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Imagine this: you have a task that you can think about. It occupies your mind every waking moment, you have everything you need, and you are motivated. Yet for some reason, you can’t get yourself started. As the days pass and the work begins to pile up, your frustration and anxiety increase, 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 by. Before you know it, you find yourself weighed down by years of expectations and responsibilities, which are not even halfway fulfilled.
This is the everyday reality for MPhil scholar Zain Ali and countless other adults struggling with ADHD.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines ADHD as a persistent pattern of inattention or hyperactivity — inattention that interferes with daily functioning. A person with ADHD will struggle to meet the expectations of everyday life. People with ADHD often have trouble staying organized, starting and completing tasks, and engaging in impulsive and impulsive behaviors. ADHD usually appears in childhood but symptoms can be missed if not properly addressed, leading to a tendency for late-diagnosed ADHD in adults. For many years, it was believed to only be diagnosed in children, a concept that has done more harm than good. In Pakistan, the situation is exacerbated by the country’s underdeveloped psychiatric infrastructure that cannot provide adequate care, sometimes even diagnostic services. Furthermore, the stigma attached to mental health in the country kills all hope for any improvement.
Left behind.
“Growing up, I always thought I was different from the rest of the kids in my class, but I could never tell why,” says Zane. He recalls that despite trying hard as a child, he always lagged behind in academics. No one around him seemed to understand that he needed help. “I became the scapegoat in my family. I was bullied in my childhood. I always felt left behind – a feeling that still haunts me,” he says.
As Zen moved into adulthood, this sense of isolation persisted. Struggling with a distorted sense of self and low self-esteem, she turned to an antidepressant, Laxutanil, to cope.
“Looking back, this addiction was a result of my ADHD because it would give me the dopamine hit I needed,” he reflects.
Research shows that addiction often goes hand in hand with ADHD because it can satisfy the brain’s need for stimulation given that ADHD brains are associated with lower levels of dopamine. Dopamine is a hormone responsible for creating feelings of pleasure and motivation. At the heart of ADHD is a severe dysfunction of dopamine.
Sara Ahmed, a recent university graduate, shares similar experiences of feeling isolated in her life. Sarah was recently fired from her job due to her struggles with ADHD.
“I’ve always wondered how people wake up and function normally. It felt like a foreign concept to me,” she says. Living together has left Sarah chronically depressed and apathetic towards those around her, “everything feels meaningless. 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 Zane, the full extent of his ADHD is reflected in his academic life. He has given up many degrees halfway through, with the same old fear of failure whenever he starts something new. Sarah had to give up her dream of pursuing fine arts as her attention problems worsened. It’s 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 disorder can often manifest in an inability to achieve long-term goals.
For Sara, it has come at the cost of her dreams and her personality. For Zane, this came at the cost of losing touch with his family for not living up to their expectations.
“They don’t know about my condition. At the moment, I prefer to keep it that way,” he says.
Deviation from the norm
“The majority of brains are wired normally, but then there are some of us who have neurological variations,” says Surhan, a coach for people with ADHD and autism. Neurodivergence or neurodiversity is a phenomenon where a person’s brain functions differently, as seen in conditions such as ADHD or autism. Surhan does not see these differences as diseases but as natural variations.
“However it can be dysfunctional because the world does not understand and understand the needs of neurodivergent people,” she says.
Surhan uses a social model of mental health to help her clients. “I don’t slap them with a label. Rather, we work together to find ways to make their lives more manageable,” says Surhan.
“For neurodivergent people, blending in comes at a price. As children, we are taught to hide our traits that are out of the ordinary and force ourselves to be ‘normal.’ There’s only so much we can hide. So as adults, we grow up depressed, always on the verge of burnout,” Surhan adds.
Finding a diagnosis
“I struggled to get a formal diagnosis of ADHD,” says Ramisha Chaudhary, a psychiatry resident. When she went to the doctor for help, she was misdiagnosed with bipolar disorder within the first ten minutes of the appointment.
“I’ve been in my body for over 20 years but they couldn’t spare a few minutes to think about what to say,” recalls Ramisha. “The problem continued with more doctors, but by then, I had learned to advocate for myself,” she adds. Sarah says she had similar experiences. Her concerns were dismissed by a doctor who, in less than minutes, diagnosed her with depression and turned her away. In fact, she was told by a doctor how ADHD was just another “fashionable” condition. It took Sarah four years to get a formal diagnosis and get the help she needed.
Zain recalls: “My addiction often made doctors judge me. At the mention of ADHD, they assumed I wanted to take stimulants,” says Zain. It took more than a year of frustrating doctor visits before she received a formal diagnosis.
“There is a dearth of qualified psychiatrists in Pakistan,” says Surhan. “Most people I know are afraid to go to psychiatrists for fear of being fired and gaslighted. Instead, they retreat into their shells. Here Even the best people in town will find a way to ignore your experiences as an ADHD adult.
According to WHO, there are 0.19 psychiatrists for every 100,000 people in Pakistan. These statistics paint a bleak picture of the state of mental health infrastructure in the country.
When faced with limited assessment options and the increased risk of misdiagnosis, one is forced to wonder if self-assessment can be a valid means of finding support and community. Surhan starts to think so. “I don’t ask my clients if they have a formal diagnosis. To me, they’re fine as long as I can provide them with some kind 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. This is especially true 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, Zayn feels he lost the golden years of his life to ADHD. Still, he remains optimistic. “I’m putting myself back together piece by piece,” he says. Ramisha, nearing the end of her degree, only strengthens her determination to become a psychiatrist through her own experiences. Like Ramisha, Surhan, already pragmatic, is “dedicated to becoming the person she needed to be growing up.”
The author is a documentary filmmaker and aspiring journalist.
