First of all I take this opportunity to wish everyone a Happy Christmas, wherever you are. I hope that you have peace in your heart and that you feel loved. Whether you are with your family, married or single, alone or in a group, I hope that you feel blessed and grateful. I know that for some people holidays can be rough so I can only say that Xmas is a concept we should have in our hearts every day, not just now. Keep this in mind when the clock ticks and 2023 comes.
Now back to the book review. This book is just marvelous.
Attention deficit disorder. ADD. It sounds like a serious medical condition because it has been illustrated this way. ADD is not an illness. It is an impairment. Gabor Mate's book Scattered minds. The Origins and Healing of Attention Deficit Disorder is truly revolutionary. It puts a completely different perspective on this issue that most adults have, some of them being unaware of it.
Gabor Mate is a world known physician, known for his studies about addiction and he also has ADD. He managed to find this out later in his life. If a specialist finds out so hard about his own ADD, what chances normal people like us have?
I have read this book with amazement. In some degrees I recognized myself. In some parts of the book I recognized others. This book makes you understand this impairment and how to overcome it. This book might help you realize if you have ADD or if someone from your circle /family might have it.
ADD is not 100% genetically inherited. You do not get born with it. You develop it because of the lack of attunement you had with your primary caregiver in the first years of your life. Yes....here we go again. So parents screwed you up since you were little. But how?
Well the book is quite filled with detailed analysis of the ADD brain. But I will try to simplify it for you. When we are a baby our brain needs another responsive brain to connect with in order to develop. In general that is our mother. We need attunement in the sense that our caregiver is constantly adapting and responding to us. An attuned parent will be present while also allowing the infant to be himself. The parent will not force the infant to connect if he does not want to. Being physically present and mentally absent as a parent is really bad for an infant because it does not allow them to develop the healthy brain circuits that lead to a well self- regulating brain. We learn to control emotions and self- regulate because of the interaction we have with our caregivers. If those interactions are not good, we "learn" to dissociate. We learn that love/connection leads to pain. We fail to develop areas of the brain which are responsible with impulse control. Neurons which fire together wire together. So when an infant is constantly forced by circumstances (absent parent, unattuned, dismissive, aggressive or depressed) to remain in a stressed response, his brain will not be flooded with dopamine and endorphins, the feel good hormones that help the brain develop in a healthy emotional way. This is how ADD takes root. This is why Gabor Mate says that ADD might as well stand for Attunement Deficit Disorder. What I have found EXTRAORDINARY is the fact that when the child grows up , the emotional memories of that early neglect or rejection stay alive in the OFC, the orbitofrontal cortex. An area of the brain which stores the emotional blueprint of early childhood left by our caregivers. And any trigger will awaken that area. And we will unconsciously pick interactions,relationships, people, events, which will make us feel the same way as we did as infants..Because it is the only thing that our brain knows. This is why in adult life, people with ADD repeat the same patterns in relationships, most of them being unable to stay in one.
I have selected some quotes from the book illustrating how the childhood of someone with ADD might have been:
WHAT DID (NOT) HAPPEN IN THE CHILDHOOD OF PEOPLE WITH ADD
A calm and consistent emotional milieu throughout infancy is an essential requirement for the wiring of the neuro-physiological circuits of self-regulation. When interfered with, as it often is in our society, brain development is adversely affected. ADD is one of the possible consequences.
Infants whose caregivers were too stressed, for whatever reason, to give them the necessary attunement contact will grow up with a chronic tendency to feel alone with their emotions, to have a sense- rightly or wrongly- that no one can share how they feel, that no one can “understand”. Those ADD children whose needs for warm parental contact are most frustrated grow up to be adults with the most severe cases of ADD
Psychological tension in the parents’ lives during the child’s infancy is, I am convinced, a major and universal influence on the subsequence emergence of ADD
Happy interactions between mother and infant generate motivation and arousal by activating cells in the midbrain and that release endorphins, They also trigger the release of dopamine. Both endorphins and dopamine promote the development of new connections in the prefrontal cortex. Dopamine released from the midbrain also triggers the growth of nerve cells and blood vessels in the right prefrontal cortex and promotes the growth of dopamine receptors. A relative scarcity of such receptors and blood supply is thought to be one of the major physiological dimensions of ADD. The letters ADD may equally stand for Attunement Deficit Disorder.
