Scattered Minds: The Origins and Healing of Attention Deficit Disorder

Maté discusses his own experience with ADD. Once he started looking into ADD, Maté recalls experiencing real insight into and hope for himself for the first time. The diagnosis seemed to organize the chaotic and discordant thoughts and emotions Maté had experienced all his life, creating a sense of psychological harmony from a fragmented mind. Maté describes some common symptoms of ADD, such as scattered and avoidant attention, the fear of one’s own mind, and the feeling that one ought to be different than one is without the understanding of how to be any other way. Diagnosis, Maté says, can be an exciting and painful experience that brings the reality of one’s own mind into view.

The wide range of ADD-related symptoms can also include disorganization, the repeated experience of humiliation, and mood swings from manic to depressive in a matter of minutes. Many ADD patients experience childish reactions that alienate them from friends and family. What these behaviors have in common, Maté says, is a lack of emotional regulation.

According to Maté, it can be challenging to find a care professional who is able to competently diagnose ADD and even harder to find one who is familiar with treatment beyond medication. Fortunately, as a care provider himself, Maté was able to find a psychiatrist to diagnose him properly. She prescribed Ritalin and spoke to him about how some of his decisions might have been compounding his ADD symptoms.

Maté, in his desperation to heal himself, had already begun taking Ritalin even though he didn’t approve of self-medicating at the time. He felt that now that he knew what his problem was, the solution would be simple, but this was not so. Soon the Ritalin made Maté feel depressed. When he switched medication, his workaholic tendencies kicked back in. This has caused Maté to believe that drugs play a lopsided role in the treatment of ADD.

The science of ADD is clearly linked to neurophysiology, Maté says, but that doesn’t mean that rebalancing these chemicals can address all ADD’s symptoms. Maté says what patients need is a compassionate listener willing to help them understand themselves. Maté’s own children have been diagnosed with ADD, but he doesn’t believe it is simply a hereditary condition; rather, he sees it as a physiological consequence of a particular set of circumstances. Treating the root causes of ADD, Maté says, requires discarding the illness model of ADD.

According to Maté, very little is understood about ADD. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, which is treated as unquestionable by the psychiatric community, calls external ADD-related issues “symptoms.” However, Maté argues that they are not symptoms as experienced by the patient, but rather signs, and that attempts to eradicate these signs focus only on behavior. Maté argues that the medical community is more concerned with categorization than with caring for pain.

There is another contingent of pundits and media figures who deny ADD altogether, preferring to blame its symptoms on flawed character. Others reject the diagnosis because the symptoms are represented throughout the population, even in people without the disorder. Maté says that the anecdotal experience of ADD is too particular, too all-encompassing, and too severely affecting to be ignored. The chapter ends with a description of a patient whose anxiety and lack of focus feel crippling.

Maté describes the three hallmarks of the ADD brain. Of these three symptoms—poor attention, deficient impulse control, and hyperactivity—only two need to be present for an ADD diagnosis. Some people with ADD have exceptional mechanical skills, while others cannot focus long enough to write down a telephone number. These issues are clearly matters of attention and motivation, Maté says. He says that the ADD brain lacks the ability to create order or to direct attention and that people with ADD need much higher levels of interest to will themselves to focus. Maté is quick to point out that this is not intentional; rather, emotional and neurological forces are acting upon them.

Impulse control and emotional regulation are also difficult for many people with ADD, according to Maté. This can manifest in either words or actions, but regardless, consequences never really seem to matter to the ADD brain. Hyperactivity, which can look like fidgeting or excessive talking, may be present or not and can be disruptive. Maté recounts the experience of a child who talked incessantly. It is as if the child felt abandoned without attention.

Maté calls the brain a “perpetual motion machine” ceaselessly looking for distraction (16). The restlessness of ADD is also connected to procrastination: The world may feel like a race against time to many with ADD. On the other hand, when motivation or desire are finally activated in the ADD brain, patience feels nearly impossible. Memory lapses, another common ADD symptom, are frequent and frustrating. Maté recounts his experiences in college, where he couldn’t seem to find motivation or meet deadlines.

People with ADD, Maté says, often feel that they have wasted their potential. They may struggle to make friends. This may be due to the inability to read social cues, or it may reflect low self-esteem. In childhood, he says, many children with ADD are desperately clingy, while others shrink away from their parents. They are described as being too talkative, joking too much, and hopping between topics of conversation at a rapid pace. The experience of being a class clown is common among people with ADD. Beneath the emotional fluctuations of ADD, Maté says, is a deep sense of having failed.

Maté examines the rise of ADD in pop culture. Many skeptics of ADD argue that by lumping together such a vast array of experiences found throughout the entire population, one risks pathologizing ordinary human behavior. Maté cites Health Canada statistics that show a fivefold increase in Ritalin prescriptions and notes that ADD is also on the rise in the US. Maté believes that there are legitimate concerns about parents and teachers who try to control their children through drugging them and about pharmaceutical companies whose greed outweighs caution. North America, Maté says, has yet to grapple with the long-term effects of massive drug intake.

