and Spiritual
Some development of the capacity to be alone is necessary if the brain is to function at its best, and if the individual is to fulfil his highest potential. Human beings easily become alienated from their own deepest needs and feelings. Learning, thinking, innovation and maintaining contact with one’s own inner world are all facilitated by solitude.
—ANTHONY STORR, Solitude
THE ADULT WITH ATTENTION deficit disorder who hopes to do more than control her symptoms with medication has to learn to take care of herself, as a parent would take care of a child. Caught up by the swirling currents of her brain, she has coasted on automatic pilot all her life, engaged in the details of daily existence, giving little thought to what her needs would be for a saner, more self-connected existence. Time is scattered like sunlight through a sieve.
A good parent does more than get her child through the day. She is mindful that the child is a life-in-development, with needs dictated by the future as much as by the present. Adults with ADD cannot remember themselves in the future, as John Ratey has said. Usually they have not considered what conditions they need to grow and develop in accordance with their true nature. When I ask adults to rate themselves according to a simple scale gauging the parenting skills and attention they devote to themselves, the scores tend to be low—so scandalously low that I have advised many of my clients that if they truly were the unfortunate child being parented by them, I would have had little choice but to alert the child protection authorities. (Restraining me was only that first I would have had to blow the whistle on myself.)
As we saw in the previous chapter, self-understanding and self-acceptance are the first responsibility of the adult who wants to foster his own growth, which really is no different from what any parent owes a child. The other aspects of self-parenting also parallel the care conscientious parents extend to their children. The adult with attention deficit disorder has not lost the inborn temperamental sensitivity he carried into this world. No less than for children, conditions in his environment continue to have a direct and major impact on his emotions and thought processes—even if he has become adept at carrying on as if he were a creature liberated from reality, with no needs for nurturing body and soul.
Without the right conditions, the brain cannot develop new circuits or the mind new ways of relating to world and to self. A person cannot become sane in the midst of the chaos she perpetuates around herself. What, then, are the environmental conditions needed for development?
First, make a conscious choice about how to live. A man may look at the disaster zone in his room and decide consciously to do nothing about it. There is no should here, nor should there be a should. Counterwill, the automatic resistance to pressure, will arise in response to dictates from himself as readily as to the commands of others. He needs to allow himself at least the same degree of autonomy he would grant to a teenager. It is not a duty to clear some physical space so that his mind is not oppressed by the clutter, but it is a sensible thing to do if the long-term goal is development. If he chooses not to, it still helps to keep aware of the consequences of choice.
The adult with attention deficit disorder needs to know that the physical space she occupies can help to either harmonize or disorganize her mind. Although many ADD adults assert that they function well in the midst of the physical chaos around them, the fact is that they are too sensitive not to be affected by it. Neglecting to honor their physical environment is to neglect themselves.
If necessary, she may set herself small, incremental goals. It is discouraging to try to accomplish something that may be beyond present capacities. The ADD brain is overwhelmed by a multipartite task. She does not know where to turn, and the all-or-nothing mind-set demands that everything be done at once. Nothing needs to be done at once. The best plan, I find, is not to insist that any one task be finished but to impose a strict time limit in which to work. When the appointed time period is over, stop. This will eventually lead to a better appreciation of what one actually does with time when carrying out strange and unnatural rituals like picking clothes off the floor or sorting out dusty magazines in a corner.
This task, like all others, requires learning to tolerate failure. The many setbacks of the ADD adult have not necessarily taught him to endure failure but only to be permanently frustrated by it. Maintaining physical order may not be a difficult chore for other people, but the ADD adult might as well accept from the beginning that he will keep failing at it for some time to come. That does not matter. The effort itself, in the long term, has an organizing effect on the mind.
The ADD adult is often a night owl. The origin of the propensity to stay up late is not clear, but I believe we can learn something from observing ADD children.
A child with attention deficit disorder may be difficult to rouse in the morning, but in the evening there is no getting him off to bed. I believe the problem is separation anxiety, because I have seen the same child be much more cooperative about bedtime when he feels more secure emotionally. I noted curiously my own experience over the years that at the times when I felt less tension and anxiety about my relationship with my wife, I had less tendency to stay up late.
