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“…we encourage you to trust your coping plan over the long haul. It is useful to acknowledge your small and daily successes, such as facing things you would typically avoid. There will likely be daily examples of slipups, too, but, similar to looking at a garden, we encourage you to focus on the flowers as much, if not more so, than you do the weeds. As an aside, both of us have taken up bike riding in the past few years. In our appreciation of the multiday, grand stage races in Europe, such as the Tour de France, we have seen a metaphor that helps to illustrate the goal of coping with ADHD. These multiple stage bike races last from 3 or 4 days on up to 3 weeks. Different days are spent climbing steep mountain roads, traversing long flat stages of over a hundred miles that end in all out sprints to the finish line, and individual time trials where each rider goes out alone and covers the distance as quickly as possible, known as “the race of truth.” The grand champion of a multiday race, however, is the rider whose cumulative time for all the stages is the fastest. That is, if you ride well enough, day-in and day-out, you will be a champion even though you may not be the first rider to cross the finish line on any single day’s race. Similarly, managing ADHD is an endurance sport. You need not cope perfectly all day, every day. The goal is to make progress, cope well enough, handle setbacks without giving up, and over time you will recognize your victory. Just keep pedaling.”

“Adults with ADHD as a group have often experienced more than their fair share of disappointments and frustrations associated with the symptoms of ADHD, in many cases not realizing the impact of ADHD has had on them. When you reflect on a history of low grades, forgetting or not keeping promises made to others, repeated exhortations from others about your unfulfilled potential and the need to work harder, you may be left with a self-view that “I’m not good enough,” “I’m lazy,” or “I cannot expect much from myself and neither can anyone else.” The end result of these repeated frustrations can be the erosion of your sense of self, what is often called low self-esteem. These deep-seated, enduring self-views, or “core beliefs” about who you are can be thought of as a lens through which you see yourself, the world, and your place in the world. Adverse developmental experiences associated with ADHD may unfairly color your lens and result in a skewed pessimistic view of yourself, at least in some situations. When facing situations in the here-and-now that activate these negative beliefs, you experience strong emotions, negative thoughts, and a propensity to fall into self-defeating behaviors, most often resignation and escape. These core beliefs might only be activated in limited, specific situations for some people with ADHD; in other cases, these beliefs color one’s perception in most situations. It should be noted that many adults with ADHD, despite feeling flummoxed by their symptoms in many situations, possess a healthy self-view, though there may be many situations that briefly shake their confidence. These core beliefs or “schema” develop over the course of time from childhood through adulthood and reflect our efforts to figure out the “rules for life” (Beck, 1976; Young & Klosko, 1994). They can be thought of as mental categories that let us impose order on the world and make sense of it. Thus, as we grow up and face different situations, people, and challenges, we make sense of our situations and relationships and learn the rubrics for how the world works. The capacity to form schemas and to organize experience in this way is very adaptive. For the most part, these processes help us figure out, adapt to, and navigate through different situations encountered in life. In some cases, people develop beliefs and strategies that help them get through unusually difficult life circumstances, what are sometimes called survival strategies. These old strategies may be left behind as people settle into new, healthier settings and adopt and rely on “healthy rules.” In other cases, however, maladaptive beliefs persist, are not adjusted by later experiences (or difficult circumstances persist), and these schema interfere with efforts to thrive in adulthood. In our work with ADHD adults, particularly for those who were undiagnosed in childhood, we have heard accounts of negative labels or hurtful attributions affixed to past problems that become internalized, toughened, and have had a lasting impact. In many cases, however, many ADHD adults report that they arrived at negative conclusions about themselves based on their experiences (e.g., “None of my friends had to go to summer school.”). Negative schema may lay dormant, akin to a hibernating bear, but are easily reactivated in adulthood when facing similar gaffes or difficulties, including when there is even a hint of possible disappointment or failure. The function of these beliefs is self-protective—shock me once, shame on you; shock me twice, shame on me. However, these maladaptive beliefs insidiously trigger self-defeating behaviors that represent an attempt to cope with situations, but that end up worsening the problem and thereby strengthening the negative belief in a vicious, self-fulfilling cycle. Returning to the invisible fences metaphor, these beliefs keep you stuck in a yard that is too confining in order to avoid possible “shocks.”

