In Part I of Feelings vs Emotions, I explored the definitional and substantive differences between the two. I wrote about the relationship between interoception—the senses that offer information about the state of our body—and the binary feeling of good/bad. In today’s post, I will focus on emotions. “Emotions,” as Damasio notes in Part 1 “indicate actions,” and then later describes them as “concerts of actions.”
A personal note: I have a vivid memory of listening to this podcast when it was first published in 2019 and being absolutely floored when the host, Sean Carroll, reframes Damasio’s point and notes that the word emotion contains the word “motion.” This was a time prior to my own adhd diagnosis and treatment, but this linkage of emotion with movement has been foundational in my understanding of adhd and psychotherapeutic dynamics generally. It guides how I describe the experience of living with adhd to myself and my clients, and it informs how I work with clients to better understand the ways in which they move through the world. Let me explain.
Adhd is a condition—“condition” as in a human condition rather than a description of health/disease—of differing levels of excitation and inhibition. Excitation and inhibition are the neuroscientific ways of describing an organism’s capacity to start and stop, which include the capacities for openness and defendedness. I will return to inhibition in another post, but for the moment, let me focus on excitation. The following is a gross generalization, but let me make for the sake of starting this conversation: people with adhd have more dramatic emotional experiences, because those higher amplitude emotions—again, “amplitude” is key—are required to produce an appropriate amount of excitation to start an organism in motion. 
The most obvious example of this is procrastination, something with which every person with adhd is well acquainted. This is not to say that neurotypical people do not experience or understand procrastination, but it is such a fundamental and common experience in those of us with adhd as to be an aspect of nearly every therapeutic relationship I have had with this population of clients. The power of procrastination is its capacity to produce dread and anxiety. These are emotions of profound excitation and then movement. I sometimes refer to these sorts of emotions as the “dirty fuels” of those of us with adhd. Let me give an example.
A couple of years ago a person came into my office, and they said something to the effect that they were either “crazy” or “psychotic.” As I wrote previously, it is extremely unusual that people exhibit legitimate aberrant or deviant or what we might colloquially refer to as “crazy” behaviour. That this person could walk into my office well-kempt and able to clearly and concisely explain themselves immediately suggested that they were neither crazy nor psychotic. “Ok,” I said invitingly, “tell me about your craziness and psychosis.” “Well,” they responded, “I like violence. It gets me going. I find it exciting.” Let me spoil the ending: this person had, and eventually received a diagnosis, of adhd. Chaos, in the form of physical and psychological violence, was, for them, exciting and stimulating. It helped this person to mobilize their capacity to move and get things done. And to return to the earlier part of this post, they expressed that, counterintuitively, in the presence of violence, they felt good.
Here is a regular confusion with which people with adhd often struggle: the sense that their way of being-in-the-world is wrong or pathological. My client could not get their head around the fact that violence is bad, for lack of a more sophisticated descriptor, but their experience of this thing about which there is pretty unanimous community consensus as a bad thing produces in them emotional states that help to get things done and, from the perspective of their interoception, feel good. This is one of the fundamental experiences of people with adhd, namely that we walk around the world from the time we are very young in what I like to call simply, “tension.” Tension suggests that there are opposing forces at work on an object… and we are that object.
Let me offer another example: a client once asked if something they regularly did was “fucked up.” The “fucked up” thing that they did was to put on Japanese horror films while cleaning their apartment. Again, let me jump to the end to say that this person too was ultimately diagnosed with adhd. I asked if these films were scary for them. They responded something to the effect of “not really.” They also reported that they would listen to horror podcasts to help them fall asleep—although apparently their partner was not a fan of the practice. What explains these sorts of behaviours? What do these media produce in people like my client?
The answer is the same as it for procrastination as the deadline nears: it produces a concert of actions through the experience of strong and activating emotions. This, I contend, is one of the things that is most important to understand regarding working with adhd clients and for people with adhd to understand about themselves: emotion is one of the fundamental vehicles by which we move through time and space. In the absence of an appropriate emotional motive force, a person with adhd is largely immobile, either physically or psychically. This brings me to my own experience.
My experience is quite different from the two examples above. Violence and horror do not produce useful results in me, with one exception. I played rugby for many years, and I enjoyed the violence of the game. But violence in sports is domain specific, and for me it remained in that domain. Horror is, to me… well… horrifying. I dislike horror movies. I am sure they are stimulating and activating to my physiology, but the feeling I am left with is one of badness. What is the experience of a person like me who does not have emotional fuels that he can burn to accomplish things? The experience is one of profound fatigue. Fatigue is a critical aspect of adhd, but look as long as you like at the DSM of any edition. You will not find a reference to fatigue. I suffered from crushing fatigue for 30 years of my life without explanation. I saw doctors and psychiatrists and naturopaths. I took untold supplements, tried the wildest eating programs, and tried taking freezing cold baths and showers, because a wild-eyed Dutch postal carrier named Wim Hoff claimed all kinds of benefits. You will be unsurprised that even if some intervention helped for a short time, none of these produced any long-term results. I was stuck with fatigue.
I was stuck with fatigue until two things happened: first, I went back to school to become a counsellor. Through that program and through my work in the field, I found that others are foundationally interesting to me. And the interest and curiosity that others provide for me kept me upright for some time. My fatigue diminished while I was in front of clients. It did not vanish, but it was much diminished. While I was seeing clients before my diagnosis and treatment, I could see clients, but I would often be so fatigued during the remainder of my day and week that when I was not counselling, I was horizontal. My curiosity in my clients kept me focused and vertical during the day. I had little left for myself or my family during the rest.
