ADHD Through the White Coat: An Autoethnographic Account from MBBS to DM Through the Lens of Self-Determination Theory

Abstract

This study examines the lived experience of an adult psychiatrist with attention-deficit/hyperactivity disorder (ADHD) through the lens of self-determination theory, exploring how neurodevelopmental challenges interact with the demanding environment of medical training and practice. A case report using autoethnographic methodology, analyzing 16 years of personal diary entries and illustrations from ages 17 to 32 years (2008–2023), documenting the author’s journey from medical school through speciality training. Thematic analysis was conducted through the lens of self-determination theory to identify recurring patterns related to autonomy, competency, and relatedness. Three major domains of challenge were identified: Autonomy (excessive curiosity, incomplete plans, compensatory lethargy), competency (fear-based motivation, difficulty with mundane tasks, recognizing dysfunctional patterns), and relatedness (gradual development of self-acceptance). ADHD symptoms created persistent conflicts with professional demands, presenting unique obstacles to motivation and self-determination. “Radical acceptance” of neurological differences, coupled with personalized adaptive strategies and strong foundational values, enables individuals with ADHD to navigate medical careers through unconventional means. This account provides insights into the complex intersection of ADHD and professional development in healthcare environments.

Introduction

Struggling to complete tasks despite a genuine interest characterizes my experience with attention-deficit/hyperactivity disorder (ADHD), diagnosed during high school due to emotional and anxiety difficulties. This account methodically explores themes in my lived experience as a psychiatrist with ADHD. While creativity and enthusiasm are advantages, falling short of expectations has been a constant burden throughout my medical journey, a sentiment echoed in qualitative studies worldwide. ¹ Through self-determination theory’s framework ² of competency, autonomy, and relatedness, I analyze the motivational challenges central to ADHD and how they have shaped my professional development.

Methodology

A case report where I employed “autoethnography” as an evocative methodology that enlivens human sciences through sensory experience ³ and memory, providing structure to my “lived experiences,” which I particularly need. This approach merges observer and observed into a unified narrative. ⁴ Following O’Hara’s ⁵ methodological framework, I extracted data from personal journals, diaries, and drawings, creating a comprehensive account of my ADHD experience. This approach follows transparent qualitative guidelines, enabling potential replication. My data source is a personal diary maintained for over 18 years since October 30, 2007, initiated upon my psychiatrist’s recommendation and consistently updated every 2-3 months. I used journal logs from age 17 years (2008) to age 32 years (2023), and I am now 34 years old in 2025 as I write this. This diary contains experiences, reflections, realizations, mission statements, and illustrations documenting my journey. For this analysis, I specifically selected entries categorized as “realizations” and “reflections,” intentionally omitting personal anecdotes to protect confidentiality. The data included have diary entries(N = 9) and drawings (N = 1), which I have analyzed following a single stage of “thematic analysis” ⁶ to find statements that reflect a specific type of challenge to my sense of “autonomy” and “competency” according to theoretical underpinnings of “self-determination theory.” ² With this approach, I have adopted a lifespan perspective to identify my challenges within three major themes (autonomy, competence, and relatedness) and have briefly described seven sub-themes to describe my lived experiences with ADHD as an adult.

Objective

This case study will analyze my lived experiences as a doctor with ADHD through the lens of “self-determination” theory to capture the major themes in my struggles, by using an autoethnographic methodology.

Experiences

Theme 1-Autonomy

Sub-theme 1: Hedonism

October 2, 2008, “My Self-control is not natural. I am too curious. I am exploring too many things.”

ADHD-driven curiosity serves as both a gift and a curse, sparking engaging conversations and positive first impressions, while simultaneously creating distractions and numerous interests that remain uninitiated despite initial enthusiasm.

Sub-theme 2: Failure to Complete Plans

September 18, 2009, “I should find a way to work efficiently, even when my thoughts and contemplations seem random.”

Often during high school, the weight of wanting to pursue medicine in a competitive environment was enough to burden anyone with anxiety. Having so many muddled thoughts while trying to find a way to bring efficiency to work was always an arduous task that never felt under control.

Sub-theme 3: Compensatory Lethargy

October 18, 2009, “Daybreak is for humans to work actively, and sleeping during the daytime is completely unacceptable.” [After medications.]

December 6, 2009, “Under conditions of absolute relaxation after an exam and during holidays, my plans have a tendency to get modified according to my actions and passing time, ultimately leading to loss of focus and failure of plan execution.”

