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Kindle Notes & Highlights
by
Gabor Maté
Read between
May 11 - June 1, 2023
Action has meaning only in relationship and without understanding relationship, action on any level will only breed conflict. The understanding of relationship is infinitely more important than the search for any plan of action.
Even if in many cases medications do help, the healing ADD calls for is not a process of recovery from some illness. It is a process of becoming whole—which, it so happens, is the original sense of the word healing.
The strangely dissonant imagery tells also of a troubled soul who found reality harsh—so harsh that the mind had to be fragmented in order to fragment the pain.
The restlessness coexists with long periods of procrastination. The threat of failure or the promise of reward has to be immediate for the motivation apparatus to be turned on. Without the rousing adrenaline rush of racing against time, inertia prevails.
“I am a person of permanent potential,”
The common theme on all days, good or bad, is a gnawing sense of having missed out on something important in life.
Conflict can have an addictive quality: It is both a familiar scene and a poignant reminder of how involved two people are with one another. People do not want conflict, but they have not found an alternative way of interacting.
Nowhere were my anxieties and unresolved tensions—which is to say, my unresolved grief—expressed as openly and as harmfully as in my own home.
There was also what I call the “weekend despair” of the driven personality. On Saturday mornings, there would be a crash. I was enveloped in a kind of enervated lethargy, hiding behind a book or a newspaper or staring morosely out the window. I was not only fatigued from the whirlwind week, but I did not know what to do with myself. Without the weekday adrenaline rush, I felt a lack of focus, purpose, energy. I was depleted and irritable, neither active nor able to rest.
Only two units of time exist for the small child: the now and the not-now. The not-now is infinity.
Environment has far greater impact on the structures and circuits of the human brain than was realized even a decade ago.
Whatever the hopes, wishes or intentions of the parent, the child does not experience the parent directly: the child experiences the parenting.
If a mother has eight children, there are eight mothers.
People with ADD are hypersensitive. That is not a fault or a weakness of theirs, it is how they were born. It is their inborn temperament. That, primarily, is what is hereditary about ADD.
We face no such difficulty if we see that what is being transmitted genetically is not ADD or its equally ill-mannered and dis-combobulating relatives, but sensitivity.
The existence of sensitive people is an advantage for humankind because it is this group that best expresses humanity’s creative urges and needs.
It is not diseases that are being inherited but a trait of intrinsic survival value to human beings. Sensitivity is transmuted into suffering and disorders only when the world is unable to heed the exquisitely tuned physiological and psychic responses of the sensitive individual.
According to the latest insights of modern neuroscience, brain development in the human infant involves a process of competition that has been described as “neural Darwinism.”4 Nerve cells, circuits, networks and systems of networks vie with one another for survival.
Life in the womb is surely the prototype of life in the Garden of Eden where nothing can possibly be lacking, nothing has to be worked for. If there is no consciousness—we have not yet eaten of the Tree of Knowledge—there is also no deprivation or anxiety.
From early infancy, it appears that our ability to regulate emotional states depends upon the experience of feeling that a significant person in our life is simultaneously experiencing a similar state of mind.
Attunement does not mean mechanically imitating the infant. It cannot be simulated, even with the best of goodwill.
In attunement, it is the infant who leads and the mother who follows. “Where their roles differ is in the timing of their responses,” writes John Bowlby, one of the century’s great psychiatric researchers.6 The infant initiates the interaction or withdraws from it according to his own rhythms, Bowlby found, while the “mother regulates her behaviour so that it meshes with his…
The ADD child’s difficulty reading social cues likely originates from her relationship cues not being read by the nurturing adult, who was distracted by stress.
Read the room
Those ADD children whose needs for warm parental contact are most frustrated grow up to be adults with the most severe cases of ADD.
Each time we scream at someone in traffic, we are telling a story from the earliest part of our life.
Interference with the conditions required for the healthy development of the prefrontal cortex, I believe, accounts for virtually all cases of ADD.
The letters ADD may equally well stand for Attunement Deficit Disorder.
