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

In part two of our story about ADHD medications, we approach the question from a different angle. We meet a doctor who spent two decades convinced that her brain does not work correctly, and who struggled to find someone who believed her. Comment on the episode https://pjvogt.substack.com/p/whyd-i-take-speed-for-twenty-years-d80 Support the show! https://searchengine.supercast.com/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00PJ Vogt?

  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 rebroadcasting 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 proudest of. 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.

• 0:38PJ Vogt?

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• 1:20PJ Vogt?

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• 1:45PJ Vogt?

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• 2:29PJ Vogt?

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• 3:13PJ Vogt?

  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, Vyvanse, 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.

• 3:40PJ Vogt?

  When we made the first part of the story, I really only had one listener in mind, a person I knew would never hear it. 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. After we published 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 read every email. I always do. Please keep sending them.

• 4:18PJ Vogt?

  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.

• 4:26Speaker 01

  Yeah, okay.

• 4:27PJ Vogt?

  Hey, can you guys hear me?

• 4:29Speaker 01

  Hi.

• 4:30PJ Vogt?

  Hi.

• 4:30Speaker 01

  Although I just moved the AirPod and now I can't hear as well then.

• 4:35PJ Vogt?

  Bianca Harris, a trained pulmonary and critical care physician. She was connecting with us from her home studio just north of New York City.

• 4:44Speaker 01

  The lights are very bright, though. This is not like a stimulant twitch that you see going. It's the lights.

• 4:52PJ Vogt?

  That was not where my assumptions were set.

• 4:55Speaker 01

  But it's okay if they were.

• 4:59PJ Vogt?

  Bianca's 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?

• 5:21Speaker 01

  Sure.

• 5:23Speaker 01

  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.

• 5:33Speaker 01

  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. And 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. So I don't think I thought that much about it until I remember one day being at our country house and there was, you know, 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.

• 6:17PJ Vogt?

  Oh.

• 6:17Speaker 01

  And that was very scary to me and I could not stand without assistance. And I think that night is when I started throwing up. And at that point, my father was a physician and my mother, who 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.

• 6:49PJ Vogt?

  Because of the way they reacted to what was happening to you?

• 6:53Speaker 01

  Yeah. Yeah. She felt like she knew something was terribly wrong, and he thought I was crying for attention.

• 7:01PJ Vogt?

  Oh, wow.

• 7:02Speaker 01

  Yeah.

• 7:03PJ Vogt?

  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 at 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,

• 7:45PJ Vogt?

  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.

• 8:08Speaker 01

  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 gonna 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.

• 8:38PJ Vogt?

  I see. 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?

• 8:51Speaker 01

  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.

• 9:11Speaker 01

  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 to her and saying, I have to have an operation.

• 9:23PJ Vogt?

  Like excited?

• 9:24Speaker 01

  Yeah, like excited.

• 9:28PJ Vogt?

  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, and 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?

• 10:03Speaker 01

  Well, from the beginning, everybody's like, oh, you're better, you know, you're fine. You had this giant goomba 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.

• 10:43PJ Vogt?

  Did they, was there something they would say? Or they would just be like?

• 10:45Speaker 01

  I think they called me Metalhead at one point.

• 10:48PJ Vogt?

  God.

• 10:49Speaker 01

  Which was not so informed, but anyway.

• 10:52PJ Vogt?

  You're like, actually, it's a mesh.

• 10:53Speaker 01

  Yeah.

• 10:56PJ Vogt?

  Okay, so like you recovered from the surgery, your hair grows back. It feels like a thing that's in your rearview. What's your first perception that like, something unusual might be going on for you?

• 11:09Speaker 01

  I remember picking up the Diary of Anne Frank. I had a sister who was three years older and she was reading it. And I think I was probably 10 or 11. 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.

• 11:53Speaker 01

  You know, that was a disaster for me.

• 11:56PJ Vogt?

  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 that 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.

• 12:38Speaker 01

  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 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.

• 13:19PJ Vogt?

  Grade after grade, Bianca kept slugging through school. It wasn't that teachers or students were constantly making fun of her. It was just that she felt like a phony.

• 13:28Speaker 01

  On the inside, I had developed a sense of, I guess, self-loathing, for lack of a better word.

• 13:34PJ Vogt?

  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.

• 13:52Speaker 01

  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.

• 14:17PJ Vogt?

  Right.