ADD is more likely to arise in a family where physical mistreatment is a possibility, whether expressed or only latent. The psychological atmosphere in such families will have been disturbed prior to the child’s birth, because the parents themselves carry the psychic scars of abuse. Only people abused in their youth will go on abuse their own children – and they will do so almost inevitably unless they have recognized the facts of their own childhood histories and have taken up the task of healing.
ADD children are far more likely than other children to have parents who have suffered major depression. Family strife and parental depression contribute to the child’s ADD problems not just because of their negative influence on attunement during brain development. Stressed or depressed mothers are found to be more short-tempered, more controlling and more angry with their children.
Parents of ADD children report fewer contacts with their extended family. 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 do. When they do see their families, the interaction tends not to be satisfactory. ADD children are less likely to have the comfort and support that only loving grand-parents can give. Something had already gone wrong in the family of origin of their parents.
An adult with ADD looks back on his life to see countless plans never fully realized and intentions unfulfilled. Social skills are also an issue. Something about ADD hinders the capacity to recognize interpersonal boundaries. Adults with ADD may be perceived as aloof and arrogant or tiresomely talkative and boorish.
ADD is not an illness, although some influential authorities have called it that. It is an impairment , like, for example, a visual impairment in the absence of any disease. There is in ADD an inherited predisposition, but that’s very far from saying there is a genetic predetermination. A predetermination dictates that something will inevitably happen. A predisposition only makes it more likely that it may happen, depending on circumstances
The ADD mind is afflicted by a sort of time illiteracy. The time sense of the ADD adult or child is warped in other ways. Ask people with ADD how long it will take to perform a particular task and they will notoriously underestimate. In ADD the circuitry of time intelligence is underdeveloped. Underdevelopment best explains another time-related malfunction of the ADD brain, the chronic incapacity to consider the future.The adult lives as if his actions had no implications for the future, no effects on future needs, relationships or responsibilities. In the moment of action or decision making, ADD adults are no more mindful of consequences than a young child.
The major impairments of ADD – the distractibility, the hyperactivity and the poor impulse control – reflect, each in its particular way, a lack of self-regulation. Self-regulation implies that someone can direct attention where she chooses, can control impulses and can be consciously mindful and in charge of what her body is doing. We are born with no capacity whatsoever to self-regulate emotion or action. For self-regulation to be possible, specific brain centers have to develop and grow connections with other important nerve centers, and chemical pathways need to be established. ADD is a prime illustration of how the adult continues to struggle with the unresolved problems of childhood. It is held back precisely where the infant or toddler got stuck during the course of development. A fully grown adult exhibiting the rage of an infant is terrifying and potentially dangerous.
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. They kept their deepest griefs to themselves. 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.
Amazing! So in a more simplified version, when a person reacts with anger or shame or lack of responsiveness, they tell us a story about their childhood. They repeat the same memory , eliciting the same emotional response. The go back in that early infant state, just like in a movie where everything happens all over again. In fact that person is recreating the early interaction with their mother/ the primary caregiver. Although their reaction seems to be anchored in the present, in fact it is about the past. It is their mother's response they long for. It is their primary caregiver's initial response they react to. I have found this to be incredible as I strongly believe to this day that 90% of the people have no idea why they react the way they do to certain things that happened in their lives. This book opened my eyes a lot.
When it comes to love....the ADD adult has a ton of problems. A fear of intimacy and a difficulty to express vulnerability are the main issues. The ADD adult can be overwhelmed in romance as they have no clue how to manage their emotions and express them. I selected a couple of quotes to help you understand this part of ADD better:
ADD IN ROMANTIC RELATIONSHIPS
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.
The ADD adult does not know the difference between refusal and rejection. Poor self-regulation also disables him from responding like an adult, no matter whethere his partner feels rejecting or only uninterested.