Yet they who belong to the distant past are in us, serving as impetus, as a burden to our fate, as blood that can be heard rushing, as a gesture rising out of the depths of time. – RAINER MARIA RILKE, Letters to a Young Poet
Parents of ADD children, in other words, seem to be relatively alienated from their own families of origin. They do not see their brothers, sisters, mothers and fathers as often as others tend to.
“Family meals, talks, reading together no longer take place,” writes Bly. “What the young need—stability, presence, attention, advice, good psychic food, unpolluted stories—is exactly what the sibling society won’t give them.”
If we want the stream to run in a different direction, we will have to create new courses for it.
Because of insufficient self-regulation, children with ADD are often underaroused or overaroused.
“Arousal locks you into the emotional state you are in,”
Or the emotionally stressed ADD child may suddenly—and genuinely—complain of being “tired,” only to regain energy a few minutes later if the source of anxiety, which may be some homework she feels beyond her capacities to do, is removed.
What looks like a deficit of attention may be a preoccupation with something important to the child but hidden to the observing adult: the child’s emotional anxieties.
Their brain’s attentional system cannot switch into “schoolwork mode” when it is consumed by anxieties about the child’s emotional connection with the world.
When the child is not concerned with seeking emotional contact, his prefrontal cortex is freed to allocate attention to the task at hand, illustrating that what we call attention deficit disorder is not a fixed, unalterable physiological state; it’s a physiological state, yes, but not fixed and unalterable.
once asked a forty-three-year-old writer with ADD to describe herself as a child. “Pepper pot, flibbertigibbet and high strung,” she shot back. I loved that account, with its spirited, hyperenergetic, all-over-the-place scatter-mindedness. For the record, though, I did ask her what exactly she meant. Unpredictably explosive, intense, unfocused and always trying to engage other children in chatter, she explained. “You see, you were focused,” I countered. “You were focused on what was important to you: your relationships in the world. But nobody understood.”
Another sign of hyperactivity may be frequent movement of the eyes, a scanning of the environment that frustrates other people. It is disconcerting to be with an individual who seems to be always on the lookout for something, or someone, else.
There are also times when the body needs to slow down, even times when being absolutely still is a matter of life and death. If flight or fight are impossible, not being noticed may be our ticket to survival. When parasympathetic nerves dominate, the body slumps, the head hangs down, the arms go limp, the eyes are averted, the facial muscles go slack. As the smooth muscle fibers encircling the arterioles in the face lose their tone, these small blood vessels dilate and the facial skin is suffused with blood. We blush. The low-arousal state is experienced in the common feeling of shame. In a
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I believe hyperactivity in ADD is fed by a current of permanent, subterranean anxiety.
If hyperactivity expresses anxiety, lethargy and underarousal express shame. Shame, like anxiety, is an attachment emotion. “Whenever someone becomes significant to us, whenever another’s caring, respect or valuing matters, the possibility for generating shame emerges,” writes the psychologist Gershen Kaufman.2 The origin of shame is the feeling of having been cut off from the parent, of having lost the connection, if only momentarily. It cannot be helped, it occurs unavoidably as part of maturing.
Shame becomes excessive if the parent’s signaling of disapproval is overly strong, or if the parent does not move to reestablish warm emotional contact with the child immediately—what Gershen Kaufman calls “restoring the interpersonal bridge.”
When the parent is distracted or withdrawn, the older infant or toddler experiences shame.
Like so much else about attention deficit disorder, hyperactivity, lethargy and shame are closely connected with the neurological memories of the distant, stressed or distracted caregiver.
A requirement of healing, becoming whole, is circuitry in the brain that can carry different messages and a different, nonhelpless image of the self. There is strong evidence that such circuits can develop at any time in life, as can neural pathways to help the cortex to do its job of inhibition and regulation.
Elderly people who remain physically and intellectually active suffer much less decline in their mental functioning than their more passive contemporaries.
Integration of cognition with emotion—the melding of what we know with what we feel—is the very integration the healing process in ADD requires. Lack of it underlies the fragmentation of the ADD mind.
It is often not our children’s behavior but our inability to tolerate their negative responses that creates the greatest difficulties.
It is not a war. He does not need to gain a victory over the child but only over his own anxiety and lack of self-control.