“A useful first step is to reverse engineer the situation back to the triggering event and to define the specific problem you are facing. You can then determine options for handling it. The various manifestations of anger reflect a sense that something is “not fair,” which is related to a should statement, such as “this should not happen.” Dealing with “shoulds” involves acknowledging that you obviously are not happy that something happened, but that you must still face the fact that it did happen. Thus, the task then turns to dealing with the situation.”

“You will invariably face jobs that are associated with uncomfortable feelings, ranging from relatively minor annoyance (e.g., taking out the garbage in the rain) to more persistent and recurring feelings of stress and discomfort (e.g., dissertation, organizing income taxes) that activate your procrastination script. Even a minimal degree of stress or inconvenience (what we have come to describe as the feeling of “Ugh”) can be potent enough to make you delay action. Think about some of the mundane examples of procrastination, such as watching a boring television show because the remote control is out of reach (e.g., “It’s ALL THE WAY over there.”) or exercise (e.g., “I’m TOO TIRED to change into my workout clothes.”). The use of capital letters is meant to illustrate the tone of voice of your selftalk, which serves to exaggerate and convince you of the difficulty of what you want to do. You are capable to perform the action, but your thoughts and feelings (including feeling tired or “low energy”) makes you conclude that you are not at your best and therefore cannot and will not follow through (for seemingly justifiable reasons). You might think, “I have to be in the mood to do some things.” But, how often are any of us in the mood to do many of the tasks on which we end up procrastinating? The very fact that we have to plan them indicates that these tasks require some targeted planning and effort. When facing emotional discomfort, ADHD adults are particularly at risk for bolting to pleasant, easy, and yet often unsatisfying activities, such as eating junk food, watching television, social networking, surfing the Internet, etc. In fact, sometimes you may escape from stressful tasks by performing other, lower priority errands or chores. Thus, you rationalize violating your high-priority project plan in order to run out to fill your car with gas. This strategy can be seen as a form of “plea bargaining”—“I will do something productive in order to justify not doing the higher priority but less appealing task.” Moreover, these errands are often more discrete and time limited than the task you are putting off (i.e., “If I start mowing the lawn now, I will be done in 1 hour. I don’t know how long taxes will take me.”), which is often their appeal—even though they are low priority, you are more confident you will get them done. You need not be “in the mood” for a task in order to perform it. A useful reframe is the reminder that you have “enough” energy to get started and recall that once you get started on the first step, you usually feel better and more engaged. Breaking the task down into its discrete steps and setting an end time help you to reframe the plan (e.g., “I’m tired, but I have enough energy to do this task for 15 minutes.”). Rather than setting up the unrealistic expectation that you must be stress-free and 100% energized before you can do tasks, the notion of acceptance of discomfort is a useful mindset to adopt and practice.”

