Scattered Minds: The Origins and Healing of Attention Deficit Disorder

by Gabor Maté MD

True self-esteem is who one is; contingent self-esteem is only what one does.

It is also, in part, due to low self-esteem that people do not reach their full potential, do not strive to locate within themselves fonts of creativity and self-expression, do not venture to embark on activities and projects where success is in doubt.

among ADD adults. The deep shame of adults with attention deficit predates any recollections of poor achievement.

A child taught to disregard or mistrust her innermost feelings and thoughts assumes automatically that there is something shameful about them, and therefore about her very self.

Absolutely universal in the stories of all adults with ADD is the memory of never being comfortable about expressing their emotions. When asked whom they confided in when as children they were lonely or in psychic pain, almost none recall feeling invited or safe enough to bare their souls to their parents. They kept their deepest griefs to themselves. On the other hand, many recall being hyperaware of the parents’ difficulties and struggles in the world, of not wanting to trouble them with their own petty and childish problems.

When I explore with my clients their childhood histories, emerging most often are patterns of relationships that required the child to take care of the parent emotionally,

ADD adults are convinced that their low self-esteem is a fair reflection of how poorly they have done in life only because they do not understand that their very first failure—their inability to win the full and unconditional acceptance of the adult world—was not their failure at all. Although low self-esteem

Around authority figures such as employers, doctors, teachers and policemen, the ADD adult will experience a nervousness and lack of confidence that cannot be explained by the actual power relationship that exists in the present. As influential as any of the above personages can be, under normal circumstances none of them have the power to evoke nearly so much fear. In the interaction with authority, the implicit memory system becomes activated. One is again a child, facing powerful adults. “Like a child” is precisely how many ADD adults describe their sense of themselves in relationship to authority.

The implicit memory of early fear conditioning probably contributes to the specific neurophysiological impairments of ADD.

Radioactive brain scans, by contrast, have shown in some ADD brains slowed frontal lobe activity and diminished blood flow to this part of the cortex during stressful mental effort. What we may be seeing here are implicit memory circuits imprinted with fear overwhelming explicit memory.*

Others with ADD may have the intellectual confidence to do well during examinations. Nevertheless, they can be reduced to the helpless inarticulateness of a semiverbal toddler in other situations, superficially trivial, if anxieties imprinted in their implicit memory system long ago are triggered.

As his forties approach, he worries that time is running out. “Is it that I haven’t met the right one?” he asked. “Or am I just incapable of settling down?” My guess was that he’d probably met at least half a dozen “right ones.”

weak to live up to them.” Sick and weak are not useful entries in the dictionary of self-understanding.

Fear of intimacy is universal among ADD adults. It coexists with what superficially would seem to be its opposites—a desperate craving for affection and a dread of being rejected.

There are memories, the psychiatrist Mark Epstein explains, “that are not so much about something terrible happening, but, in the words of D. W. Winnicott [the great British children’s psychoanalyst] about ‘nothing happening when something might profitably have happened.’ These events are more often recorded in the soma, or body, than in the verbal memory, and they can be integrated only by subsequently experiencing and making sense of them.”[1]

His fear of intimacy was itself a reliving of long-ago events, a precise marker of what had never occurred. It was a function of implicit memory.

We saw in the previous chapter that implicit memory is the imprinting of brain circuits with the emotional content of early experiences.

Trevor’s anxiety is not over the ending of the relationship—he is serially ending relationships—but over being the one who is left by the other.

hyperreactivity of temperament everyone with ADD was born with. In

The fear of rejection is never far below the surface. People with ADD are exquisitely sensitive to the merest hint of it, even if the hint is only a figment of their fearful imagination.

The ADD adult does not know the difference between refusal and rejection. When he hears no from a lover, a friend, an employer, it’s as if the universe is negating his right to exist.

We can recall now that the orbitofrontal cortex is also thought to play a major role in emotional self-regulation. It helps to inhibit the powerful emotions, like fear—and fear’s offspring, anxiety—that are generated in the amygdala and other brain centers below the level of the cortex.[3]

Especially men with ADD will, entering deeper into a relationship, keep half an eye on possible exits. “I am always on the lookout for a parachute relationship,” one thirty-year-old man said.

The other aspect of Trevor’s criticality arises from boredom. Many adults with ADD report that they quickly become bored with relationships, as with much else in life. They imagine this boredom of theirs to mean that something is lacking in their partner: the reality is that they are bored with themselves. A person not in contact with internal sources of energy and interest in the world has to search for outside sources, believing that fulfillment can come only from someone else.

So long as I expect another person to provide what I am lacking in myself, I am bound to be disappointed.

