Scattered Minds: The Origins and Healing of Attention Deficit Disorder

Maté explores two case studies to show how adults with ADD are hyperaware of injustice. In the first situation, a woman screamed at high school girls for making fun of an old man. In the second, a man wanted to scream at police for arresting an old woman. Many people with ADD are sickened by injustice, Maté says. To Maté, however, the acute pain experienced by these individuals doesn’t reflect empathy but rather personal identification with the victims: They react as if they were the one victimized and are triggered into the very states of humiliation and rage that they felt in the past.

Maté believes that this is the result of being trapped in a state of implicit memory in which early experiences are reactivated beneath conscious awareness. When this memory is activated, a person may feel like they are reacting to present events when in fact the experience is being shaped by the past. Short-term memory is encoded into long-term storage through certain circuits that can be reactivated, triggering explicit memory. Emotional experiences heighten encoding and can trigger these sensations more easily. Maté says that implicit memory is largely responsible for human behavior. Feeling trapped and overwhelmed, he says, is evidence that one is under the influence of implicit memory.

Maté reflects on how his two patients’ sense of injustice was triggered by their own childhood experiences of helplessness and pain. In both cases, the patients had to dissociate to maintain relationships with their parents. This is the experience that triggered their adult reactions. Trauma doesn’t have to occur, Maté says, for one’s neurological circuits to become encoded with overwhelming emotions; all that has to happen is that a child persistently feels alone and misunderstood.

The goal is for the adult with ADD to move from a state of helpless identification to empowered empathy. To Maté, the desire to expose the flaws of authority is healthy and speaks to a desire to understand ourselves beyond the pressures and priorities of those who have held power over us. Counterwill and implicit memory, Maté says, were at play in the 1960s protest movement.

Citing Joseph LeDoux, Maté says that the neurological aspects of ADD may be the result of fear conditioning in the implicit memory. Brain studies showing diminished blood flow in the cortex during stressful events imply that implicit memory has the power to overcome explicit memory. Maté says that the need to prove one’s worth and the fear of failure sabotage the ADD brain’s ability to recall.

Maté cites the experience of a client named Trevor whose fear of intimacy coexists with fear of rejection. Trevor cheated on his partners and yet felt devastated when his partners withdrew from him. Maté says that Trevor would use terms like “sick” and “weak” to describe himself, so Maté suggested to him that he treat himself with compassionate curiosity to understand his fear of intimacy.

Maté believes that fear of intimacy is universal among adults with ADD. Mutually committed loving contact is what many adults with ADD would find most healing, and yet they resist it because often they have never experienced it. This is an example of what Maté calls an implicit memory that never occurred. An infant who never received attunement with a parent is likely to experience the anxiety of abandonment: It is what did not happen that triggers the implicit memory. Implicit memory can become activated without a person realizing it, causing the person to respond in the present as if they were responding to that past event. Joseph LeDoux calls this emotional memory. According to Maté, Trevor’s early experience as a sensitive child who felt abandoned by his parents replayed at the slightest hint of rejection from women in his life.

No feature of ADD is unique to the disorder, Maté says. People with ADD are simply more attuned to fear of rejection than people without ADD. The adult with ADD may not even be able to tell the difference between refusal and rejection. When they hear no, Maté says, it is as if the universe is rejecting their very existence. Implicit memory experiences can be so intense that the adult may consider suicide. Maté describes married couples who struggle with this scenario. When the wife says no, the husband experiences total isolation, rejection, and helplessness in the face of crippling emotional pain. This represents a lack of self-regulation.

The OFC controls self-regulation by inhibiting the amygdala. This inhibition function is impaired in ADD because the proper pathways did not develop. Hypersensitivity, Maté says, magnifies the feeling of rejection in the same way that impaired emotional inhibition exaggerates rejection. The infant, like an adult with this impairment, responds to rejection with rage, withdrawal, or some combination of the two, causing further isolation.

Maté references John Bowlby’s phrase “defensive detachment” to describe the way the ADD brain may be so hurt that it rejects the possibility of love to protect itself from pain. Personal development is critical to overcoming the fear of intimacy, Maté says, which is itself the fear of loss of self.