• 14:17Speaker 01

  So I would often wait until like one o'clock in the morning of the day an assignment was due to do the work.

• 14:24PJ Vogt?

  Right, because the adrenaline of the fear gives you like a little boost.

• 14:28Speaker 01

  Yep.

• 14:29PJ Vogt?

  It's funny, like I had a similar, like, I didn't have a brain tumor, but I had the the feeling of like,

• 14:37PJ Vogt?

  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, I 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 could look in at your brain, I think as a kid, I would have just stared at my brain all the time because like,

• 15:14PJ Vogt?

  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.

• 15:34Speaker 01

  Yeah, I mean, I can totally relate to that because every moment alone or in comparison to others, you try to like decide once and for all, am I this or am I that?

• 15:46PJ Vogt?

  Yeah. What was the cruelest story you told yourself that explained it at the time?

• 15:53Speaker 01

  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.

• 16:13PJ Vogt?

  Right.

• 16:14Speaker 01

  So I was a master at that, which also made me feel really bad about myself.

• 16:19PJ Vogt?

  Bianca graduated high school in 1993, about a decade before I did. The wave of stimulant medications that I would boogie board in on had 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.

• 16:37PJ Vogt?

  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.

• 16:49PJ Vogt?

  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.

• 17:06PJ Vogt?

  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.

• 17:25PJ Vogt?

  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.

• 17:32Speaker 01

  I would always have like an hour or two of euphoria that maybe I was wrong about myself.

• 17:42Speaker 01

  But then the crash would be even worse.

• 17:46Speaker 01

  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 gonna do this. I'm gonna 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-bac, I actually had a herniated disc in my neck.

• 18:32Speaker 01

  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.

• 18:44PJ Vogt?

  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 have ADD, they were like, extra time, extra time. But you sort of got there by accident.

• 18:56Speaker 01

  By accident, yeah. And I did really well in the MCAT and that changed my life.

• 19:01PJ Vogt?

  What do you mean it changed your life?

• 19:04Speaker 01

  Because at that point, I think I had measured so much of my intelligence and therefore worth on performance on exams.

• 19:11PJ Vogt?

  I see.

• 19:14Speaker 01

  And of course, now I lost my train of thought because I did not take Ritalin today.

• 19:22PJ Vogt?

  When was the first time someone, when was the first time you remember hearing about amphetamine?

• 19:27Speaker 01

  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.

• 19:58PJ Vogt?

  Yeah.

• 19:59Speaker 01

  And that's when he brought up the possibility of a stimulant.

• 20:03PJ Vogt?

  And what did you think?

• 20:06Speaker 01

  I think I took a minute and I wasn't sure because I didn't want to take anything. I just like sat on it and then I was really struggling one day and I was just sort of like, fuck it, let's try it.

• 20:20PJ Vogt?

  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.

• 20:39PJ Vogt?

  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.

• 20:52Speaker 01

  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.

• 21:15Speaker 01

  But I felt it behind my eyes in a way that I don't feel with coffee.

• 21:20PJ Vogt?

  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?

• 21:26Speaker 01

  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.

• 21:51PJ Vogt?

  Yeah, I remember.

• 21:55PJ Vogt?

  Yeah, it's like sharp and it's bright. Coffee feels like, the image in 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 amphetamine 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.

• 22:17Speaker 01

  Yeah, I like that. I didn't feel high, though. I just felt right.

• 22:26PJ Vogt?

  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.

• 22:39Speaker 01

  I mean, it was, it was, 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.

• 23:02PJ Vogt?

  Yeah.

• 23:03Speaker 01

  But it was, it was such a relief.

• 23:06PJ Vogt?

  Did you feel upset that it had taken this long to find something that helped you?

• 23:11Speaker 01

  Devastated.

• 23:13Speaker 01

  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. Um, 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.

• 23:58PJ Vogt?

  Right, right, right. And so if you ask more questions, you might get an answer that you don't like.

• 24:03Speaker 01

  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, um, yeah.

• 24:17PJ Vogt?

  Sometime 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.

• 24:42Speaker 01

  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.

• 25:15PJ Vogt?

  Yeah. How old were you when you got the neuropsych testing?

• 25:18Speaker 01

  Thirty-four.

• 25:19PJ Vogt?

  Oh, wow.

• 25:20Speaker 01

  Yep. And if you want to 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.

• 25:36PJ Vogt?

  Wow.

• 25:37Speaker 01

  Yes.