“The topic of motivation often comes up when dealing with the issue of follow-through on plans. Many adults with ADHD may aspire to achieve a goal (e.g., exercise) or get through an unavoidable obligation (e.g., exam, paying bills), but fall prey to an apparent lack of motivation, despite their best intentions. This situation reminds us of a quote attributed to the late fitness expert, Jack LaLanne, who at the age of 93 was quoted as saying, “I’m feeling great and I still have sex almost every day. Almost on Monday, almost on Tuesday . . .” Returning to the executive dysfunction view of ADHD, motivation is defined as the ability to generate an emotion about a task that promotes follow-through in the absence of immediate reward or consequence (and often in the face of some degree of discomfort in the short-term). Said differently, motivation is the ability to make yourself “feel like” doing the task when there is no pressing reason to do so. Thus, you will have to find a way to make yourself feel like exercising before you achieve the results you desire or feel like studying for a midterm exam that is still several days away. You “know” logically that these are good ideas, but it is negative feelings (including boredom) or lack of feelings about a task that undercut your attempts to get started. In fact, one of the common thinking errors exhibited by adults with ADHD when procrastinating is the magnification of emotional discomfort associated with starting a task usually coupled with a minimization of the positive feelings associated with it. Adults with ADHD experience the double whammy of having greater difficulty generating positive emotions (i.e., motivation) needed to get engaged in tasks and greater difficulty inhibiting the allure of more immediate distractions, including those that provide an escape from discomfort. In fairness, from a developmental standpoint, adults with ADHD have often experienced more than their fair share of frustrations and setbacks with regard to many important aspects of their lives. Hence, our experience has been that various life responsibilities and duties have become associated with a degree of stress and little perceived reward, which magnifies the motivational challenges already faced by ADHD adults. We have adopted the metaphor of food poisoning to illustrate how one’s learning history due to ADHD creates barriers to the pursuit of valued personal goals. Food poisoning involves ingesting some sort of tainted food. It is an adaptive response that your brain and digestive system notice the presence of a toxin in the body and react with feelings of nausea and rapid expulsion of said toxin through diarrhea, vomiting, or both. Even after you have fully recuperated and have figured out that you had food poisoning, the next time you encounter that same food item, even before it reaches your lips, the sight and smell of the food will reactivate protective feelings of nausea due to the previous association of the stimulus (i.e., the food) with illness and discomfort. You can make all the intellectual arguments about your safety, and obtain assurances that the food is untainted, but your body will have this initial aversive reaction, regardless. It takes progressive exposure to untainted morsels of the food (sometimes mixing it in with “safe” food, in extreme cases) in order to break the food poisoning association. Similarly, in the course of your efforts to establish and maintain good habits for managing ADHD, you will encounter some tasks that elicit discomfort despite knowing the value of the task at hand. Therefore, it is essential to be able to manufacture motivation, just enough of it, in order to be able to shift out of avoidance and to take a “taste” of the task that you are delaying.”

“In his book-length review of the executive functions, Dr. Russell Barkley (2012) explored the reasons that these skills evolved in humans in the first place. He makes the compelling case that it was the selection pressures associated with humans living in larger groups of genetically unrelated individuals, which made it selectively advantageous to have good self-regulation skills. That is, these abilities became more important to survival as humans became more interdependent with and reliant on dealings with people who were not family. Attention-Deficit/Hyperactivity Disorder (ADHD) and executive dysfunction continue to have effects on the myriad relationships and social interactions in daily life. These connections include romantic and committed relationships/marriage, relationships with parents, siblings, children, and other relatives, friendships, and interactions with employers, coworkers, and customers. The executive functions in relationships also figure in the capacity for empathy and tracking social debt, that is, the balance of favors you owe others and favors owed to you. The ability to effectively organize behavior across time in goal-directed activities gains you “social collateral.” That is, the more you deliver on promises and projects, the more that you will be sought out by others and maintain bonds with them. Some of the common manifestations of ADHD and executive dysfunction that may create problems in relationships include: • Distractibility during conversations • Forgetfulness about matters relevant to another person • Verbal impulsivity—talking over someone else • Verbal impulsivity—saying the “wrong thing” • Breaking promises (acts of commission, e.g., making an expensive purchase despite agreeing to stay within a household budget) • Poor follow-through on promises (acts of omission, e.g., forget to pick up dry cleaning) • Disregarding the effects of one’s behavior on others (e.g., building up excessive debt on a shared credit card account) • Poor frustration tolerance, anger (e.g., overreacting to children’s behavior) • Lying to cover up mistakes • Impulsive behaviors that reduce trust (e.g., romantic infidelity)”