More on Attention Deficit Disorder

I would let this go, except that last night there was a one hour special on PBS about ADD, with four major specialists in the subject. The diagnoses they came up with is what I think is the problem with the whole field of psychotherapy, psychology and psychiatry.

Not once in the hour did I hear what the origins of ADD might be and why it occurs. Most of the time, it was spelling out how to cope with it. So we also might add how to deal with phobias, obsessions, migraines, high blood pressure and on and on. It is tantamount to saying that the illnesses stay but how we deal with them changes. It is all about our attitude. So you still have the allergies and you avoid this and that to cope with your allergy. Or you have a chaotic mind, try to avoid clutter.

The first point they made is that diagnosis is essential. And they list ten things that make you an ADDer. You need to be impulsive, not able to focus and concentrate, unable to pay attention, hyperactive, unable to sit still (I am adding here), low self esteem, learning disorders, can’t listen, needs to talk constantly, cannot wait, no long-term goals, lose temper easily, act without thinking, very impatient, a bad memory, an underachiever, etc. I added here some from a list of the Brown Scale for ADD. It pretty well covers it. But you have to be suffering from this for six months or more, they claim.

What the experts concluded was that a diagnosis was critical. Once you are aware, they claim, you are half-way there, because you know what to do; which includes: making future plans, making your environment work for you, find a calm partner and a job that suits you, making an effort not to lose patience, and above all, they claim that the therapy for this is success. Once you have a success you can build on it. And you will have a higher self-esteem and won’t be an underachiever.

So let me see: you tell the doctor that you are impulsive, impatient, cannot wait, cannot concentrate nor sit still, and she says to you that you have ADD. Ok there is the diagnosis, now what? She has told you what you just told her in more simple terms. Have we made progress? Is that what a diagnosis is? Saying things in esoteric language? The doctors have then many suggestions: don’t do too many chores at once, stay in a calm environment, jog to work off tension but do not over-talk. Don’t work amid chaos. I say to the doctor that I cannot stand crowded restaurants and he tells me to avoid them. And he adds “do not take so many risks in your life”, yet he adds it is the risk takers who invent and innovate and tend to be more creative. Now I am confused.

Not once did I hear in one hour the word, why? Where does it come from and what I can I do about it. What is the generating source of all that? So now you will read my opinion about it. It is an educated opinion since I have treated many cases. What happens is that cognitive/behavioral approaches have taken hold so that the psychiatric diagnostic manual indicates all these behaviors, and it is assumed that to treat it all, we need to change behaviors, hence, behavioral therapy.

Let’s go back to womb-life; there is a good deal of evidence that a mother’s hyperactivity, the drugs she takes, such as cocaine can leave an imprint or a residue that affects the offspring for a lifetime. If the mother is “hyper” the child may also be. Just that can set up a child who is revved up from the start. An Israeli study found that the children of holocaust survivors, very anxious people gave birth to anxious children. At first they thought it was because the parents told horrible stories to the children but then they discovered that the anxiety came down through the genetic chain; that is, it was descended from the mother’s physiology—epigenetics. (Laura Spinney, 2,Dec. 2010. Internet) Then there is the trauma of birth and infancy where the child may be left for days without warm cuddling. And then harsh parents who fill the child with feelings of rejection and abandonment. All this sets up imprints down low in the neuraxis. This is then transmitted to higher centers (as they develop and evolve) where the child is filled with input from inside that frazzles his brain; that feeds constant and varied input to the neo-cortex, no different from listening to ten people at once all talking at you. Except...,except that this information is constant from inside not outside. It competes with stimuli from outside but it all gets to be too much. It is paying attention to too much input which is normal, not an aberration. The disease, if it exists at all, is stimulating information that floods the cortex with electrical input just the same as being flooded with shock therapy.

Of course, he is hyperactive, he is being prodded all of the time from below so that any new input is overwhelming and he starts to crumble. He cannot manage complex instructions; you go to the right two blocks and then one block to the left and then go straight to the roundabout and then………we have already lost him because the internal input is crowding out the information. And of course, he cannot sit still because there is information that needs connection and resolution, the integration. That cannot happen so long as he has no access to his early imprinted memories. The information is constantly climbing upwards and forwards for that connection so that the system can function better.

And then he cannot get down to things, quickly start a paper, a project or an article because there is so much going on in his brain for him to focus on just one thing. So others get impatient because he did not turn in his paper on time. He was so busy, doing this or that, as his moods dictate because he is being twisted and turned here and there internally with little cerebral control.

