Discrete and continuous diseases

Some three years or so back I got diagnosed with ADHD, and put on a course of Methylphenidate. The drug worked, made me feel significantly better and more productive, and I was happy that a problem that should have been diagnosed at least a decade earlier had finally been diagnosed.

Yet, there were people telling me that there was nothing particularly wrong with me, and how everyone goes through what are the common symptoms of ADHD. It is a fact that if you go through the ADHD questionnaire (not linking to it here), there is a high probability of error of commission. If you believer you have it, you can will yourself into answering such that the test indicates that you have it.

Combine this with the claim that there is heavy error of commission in terms of diagnosis and drugging (claims are that some 10% of American kids are on Methylphenidate) and it can spook you, and question if your diagnosis is correct. It doesn’t help matters that there is no objective diagnostic test to detect ADHD.

And then your read articles such as this one, which talks about ADHD in kids in Mumbai. And this spooks you out from the other direction. Looking at some of the cases mentioned here, you realise yours is nowhere as bad, and you start wondering if you suffer from the same condition as some of the people mentioned in the piece.

The thing with a condition such as ADHD is that it is a “continuous” disease, in that it occurs in different people to varying degrees. So if you ask a question like “does this person have ADHD” it is very hard to give a straightforward binary answer, because by some definitions, “everyone has ADHD” and by some others, where you compare people to the likes of the girl mentioned in the Mid-day piece (linked above), practically no one has ADHD.

Treatment also differs accordingly. Back when I was taking the medication, I used to take about 10mg of Methylphenidate per day. A friend, who is also on Methylphenidate and of a comparable dosage, informs me that there are people who are on the same drug at a dosage that is several orders of magnitude higher. In that sense, the medical profession has figured out the continuous nature of the problem and learnt to treat it accordingly (a “bug”, however, is that it is hard to determine optimal dosage first up, and it is done through a trial and error process).

The problem is that we are used to binary classification of conditions – you either have a cold or you don’t. You have a fever or you don’t (though arguably once you have a fever, you can have a fever to different degrees). You have typhoid or you don’t. And so forth.

So coming from this binary prior of classifying diseases, continuous diseases such as ADHD are hard to fathom for some people. And that leads to claims of both over and under medication, and it makes clinical research also pretty hard.

Do I have ADHD? Again it’s hard to give a binary answer to that. It depends on where you want to draw the line.

Maybe not a fanboy any more

Over the last one year or so I’ve been on course to becoming an Apple fanboy. I had already quite liked the interface of the iPod touch and the iPad, though I hadn’t taken very well to the wife’s iPhone4. And then around this time last year, she bought herself a Macbook Air.

That was a gamechanger as both in terms of physical specifications and ease of use, it seemed a world away from the Windows laptops that I had at that time. A couple of months later (my laptop needed replacement anyway), I bit the bullet and invested in a Macbook Pro. And I became a bigger fanboy. I even decided last month that my next phone will be an iPhone (I’ve never had one so far).

After the events of the last two weeks, however, I’m not so sure. I was upgrading the iPad (it’s technically my wife’s since I had gifted it on her birthday two years back, but I’ve used it more than her) to iOS 8.4 when the update failed midway. It was inexplicable. I tried it a few more times, upgraded iTunes on my computers, downloaded the OS again, did a zillion things but the update continued to fail.

Considering that the iPad isn’t as integral to my life as the phone or computer, it was two weeks before I took it to hospital. Yesterday I went to iCare, an authorised Apple service centre, and showed them the iPad. They took it in and asked me to come back after an hour. An hour later, they said it wasn’t updating and that there was a hardware issue and the iPad was effectively dead.

It was then that I started losing it (I thought the lack of updation was a routine bug that happens with OS upgrades). And it was clear that these guys had done nothing more than what I had done at home. Connected iPad to iTunes, hit on the process to update, see error code, become clueless and give up. And then say “hardware issue”.

I mean, I’m an engineer, and I know that there is clearly no hardware problem with the iPad. And I couldn’t have possibly burned something in it when updating the OS. Who are they bullshitting when they say that it’s a “hardware issue”?