The fear of intimacy is also a fear of the loss of self. There is the well-known paradox that the person with ADD craves real human contact, feels like an outsider and wishes to belong—but at the same time is reclusive, often preferring his own company to that of others. The paradox is due to his oscillating back and forth between two fears: the anxiety of loneliness and abandonment, and, opposing that, a parallel sense of danger that if he commits to a relationship, he will be overwhelmed, swallowed up.

This dynamic is often seen after the most intimate act of all, sexual intercourse, when following deep attraction and union, there is an alienation and a drive to separate which men, particularly, may experience. One may be in a long-term relationship, lasting even decades, without ever feeling completely committed to it. The ambivalence is an intrinsic memory of childhood emotions when a choice had to be made between staying with oneself, with one’s real feelings, and thereby jeopardizing the relationship with one’s parent, or going for the relationship, at the cost of suppressing parts of oneself.

One gauge of persistent problems with intimacy in an ADD relationship is the couple’s sexual life—or the lack of it. “Nonexistent” and “What sex life?” are two of the common replies my questioning around this subject tends to bring.

Also dampening sexual ardor is the propensity of the ADD adult, the male especially, to behave like an irresponsible child.

“People gravitate toward their emotional mirror images,” Michael Kerr points out.[5] It is well recognized now that people will form relationships with others exactly at the same level of psychological development and self-acceptance as their own. “People tend to sort themselves by levels of emotional development for many purposes, not just marriage,” writes Stanley Greenspan, “because those functioning at different levels are practically speaking different languages. . . People widely separated developmentally in fact have very little to talk about.”[6]

An individual with ADD choosing a partner on the same plane of psychological growth as herself is unavoidable. Since ADD by definition implies underdeveloped emotional intelligence, any such relationship, also by definition, will begin with two people who have both been stuck at fairly early stages of emotional development.

Relationships have to change if one is to create the conditions for growth. “I must be a very strong person,” Jennifer, a thirty-three-year-old woman with attention deficit disorder said to me. “I must be, otherwise I could not have put up with what I have had to in my marriage.”

marriage has to ‘put up’ with stuff?” I said. “The less or the more powerful one?” Jennifer’s

One of the most perplexing problems for the non-ADD partner is what John Ratey has called “the ahistorical memory” of the ADD mind. In other words, the ADD adult (and also of course the ADD child) functions at times as if previous events, even the most recent ones, had never taken place.

summon up. The ADD adult, like the child, needs more than organizational tools and behavior modification techniques. Although these do have their place, they will not address the fundamental problem, which is not how the person manages this or that duty or self-appointed task but in what relationship he stands vis-à-vis his own self.

The first of the self-parenting duties I suggest people engage in is the all-important one of self-understanding and psychological support.

1. Compassionate curiosity in the search for self-insight

Developing a new view toward oneself is no easy task, for it goes against the grain of a lifetime of conditioning.

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. She notices, and asks—as parents need to ask regarding their child—what the meanings are, what is being acted out, what messages the Morse code of her behavior is trying to convey.

One notices, and gradually learns not to judge the behavior but to accept the feelings that drive it. “I am my worst enemy,” a person will complain. “Why do I care so much what others think?” Or, “Why would I do something like that when I know it never works anyway?”

Everything being equal, it helps if the prospective therapist, of whatever professional background, is knowledgeable about ADD. More important, though, is that he or she know about people—and first of all, about him- or herself. The most well-accredited academic learning remains dangerous nonsense issued from the mouths of mental health professionals who have not dealt with their own unfinished psychological business. Worse yet if they deny to themselves that they have any. No one does not have any. Certainly no one who enters the mental health field as his or her chosen area of work is free of emotional problems.

all types of professional training, the one I consider most likely to be of benefit in ADD is family therapy.

She encourages people to take responsibility for their own feelings rather than imagining that these feelings arise from the failures or ill will of their partners, friends, or co-workers—a liberating perspective that allows a client to shed the garb of victimhood.

In the end, it comes down to how one feels in the presence of the therapist. People with ADD tend to have trouble recognizing, let alone respecting, their gut feelings. And

Their fear of those old servants guilt and anxiety kept them there. Better to have stayed with the guilt and the anxiety and left the therapist.

The adult with attention deficit disorder who hopes to do more than control her symptoms with medication has to learn to take care of herself, as a parent would take care of a child.

A good parent does more than get her child through the day. She is mindful that the child is a life-in-development, with needs dictated by the future as much as by the present.

When I ask adults to rate themselves according to a simple scale gauging the parenting skills and attention they devote to themselves, the scores tend to be low—so scandalously low that I have advised many of my clients that if they truly were the unfortunate child being parented by them, I would have had little choice but to alert the child protection authorities. (Restraining me was only that first I would have had to blow the whistle on myself.)

What, then, are the environmental conditions needed for development?

1. The physical space First, make a conscious choice about how to live. A man may look at the disaster zone in his room and decide consciously to do nothing about it. There is no should here, nor should there be a should.