• 25:38PJ Vogt?

  Wow.

• 25:39Speaker 01

  So that means that 98% of the population can read faster than I do for comprehension.

• 25:46PJ Vogt?

  You must have worked so hard.

• 25:50Speaker 01

  Yeah.

• 25:51PJ Vogt?

  I can't imagine what it would be like to have had that information withheld from me until I was 34.

• 25:56Speaker 01

  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 my self-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 like twist a narrative around it that's wrong, but it's all you can do to make sense of a confusing situation.

• 26:31PJ Vogt?

  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 neuroscientists who study the cerebellum and who are now looking into adding Bianca as a case study. We spoke to one of those neuroscientists, Dr. Anila DiMello, 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.

• 27:15PJ Vogt?

  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. Foggyness, headaches, and inability to focus without the help of stimulant medication.

• 27:41PJ Vogt?

  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. DeMello, actually looked at a scan of Bianca's brain and saw something closer to what Bianca sees. Dr. DeMello 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.

• 28:26PJ Vogt?

  Dr. DeMello 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. DeMello 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.

• 29:11PJ Vogt?

  And she turns the tables on her interviewer.

• 29:32PJ Vogt?

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• 30:15PJ Vogt?

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• 30:35PJ Vogt?

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• 31:20PJ Vogt?

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• 31:52PJ Vogt?

  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? Were there downsides?

• 32:21Speaker 01

  Yes, I felt a little edgier. I remember if I were arguing with my husband, I just, knowing how it is to have, you know, 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 later socially, I might take it, but not for the purpose of work. That was a slippery slope, but I never really got into trouble with that. But it is, if you feel good on it, why wouldn't you take it, I guess, is 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

• 33:06Speaker 01

  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, I mean, 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.

• 33:49PJ Vogt?

  Yeah.

• 33:50Speaker 01

  Because that was so overwhelmingly positive.

• 33:54PJ Vogt?

  It's funny, you know, one of the personality traits I'm trying to correct in myself as I get older is not to just be like a zealot for whatever my new opinion is. And I think 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

• 34:34PJ Vogt?

  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, 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

• 35:18PJ Vogt?

  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.

• 35:50Speaker 01

  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,

• 36:13Speaker 01

  it is challenging. Everybody would like to feel the best that they can feel without taking something. I think that's probably true because there are side effects to everything.

• 36:23PJ Vogt?

  Yeah.

• 36:24Speaker 01

  But I can tell you, since I was thirty-four when I was diagnosed, um, at thirty-six, my husband and I started to try to have a family.

• 36:34Speaker 01

  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 and 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.

• 37:05PJ Vogt?

  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 were bad, but I still miss it.

• 37:21Speaker 01

  But what do you think your life would have been like if you hadn't taken it? You know, it, 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?

• 37:34PJ Vogt?

  I don't know, you know, I like,

• 37:38PJ Vogt?

  I think there's a version of my life where I'm like, um,

• 37:45PJ Vogt?

  Really frustrated because for you, the way you handled the mixed messages you were getting about your own worth or potential was to just like force yourself to try and to excel and to just like sort of make up the difference with hard work. And the way I handled those things was to not try. Like my college GPA at one point was 1.9, which is like kind of astounding. Like it's kind of hard to get a 1.9. And like, 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.

• 38:27PJ Vogt?

  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 of my brain as like a fussy, imported sports car where like it could go really fast some of the time, but it's usually in the shop.

• 39:09PJ Vogt?

  And I think now I've 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 it would work and that it's like not a computer. It's like a living thing. Um, 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 less restraint 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

• 39:53PJ Vogt?

  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.

• 40:06Speaker 01

  Yeah.

• 40:07PJ Vogt?

  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.

• 40:47PJ Vogt?

  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.

• 41:08Speaker 01

  It sounds like you are 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

• 41:49Speaker 01

  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 yours 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. And that's great. I mean, that's maturity and reflecting on your life experience.

• 42:20PJ Vogt?

  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've 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 from now, I might 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 amphetamine, 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

• 43:01PJ Vogt?

  struggles in you. And I'll tell them my story conspicuously, like the desire to influence other people unfortunately is very strong in me, even though I hopefully have like more intellectual humility than I used to.

• 43:16Speaker 01

  But that's a good trait.

• 43:18PJ Vogt?

  I mean, it's a trait. It's a trait. There's no 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. Like, it's, I find your story powerful for that reason.