Maté says that the neurophysiological explanations of behavior are a convenient way to blame social problems on biology. It is true that everyone must take responsibility for their actions, but there is real insight in understanding why people become antisocial or irresponsible. He postulates that many people who have committed crimes likely developed mental or emotional deficiencies in response to their environments.

The person with ADD is not helpless, Maté says. ADD diagnosis can instigate a healing journey. However, rather than promoting understanding, the ADD label has become stigmatized. Maté says that the medical model of ADD is easier to accept because it eliminates the ambiguity of a person’s experience of the illness. He posits that perhaps “abnormality” is a spectrum as opposed to a binary. In this model, there can be no fixed genetic brain disorder, and anyone can develop a developmental or psychiatric disorder given the right (or wrong) circumstances. Maté says that calling ADD a “disorder” can give the false impression that it is a disease, when in fact it really means that the brain has developed a lack of organization. Maté prefers the term “impairment.”

In the absence of definitive proof of ADD’s origins, Maté says, the only method of treatment that makes sense is listening to people and reducing harm in their lives. Maté disagrees with the majority of people who have authored ADD books on the point that ADD is a heritable genetic disorder. He prefers to look at people’s lives rather than DNA to understand the development of their personalities. He emphasizes the impact of environment; though he considers the nature versus nurture distinction a false dichotomy, he focuses on nurture to even the scales of the ADD conversation. While he believes there may be inherited predispositions for ADD, he doesn’t believe that genetics predetermine developmental outcomes.

Maté observes that ADD-correlated behavior such as physical abuse and alcoholism were not present in his household, and yet all three of his children have ADD. Maté says ADD isn’t “caused” by environment but argues that genes are informed by environment. His marriage was filled with strife, which filled his children’s lives with decades of pain. Though his marriage is now healthy and there was never a lack of love in the home, Maté feels that his children were often emotionally suppressed. Maté recounts his experience of overworking and finding himself incapable of turning down opportunities to help out patients. As a doctor, Maté got his self-worth out of staying active and helping others. This compulsive overwork took him away from his family. He also recalls feeling perpetually behind schedule and frantic. His family had to make accommodations that made his wife and children subliminally feel unimportant and unworthy of their husband’s/father’s time. Maté concludes that his children were unable to establish a sense of security, which he says undermined their formation of an authentic self.

Mostly, Maté regrets what he wasn’t able to do, such as offer his children an attentive and loving adult who could support them. Far from considering himself the villain, however, Maté believes that understanding his mistakes provides an opportunity for empathy and healing.

Maté argues that his familial experience is commonplace among people with ADD. Society, he says, is detached from human emotion. He says that research data support the theory that childhood experiences shape the human brain. ADD develops, according to Maté, when certain childhood environmental factors are at play.

Maté says the ADD mind is dominated by an immature sense of time. He discusses his own experience with the frustration and routine of being late, a state that he calls time illiteracy. He says that this state represents a stage of development that was never transcended. A young child sees time as infinite, Maté says, borrowing cognitive psychologist Jean Piaget’s phrase “preoperational stage” to represent the egocentric underdevelopment characteristic of the brain before the age of seven. Underdevelopment, Maté says, also explains an incapacity for future thinking: The ADD brain is so focused on arousing its motivation-reward nexus that it focuses on the short term to the detriment of long-term planning.

Maté argues that ADD impairments correspond with a lack of self-regulation. For self-regulation to properly develop, specific neural networks must develop in the cerebral cortex during infancy. Maté notes that emotional intelligence is defined in part as the ability to regulate one’s moods and control one’s impulses; the absence of these abilities corresponds succinctly with a description of ADD. Immature reactions, Maté says, often indicate deeply unconscious anxieties corresponding to disruption that occurred during infant emotional development. The poor connections between the cerebral cortex and lower areas of the brain that are characteristic of infant and toddler brains are characteristic of the ADD brain as well.

Based on radiological studies, Maté says that the organic component of ADD presents itself most notably in the right prefrontal cortex, which acts as an important inhibitor. MRIs show smaller structures in this region of the brain in patients with ADD. Chronic underactivity in this region is responsible for the lack of inhibition present in ADD. Stimulants are often prescribed because they are thought to stimulate this inhibitor. However, understanding ADD as a development issue removes it from its narrow medical context.

Perfect parenting is impossible, Maté says, but that doesn’t mean we can’t understand the parameters for healthy development. He uses the metaphor of small conifers on Vancouver Island to symbolize development of the brain in harsh conditions. Medication can only partially address the problems of ADD, which are largely the result of environment.