Scattered Minds: The Origins and Healing of Attention Deficit Disorder

by Gabor Maté MD

Attention deficit disorder is sometimes abbreviated to ADD, sometimes to ADHD. To

Attention deficit disorder is usually explained as the result of bad genes by those who “believe” in it, and as the product of bad parenting by those who don’t.

emotional states of the parents and how they live their lives have a major impact on the formation of their children’s brains, though parents cannot often know or control such subtle unconscious influences.

A doctor in Ontario gave the father of a nine-year-old girl with attention deficit disorder a dramatically apt analogy. Imagine, he said, you’re standing in the middle of a really crowded room. Everyone around you is talking. Suddenly someone asks you, “What did so-and-so just say?”

written to encourage such awareness. The book is written also with two other sets of readers in mind. My hope is that adults with attention deficit disorder will find insights here that will help them gain a deeper understanding of themselves and of the path they could take toward their own healing. Scattered Minds is meant also to give health professionals with ADD clients and teachers working with ADD students a comprehensive view of a much misunderstood condition.

Medicine tells us as much about the meaningful performance of healing, suffering, and dying as chemical analysis tells us about the aesthetic value of pottery. — IVAN ILLICH, Limits to Medicine

seemed to me that I had found the passage to those dark recesses of my mind from which chaos issues without warning, hurling thoughts, plans, emotions and intentions in all directions. I felt I had discovered what it was that had always kept me from attaining psychological integrity: wholeness, the reconciliation and joining together of the disharmonious fragments of my mind.

The British psychiatrist R. D. Laing wrote somewhere that there are three things human beings are afraid of: death, other people and their own minds.

One longs to escape the fatiguing, ever-spinning, ever-churning mind. I took Ritalin in a higher than recommended initial dose on the very day I first heard about attention deficit disorder. Within minutes, I felt euphoric and present, experienced myself as full of insight and love. My wife thought I was acting weird. “You look stoned” was her immediate comment.

have always advised patients against self-medicating. Such striking imbalance between intellectual awareness on the one hand and emotional and behavioral self-control on the other is characteristic of people with attention deficit disorder.

The Ritalin soon made me depressed. Dexedrine, the stimulant I was next prescribed, made me more alert and helped me become a more efficient workaholic.

now think that physicians and prescriptions for drugs have come to play a lopsidedly exaggerated role in the treatment of ADD. What begins as a problem of society and human development has become almost exclusively defined as a medical ailment.

There is no disputing the malfunctioning neurophysiology in what we call attention deficit disorder. It does not follow, however, that we can explain all the problems of the ADD mind simply by referring to the biology of out-of-balance neurochemicals and short-circuited neurological pathways.

I do not see it as a fixed, inherited brain disorder but as a physiological consequence of life in a particular environment, in a particular culture.

A certain mystique has recently evolved around ADD, but—despite what many people think—it is not a recent discovery. In one form or another, it has been recognized in North America since 1902; its present pharmacologic treatment with psychostimulants was pioneered more than six decades ago.

ADD has much to do with pain, present in every one of the adults and children who have come to me for assessment. The deep emotional hurt they carry is telegraphed by the downcast, averted eyes, the rapid, discontinuous flow of speech, the tense body postures, the tapping feet and fidgety hands and by the nervous, self-deprecating humor. “Every

Most often they are firm in the conviction that their problems are the result of a basic, incorrigible flaw in their personalities.

Attention deficit disorder is defined by three major features, any two of which suffice for the diagnosis: poor attention skills, deficient impulse control and hyperactivity. The hallmark of ADD is an automatic, unwilled “tuning-out,” a frustrating nonpresence of mind.

This absence of mind is one cause of the distractibility and short attention spans that bedevil the adult or child with ADD, except around activities of high interest and motivation. There is an almost active not noticing, as if a person purposefully went out of her way to be oblivious of what is around her.

you do so, you notice that two volumes of poetry by William Carlos Williams are not stacked side by side. Forgetting the debris on the floor, you lift one of the volumes to place it beside its companion. Turning a page, you begin to read a poem. The poem has a classical reference in it, which prompts you to consult your guide to Greek mythology; now you are lost because one reference leads to another. An hour later, your interest in classical mythology exhausted for the moment, you return to your intended task. You are hunting for the missing half of a pair of socks that has gone on furlough, perhaps permanently, when another item of clothing on the floor reminds you that you have laundry to wash before the evening.