And so off I went to another (this time unauthorised) service centre which had come recommended. They made me wait, and tried all sorts of things. I had to wait longer here since they had to download iOS 8.4. Again it is not clear if they did anything beyond what I had already done at home. And I repeatedly told them not to repeat that but to find out what the problem is. And they seemed clueless.

So the iPad is a brick now. And since it’s been two weeks, I’ve really started missing it. I’m fairly pissed off with Apple right now, for making something that cannot be repaired. And for staffing their service centres with incompetents who do little more than what can be done at home.

I’m not sure I’m a “fanboy” any more. It seems like there is too much “tail risk” in apple’s products. To their credit, they possibly recognise that and exhort you to buy extended warranty (which I now plan to do for my Macbook). But it’s surely a problem that their repair centres (I’m not talking about the “unofficial” place) don’t do much more than what can be done at home.

I’m not so sure that I’m going to buy that iPhone now. If you’re investing so much (relative to “competition”) into a single product that carries so much tail risk, I don’t know if it’s all that worth it. But lack of worthy androids might just push me in that direction.

Meanwhile, I need to figure out how to salvage my iPad. Does anyone know of any competent apple service centres that I can take it to, where they’ll do more than just a cursory sniff? And are the so-called “geniuses” at Apple stores in the US actually good?

Intellectual discussions

So this afternoon a friend came home and we had a nice long discussion on a lot of things. And then it was time for him to leave. But by then, I was in the frame of mind where I was craving intellectual discussions, but there were no avenues for me to execute!

I remember this time five years or so ago, when each day when I would come back home from work, I would open Google Talk and initiate five or six conversations with friends who were online. Some would be stillborn, as the counterparty wouldn’t reply, but my carpet bombing would work and there would be 2-3 conversations that would fructify, and I would have a nice time talking!

Unfortunately, with the decline of Google Talk, there are no avenues for such discussions now. In fact, what killed it was the move to mobile – the original point of Google Talk was that you could signal that you were available by logging on. And so when you signalled thus, someone would ping you, and you would have a conversation.

By moving Google Talk to the mobile phone, where you were online by default, it meant that you were shown online even when you weren’t in a mood to chat. People would occasionally ping you, but then give up. It was like the case of the shepherd boy crying “wolf”. So a green button next to someone’s name on Google Talk means nothing now, in terms of their availability to chat!

Other chatting mechanisms, such as WhatsApp are no better, being “mobile first” and thus “always logged in”. You don’t know who is available when, and who you can possibly ping to have a good conversation.

And then five years back, I stopped logging on to Google Talk and initiating five different conversations. I started logging on to Twitter, instead, and making conversation with people on my timeline . Unfortunately, twitter has been ruined, too. It is so full of outrage, and some of such outrage conducted by otherwise smart people, that I’ve radically cut down on the number of people I follow.

As the world solves some problems, it un-solves others, and creates yet others. And there was a time when I would blog, and visit other blogs, to have intellectual discussions. And now people have stopped commenting on blogs, also!

On dealing with good and bad news

So I was having a rough time an hour or so back and called the wife, and told her so, and that I’d been stuck in this vicious circle of negativity for a while now. In response, she said there was this nice TED talk that she had seen on the topic recently, and I should watch it too. And so she sent me this:

It’s a nice TED talk, but I think she uses too many words to describe what she needs to describe. It’s just not “quick enough” (check out the wife’s blog post on distractions caused by professors being too slow in class. She only talked about the throughput of words here, but I think it’s deeper and extends to throughput of information content) and it doesn’t need ten minutes to communicate what she has said here.

And so I thought about how I could convey the message better. I realised that the entire talk above could be condensed into one little finite automaton. And then I drew it (using the Paintbrush App on my Mac).

Goodandbadnews

I must say I’m feeling much better already! Tell me if this is a good representation, though!

On the wife looking Hispanic

So the wife had mentioned to me sometime in the past that many people here in Barcelona mistake her to be Hispanic, and instinctively talk to her in Spanish, which she is not very good at (though she is much better than me, and is taking regular lessons in her university). She claimed that it was because of her skin colour (“fair” by Indian standards, but much darker than white), and “features”.

Now, as far as I can see, she has no Hispanic blood. She is a born and thoroughbred Gult (though her ancestors migrated to Karnataka generations ago). So when she first mentioned this to me a few months back, I didn’t particularly believe her. And then it happened last night.

