Scattered Minds: The Origins and Healing of Attention Deficit Disorder

by Gabor Maté

“I don’t trust my words,” I would say. “They come too easily.” It never occurred to me that possessing a vein of talent did not mean that one could not work diligently at mining it. If I had a facility with something, or if I enjoyed it, it could not be worth much. Unless it was pure blood, sweat and tears, it could not have value.

“It drives me nuts when someone asks me what my feelings are,” a student in his midtwenties said. “I have no idea what my feelings are. I’m lucky if I figure out what my feelings were hours or days after something happens, but I never know what they are.”

Women with ADD are especially prone to give a higher priority to protecting the needs of others than to respecting their own. “I don’t know how to say no. I’m always so worried about what the other person is feeling,” said Diane, a forty-three-year-old high school teacher. “I don’t know why. I guess it’s my second nature.”

Both Elsa and David have attention deficit disorder, and the stories they told echo experiences and feelings I have heard from many others with ADD: a painful hyperconsciousness of injustice, accompanied by ineffective rage or by shamed silence. Time after time, adults with ADD relate how sickened they are at seeing some-one weak hurt or humiliated—how sickened they are, and how helpless they feel at intervening. I use the word sickened literally: there is a churning, nauseating feeling in the pit of the stomach and the head spins.

As we have seen, in ADD the ability to inhibit powerful emotions is impaired because the connections of the OFC with the lower brain centers did not develop optimally. Just as hypersensitivity magnifies the sense of being rejected, so deficient self-regulation due to impaired inhibition by the cortex exaggerates the response to rejection. With this in mind, we can understand what comes next. The response of the infant to the fathomless anxiety of physical or emotional separation from the parent is either rage or withdrawal, or a combination of both in sequence. This is how I have many times reacted in similar circumstances. Being activated, I am sure, was anxiety and rage from my first year of life when my mother was emotionally dissociated, and particularly from our three-week separation just around my first birthday.

Developing a new view toward oneself is no easy task, for it goes against the grain of a lifetime of conditioning. It is not a matter of so-called positive thinking or the naive affirmations exemplified by vows like “Today I will be kinder to myself.” It requires the shedding, gradually, of defenses constructed long ago out of sheer necessity, defenses maintained out of the anxieties embedded in implicit memory. Needed are both a desire to accept the self and the courage to look honestly. Beyond that, the ADD adult also has to acquire the skills of self-understanding, the first of which is the capacity to notice each time she makes a critical, judgmental comment against herself, to notice whenever she is seized by anxiety, to notice when her behavior does not jibe with her long-term goal.

So self-acceptance does not mean self-admiration or even self-liking at every moment of our lives, but tolerance for all our emotions, including those that make us feel uncomfortable.

“I cannot believe how much time I have wasted in my life” is a refrain often heard in the litany of self-judgments uttered by the ADD adult. “Here I am finding out in my forties what I should have known as a teenager.” I, too, have gone through wishing I had known ten, twenty, thirty years ago what I have learned since—much of it relatively recently. But I didn’t. If I could have, I would have. It’s that simple. I have no reason to see myself as a victim, but I did not choose the circumstances that shaped my neurophysiology or my personality, which are one and the same thing. One can make choices when one becomes aware and awake, not before.

The person with ADD, whatever her age at diagnosis, has lived with low self-esteem and emotional pain all her life. Many of her behaviors are futile and not very cleverly disguised attempts to kill the pain. But pain cannot be killed; it needs to be listened to. It has a story to tell and lessons to teach.

Adults who hope their ADD-related problems can be addressed without psychological work under the guidance of a professional are, in most cases, setting themselves up for failure. The purpose of psychotherapy and counseling is not that the therapist either heals the “patient” or advises him what to do with his life. The goal is to mature and to individuate, to become a self-respecting person in his own right. In other words, the goal is not to be “cured” but to develop.