Where ADHD Meets Freud

Based on the recommendations of more than one reader, I read Gabor Maté's Scattered Minds in the last week. A sort of review

Mothered

The one time I went to a psychologist (not to be confused with a psychiatrist) she suggested that we start by talking about my upbringing. It took a couple of sessions to describe my personal history to her.

And then, over the course of the next 4-5 sessions, I found myself talking to her exclusively about either my mother (as a proxy for “upbringing”) or about tactical issues, and it wasn’t helping me at all. Finally, I requested her for a reference to a psychiatrist (which she helpfully provided), and moved on.

Someone else I know well also quit therapy after a few months because the sessions increasingly became about this person’s mother! “I’ve been telling my mother for a long time that she needs counselling”, she said. “Yeah she should go for it. After all, I suppose your therapist already knows her fairly well”, I replied.

Traditionally, largely (but not exclusively) based on the work of Sigmund Freud, a lot of psychology and psychiatry has focusses on people’s upbringing and “mothers”. A mother’s “uncertain hugs” are responsible for some things. A dominating mother can be responsible for some other problems. An overly meek mother can cause yet another class of problems. Whatever kind of problem you have, there will be a branch of psychology that can ascribe it to something about your mother.

Somehow, until very recently, I hadn’t heard of any maternal connections to ADHD. Based on everything I’d heard and read about it, it was largely due to some chemical imbalances in the brain (typically, too little dopamine, I think), and was largely known to be genetic. And then, based on replies to this newsletter, I came to know that one’s mother can be held responsible for ADHD as well.

Shaping your brain

I just realised that the book I read last week, Gabor Maté’s Scattered Minds, first came out in 1999. And I hadn’t heard of this book at all until it was mentioned by a few people in response to earlier editions of this newsletter. In any case, I read it. It is intuitively a good book and a fast read, though four days after finishing I’ve pretty much forgotten most of it ( and so I’m having to rely on my highlights to write this).

In any case, the book description on Goodreads says:

“Scattered Minds explodes the myth of attention deficit disorder as genetically based – and offers real hope and advice for children and adults who live with the condition”.

Like all book descriptions, this is a gross oversimplication. Nowhere does Maté say that genetics doesn’t cause ADHD. All he says is that genetics is only one of the factors that causes ADHD, and a lot of it is actually down to your upbringing and home environment.

Now, to be very honest, I didn’t very well catch the point on this one. I throughly enjoyed the first part of the book where he nicely builds up describing all the features of ADHD. And I largely enjoyed the last part that talks about what one should and should not do in terms of dealing with ADHD. The part I largely missed, though, is his reasoning on why genetics alone doesn’t cause ADHD.

All I remember is - he is the oldest of 3 brothers, born in a Jewish family in Budapest in 1944, just when the Nazis had occupied Hungary. His father was then in a labour camp and his mother nearly sent off to the gas chambers. The second brother was born in 1946, just after the War, when the family was relatively stable. And the third brother came in the late 1950s, when the family had migrated to Canada and was struggling to make ends meet. Gabor Maté and his youngest brother, born in stressful times, both have ADHD. The middle brother doesn’t.

So when it comes to the main part, the book is like a bad maths lecture. There is a lot of nice build up, and then some sudden hand waving and the professor goes “QED”. And then spends a long time discussing the results! That said, all the “side stories” in the book are enjoyable enough (especially for someone with ADHD) to keep going.

In any case, the book has a lot of good concepts. Among all the ADHD books I’ve read (this, and this, and this, and this) this book has the best description of the symptoms of ADHD and their implications (or maybe it’s just recency bias at play here). It goes into depth on a lot of the features of ADHD and the associated issues. It is an enjoyable read.

Maybe it is comforting to some American (or Canadian) parents who can read it and think that their wards’ ADHD can be “prevented” or “cured” (it can’t, IMHO). But to me, the biggest impact of this book is that it brings the mother into the equation as far as ADHD is concerned - something that had hitherto only been a feature in anxiety and depression and other mental issues.

Learnings($)

Maté’s basic thesis is that in humans, a lot of development of the brain happens post birth (else the baby’s head can’t fit in its mother’s vagina), and so the early environment and childhood has a huge impact on how the brain is shaped. Whatever we learn in the early years, we internalise it to the extent that our neural connections optimise for it.

It’s almost like our biological neural network is being “trained” in the first few years of life, and the wrong kind of training (bad parenting, parents fighting, jittery mothers) can lead to badly trained neural networks that won’t be able to deal with the out-of-sample events that life later throws at us.