Something in the ADD adult dreads going to bed and turning the light off. The fear is of being alone with one’s urgent mind for even a few short minutes. I used to read until the book would drop from my hands and would wake hours later, still wearing my glasses and the lamp still burning. Many others with ADD have described the same bedtime routine. The fear of being alone with the mind is, I believe, an implicit memory of finding oneself, in infancy, cut off from contact with the parent. An infant in that situation would feel intense distress and would cast about for some other mental or physical object to relate to so as not to feel that distress. This is why small children begin to hold on automatically to their body parts, such as hair or genitalia. The unconscious fear of reactivating that implicit memory is what leads to the adult’s aversion to lying down to sleep without any diversions.
A contributing factor is that the distractible ADD mind does find it easier to focus when the noises and intrusions of the day have abated, and everyone else has gone to bed. Many adults have told me this is when they get their best work done, or when they feel at peace enough to read or to rest.
The problem, of course, is that sleep is essential for the brain to regenerate the sensitive neurological apparatus of alertness and attention. During sleep also, the mind integrates events from the waking hours. “Entering the mad world of dreams each night probably promotes mental health in ways we do not fully understand,” suggests Anthony Storr. “It seems clear that some kind of scanning or re-programming takes place in dreams which has a beneficial effect upon ordinary mental functioning.”1 This much is perhaps self-evident, but the ADD adult tends to regard his undisciplined sleep pattern as a “symptom” of the disorder rather than seeing it as undermining his emotional state, his alertness and his capacity for attention.
The parent wishes to provide the child with nutritious and attractive meals, served in an atmosphere free of tension and meant to be consumed in a leisurely fashion. Challenged on this point of self-parenting, most ADD adults throw up their hands in exasperation. Meals are not regular, not planned with nutrition in mind and tend to be wolfed down rather than eaten.
The child or adult with ADD is exquisitely sensitive not just to the external environment but also to the internal one. If we are concerned about the brain’s biochemistry, so we ought to be concerned about the biochemistry of the body: to the health of both, proper nutrition is indispensable. The ADD child completely falls apart when his blood sugar is too low, becomes hyper when it is too high, showing how directly nutritional states affect the brain. Once more, it is a matter of what the goals are. If the long-term development of mental balance is to supersede charging through the day as the objective, the internal environment cannot be ignored.
“Is your ‘kid’ getting enough exercise?” I ask ADD adults. Well-toned muscles and a healthy cardiovascular system are essential for everyone, of course. Lack of exercise leads to an internal sluggishness that undermines alertness and attention. Exercise releases substances in the brain that are necessary for mood stability, motivation and attention and, in the long term, makes the chemical apparatus that manufactures these substances more efficient. I recommend that people set a goal of vigorous exercise every day.
To balance the muscle-contracting effect of physical activity, some time must be devoted to stretching exercises before and after the workout. Stretching is important even for someone unable to do cardiovascular exercise. People with ADD, habituated lifelong to self-generated tension, tend to have tight muscles and stiff joints and ligaments. Simple stretching exercises done for a few minutes daily are tremendously freeing physically and psychologically. They are an excellent way to begin the day, and a good way to release accumulated tension before going to bed.
The parent who never takes his child out into nature, away from the city, is depriving him not only of wonderful experiences but also of a powerfully harmonizing influence for the mind. There is matchless unity, harmony and peace in nature—all that is lacking, in other words, in the ADD mind. Many parents will note that the hyperkinetic brain or body or mouth of their son or daughter will gradually slow down after a few short days away from the hurly-burly of everyday urban life. The adult, too, neglects an important need if she deprives herself of regularly experiencing the outdoors. “Nature,” writes the reclusive and hypersensitive author Marcel Proust, “by virtue of all the feelings that it aroused in me, seemed to me the thing most diametrically opposed to the mechanical inventions of mankind. The less it bore their imprint, the more room it offered for the expansion of my heart.”
Andrea, the self-declared incompetent mentioned in chapter 25, related a wonderful concentration exercise taught to her by a Native elder practiced in her people’s healing techniques. “She told me to sit down in a meadow, measure out with my eyes a patch of ground one yard square and do nothing but gaze at it for an hour. I got to know every blade of grass, noted the different textures of fallen leaves, followed every movement of ants and ladybugs, and the time went before I knew it. I was never so exhilarated. I have done it many times since.”
No parent would want to overload a child with an impossible number of tasks and responsibilities. The ADD adult’s workaholism and dread of the word “no” leads her to overextend herself. A large proportion of the ADD clients I have seen are juggling too many projects, commitments that leave them with nary a moment to finish a thought. We engulf ourselves in hubbub, chase our minds in ten directions at once and then wonder why we cannot stand still long enough to notice anything. This “symptom” of ADD, too, is self-perpetuating. It creates itself. If a mind in a different relationship to itself is a goal, we need to clear some ground for its development. We may need to let some activities go.