We were taking a RyanAir flight from Budapest to Barcelona. I was in the aisle seat and she was in the middle seat, and as the drinks cart passed by us, I asked for a Coke (and was offered a Pepsi, and must mentioned that the Pepsi I thus got is nowhere similar to the oversweet Pepsi we get in India. It was actually good), and held a conversation with the steward for over two minutes, speaking in English all the time.

Once the steward had handed me the can of Pepsi and two glasses with ice, the stewardess on the other side of the drinks cart said “that would be two Euros fifty”. Since I wasn’t carrying money (our division of labour (and hedge) during the trip was that I carried the local currency and debit card, while the wife carried Euros), the wife shuffled into her pocket for change.

The stewardess promptly noticed this and immediately said “dos cincuenta” – Spanish for “two fifty”. Clearly she thought the wife was Hispanic! And it is not that the stewardess hadn’t heard me speak to the steward all the time so far, in fairly chaste English!

This must go down as a bizarre occurrence, except that from what the wife tells me this is a rather common issue with her. And she treats this as a feature, not a bug.

Anyway, here is a picture taken on the day that the wife told me that people in Spain mistake her to be Hispanic. This picture was taken in October, on the first day of my first visit to Barcelona.

profile

ADHD and appreciating art

So a week back I finished reading my third fiction book in four months – “the Rosie project”, a book about a professor of genetics who has Asperger’s syndrome and his effort to find a wife. I got this recommendation via Twitter and procured the kindle sample, and having really liked it went on to read and like the book.

This is not a book review. Essentially in this post I try to analyse why I don’t really read too much fiction. About why in the last ten years I read not more than two or three books of fiction before finally starting on and finishing Neal Stephenson’s cryptonomicon. And then read the same authors 3000 page eight part baroque cycle.

So I’m not a great fan of movies. There are many movies which look interesting thanks to which I DVR them and start watching them but am just unable to sustain interest in them thanks which I end up not watching them. And these movies end up unwatched.

On the other hand there at movies that generate such deep interest that I can’t take my eyes off them and I finish seeing them in one sitting. Thinking  about them these movies have really taut plots, without any fluff, and this allows me to sustain my interest and watch them.

Three years back I was diagnosed with attention deficit hyperactivity disorder (ADHD). This so-called disorder means that it’s really hard for me to hold my interest on anything that I’m doing. That it means that I’m perennially distracted. That I’m not able to be in the present and am always daydreaming. Because of which I under perform and am occasionally not able to function etc.

Now thinking about it, thanks to my ADHD I’m a great judge of movies and books and lectures and any other media that need to hold your attention to succeed. Because I’m forever distracted it’s very difficult to hold my interest in anything. So my interest can be held iff the “plot” (this applies to movies books articles lectures and all such) is tight and without too much extra fittings. When the plot is not taut there is a higher chance that I get distracted, and since I have ADHD I stop making an effort to concentrate and focus and capture essence and it’s all lost.

Its interesting to note that movies that I like instinctively are those that are generally highly rated. The converse is also true – movies that fail  to hold my attention by not having a taut enough plot are those that are generally not highly rated. Of course you could argue that I’m a sucker for public approval but the correlation is remarkable.

So my ADHD means that I’m unable to enjoy a movie or a book or a lecture or an article unless it’s really well written/ Spoken/performed. In that sense my lack of tolerance for something that’s not up to par – by having redundancies and inanities and thus having too many “extra fittings” – means that I’m unable to consume any content that is even marginally under par. Or that I have very high standards for grabbing my attention towards anything which means that I consume little but whatever i consume is of high quality!

So the reason I gave up on fiction itself is a function of reading a lot of bad fiction. Stuff that was badly written but what I forced myself to read because of the “I’ve started so I’ve finished” principle. And the trouble it’s caused my has meant that I’ve decided not to read fiction at all!

In terms of non fiction I’ve been much more discerning in the first place in terms of stuff I’ve started reading. And the generous peppering of “fundaes” in most non fiction books means that my interest has been sustained and I’ve managed to read a fair bit!

