask my clients if they have a formal diagnosis. To me, they’re valid as long as I can provide them some form of help and support.”

Living with an invisible and widely misunderstood disability in a place that fails to validate your struggles is a battle in itself. It is especially so when you are advocating for yourself in a system that actively refuses to help. ADHD is more than just losing your keys or wallet; it’s about losing yourself under the weight of wasted potential and unfulfilled dreams. Now 31, Zain, feels that he lost the golden years of his life to ADHD. Yet he remains hopeful. “I am collecting myself piece by piece,” he says. Ramisha, nearing the end of her degree, finds her resolve to become a psychiatrist only strengthened by her experiences. Much like Ramisha, Surhan, already in practice, is dedicated to “becoming the person she needed while growing up.”

The writer is a documentary filmmaker and an aspiring journalist