There is a nice tweetstorm I had read last year on why medicine relies on cases rather than on first principles.

Cedric Chin @ejames_c

1/ Let's talk about how note taking can help you accelerate expertise. Yes, I know how that sounds like. No, this isn't hype. There's some solid cognitive science here, and it has FASCINATING things to say about the nature of learning in messy, real world domains.

I had also written a blogpost based on that, extending the argument to data science. There, I got distracted again - this newsletter is supposed to be about ADHD and Gabor Maté’s book.

(at this point, I got distracted by something major, and then life happened, and I’m taking this up again 24 hours later. So you can expect a drop in quality in the immediately succeeding paragraphs)

And so Maté relies on cases to make his point on ADHD being “learnt”. Most of the patients he describes in the book have both ADHD and troubled childhoods (the other 3 quadrants of this 2x2 are untouched by his work). A number of cases involve domestic abuse, or divorce. A lot involve highly dominating parents. A few other cases have sources of instability in the environment that makes the child jittery.

The broad message in the book seems to be “yes, your child might have the sort of genes that make them more prone to ADHD, but if you improve their environment, you don’t fight with your spouse, and keep things normal with the kids, their brains are likely to be “shaped better” and they are less likely to have severe ADHD.

The problem, however, is that if a child is genetically predisposed to having ADHD, it is very likely that at least one of its parents has ADHD, and in this case, maintaining an especially serene and perfect environment is hard. ADHD generally has an adverse effect on relationships, which means when one parent has ADHD you expect a more unstable and rocky home environment.

So yes, even if Maté’s hypothesis is true - that a large part of the “ADHD development” happens during childhood (well after the genes have had their say) - that children predisposed to ADHD overwhelmingly grow up in households with one adult with ADHD (or with a pair of parents who don’t live together), there is a limit on how much the ADHD can be limited.

That said, the advantage of at least one parent having ADHD is that this parent will be able to empathise better with the child’s symptoms and “ADHD features”. Normally I’m not in favour of labels such as “this person has ADHD” but this is where the labels can be helpful. If the adult is self-aware of his/her ADHD label and notices similar traits in the child, it is easier (IMHO) for the adult to empathise with these traits and not unfairly punish the child.

And even if some parents may not be strictly aware of ADHD traits, this book does a good job of detailing all the personality quirks and features that you would expect for someone who has ADHD.

So if you are a parent whose child either has ADHD or is prone to ADHD (because either you or your spouse has it), you might want to keep in mind some of the following:

• The child will make mistakes. Know that. Don’t punish it for mistakes. Or say “don’t make mistakes again”. That will only reduce its confidence.

• The child will struggle to focus on things it doesn’t have an inherent interest in. Don’t force it to focus on particular things at particular times.

• Sometimes the child will want to hyperfocus on things. Like, say, finish a book in one sitting (including taking the book to meals and to the loo). Or not stop working on a puzzle or project until that is completely done. This is again normal.

• The more you try to force the child to do something (pursue a hobby, for example), the higher the chances that it will resist actively and abandon it (Maté calls this “counter will”). So don’t press too hard

• The child might try out many hobbies / activities before finding something it can focus on.

This list is by no means exhaustive. But yes, having a child with predisposition towards ADHD can be exhausting.

Creativity

Over the years I have come to believe that ADHD is highly correlated with creativity since it allows you to think laterally (and sometimes even hallucinate). Peter Shankman’s book on ADHD is actually called “Faster Than Normal” since when you hyperfocus, you can work at tremendous speed (though you trip up in other ways - I’ll write a separate blogpost about this).

Gabor Maté, however, doesn’t agree that ADHD makes you faster than normal. He simply believes believes that it is a correlation. Quoting the book,

I do not believe ADD leads to creativity any more than creativity causes ADD. Rather, they both originate in the same inborn trait: sensitivity.

Now, it might just be a correlation (without any causation involved), but I have personally noticed in myself that I’m far more creative when I’m not on ADHD medication. Putting it another way, I both have ADHD and the ability to be creative, and within myself I find them to be positively correlated (taking pills allows me to focus better but hinders my lateral thinking).

In any case, by the time I had come to the end of the book, I had no patience left to read the footnotes. There might actually be some research backing up Maté’s claims, but I don’t know about it.

The book is good. It is entertaining. It very nicely describes what you go through when you have ADHD. And describes what to do and not do when you have a child predisposed to ADHD.

You can read it once.