I’ve written this blog post sitting at a lecture written by a rather popular academic. It’s a promising lecture but the first few minutes were not crisp or competing enough – which means that my interest hasn’t been sustained and so I’ve switched off!

The lecturer’s reputation precedes him so my opinion may not match popular opinion about the lecture ( expressed publicly) this time. But I believe that my ADHD has made be a great judge of whether something has been communicated well!

Basketball and playing to your strengths

Earlier this week the wife went to play basketball with some classmates in Barcelona. As she was on her way back home, we were talking about the game and I inevitably referred to my own style of playing (it’s a theme now – she says something about school, and I start off my own story with “back when I was in B-school…”). I was telling her about how I never really got good at laying up or dribbling, and I built my game around a careful avoidance of those themes.

She snapped that I was “one of those guys” who doesn’t bother learning certain kind of stuff because I’m good at other kind of stuff, so I assume that I don’t need to learn new stuff. What she said took me back to this piece in Scientific American¬†which talks about two kinds of learning – which the piece calls as “fixed mindset” and “growth mindset”. The piece goes on to say that kids who are usually praised for results or intelligence end up developing “fixed mindsets” and that for such kids, learning stops at some stage. Those praised for effort and process on the other hand, the piece says, continue to learn and their learning is everlasting.

When I read the piece I completely identified with the fixed mindset. I sailed through most of school without putting in much effort, but when the learning curve got steep (like in Class XI physics, or at IIT) I simply gave up and started working around concepts that I found hard to learn. I didn’t do badly then, but it started affecting me when I started working. And over the last three years I’ve institutionalised playing to my strengths, while making an effort to simultaneously learn.

Coming back to basketball, the wife talked that day about how my view of the game was wrong and compared my views to those of people who would ask her “so how many points did you score” after a game – which she said was extremely pointless.

Anyway I had a chance to put that to test this morning when I played basketball (after a gap of close to 9 years) with Rohin, Vivaan and Issac (links not available to latter two). It was a chance occurrence – I stumbled upon Rohin’s tweet calling for people to play basketball with him and I responded. And it was a wonderful morning today, as I played the game after nine years.

Two pertinent observations – firstly I haven’t regressed too much. I missed shots much more frequently than I normally do, but got better as the game wore on. The second and more important pertinent observation – I still play in a fashion similar to how I played back in 1997.

So despite having gone for formal training in basketball for a brief period when I was in class 1 (or 2), I’ve never been good at dribbling. I’ve never learnt to put a good lay up . And I’ve never been a quick runner. And right from the beginning rather than working on these weaknesses, I simply played to my strengths and improving my play in those – I can shoot reasonably well (though I didn’t do so today), my above-average height (by Indian standards) means I can pick rebounds well, I have developed a good sense of positioning to compensate for my lack of speed, which also means I can defend fairly well, and so forth. And I make up for lack of dribbling and layups by relying on quick short passing. And all this put together has made me a reasonable player at casual level, and I had a satisfactory game this morning too.

In short, the way I’ve developed my basketball is by just ignoring what I suck at but focussing on getting better at my strengths. While this means that I rarely put myself outside of my comfort zone, it also means that I become an overall better (though incomplete) player given the amount of effort I put in. I remember times when I would play alone in the half-court behind my hostel at IIT. When you play basketball alone, you have two choices – do layups and shoot. To become a complete player I should’ve practised the former. I chose the latter!

So coming back to the Scientific American piece, while I agree that a fixed mindset can stop growth at some point in time, it is possible to grow around it as long as you recognise your limitations and simply focus on your strengths. And with the coming up of the on-demand economy (which I’m in a weird way part of), division of labour can be such that you can possibly get away doing only those things that you are good at! At least that’s the hope for people like me who’ve grown up with a fixed mindset.

And finally, I realise I’m unfit. Despite going to the gym fairly regularly, the game of basketball this morning showed me up as being severely unfit. Despite being the youngest guy on the court ( I think, but am not sure), it was I who was calling the time outs this morning, and it was I who was panting the most. It’s not good. Basically the kind of fitness you need to play sports such as basketball (lots of short sprints) is very different from what you build by doing “normal gym activities”. To put it another way, squatting 150 lb is no indication of whether you’re capable of playing half-court basketball for 30 minutes!