So why so little control? Because trauma in late pregnancy can damage or prevent the evolution of prefrontal cortical cells, as well as the cells that carry information from down below via the right to left brains, the corpus callosum. So there is damage or impairment of sorts. They do not have the cerebral equipment to control impulses thereafter. And we know that the prefrontal area works often times to control right subcortical feelings in order to shut them down for a time. When control is weak it is harder to put off an impulse, to wait for later to do something, to reflect and ponder rather than act. But those impulses are the imprints originating deep down in the brainstem centers. The impulses, the same as with the salamander or snake or shark, are there for an evolutionary reason: to strike, attack or flee at the instant when it is necessary--survival. They come out of those primitive brains and are essential, as well, for our survival—needing to swerve to avoid a car accident, for example. Here we do not want to be too reflective. Immediate reaction is called for.

Now think of the snake; he too must act immediately for his survival. It is not an aberration unless the snake brain overtakes the rest of our cerebrum and runs the show. In a way, in ADD he is running the show. What are we fleeing from? Danger. Menace. Feelings that are overwhelming. Pain that is much too much. Suffering that threatens our mental stability. It has to be contained. Think of this when we are dealing with ADD, and believe that a different turn of behavior can solve things. Think of this when we offer advice to “Make your world comfortable to you. Make your world work for you.“ Think of what and whom we are talking to because the salamander brain is doing its best to deal with matters and it isn’t getting much help from the impaired neo-cortex. Remember, then, it is an ancient survival mechanism there for a reason and very necessary in our evolution.

What is behind a lot of this, is anxiety; that is the major prod. It is pure terror engraved down below from traumas in the womb that have been reacted to just in terms of the non-verbal brain system. Or imprints from a bad birth that was life-threatening.

The ADDer is an underachiever because he could never stay with anything long enough to learn it properly. So he becomes a salesman; someone with a gift of gab who runs off at the mouth, running off part of the tension and energy of anxiety. When he recognizes this maybe he suffers from low self esteem, as the project stated. He must know that he cannot succeed because success requires sustained effort; his scattered mind cannot do that. But he may find a job that suits him and that will allow distractability. But do not ask him to be calm and to follow directions because his brain is revolting. To infuse too much input into his brain, even a simple idea, is overwhelming and that is how he feels—overwhelmed. The cortical level is being overwhelmed so he should feel that way. It is all too much. Literally.

I cannot help but feel that current therapy for ADD and most other psychologic afflictions is just “get over it”. One psychiatrist tells his patient that you must first identify the problem and then develop good habits to overcome it.”Do not live in a cluttered environment.” But he needs chaos because it reflects his brain. And as one specialist in ADD said at the end, “I am not interested in making you normal. I just want you to be successful.” The reason he is not interested is that the depth of the problem and its origins seem so mysterious, arcane and recondite that the condition, like Freud’s Id, becomes a given, not to be tampered with; an immutable force, part of genetics—our inherited weakness. All because the field and the populace is not used to considering womb-life and birth experiences as critical in our development. The science is now there; we have only to use it.

In my previous books I have discussed the notion of the parasympath and sympath. These are two different personality types governed by the hypothalamus. The parasympath is the slow, reflective type and the sympath is the hyperactive unflective type who keeps driving and going and doing. This largely is set up during womb-life and at birth; was the end of the birth difficult? Was the newborn shut down by anesthetics given to the mother, or was the end a success because the child struggled and got out successfully? He learned that he could not wait because waiting could have meant death. He wants out! It sets up an inability to wait, impulsivity and a driven brain. The parasympath is much more passive, less driving and less spontaneous. Keep in mind that those experiences happen to a brain that could register, code and store. The memory endures. And it creates a hyperactive system that is largely beyond our control. It goes to where we are weakest and most vulnerable. Trying to go to sleep is a big effort because impulses from down below are activating the mind into constant rumination and won’t let us relax enough to fall asleep. That is, it won’t allow us to go below the top thinking level and into where sleep might happen.

One of my senior therapists who has stayed with doing therapy for years was a classic ADDer. He never went to college because he was sure he could not concentrate enough to do classes. He can now and is on his way to a Ph.D.

I have treated enough of those who have ADD to know what a successful therapy entails and it is not advice, even though that might help a little. It is a deep voyage to the antipodes of the mind to where it all began.