Completely lacking in the ADD mind is a template for order, a mental model of how order comes about.

The law of entropy rules: order is fleeting, chaos is absolute.

The distractibility in ADD is not consistent. Many parents and teachers are misled: to some activities a child may be able to devote, if anything, compulsive, hyperconcentrated attention. But hyperfocusing that excludes awareness of the environment also denotes poor attention regulation.

Passive attention permits the mind to cruise on automatic without requiring the brain to expend effortful energy. Active attention, the mind fully engaged and the brain performing work, is mustered only in special circumstances of high motivation.

facility for focusing when one is interested in something does not rule out ADD, but to be able to focus, the person with ADD needs a much higher level of motivation than do other people.

What can be immobilizingly difficult is to arouse the brain’s motivational apparatus in the absence of personal interest.

There are certain classes, for example, in which the ADD child may perform remarkably well, while in others she is scattered, unproductive and perhaps disruptive.

The second nearly ubiquitous characteristic of ADD is impulsiveness of word or deed, with poorly controlled emotional reactivity. The adult or child with ADD can barely restrain himself from interrupting others, finds it a torture waiting his turn in all manner of activities and will often act or speak impulsively as if forethought did not exist.

Hyperactivity is the third salient characteristic of ADD. Classically, it is expressed by trouble keeping physically still, but it may also be present in forms not readily obvious to the observer.

a minority of cases, especially in girls, hyperactivity may be absent altogether.

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.

On the other hand, when there is something one wants, neither patience nor procrastination exist. One has to do it, get it, have it, experience it, immediately.

The general answer is that there are many people who seem to be high achievers despite their ADD. ADD can blight various aspects of life.

It is also true with ADD, as with everything else, that there are degrees of it, with wide variations from one end of the range to the other.

Social skills are also an issue. Something about ADD hinders the capacity to recognize interpersonal boundaries.

Although poor social skills generally accompany ADD, this is not universal.

Adults with ADD may be perceived as aloof and arrogant or tiresomely talkative and boorish. Many are recognizable by their compulsive joking, their pressured, rapid-fire speech, by their seemingly random and aimless hopping from one topic to the next and by their inability to express an idea without exhausting the English vocabulary.

To interview adults with attention deficit disorder is often to be ambushed by jokes. Unexpected turns of phrase and consciously absurd associations pepper life histories that in themselves are not much to laugh about.

The common theme on all days, good or bad, is a gnawing sense of having missed out on something important in life.

This feeling of duty toward the whole world is not limited to ADD but is typical of it. No one with ADD is without it.

Young children cannot possibly understand the motives of adults. It means little to a young child that the parent feels love for him if that parent keeps disappearing at almost any time.

couples choose each other with an unerring instinct for finding the very person who will exactly match their own level of unconscious anxieties and mirror their own dysfunctions, and who will trigger for them all their unresolved emotional pain.

The fact is, we in this society are often quite removed from our own emotional reality.

The ADD mind is afflicted by a sort of time illiteracy, or what Dr. Russell Barkley has called “time blindness.” One is either hopelessly short of time, dashing about like a deaf bat, or else acts as if blessed with the gift of eternity.

Only two units of time exist for the small child: the now and the not-now. The not-now is infinity.

Ask people with ADD how long it will take to perform a particular task, and they will notoriously underestimate.

No infant is born with a sense of time. The gradual acquisition of time sense is a task of development that begins in early childhood. At the outset, the infant has no categories such as time, space or causality, no awareness that one event leads to another.

With ADD we witness a delayed or permanently arrested maturation of the balanced time sense most people achieve by adulthood. In

Underdevelopment best explains another time-related malfunction of the ADD brain, the chronic incapacity to consider the future.

He lives as if his actions had no implications for the future, no effects on future needs, relationships or responsibilities.