Words&Dirt

Anyone who turns their attention to the world of modern psychotherapy will quickly start finding references to Gabor Maté all over the place. He has made a special contribution to how mental health professionals approach trauma, addiction, and––as his book Scattered Minds demonstrates––attention deficit disorder (ADD). Like many others before me, I was excited to explore Maté’s work and feel that I benefitted immensely from his method of framing and treating ADD.

Something that’s good to point out up front is that Maté himself has ADD, so he writes about it from an intimate, internal perspective. This confessional style doesn’t always hit the mark in nonfiction, but in this case I think he pulled it off beautifully. Describing his initial “ADD epiphany,” he writes:

It seemed to me that I had found the passage of those dark recesses of my mind from which chaos issues without warning, hurling thoughts, plans, emotions and intentions in all directions. I felt I had discovered what it was that had always kept me from attaining psychological integrity: wholeness, the reconciliation and joining together of the disharmonious fragments of my mind…

The shock of self-recognition many adults experience on learning about ADD is both exhilarating and painful. It gives coherence, for the first time, to humiliations and failures, to plans unfulfilled and promises unkept, to gusts of manic enthusiasm that consume themselves in their own mad dance, leaving emotional debris in their wake, to the seemingly limitless disorganization of activities, of brain, car, desk, room. (4)

This opening passage shows how Maté’s deep well of compassion for others draws water from the aquifer of his personal narrative. It also displays his talent as a writer (including a flair for great analogies and metaphors), creating an overall reading experience that’s engaging and inspiring.

Another excellent asset is Maté’s background as a medical doctor, which means he has both the training and experience to comment on psychiatric and therapeutic practices from the inside. His critiques of the medical model of mental illness and overuse of psychotropic medications carry the weight of someone who knows of what he speaks. Maté sees people with mental “disorders” not as fundamentally “ill” or “disturbed,” but rather as “normal” individuals who––largely through no fault of their own––happen to be experiencing “a great concentration…of disturbed brain processes found in everyone” (24). His balanced view falls short of a rejection of mainstream psychopathology as an important aspect of ADD; instead, he merely asks it to take a backseat to his developmental theory:

Recognizing that ADD is a problem of development rather than one of pathology takes us in a direction completely different from that dictated by a narrowly medical approach. When we ask why the medical disorder ADD develops, we are adopting the illness model of ADD. Implied in the illness model is the presence of a pathological entity in the brain, analogous to, say, inflammation of joints in rheumatoid arthritis or bacterial invasion of the lungs in pneumonia. Such a way of formulating the question of how ADD originates almost demands a medicalized answer. We look for the narrowly biological, exclusively physiological explanation.

If we choose not to see ADD as a medical disorder or illness, the question of causation is turned around and examined from the opposite angle. Recognizing that time sense, self-regulation and self-motivation are nature driven and necessary developmental tasks, we ask the following: What conditions are needed for human physiological and psychological maturation? What conditions would inhibit or interfere with that growth process? Instead of asking why a disorder or illness develops, we ask why a fully self-motivated and self-regulated human personality does not. (41-2, emphasis his)

He continues:

In some people, there will be a greater concentration of developmental problems. This may be because their specific circumstances were worse, or because they were more sensitive, deeply affected by conditions that others with more robust temperaments could better withstand. They are the ones likely to be diagnosed with ADD or with some other “disorder.”

On the westernmost shores of Canada, on Vancouver Island, one sees scruffy and twisted little conifers, stunted relatives of the magnificent fir trees that dominate the landscape just a short distance inland. We would be wrong to see these hearty little survivors as having some sort of plant disease; they have developed to the maximum that the relatively harsh conditions of climate and soil allow. If we wish to understand why they differ so dramatically from their inland relatives, we need to know under what conditions majestically tall, stout and ramrod-straight fir trees are able to thrive. It is the same with human beings. We do not have to look for diseases to explain why some people are not able to experience the full flowering of their potential. We have only to inquire what conditions sustain unfettered human development and what conditions hinder it.