The parent can be physically present but emotionally absent due to stress, anxiety, depression or preoccupation with other matters. From the point of view of the infant it hardly matters. His encoded reactions will be the same, because for him the real issue is not the parent’s physical presence but her emotional accessibility. The withdrawal dynamic has been called defensive detachment. It has one meaning: so hurtful was for me to experience your absence that I will encase myself in a shell of hard emotion, impervious to love – and therefore to pain. I never want to feel that hurt again. As a result, ADD adults find it difficult to trust in relationships, to make themselves open and vulnerable.
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.
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. 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. Our choice of relationship partners is patterned on our interactions with our parental caregivers. In neurophysiological terms, our choice of mate reflects the early relationship patterns stamped in the neural circuits of the right prefrontal cortex, expecially its orbitofrontal portion. The OFC will recognize and hone in on someone who, on the unconscious level, activates its familiar reactions. This person, after all, will most resemble the persons whose love one so desperately craved all one’s life. We are inexorably drawn to marry the individual who is, of all potential partners, the very one most likely to trigger in us the most painful and confusing of implicit memories – as well as the warmes, happiest ones.
There are some core traits specific to the ADD adult which are summed up in some of the quotes I have selected:
SPECIFIC TRAITS OF PEOPLE WITH ADD
Active attention, the mind fully engaged and the brain performing work, is mustered only in special circumstances of high motivation. Active attention is a capacity the ADD brain lacks whenever organized work must be done, or when attention needs to be directed toward something of low interest. A 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.
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 turns in all manner of activity and will often act or speak impulsively as if forethought did not exist.
Hyperactivity is the third salient characteristic of ADD. Toes or fingers tapping, thighs pumping, nails being chewed, teeth biting the inside of the mouth. The hyperactivity may also take the form of excessive talking.
People with ADD are hypersensitive.Sensitivity is the reason why allergies are more common among ADD children than in the rest of the population.
True self-esteem is independent of others’ opinions. True self-esteem is who one is; contingent self-esteem is only what one does. ADD adults don’t have low self-esteem because they are poor achievers, but it is due to their low self-esteem that they judge themselves and their achievements harshly. They feel safer not trying, because their poor self-regard is terrified of the risk of failure. The association between low self-esteem and attention deficit disorder is not that the first arises from the second, but that they both arise from the same source: stress in the parenting environment and disrupted attunement/attachment.
*** The need to be needed at all costs comes from one’s earliest experiences. If the child does not feel accepted unconditionally, he learns to work for acceptance and attention. Later, as an adult, when not doing something specific, he has a vague unease, the feeling that he should somehow be working. The adult has no psychological rest because the infant and child had never known psychological rest.***
”The ahistorical memory” of the ADD mind. In other words, the ADD adult ( and child) functions at times as if previous events, even the most recent ones, had never taken place. Your ADD partner may have insulted you the night before but this morning greets you with a warm smile, the offer of a hug and the expectation of warm reciprocal contact. It is difficult to live with a partner who may be messy and disorganized, does not remember promises, tunes out in the middle of conversations, forgets events and anniversaries, has a short fuse and in moments of crisis may lack self-insight.
It sounds like there is not a lot of hope right? But in the book we can understand more if we read about the brain of the ADD individual and see that this is something which can be fixed with enough patience and self awareness. For someone to be able to repair the bad blueprint created by unconscious parenting first that person needs to understand their own brain. How does the brain of the ADD adult or child looks like? What is different? Here are some quotes to help you understand the mysterious brain :
THE ADD BRAIN
MRI pictures have shown smaller than normal structures in the right prefrontal cortex of ADD patients. The prefrontal cortex may be seen as a policeman. One if its major tasks is inhibition. One way to understand ADD neurologically is as a lack of inhibition, a chronic underactivity of the prefrontal cortex. The cerebral cortex in the frontal lobe is not able to perform its job of prioritizing, selection and inhibition. It may seem paradoxical to consider that hyperactivity of mind or body can be caused by an underactivity of the cortex
The right orbitofrontal cortex, which for the sake of brevity we will call the OFC, has connections with virtually every other part of the cortex. It is at the center of the brain’s reward and motivation apparatus and contains more of the reward chemicals associated with pleasure and joy – dopamine and endorphins- than almost any other area of the cortex. Has a major role in attention. The OFC helps to pick out what to focus on. It also functions in impulse control. Finally, the OFC records and stores the emotional effects of experiences, first and foremost the infant’s interactions with his or her primary caregivers during the early months and years. ITS IMPRINTING OF THE EARLIEST INTERACTIONS WITH THE PRIMARY CAREGIVERS IS THE UNCONSCIOUS MODEL FROM WHICH ALL LATER EMOTIONAL REACTIONS AND INTERACTIONS WILL BE FORMED. Groups of neurons in the OFC encode the emotional footprints of these important experiences – footprints in which, willy-nilly, we tend to follow later in life, again and again and again. 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.
