Once More on Attention Deficit Disorder

   Yes, there are diminishing numbers of us therapists dealing with patients; most of us are dealing drugs because we don’t know what else to do.  We do not recognize patients’ inner lives; maybe because we do not acknowledge our own.  This is my third piece on ADD, and I hope the last.  A major article on ADD appears in today’s NY Times (April 1, 2013. Front page).  It states that there are more and more cases of ADD among children…..one in five, to be exact. Two thirds of those with ADD diagnosis are given drugs to help out.  They get stimulants such as Ritalin, or they get repressants such as Prozac and other serotonin enhancers (keeping more of it active in the synapse).

  So what is going on?  If I were to say to them that their brains (children) are too active because of birth trauma and life in the womb, I would be judged a bit bonkers.  So I will say it: imprints due to early trauma activate the system to help in repression.  And as the brain evolves the top level cortex is also activated to deal with the imprint.  The brain is busy, busy, dealing with the pain and has a hard time dealing with or focusing on one thing.  The input from inside is too much.  And when there is stimulation from the outside, from school tasks and homework assignments, it meets up with a very active brain which says, “Whoa there. Stop the input.  I have too much going on inside to listen to what you ask for.  It is overwhelming.”  But if there is no recognition of history, and by the way, recognition is also cognition, then ADD can never be understood.

  If we do not understand that there is a history that remains in the brain and agitates us, then ADD is a mystery.  It does not have to be.  So why do the professionals offer downers and uppers? Because there are two ways to deal with brain activation.  Either we soup up the top level neo-cortex to get stronger in its efforts to shut down pain, or we start at the bottom and use painkillers to hold down the pain from coming up.  Both work at two ends to deal with the source of the agitation: imprinted pain.  The kids are distracted because so much is already going on inside.  They have to deal with that first because it is a primary source and cannot be ignored; and since there is no recognition of inner life, all that is left are drugs. The input is so strong and so diverse without any specific scenes that can be attached to it that it remains a vague entity that leaves some professionals feeling it is a mysterious force, that ADD.   Why, by the way, do we offer stimulants to enhance the work of the top level cortex?  Because it has been over-occupied by engraved pain and it needs help; more neurons to offer its shoulder.   Enter stimulants.  Those stimulants do activate the entire brain; only the upper part, the thalamus and neo-cortex.  That is why they improve focus; the cortex is stronger now; it has had help.   Not a word about why kids need stimulants when they are already over-stimulated.   The drug companies are active here encouraging more and more drugs.   What most drugs do is make up for deficits in our own ability to produce them.  More tranquilizers because we can no longer manufacture serotonin (the key ingredient in tranquilizers), or in ADD the cortex is suffused by internal input, taxing it immensely, and so we need outside help to make it stronger and more active.

    This attitude is exemplified by Dr. William Graf, pediatric neurologist At Yale University, who says he is floored by the numbers of cases.  The American Psychological Association has decided to change the diagnosis, which they believe is a “brain disease.”   This “disease” impairs impulse control and other factors so that the Association wants to widen the diagnosis to enable more people to be treated. And how will they be treated? By medication, of course.   If we do not understand how pain is installed in the system and endures then all we can do is medicate, leaving an entire generation of ‘zombies.”  Why on earth is it so difficult to understand that we are victims of our childhood?  Are all of us professionals so estranged from it that it remains a mystery?  You mean none of us can look back and realize that there was no love there?   Maybe we cannot because our parents wanted smart kids and we filled the bill, (not at all my case) never realizing it was conditional love.

   My mother was psychotic and so there was no expectation that I would be anything, so I could not develop a defense nor a profession that I could use as a defense. That came decades later, but I was ADD to the maximum and had the worse grades possible in school.  I know what it is and was.  So much tumult was going on inside from my immediate environment that focusing on one thing was impossible.  I have relived that early life and the birth trauma, being given away right after birth to others that there is no doubt what was inside me.  Every teacher wrote “nervous” on my report card.   I remember, why can’t others?   Maybe they fulfilled what the parents expected.  I don’t know but it is a mystery why it early pain is ignored.

   You know, ADD is also called the hyperactivity disorder.  (ADD  HD: Hyperactive Disorder)  Of course, the kid is agitated out of his mind, driven by agony inside.  We want her to focus on 18ths century art and she is drowning in misery.  The drug director, T.R. Frieden, also sees medication as key, only we must not abuse it.  And how do we do that?  Stop so many prescriptions.

   The drug officials will  publish a new list of what constitutes ADD in the next month.  Will it be behavior, in the thrall of the behaviorists, or will it be about feeling?  I leave you to answer.