There is a difference between entertaining diversions and recreation. Watching television may be entertaining but it is not a process that re-creates. One does not flick off the set feeling refreshed. Re-creation needs activities that nourish the mind or liberate the body. What these may be will vary from person to person, but universally ADD adults deny themselves regularly scheduled times for mental and physical regeneration.
It is unusual for me to meet an ADD adult who does not have some secret longing for artistic expression, and almost as unusual to find one actively doing something about it. Essential to finding meaning and purpose in life is the liberation of one’s creative instincts.
On Internet chat lines about attention deficit disorder, one can find lists of success stories: individuals who, despite their ADD, became great artists, writers, geniuses. It is even argued—dubiously, in my opinion—that ADD confers advantages such as creativity and a good sense of humor. Mozart, Einstein and Edison are some of the illustrious examples.
The tendency to creativity of the ADD mind cannot be denied. Even those without an artistic interest will show a creative streak, being able to apply their fertile minds to difficult situations and to come up with solutions others would never dream of.
I would myself love to believe that the neurophysiological impairments and psychological dysfunctions I have been writing about in this book also have their positive side, granting me, like others, some powers of creative expression. Unfortunately, though, what gifts I may have been blessed with have not been helped in their development by my disorganization, drivenness, distractibility, lack of persistence, forgetfulness and periods of psychic lethargy. But for such ADD traits, they would, I believe, have found their way to whatever sunlight they merit much earlier in my life.
I do not believe ADD leads to creativity any more than creativity causes ADD. Rather, they both originate in the same inborn trait: sensitivity. For creativity, a temperamental sensitivity is indispensable. The sensitive individual, as we have seen, draws into herself the unseen emotional and psychic communications of her environment. On some levels of the unconscious, she will, therefore, have a deeper awareness of the world. She may also be more attuned to particular sensory input, such as sound, color or musical tone. Thus the sensitivity provides her with the raw materials her mind will rework and reshape. Thus sensitivity contributes to the emergence of attention deficit disorder, as well as to creativity.
Colin, a forty-year-old I diagnosed two years ago with ADD, had been working as a bartender for the past twenty years, making good money, drinking more than he should and berating himself for not having a university degree like his siblings. His real interest was in filmmaking. Part of my treatment approach is to explore with people their creative natures, to urge them to do some self-inquiry why this side of the personality may have been disregarded. If self-esteem means esteeming the self, the individual’s deepest creative urges must be honored. The self-parenting part of healing ADD must, I am convinced, involve paying attention to one’s need to create.
Colin came to see me recently. He has begun to work in Vancouver’s thriving film industry. He is loving it and will soon take a courageous plunge into economic insecurity by quitting his hotel job. “There is only one thing I feel bad about,” he says. “I am working with all these people who knew what they wanted. They are twenty years ahead of me. I have a lot of catching up to do.”
“It’s a loss,” I agreed. “But first you had to catch up to yourself.”
Not everyone would be able to earn a living in his chosen field of creative expression, but I always urge people to identify the direction in which their creative energies would naturally flow, and to allow them expression. Many ADD adults don’t have to search for anything new in following this advice; they just have to reconnect with something they had lost contact with long ago.
The problem of ADD, like any other problem facing people individually or collectively, can only be resolved if we take a balanced view of our needs as human beings. We have seen how it is important to be attentive to the body and also to seek help in untying the psychological knots binding us. The third pillar of a balanced human existence is spiritual work. This could take place in a religious context, but not necessarily. Spiritual work is the cultivation of a mindful solitude. All traditional meditative and contemplative practices, including many types of prayer, have as their purpose helping us to disengage for a time from our concerns with people, objects, desires, thoughts and fears, to actively strive for connection between ourselves and the rest of creation. Enormously beneficial to everyone, spiritual work is essential in the self-treatment of ADD.
The age-old wisdom of traditions from all continents and cultures tells us that reality has aspects more profound and more universal than we tend to imagine in our harried and isolated workaday lives. The person who feels that he is not being “himself” recognizes this implicitly. Without being able to explain why, he senses there is a truer self he does not experience directly but which exists nonetheless—otherwise how would he know that he is not being that self? Intimations of the true self, a vague awareness, seeps into our consciousness, if only in the form of the dissatisfaction we feel at not being able to contact it. We sense somehow that in many of our pursuits we are chasing shadows, but the very existence of shadows implies the existence also of the real objects, beings, or entities represented by them. When a human being says that she does not know who she is, she is communicating her conviction that what she does know of herself is only a partial reflection of the completeness which is her true self.
