Marriage: ADD
A hallmark of a conflictual marriage is that husband and wife are angry and dissatisfied with one another. While the atmosphere of conflictual relationships is intensely negative much of the time, it is usually punctuated by periods of equally intense, sometimes very passionate closeness.… Conflict can have an addictive quality: It is both a familiar scene and a poignant reminder of how involved two people are with one another. People do not want conflict, but they have not found an alternative way of interacting.
—MICHAEL E. KERR, M.D., Family Evaluation
MY WIFE, RAE, AND I have three children: two boys, aged twenty-three and twenty, and a ten-year-old daughter. They have all three been diagnosed with ADD, as have I.
Our family could almost be seen as poster perfect for the genetic argument: a financially secure, stable middle-class couple, married now nearly thirty years, who love each other and their children. There is no alcoholism or substance addiction, no family violence, no abuse. If these children have attention deficit disorder, surely it must be due to their genes. What about this environment could have caused ADD?
Environment does not cause ADD any more than genes cause ADD. What happens is that if certain genetic material meets a certain environment, ADD may result. Without that genetic material, no ADD. Without that environment, no ADD. The formative environment is the family of origin.
So far as marriages go, ours has been firmly at what may be called the “conflictual” end of the spectrum. We have worked things out, but it took decades and a lot of energy. In retrospect, we shudder at how hurtful and dark it felt at times, and particularly how our struggles burdened our children’s lives.
Our marriage is now something we celebrate. Our ships, having been tossed and thrown about on heavy seas, have finally arrived safely in the same harbor. But the storms took their toll on our children. At the end of his delightfully candid 1972 essay, “My Own Marriage,” the great American psychotherapist and teacher Carl Rogers wrote of the difficulties his adult children were having in their relationships. “So our growth together into a satisfying relationship for ourselves,” he concluded, “has constituted no guarantee for our children.” Children are a great incentive and impetus for parents to learn about themselves, about each other and about life itself. Unfortunately, much of the learning may occur at their expense.
There was never any question of a lack of love in our home. But love felt by the parent does not automatically translate into loving experienced by the child. The atmosphere in our home was often one of open or suppressed emotional conflict between the parents, mutually disappointed expectations and profound anxieties we were not even aware of.
My frustrations with life could, without warning, erupt against Rae or directly against the children in the form of rages or cold withdrawals. I could be supremely compassionate and helpful to relative strangers but present a double face of loving support and hostile rejection to those closest to me. Nowhere were my anxieties and unresolved tensions—which is to say, my unresolved grief—expressed as openly and as harmfully as in my own home.
During my children’s early years, I was not comfortable with myself except as a superactive and sought-after doctor. Besides professional responsibilities, I frequently took on other highly demanding projects at the same time. I wore my beeper as a badge of distinction. Especially in the first few years, I would hope it would sound, so that other people might see how important I was. I might have felt satisfaction in every one of my activities, but I never felt satisfied with myself or my life. I had great difficulty turning down any new responsibility that came my way—except those at home. It was virtually impossible for me to say no to any request for help, no matter what the cost to my personal life. In honoring this overwrought sense of responsibility toward others, I neglected my responsibility toward the only people for whom I really was indispensable. This feeling of duty toward the whole world is not limited to ADD but is typical of it. No one with ADD is without it.
It is exhausting even to list the various activities I was pursuing at the time I first became aware of my ADD patterns less than four years ago. Besides my busy office practice, obstetrical work and the psychological counseling of patients, I also served as medical coordinator of the Palliative Care Unit at Vancouver Hospital, one of Canada’s largest hospice wards. I was on call for the palliative service almost every night and every weekend for five years, except when on holiday. At any moment, I could be called away to attend a delivery or to look after the needs of a terminally ill person. On top of all this, I was writing a weekly medical column for The Globe and Mail. And just for something to do in my spare time, I was researching a book that—in fine ADD fashion—I dropped like a hot potato as soon as attention deficit disorder caught my interest.
One cannot live like that and not be affected. I was constantly on the go from one place to the next, always behind schedule. My newspaper columns were filed late at night, just before deadline. My office was invariably filled with patients who had been kept waiting much too long. I was semioblivious to the fact that my frenetic, catch-as-catch-can working style meant that others had to make adjustments and accommodations to their work that I had never formally negotiated with them. The palliative care nurses, with whom I had a mutually respectful and cordial relationship, said that working with me was like working in the center of a tornado. In her own efficient, quiet and calm way, my office nurse, Maria Oliverio—destined to win the Nobel Peace Prize someday—climbed the walls. People experienced me as tense, urgent, insistent.
