Beverage Repertoire

One wrong guess about spinal fluid and I've been drinking coffee ever since

The dark, heavy smell — a mix of burnt toast and oil, yet somehow oddly appealing — defined morning. My dad always drank his from a slightly bowl-shaped cup. I don’t know what drew me more. Was it the contrast? My cold white milk against his steaming brown liquid?

Coffee.

I did not then know why. I only knew I wanted. But children are seldom permitted coffee as part of their beverage repertoire. When I asked, I was told it was for grown-ups. Being as they’re already grown up, it wouldn’t stunt their growth like it would mine.

Little boys drank milk. Big boys got the coffee.

Years before I was born, Dr. Charles Bradley was trying to cure headaches at the Emma Pendleton Bradley Home in East Providence, Rhode Island. The headaches had been brought on by a horrific, terrifying, and primitive technique of draining spinal fluid from the brain’s ventricles and replacing it with air so that brain structures showed up better on the equally-primitive x-rays of the day.

Bradley thought that benzedrine — an amphetamine — would perhaps help replace the fluids faster after the procedure.

I don’t know if it replaced the spinal fluid. And it did nothing for the headaches. It did have a transformative effect on some of the children. Kids who had been wild, aggressive, and unable to sit still suddenly did just that. They quietly worked at their desks. Grades improved. Instead of making them hyper, the amphetamine brought focus, calm, and improved grades.

The doctor wrote a paper. The children gave the white tablets a name. They called them “arithmetic pills.”

By the time I reached the third grade, nobody needed any x-rays or machines to understand my brain was always in hyperdrive. Diagnosis then was predicated on things like “does not follow directions” and “finds it impossible to sit still” and “won’t stop talking” and “constantly loses his jacket.”

Nineteen-forty-four. Ciba Laboratories. Basel, Switzerland. The rest of Europe was caught in the thicket of World War II. A chemist by the name of Leandro Panizzon creates a new compound called “methylphenidate.”

Panizzon wasn’t looking for a way to treat hyperactive kids. ADHD wasn’t a thing yet. Well, not by that name. Melchior Adam Weikard, as far back as 1775, had published the first textbook description of attention and hyperactivity symptoms. Sir George Frederic Still’s Goulstonian Lectures at the Royal College of Physicians in 1902 marked the true scientific turning point. But in 1944, Panizzon was just creating synthetic stimulants using himself and his wife, Marguerite — nicknamed “Rita” — as guinea pigs.

Rita suffered from low blood pressure and, as she headed out for a game of tennis, felt sluggish. So she takes a dose of her husband’s new chemical and, “Wow!” It was as if she’d swallowed an entire pep squad. Her focal point, precision, and drive on her forehand noticeably improved.

Panizzon was thrilled and decided to name the molecule after her: Ritaline.

The combined discoveries of Bradley and Panizzon brought the Americanized Ritalin to the chaos that was me.

Well, it worked. I mean, I “learned” to shut up, to do what I was told, to sit still. But I didn’t just stop doing all the things they wanted me to stop. I stopped doing all the things. Panizzon’s romantic tribute to his wife was like a tennis racket to the side of my head.

And here, perhaps, I should give my parents credit: they pulled the plug after taking one look at the ghost I’d become.

Or, as my mom put it, “The pills zombied him out.”

What had for a moment been the end of “me” was instead the end of that prescription. The bottle was tossed. For my part, I returned to my natural state: unmedicated, loud, and entirely on my own.

My parents found other ways — maybe I’ll write about them someday — to manage my ADHD. The medical establishment continued searching for better ways. In 1973, at the William S. Hall Psychiatric Institute in South Carolina, Dr. Robert C. Schnackenberg found his own guinea pigs: eleven “hyperkinetic” children suffering severe side effects similar to those that had put an end to my own Ritalin experiment. And instead of Ritalin, he gives them two cups of coffee each day. Coffee at breakfast; coffee at lunch.

Schnackenberg then published a paper in the American Journal of Psychiatry about the miraculous result. As had happened with Bradley’s kids, parents and teachers reported that the coffee clatch was calmer, focused, and doing better in school. It was a miracle! A cheap folk medicine solving a clinical problem. No prescription — or regulation — needed.

There was just one problem. Well, three, to be exact. In 1975, C. Keith Conners (one of the fathers of ADHD research) tries to repeat the results using strict, double-blind conditions. It fails. Again in 1975, Mortimer Gross tries. And fails. Finally, still in 1975, the bridge over troubled water completely collapses when B.D. Garfinkel’s methodological hammer effectively crushes Schnackenberg’s coffee hypothesis in Methylphenidate and caffeine in the treatment of children with minimal brain dysfunction, published in the American Journal of Psychiatry with colleagues C.D. Webster, and L. Sloman of the Hospital for Sick Children in Toronto. That was in July. Then in October, the same three published Individual responses to methylphenidate and caffeine in children with minimal brain dysfunction in the Canadian Medical Association Journal.

Their sample size? Exactly eight boys. Schnackenberg’s eleven-child folk miracle was officially crushed by eight kids in Toronto. (A fourth paper that same year by Huestis, Arnold, and Smeltzer arrived at the exact same disappointing conclusion.)

Having “definitively proven,” in their opinion, that caffeinating kids did nothing to curb their ADHD, the medical establishment moved on.

For whatever reason — I really don’t know the reason — in the 1970s and 1980s and even into the 1990s the assumption was that children “grew out” of ADHD when they hit puberty. Adults didn’t have it. The Diagnostic and Statistical Manual of Mental Disorders (DSM) treated ADHD as a strictly childhood disorder, a “hyperkinetic reaction of childhood.”