The quintessential achievement of Western civilization, the scientific method, has come to be interpreted so narrowly that it has been used to exclude essential knowledge human beings have worked and studied and struggled over hundreds of generations to gain: the knowedge that we are not just the molecules that accidentally have come together to form our bodies, the thoughts that temporarily engage our minds, the feelings that agitate or soothe us from one moment to the next. So “scientific” have we become, that our science has come to ignore or deny the work and experience of the greatest teachers of humankind.
Lest I present myself as a proselytizer or as one who has any right to claim authority about such things, I must confess that I have never had the spiritual experiences that would allow me to speak of these matters from direct knowledge. For one thing, only recently have I begun to pay some deeper attention to my own spiritual needs—and so far only in a typically inconsistent ADD fashion. Yet it seems to me somehow that I remember these spiritual realities, which to me means that somehow I am not completely cut off from them, although I used to think that I was.
People who have examined the question of “the real self” in some depth, for example the psychiatrist and Buddhist practitioner Mark Epstein and the spiritual master and psychologist A.H. Almaas, say that for the full realization of the self one must employ the understandings and insights of modern Western psychology, and also the spiritual explorations of the Eastern and Middle Eastern traditions, or, no doubt, of the native spiritual teachings of other continents. They do not suggest a synthesis of Eastern spirituality and Western psychology—they show that both these pathways explore the same ground. You do not need to synthesize that which is already a unity. I am convinced they are right.
The search of the fragmented ADD mind for oneness must, therefore, involve also the spiritual quest, however an individual may wish to define that for him or herself. Meditation is the method I have chosen for myself. The ADD mind is most uncomfortable with meditation, is intensely bored with it. It’s all the more amazing to me that recently I have actually come to enjoy and look forward to it. It becomes fun, after a while, to watch the fretful and anxious mind do its backwards flips, somersaults, and disappearing tricks—to observe it all, and work at not being identified with it, not mistaking it for me.
Of all spiritual traditions, Buddhism has cultivated meditation most deeply. Nietzsche called Buddha “that profoundest physiologist.” He may well have said neurophysiologist. We have seen that part of the neurophysiological basis of ADD is the tenacious survival of neurological pathways first activated in early childhood, resulting from the tendency of a group of nerves to fire off together repeatedly if they have fired off together once. Meditation aiming at mindfulness, at strengthening the observing “third eye” in the mind, is a direct way of weakening the hold of ingrained neurological responses. “Pay precise attention,” writes Mark Epstein, “moment by moment, to exactly what you are experiencing, right now, separating your reactions from the raw sensory events.”2
Meditation is one way of acting on the neurophysiology of ADD. It is an important way, but not the only one. Any activity, from gardening to martial arts, 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.
Without some sort of practice, we can no more develop the skill of concentration than we can learn to play the piano. Nothing is more difficult for the ADD mind than to meditate, or to contemplate anything with determined attention. A brain used to decades of inattention and disorganization will not overnight reorganize itself. If attention and presence of mind are the long-term goal, time and effort need to be devoted to their cultivation each and every day. In the beginning, a person does well if out of the, say, twenty or thirty minutes he devoted to such a practice each day, he succeeded in focusing for even 10 percent of the time. It really is a matter of developing sinews long weak from disuse.
With all these self-parenting tasks, the catch-22 for the ADD adult is that the very state he is wanting to grow out of hinders his capacity to create the conditions required for growth. In order to settle the chaos inside, we have to clear up the chaos outside, which was generated in the first place by the chaos inside. After a lifetime of discouraging experiences, people naturally hope that the help they need will be found in a pill or in the wisdom of some expert. “Many people want to remake their lives,” the physician and writer Andrew Weil points out, “but cannot imagine doing so without outside help. If only some skilled hands could apply the necessary force to get them going, they could do it, but on their own they remain in habitual ruts.”
As we have already seen, no one can instill motivation in anyone else. No one can forcibly induce motivation in oneself either. The best attitude to adopt is one of compassionate patience, which has to include a tolerance for failure. When it comes to changing unhealthy habits or instituting healthy ones, writes Weil, “whether you succeed or fail is less important than making the attempt.”3
When to begin? No better moment than the present. Or, in the memorable and eternally inspiring words of a former British Columbia cabinet minister: “It’s time to grab the bull by the tail and look him firmly in the eye.”