The effect of this kamikaze juggling act on my family was devastating. On Rae’s shoulders fell all the responsibility of organizing and maintaining not just a family home but the family itself. Without any discussion or conscious decision making, she was thrust into the position of the family’s emotional lynchpin. She felt abandoned. She felt, too, that I saw her own calling as a painter as something of secondary importance.
There was also what I call the “weekend despair” of the driven personality. On Saturday mornings, there would be a crash. I was enveloped in a kind of enervated lethargy, hiding behind a book or a newspaper or staring morosely out the window. I was not only fatigued from the whirlwind week, but I did not know what to do with myself. Without the weekday adrenaline rush, I felt a lack of focus, purpose, energy. I was depleted and irritable, neither active nor able to rest.
Rae was hurt, anxious and angry. She withdrew emotionally. A vicious cycle was now complete, as my own fear and rage at abandonment were triggered. In such states of mind did we parent our children.
Young children cannot possibly understand the motives of adults. It means little to a young child that the parent feels love for him if that parent keeps disappearing at almost any time. The child experiences a sense of abandonment, a subliminal knowledge that there are things in the world much more important to the parent than he, the child, that he is not worthy of the parent’s attention. He begins to feel, at first unconsciously, that there must be something wrong with him. He also begins to work too hard to get his needs met: demanding contact, acting out or trying to please the parent to gain approval and attention.
There were many good times, of course, when we would feel connected and our children felt the warmth of our love for each other. Our photo albums are full of happy memories. But the tough times came often enough to make it difficult for the children to construct in themselves a sense of security. The emotional climate was too unpredictable and confusing.
Not only was I physically absent much of the time, but there were also my difficulties staying focused in the present. Young children are completely in the right-brain feeling world of the here and now, precisely where I felt most uneasy. My ADD-based, tuned-out absentmindedness was such that I was quite capable of reading one of my sons or my daughter a story without following a word of it myself, engaging in thoughts or fantasies that took me far away. If the child asked me a question about what I had just read, I could not answer. Even without such evidence, children can sense this nonpresence of the parent. They suffer from it.
Some of our most stressful times came during two of Rae’s pregnancies and in the first few years of our children’s lives. When one of our children was twelve months old, Rae experienced a full-blown clinical depression. During the worst of it, she was hardly sleeping at all and could barely cope with the physical demands of parenting. She was painfully conscious that she was not providing the emotional contact the child needed and helpless at the same time. She was not diagnosed or given the appropriate care for many months. The failure occurred perhaps because she was a doctor’s wife—not an uncommon occurrence. I myself was too close to her experience, too threatened by what was happening, too enmeshed in the process of it to see clearly.
There are things I wish I had not done during my children’s early years, but mostly I regret what I did not do: give my children the gift of a mindful, secure and reliable parental presence. I wish I had known how to allow myself to relax, to release myself from the compulsions driving me and to fully enjoy the wonderful little persons they were.
It may seem from what I have written here that I consider myself the villain of the piece when it comes to our family. Not so. I intend no judgment of myself, nor of anyone else. For one thing, my contribution was responsible for only one half of the strain between Rae and me. As I will discuss in a later chapter on relationships, couples choose each other with an unerring instinct for finding the very person who will exactly match their own level of unconscious anxieties and mirror their own dysfunctions, and who will trigger for them all their unresolved emotional pain. This was certainly mutually true for us. Second, judgment or blaming is not the point. Understanding is. In retrospect Rae and I can see that between us there has been a coherent process at work all these years. Everything that happened had to happen, given what we knew, who we were, and what we each brought to the marriage. It is also true that we gave our children the best that we could, and continue to do so.
None of this personal history would be of interest if it were simply an isolated tale of one family’s emotional travails. It isn’t. In virtually every one of the families I have seen where one child or another has ADD, I found stories that, while different in detail, spoke similarly of tension and stress. While most parents are aware of the stresses in their lives during their child’s early years, some report that the period of their ADD child’s infant and toddler months were purely happy ones for them. On further discussion, they usually recognize that mixed in with happy times were also considerable stresses they had not at first identified. The fact is, we in this society are often quite removed from our own emotional reality. (More discussion of the families of adults and children with ADD is included in chapter 12.) I believe that it is in these stresses experienced by the parents in spite of their will to do the best for their children that the environmental roots of attention deficit are to be found. What research data exist also supports this view, even if not all researchers or scholars have drawn the same conclusion from the evidence before them. We will turn to that, after examining how the fascinating interplay of heredity and early childhood experience shapes the development of the human brain.