The answer to underdevelopment is development, and for development the appropriate conditions must exist. No matter how efficiently they are able to arouse the higher brain centers, medications offer only a partial solution to the problems posed by ADD. We may not be able to prescribe development directly, but we can promote an environment that makes development possible. Fortunately, as we will see when we come to the chapters on the healing process in ADD, neurological and psychological maturation can take place at any time during the life cycle, even in late adulthood. (42-3)

Maté’s positive, humanistic tone generates an underlying hum of empowerment and possibility, even as he refuses to downplay or sidestep ADD’s many negative effects. He walks the reader through the many nuanced causes and symptoms of ADD, returning repeatedly to the importance of attachment relationships during infancy and early development. He dives into reductionist frameworks by exploring the neuroscience and neurochemistry of ADD, traverses the common ground of relationship dynamics that either foster growth or produce oppositionality/counterwill, and then expands his scope to cultural influences––a refreshingly broad and interdisciplinary journey. Finally, Maté shares a series of chapters on how ADD can be effectively treated in children as well as adults. For mental health workers and laypeople alike, there’s tons of great intellectual fodder to chew on.

Although Maté doesn’t explicitly go this far, I believe his work has consequential implications for politics, economics, and social justice. When it comes to harm reduction and symptom control, much of Maté’s advice boils down to something like: “First, parents need to be loving, respectful, mutually supportive, and emotionally mature with each other and other adults. Second, they’ve got to spend time with their kids and devote a lot of conscious attention to them, striving always to model compassionate curiosity and patience.” Adults with ADD, of course, also benefit from these behaviors.

In America, our multi-decade project of making life harder for poor, working class, and middle class people appears to be correlated with increasing ADD diagnoses. While we are not sure if this increase results from more children having ADD or simply more diagnoses, what we do know is that the overall impact of this condition on our society is waxing. Maté’s book made me think that perhaps this trend is at least partially fueled by parents needing to work more days and hours just to get by, which pits their economic survival in a zero-sum game with the time and energy required to establish secure attachments with children thereby decreasing the likelihood that ADD will manifest. And since upper class and wealthy Americans also tend to work too much, this may explain why ADD also shows up in plenty of kids from well-off, supportive families.

So, our collective workaholism––whether chosen or coerced––could be one of the main drivers of the ADD epidemic. Combine that with the meteoric rise of social media and its attendant mental health risks; the capitalistic incentives of pharmaceutical companies that produce drugs like Ritalin, Adderall, and Dexedrine; and the profit margins of insurance companies that act as gatekeepers to “legitimate” treatment; and you’ve got a real mess on your hands. All of this is purely speculative, so take it with a grain of salt, but it was interesting and fun for me to knit these threads together and I thought it might be helpful to share this part of my learning and exploration process.

Another feature worth mentioning is Maté’s advocacy for the ongoing cultivation of self-understanding, self-care, and self-acceptance. As a person with many friends and family members who struggle with ADD every day, I found Maté’s focus on this topic encouraging, and see no reason why it’s not applicable to people in general. Everyone’s weird, after all, and the goal should be to comprehend, welcome, and grow that weirdness into something vibrant and beautiful:

The world is much more ready to accept someone who is different and comfortable with it than someone desperately seeking to conform by denying himself. It’s the self-rejection others react against, much more than the differentness. So the solution for the adult is not to fit in, but to accept his inability to conform. The child’s uniqueness has to first find a welcome in the heart of the parent.

None of this is achieved by an act of will, and it is possible one will not succeed completely. That is not important. What is important is to engage in the process, difficult as that is. Healing is not an event, not a single act. It occurs by a process; it is in the process itself. (320)

Scattered Minds has a handful of notable weaknesses, none of which significantly undercuts its beneficent message and values. A couple times I felt like Maté was strawmanning what he calls “genetic fundamentalism,” and I also thought some of his parenting advice might be a bit too permissive, though I can’t claim either personal or professional knowledge of how this cashes out in actual childrearing. He appeals to nature somewhat by asserting that “Nature has its own positive agenda, which is at work in all of us”––a claim that sounds more religious than scientific and for which he doesn’t provide satisfactory evidence (220). I also think that, as we learn more about ADD and related disorders, it’s possible we’ll discover it’s actually not as sensitive to environmental changes as Maté believes. “If we can actively love,” he concludes, “there will be no attention deficit and no disorder” (323). I sincerely hope he’s right.

Rating: 8/10