ADHD: Mask on, mask off

Let’s get something straight: I’ve got a complicated relationship with neurodiversity.

Not complicated in the “I don’t believe in it” way — complicated in the “I am it, but I’m still trying to figure out what that actually means” way.

I have a diagnosis. That’s the easy part.

The hard part is figuring out what to do with that label when you’ve spent your life shape-shifting to keep other people comfortable — especially in medicine, where neurodivergence is tolerated only when it’s invisible, palatable, or wrapped in productivity.

The Diagnosis That Was Always There

I was the classic missed kid. The one who saw psychologists at 10, who had “behavioural input” and emotional support, but no one could quite put their finger on what the problem was. I hit milestones. I wasn’t disruptive enough. I was eager to please even if I was told to sit on my hands a lot.

I was just, to quote an old psychology report: “excessively sensitive.”

Great. Thanks for that.

It wasn’t until my 30s — after what I could best describe as a full-on psychological collapse — that the diagnosis finally landed.

ADHD. Combined subtype, chaotic overlay.

My brain. That combination of barely held-down brilliance and constant cognitive noise. A brain that could generate ideas faster than it could finish them. A heart that always felt one step out of rhythm with the world.

And let me say now, clearly: I didn’t get the label for fun - I’m still a firm believer that labels don’t always benefit everyone. I got the label to try the treatment. I was unravelling. I needed something — anything — to hold the thread.

The ADHD Avalanche

Since the rise of TikTok psychiatry and the great neurodiversity discourse of the 2020s, ADHD’s gone from obscurity to headline. Everyone’s got it. Everyone’s masking. Everyone’s burnt out.

And maybe they are. I don’t want to gatekeep diagnosis — God knows that system is already hard enough to access — but I do want to complicate the conversation.

Because here’s the uncomfortable bit: having ADHD doesn’t make you interesting, and it doesn’t excuse you from being an arsehole.

It’s not a shield.

It’s not a get-out-of-jail-free card for bad behaviour.

And it sure as hell doesn’t make you exempt from the same kind of personal growth that we expect from everyone else.

You’re not to blame, but you’re still responsible for how you show up — especially when it gets hard.

A lesson that, genuinely, someone else had to teach me.

Masking as Survival

I’ve masked my entire life.

Not subtly, either. Full-on Oscar-worthy performances of normality, professionalism, agreeableness — whatever would make the moment pass without conflict.

That’s why people used to think I was fake (cause I was).

That’s why my relationships wobbled.

That’s why my breakdown hit like a demolition crew.

Because once the mask slipped, I didn’t know who the hell I was underneath.

There is no training in medicine for what to do when your sense of self is a work in progress even Post-graduate. It’s essentially normal to be a fluid personality till executive function kicks in in your late 20s.

But what if it doesn’t? What if it can’t?

We talk about resilience, but we don’t talk about identity. We talk about burnout, but not about the slow corrosion of having to pretend you’re someone else just to be safe at work.

Masking — or camouflaging — is acting all day long. It’s running a second operating system in the background of your brain. And when it crashes? So do you. Neurodiverse clinicians face burnout at higher rates, often without the psychological scaffolding or institutional empathy needed to recover.

Medication Isn’t a Cure. It’s a Torch.

I take Concerta. It helps. Not dramatically, not life-alteringly — but enough.

Enough that the fog lifts a little.

Enough that I can swallow the frog jobs.

Enough that my executive function doesn’t shut down at the sight of a to-do list.

But medication isn’t the full answer. It stabilises the water. It doesn’t fix the holes in the boat. That’s where psychotherapy comes in. That’s where self-awareness comes in. That’s where the real work is — and that work is brutal.

Because it means going back. To the childhood stuff. To the family patterns. To the days where you decided — probably unconsciously — that being “you” was unacceptable.

What Helps (And What Doesn’t)

To be crystal - I write these things as catharsis. I say that to disabuse any notion I portray, in accident or inference, that I have a professional or personal expertise in this worth scrutiny.

I am, to a man, still a fuckwit.

But if I drill into this what’s helped me most isn’t the diagnosis - some in my “journey” even put me off it for good reason - it’s the language to talk about it that helps.

It’s knowing what masking feels like in real time.

It’s knowing how to speak to people without being a crusadi by warrior for social justice, but also calmly advocating for what I - specifically - need in that moment.

• It’s being able to say to a colleague: “I’m demasking a bit — just flagging in case I come off a little odd.”

• It’s having a laminated checklist in my office. A tracker in my pocket.

• A grounding page with the names of my partners and their spouses so I don’t panic when I blank on something obvious.

• It’s brain-dumping into a Dictaphone while pacing the room.

• It’s learning how to say: “Give me a sec — I’m holding a thought I don’t want to lose.”

What doesn’t help is pretending this is a superpower and nothing else. That’s TikTok bollocks.

ADHD is a double-edged sword. The creativity, yes. The pattern-recognition, yes. The humour, yes. But it comes with executive chaos, sensory overload, and a terrifying susceptibility to burnout. And if you don’t name it, own it, and work with it, it will wreck you.

Final Word: Diagnosis Isn’t Enough

Here’s what I wish someone had told me earlier:

• You are not broken. But you are different.

• You do not owe anyone your masking.

• You are still responsible for the chaos you cause.

• You’re allowed to be creative, intense, messy — but you are not exempt from learning how to self-regulate.

And finally:

Don’t use ADHD to explain away the worst parts of yourself. Use it to better understand them.

Stay Twitchy

—DW