• 43:31Speaker 01

  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 is 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. So it's

• 44:11Speaker 01

  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.

• 44:33PJ Vogt?

  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 medicines that she and her husband can raise their son. She's also working on a book about imposter syndrome, although has she really the right person to write it? Just kidding, we're very excited to read it. And I want to thank her for her vulnerability and sharing her story. We have a tiny bit more show after some ads.

• 45:51PJ Vogt?

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• 46:34PJ Vogt?

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• 46:49PJ Vogt?

  This episode of Search Engine is brought to you in part by Mint Mobile. Remember back when you were a kid and you'd spot something cool at the store, only for your mom to remind you to just wait until the holidays? Well, Mint Mobile is giving you the present early with zero waiting required. Right this minute, all of their wireless plans are available for just $15 a month. If you make the switch to Mint, your monthly expenses will take a huge step without your signal quality taking a hit. You get high-speed data, unlimited talk, and unlimited text powered by the nation's largest 5G network. There's no need to buy a new device either. You bring your own phone and keep your current number. So what are you waiting for? To get your new wireless plan for $15 a month, go to mintmobile.com search. That's mintmobile.com search. Cut your wireless bill to $15 a month to mintmobile.com search.

• 47:32PJ Vogt?

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• 47:55PJ Vogt?

  This episode of Search Engine is brought to you in part by Square. You probably recognize Square as the sleek reader you tap your card on at your favorite local spot, but for business owners, it's so much more. Every Friday, when I grab pizza at my local spot, Frenzy, checkout is so quick and smooth. My receipt pops right onto my phone and I'm earning loyalty rewards without even thinking about it. It just works. Square brings your payments, inventory, scheduling, and customer marketing into one intuitive system. You can accept every major card, use tap to pay, and with Square Checking, your sales funds are generally available immediately. Everything is straightforward, beautifully designed, and simple to set up. Whether you're starting something new or looking for a better way to run the business you already have, Square gives you the tools to take payments,

• 48:39PJ Vogt?

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• 49:06PJ Vogt?

  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 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,

• 49:50PJ Vogt?

  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 Wren. It's just like a really, really good chicken sandwich. It's, I can't pronounce any of these ingredients. Cumin paprika roast chicken, I could already be off. Agi 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 S&S focaccia. S&S, like Sea and Soil focaccia. They make it on-site. It's really good. They keep telling me to get stuff that's not the chicken sandwich.

• 50:35PJ Vogt?

  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.

• 50:58PJ Vogt?

  Search Engine is a presentation of Odyssey. It was created by me, PJ Vogt, and Trudy Pinamaneni. This episode was produced by Garrett Graham and Noah John. Theme, original composition and mixing by Armin Bazarian. Fact checking by Sean Merchant. Special thanks this week to the many people who listened to drafts and gave notes, including Vlad Chituk, Dr. Eli Wilder, Dr. Colin Reef, and Jenna Lehrer, and Matthew Smith, author of the book Hyperactive. Thanks also to Dr. Anila Demello, Assistant Professor at UT Southwestern and UT Dallas, and to Dr. Katherine Studley, Associate Professor in the Department of Neuroscience at American University. At Odyssey, our executive producer is Leah Reese Dennis, and thanks to the rest of the

• 51:40PJ Vogt?

  team at Odyssey: Rob Morandi, Craig Cox, Eric Donnelly, Colin Gaynor, Maura Curran, Josephina Francis, Kurt Courtney, and Hillary Schuff. Our agent is Orin Rosenbaum at UTA. If you'd like to support our show, get ad-free episodes, zero reruns, and some additional audio, please consider signing up for incognito mode. You can learn more at searchengine.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.

• 52:23PJ Vogt?

  This episode of Search Engine is brought to you in part by Vistaprint. As a small business owner running a podcast, I'm always looking for authentic ways to connect with listeners, which makes Vistaprint such a valued expert partner for us. I was on their site the other day brainstorming new things we could make for our show, and the creative momentum took over. I ended up designing Search Engine stickers, and I tried to make a sign for our office. When your physical branding looks this sharp and professional, it immediately communicates credibility and shows your audience that you mean business. Vistaprint truly helps every dollar go further, delivering premium quality and design support that make your company look established without breaking the bank. Whether you need your design tweaked or a total rebrand, Vistaprint has you covered with the expert service small businesses deserve.

• 53:08PJ Vogt?

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