After my first year of medical school, reducing my medication regimen by discontinuing stimulants created a challenging period. The remaining medications induced daytime drowsiness, severely compromising my study planning abilities. Without the internal control to prepare systematically, I consistently delayed work until immediately before exams. The intense pressure of last-minute cramming would deplete me completely once exams concluded. Mental exhaustion would trigger a “decompression phase” where my mind sought immediate gratification through unproductive activities. This pattern proved especially problematic during consecutive exam periods, as the recovery time between assessments was squandered rather than utilized effectively. Often in this decompression, as time passed on with me doing tasks giving me instant relief, I would intermittently try to recalibrate a fresh study plan, only to lose track again and continue to modify the plan in vain. This created a destructive cycle: Frantic last-minute studying followed by complete mental fatigue with low arousal, where I indulge in extended leisure that wastes time, followed by another round of desperate cramming. Without proper medication support, I remained trapped in this pattern of procrastination-induced cramming, post-exam exhaustion, and extended leisure, leading to more procrastination.

Theme 2: Competency

Sub-theme 1: Using Fear to Complete Tasks

August 2, 2010, “I am gaining knowledge out of fear, but not gaining due to my hunger for it.”

One area of learning competency that always concerned me was that it was always an approach to escape the immediate consequence of embarrassment of not performing well, which acted as a drive for me to study during MBBS. Despite having a passion for learning, the necessary and routine efforts to do meticulous studying never happened until a situation that caused fear of failure. Thus, the coordinated learning fueled by passion hardly happened, and it made me feel less competent compared to peers who did regular reading.

Sub-theme 2: The Unfulfilled Dream of High Productivity

June 12, 2011, “To become skilled in knowledge, you must spend a lot of time doing ‘raw labor’ and try to be in control actively.”

July 28, 2015, “I must learn to keep myself in the present and focus on just one thing each day, I should never dream about things unrelated to my work, and just finish my daily portions.”

The major challenge as I pushed toward completion of MBBS was the need to execute so many mundane tasks that were essential in the process to ensure good productivity. The curse of ADHD meant only interesting things deserved to get my mind’s attention. The lack of drive in executing necessary but low-priority (less interesting) work, which I termed “raw labor” in my records, always came back to bite me.

Sub-theme 3: Discovering my Patterns of Malfunctioning

The year 2015 (age 24) was quite significant as I was discovering my love for psychiatry and engaged myself in active efforts to introspect and notice patterns in my thinking process. I was preparing for post-graduate entrance exams, and I wanted to find out what was causing my poor productivity in preparation. This drawing (Figure 1) came at a time when I was completely off medications, and I was able to note down the elements in my life that constantly distracted me from optimal productivity.

Figure 1.

A Personal Illustration I Drew in My Diary on 14.08.2015 as a PG Aspirant, in a Desperate Attempt to Make Sense of My Patterns of Distractions.

Theme 3: Relatedness

Sub-theme: Acceptance, Embracing My Relationship with Work

May 9, 2018, “Just realize the benefits of an attempt or partial completion.”

October 31, 2022, “Do not wait for the weekend. Live a full-fledged life; what you cannot do, you cannot do, just ensure you do what you can do properly.”

Completing post-graduation and entering my child psychiatry super-specialty marked a significant turning point. I had finally found peace with my ADHD traits and developed effective productivity strategies, including acknowledging partial accomplishments and small wins. This newfound self-acceptance enhanced my clinical work, allowing me to share authentic experiences that normalized ADHD for both young and adult patients I handled. My improvement likely stemmed from both psychological growth and neurological development, as frontal lobe maturation in my late twenties reduced mood fluctuations and anxiety. My reflections revealed a profound shift: I began living authentically, cultivating a healthier relationship with work, embracing present moments, and accepting life’s unpredictability. This evolution helped me recognize that everyone faces struggles with commitment and motivation. I simply experienced these universal challenges through my unique ADHD lens, which ultimately enriched both my personal life and professional practice.

Discussion and Conclusion

This analysis used an autoethnographic approach to allow a careful consideration of how the demands of life and self always come at loggerheads with one’s ADHD symptoms as an adult.^7,8 The themes of frequent stress related to controlling one’s desires and learning to manage time and productivity came through in my thematic analysis. Thus, some examples provided in this qualitative analysis gave light to a few of the prominent issues which help identify adults with ADHD, namely finding consistent motivation (presenting as poor time management, problems in productivity) and developing a sense of “self-determination” (presenting as frequent career changes, feeling like an impostor) that haunts many of us during the formative years. In conclusion, the simple things that helped me cope were accepting the fact that you are born with these traits, and you still need to choose the struggles you believe are worth committing to. This “radical acceptance” that there will never be any cakewalks in life gives way to accepting the unique career choices in which someone with adult ADHD can settle and persist with. It unlocks the mind to accept and make peace with all the unconventional ways you will learn to get the job done, while not worrying or comparing the way in which people are expected to go about doing their job in general. You still need to develop strong values with regard to certain principles you will never compromise on and certain routines that you will never give up. These routines can be as simple as using a Google Calendar or noting down your wild ideas every moment as they come to your WhatsApp, or just finding a fancy pill box to remind you to take the pill every day. That is it. With a clear value and acceptance of your whole self, you begin to embrace your shortcomings and learn what works for you. In time, you will enjoy the fruits of your labor that will eventually come to you by your unorthodox methods, courtesy of your ADHD.