Maté believes that most people with ADD will find partners on a similar plane of psychological growth. Many people seek out relationships with people who have their former caregiver’s positive and negative traits, which often results in mutual emotional shutdown. When a partner, especially male, begins to act out like an irresponsible child, the partner may step into a mothering role, taking on more emotional and physical responsibilities. This may in turn make the man feel controlled, which can lead to counterwill expression. Many couples find themselves caught in this cycle of oppositionality and control. Maté advises couples to recognize and reform this dynamic. To begin, Maté says, each person must take on the responsibility of individuation, learning to genuinely sustain their equilibrium during challenging emotional circumstances without parenting from their partner.

Maté concludes by discussing a client who felt powerful for withstanding abuse in her relationship but also very lonely. Maté agreed that she was strong but distinguishes between strength, an inner quality, and power, which is a matter of relationship. To create the conditions for growth, Maté says, one must equalize the playing field in relationships.

For the adult with ADD, the conditions necessary for developing self-esteem, self-regulation, and self-motivation must come from within: The relationship with oneself takes the place of the parent-child relationship. Maté suggests four techniques for self-parenting. The first is “compassionate curiosity” about oneself. To simulate parental love, the adult with ADD should have an open mind toward the self, allowing for mistakes and loving unconditionally. The second is learning to tolerate guilt and anxiety. Maté relates the biblical story of Moses to convey that guilt is a survival mechanism that corresponds to the parts of a child’s authentic self that have been repressed to maintain a connection. Third, adults with ADD should avoid punishing themselves based on their perceived progress (or lack thereof). Fourth, they should consider psychotherapy and counseling, which encourage individuation through unconditional positive regard and may offer a parental substitute through which a mature self can emerge.

Mate believes that healing comes when the adult with ADD takes care of themselves as though they were a child. Maté lays out nine environmental conditions without which healthy self-understanding and growth cannot occur. The first involves the physical space in which one lives; neglecting this entails neglecting oneself. The second involves sleep hygiene. Maté suggests that restlessness is not a symptom of ADD but a contributing factor to symptoms such as alertness and attention. The third is nutrition, as the internal system is just as important as external environment, especially for the sensitive child with ADD. The fourth is physical exercise, a lack of which can lead to sluggishness that can make attention and motivation difficult. The fifth involves spending time in nature. Sixth, Maté recommends considering one’s “extracurricular” duties; overwhelming oneself with tasks and responsibilities is a self-perpetuating symptom of ADD. Seventh, recreation is important. Likewise, Maté’s eighth recommendation involves seeking out creative expression. Finally, adults with ADD should consider meditation and mindfulness. Though there is nothing more difficult for the ADD mind, Maté recommends contemplative solitude and meditation to weaken the hold of ingrained neurological defenses.

Maté says that all addictions are anesthetics meant to keep the individual in a comfortable state. Adults with ADD are prone to addiction because addictions activate the release of dopamine and endorphins, which are important for motivation and pleasure. Maté discusses his workaholism and compulsive shopping, which affected his life and filled him with self-contempt. He spent thousands of dollars at great personal risk and lied to his family to protect his compulsions. What he learned in healing these addictions was that they stemmed from emotional parts of his personality, such as a value of aesthetic things and a desire to serve, thus straddling passion and addiction. In a way, Maté’s addiction made him feel more connected to his life even as the latter began to fall apart. However, he was filled with crippling shame and became more controlling with his children; in the throes of serving a false need, he says, one cannot stand to look at the needs of others. For people with both ADD and an addiction, Maté believes that the treatment of the former cannot begin until the person takes steps to end their addiction and take ownership of their pain.

Maté notes that both addiction and the ADD brain are commonly understood in terms of dopamine deficiency. When trying to understand why this happens, the medical community tends to blame genetic inheritance. Others prefer to blame individual choices, Maté says, moralizing about personal responsibility. Maté suggests that it is actually events in the first several years of life that are responsible for deficient neurochemicals in the brain. Maté quotes researcher and theorist Allen Shore, who says that alienation in infancy creates a permanent reduction in opiate receptors. Maté says one must also account for the unbearable strains society places on the poor and powerless to understand the rise of substance abuse in North America.