Since the establishment believed adults could not have ADHD, 30-year-olds were not given Ritalin prescriptions. When an unmedicated adult went to the doctor with complaints of “brain fog,” chronic disorganization, or the inability to sit still through a meeting, they were given an antidepressant and a day planner and sent on their not-so-merry way.

On April 17, 2007 — my coffee-drinking father’s birthday — I became a lawyer. Criminal defense. A solo practitioner with a downtown office across the street from the courthouse to which I could go, or not go, whenever I wanted. I’d been unmedicated and largely untreated for my ADHD ever since my parents de-zombified me as a child. But one thing I’d learned from my parents that is true is that ADHD brains benefit from structured environments. Mine was gone.

Sure, I had court hearings. But I was just starting out and they were not numerous. I had no staff — no Serena yet — to tell me when to make notes, or remind me of appointments, or even tell me when to go to court.

Like a lot of other ADHD brains who never read Schnackenberg, I’d nevertheless stumbled onto coffee as something of a substitute for what was missing. Two cups of coffee in the morning kickstarted legal research. Another mid-morning to begin typing the brief. And a whole pot gone by mid-afternoon to finish off both the brief and my stomach lining.

I eventually came to realize I needed help — and not just for GERD. I saw an ADHD “specialist” and learned that since I was a kid there were new tests, new drugs, and a recognition that ADHD does indeed persist into adulthood.

The new tests were computerized. As I remember it, there were two parts to the test. In one part, the test bored me; in the other part, it frustrated me. In both parts, you’re supposed to watch for something to happen and you click a button. In the boring part, the target shows up infrequently; in the frustrating part, it’s showing up a lot.

Regardless, I was told that I tested “off the charts.” In fact, I was so far off the charts that the therapist initially thought I had somehow figured out how to game the system. A system that is actually supposed to be nearly impossible to game.

And why would anyone want to game the system? Because apparently neurotypical people want to get their hands on ADHD prescriptions. They are, after all, stimulants. And they work differently on ADHD brains than neurotypical brains.

Three things convinced the therapist that I wasn’t trying to game the system. First and foremost, I didn’t want the drugs. I still had my memories of Ritalin and the stories from my family as to why I wasn’t on it. Second, I had all the symptoms of ADHD. And, finally, I had the childhood diagnosis.

I entered therapy where I learned to develop routines like one I call “Pocket, Pocket” to keep me from driving 25 minutes to my downtown office only to realize I left my keys at home.

And I tried various drugs at the insistence of the therapist. One made me suicidal. When I realized the abnormal attraction I had to the idea of jumping out my sixth floor office window, I stopped that one. Others, including everyone’s favorite Adderall, worked great. Everyone else loved me while I was on it. I was “less hard” or “less argumentative” — unfortunately also less good at my new career. And, while everyone else liked me, I didn’t like myself. Because while not as bad as Ritalin, what was “smoothing me out” was still a form of zombification.

Somewhere between 2012 and 2015 — I’m being deliberately vague for client confidentiality reasons — I hired an expert for a murder case. Ironically, the expert was Dr. Robert A. Leark, lead author of the T.O.V.A. Professional Manual. Leark was a professor of forensic psychology. He wasn’t a general therapist. He was the measurement guy. More specifically, his published academic research dealt with malingering and “fake bad” response bias on the T.O.V.A. He wrote the literature on how to spot people trying to game T.O.V.A. — Test of Variables of Attention — the very test I’d briefly been suspected of trying to game a few years earlier!

By the time I met Dr. Leark, I was no longer seeing a therapist. Nor was I taking any medication. I’d learned a few techniques for dealing with my ADHD “irregularities,” adapted to the rest, and come to realize that Dexilant and copious amounts of coffee seemed to stabilize me.

Dexilant, by the way, is used to treat gastro-esophageal reflux disease (GERD), something brought on by all the coffee. (I want to type “LOL!” right here, but this is a Substack essay, not a text mes—oops!)

Anywayser, over the course of my time with Dr. Leark, I told him my story — including that I’d come to terms with the idea that the best thing for me was coffee. To my surprise, Dr. Leark didn’t scoff. No lecture on FDA-approved protocols. He just nodded.

What caffeine does to an adult ADHD brain isn’t magic; it’s basic chemistry. It blocks adenosine, a natural slowing mechanism of the brain, which indirectly boosts dopamine levels in the prefrontal cortex. You probably already know that this extra kick causes jitters and racing thoughts in a neurotypical brain. But for the under-aroused ADHD brain, it supplies just enough baseline fuel to kick the system up to idle, quieting the background static, and letting me focus.

Dr. Leark basically confirmed what I — and innumerable others with ADHD brains — had discovered by trial and error: if an abundance of coffee leads to an abundance of concentration that gets me through legal research, brief-writing, and a murder trial without turning me into a ghost or sending me toward a sixth-floor window, it needn’t be a dirty secret.

So every morning, you can find me sitting with a cup of coffee — I like my first cup with a packet of stevia and 5 grams of creatine — in front of my stock-trading station. Another couple hours after that, you might catch me in my office doing a final prep before court. On the desk, helping me prep? Coffee and a corndog.

I think the smell — dark, heavy, smelling like burnt toast and oil with a hint of cornbread and almost imperceptible hot dog — enhances the effect.

Little boys drink milk. Grown-up me prefers coffee.

And a corndog.