In ADD individuals are triggered too easily and once triggered, they tend to go out of control. Physiologically and emotionally, the child or adult with ADD swings back and forth between over-the-top, purposeless excitement and a nonrestful vegetative state in which the predominant emotion is shame. Like so much else about ADD, hyperactivity, lethargy and shame are closely connected with the neurological memories of the distant, stressed or distracted caregiver.
I can only say: WOW. Early years are fundamental in all of our future relationships. If only more adults would know this before commiting to marriage and to making kids. Do not get me wrong, I judge no one, but if two very traumatized and not self aware people get together to form a family, they will only inflict trauma to their children and perpetuate the generational burden of emotional hurt. Even Gabor Mate admits his own mistakes in parenting and how his own issues influenced the upbringing of his kids.
Tension between the parents and lack of attunement with the caregiver are the main reasons why an infant will grow up developing ADD. We need more education and more adults to realize their own trauma and work toward healing before thinking to start a family. Sadly enough I have seen many abused adults abuse their own children and pretend that is ok. Emotional or physical abuse becomes a family tradition and by the 6th generation everyone thinks it is ok. This is what is deeply wrong with trauma when people do not heal.
It sounds pretty gloomy to have ADD. Is there any hope to heal? Gabor Mate gives some great advices when it comes to the hope one with ADD might have. It is not easy. It is not fast. You have to reparent yourself and give to yourself what your caregivers lacked to offer. The brain has the amazing capacity to change and learn. If you are old it does not mean you can't change. But what is ESSENTIAL to know about healing ADD is the CHANGE of the ENVIRONMENT. I remember one saying : you can't heal in the same place where you've got hurt. And this is deeply important for anyone who has ADD: the power to leave from a toxic environment, whether it is about your own parents, the workplace or friends. The ADD adults needs to learn how to be compassionate towards oneself, to sit with uncomfortable emotions, to find activities which help them keep focus and to lower the inner critic voice. I was deeply impressed by this book and I can only hope that it will help all of those who read it to make the first step toward healing.
HOPE AND HEALING FOR THE ADD ADULT
Most encouraging was Dr. Diamond’s finding that even the brains of animals deprived before birth, or deliberately damaged in infancy, were able to compensate by structural changes in response to ENRICHED LIVING CONDITIONS. “Thuse”, she writes, “we must not give up on people who begin life under unfavorable conditions. Environmental enrichment has the potential to enhance their brain development too, depending on the degree or severity of the insult”. That in humans , too, we can expect even the adult brain to be positively influenced by the environment is not surprising
If self-esteem is to grow in the long term, the individual has to heal psychologically, has to feel accepted unconditionally, has to be able to make his own choices.
Learning to become aware of the tone in which he addresses his inquiries to himself: am I conducting an inquisition against myself or a helpful, insight-oriented interview?
If you want to go further in the direction of healing, you do not chastise yourself for wherever you happen to be along the road. You don’t berate yourself for not having got there faster
Of all types of professional training, the one I consider most likely to be of benefit in ADD is family therapy. The skilled family therapist is not fixated on people’s dysfunctions and their difficult feelings, She helps clients acknowledge painful emotions but also helps them to see their problems in the context of multigenerational family system that they are part of. 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.
Make a conscious choice about how to live. Get good sleep .Exercise. Go out in nature. Spiritual work is essential in the self-treatment of ADD.
Any activity, from martial arts to gardening, that promotes mindful concentration, will bring benefits. Adults with ADD should at least consider giving themselves some daily opportunity for contemplative solitude. Contemplative solitude is different from being alone in a room, reading, listening to music or being lost in reverie. It means putting some attention on one’s life, one’s thoughts and feelings. Like nature, it has an integrating and harmonizing effect.*