The second thing that affected my fatigue was stimulant medication. Stimulant medication allowed me—and continues to allow me—to expand my curiosity towards clients, while allowing me the metabolic resources to live a life outside the office. I can say that after spending thousands of hours with clients with adhd, this experience is not uncommon. Fatigue is one of the most usual experiences in this population. It is not properly addressed by the professional literature on the topic. This is an oversight of the absolute highest order.
I will save a medication discussion for another day. It is a big and important topic and requires its own forum. In the remainder of this post, let me discuss the motive power of certain emotional states and their presence in the lives of those of us with adhd.
The following is a somewhat sad fact that I have only come to late in life: the emotions we label as good and pleasant and are told are primary goals in many domains in life do not call us to do much. Joyousness and happiness and sexual gratification are, well… great, but they ask little of us. Orgasm is perhaps the most dramatic example: orgasm produces, for the large majority of us, emotional states of joy, satisfaction, and contentment. But what do those extremely desirable and valorized states call us to do? I think the answer is not much. Reaching those vaunted states, whether through sexual gratification, parental success, scoring a game winning goal, or getting that raise, do not call on us to do much of anything. Those states are in themselves the terminus points of previous actions. In other words, happiness as “a concert of actions,” to extend Damasio’s metaphor from Part 1, is the final note of the symphony. To a person with adhd, looking for the motive force that emotions can offer does not find much juice in happiness.
A personal anecdote to underline the point above. I have graduated from several programs from high school to my degree in counselling. I did not attend a single of the graduation ceremonies (to the dismay of my folks). Every time I finished a program, my peers would talk with excitement about the ceremony. I could never identify why. The work had been done. I had gotten out of the program whatever was available for me to get. The moment I had finished, there remained nothing left to figure out, no more possible understanding for me to chase down.
And so, the idea of getting together with a bunch of other people to celebrate our accomplishment seemed like a waste. Celebration held nothing for me. As someone who has suffered with fatigue his entire life, I am meticulous in the way I spend my metabolic resources. Because celebration is not capable of producing any meaningful movement for me… I typically pass.
If what I have written above is correct, it leaves people with untreated adhd two general ways-of-being: through the use of difficult emotional states that can provide a motive force to accomplish goals or fatigue. The first often means the application of difficult but functionally productive emotions. This allows people with adhd of this sort to get things done but at the tip of a spear. The alternative is to largely live without using this kind of emotional fuel, but doing so leaves one with few resources. Both options are poor. In my experience, all people with adhd do some combination of both. Let me also say, in case it is not clear, that it is not productive to bring any sort of judgement to the ways in which people with adhd are in-the-world. Burning dirty emotional fuels and the difficulties attendant are no better or worse than suffering from fatigue and its attendant problems. At this point in the analysis, the task is simply to identify the contexts in which we might use emotional fuels and contexts in which we suffer from fatigue.
Let me conclude by offering some novel but immediately understandable language around the idea of metabolic resources from someone I introduced in the Part I, the great Lisa Feldman Barrett. I mentioned in the last post that Feldman Barrett is one of my scholarly heroes. Though it is not strictly a book about Counselling, her 2017 book, How Emotions are Made: The Secret Life of the Brain, is one of the books that has made the most profound impacts on the way I understand and practice psychotherapy. There are many profound insights into the nature of personhood, connection with others, and connection to our environments that are offered. The one aspect that I would like to offer here—there will be more forthcoming in future posts—is her introduction of the phrase, “body budget”.
I like the idea of a body budget, because it immediately brings to mind the idea of spending and saving. All adults have some sense of their financial budget. A body budget simply refers to the metabolic resources available to run our own personal physiological economy, i.e. our bodies. There is an important difference between a financial budget and a body budget, though: a financial budget is completely transparent and volitional. It is true that you need a place to live, and you need food to survive. You cannot opt out of those expenses. But you choose—or at least you can choose—how your financial resources are spent down to the last cent. This is not the case with a body budget. If you had to control consciously each of your body’s systems on a moment by moment basis… well the task would be so cognitively expensive that you would likely never move. The non-conscious parts of your body take care of heart rate and blood pressure and immune function and hormonal regulation and circadian rhythm and a hundred different enzymatic processes, each vital to the well-being of your body. There is a lot to which your body must constantly attend!
I am going to leave this post on a bit of a cliffhanger. In a future post, I will focus on the simulation and prediction—that is, the manner in which your body creates a present that is predicated on its predictions of your future. Let me leave you with a passage to hopefully pique your interest from Feldman Barrett:
Every person you encounter, every prediction you make, every idea you imagine, and every sight, sound, taste, touch, and smell that you fail to anticipate all have budgetary consequences and corresponding interoceptive predictions. Your brain must contend with this continuous, ever-changing flow of interoceptive sensations from the predictions that keep you alive. Sometimes you’re aware of them, and other times you’re not, but they are always part of your brain’s model of the world. They are, as I’ve said, the scientific basis for simple feelings of pleasure, displeasure, arousal, and calmness that you experience every day. For some, the flow is like the trickle of a tranquil brook. For others, it’s like a raging river. Sometimes the sensations are transformed into emotions, but as you will now learn, even when they’re only in the background, they influence what you do, what you think, and what you perceive. (my emphasis in bold)