Let’s Have a Problem”
“I Bet I Can Get You to Yell at Me or Hit Me”
“My Thoughts Are More Terrible than Your Thoughts”
“It’s Your Fault and I’m Not Responsible”
“No, No Way, Never, You Can’t Make Me Do It”
“I Say the Opposite of What You Say”
“I Say the First Thing That Comes to Mind”
“Let’s Call It Even”
“Fighting as Foreplay”
Many people with ADD unconsciously, based on brain-driven mechanisms (not will-driven), play ADD games as a way to boost adrenaline and stimulate their frontal lobes. These games just seem to happen. No one plans for them to happen. Most ADD people deny that they engage in these behaviors, but I have seen these games in my own family and I’ve heard about them from my patients for many years. Let’s look at each of these games in depth.
Without enough stimulation, the brain looks for ways to increase its own activity. Being mad, upset, angry, or negative has an immediate stimulating effect on the brain. Whenever you get upset your body produces increasing amounts of adrenaline stimulating heart rate, blood pressure, muscle tension, and, yes, brain activity. Many people with ADD pick on others to get a rise out of them, to get them upset, to make them crazy. So often family members of my patients tell me they are tired of the problems in their families. They say, “I’m so tired of fighting with my brother [sister, mother, father, son, daughter, etc.]. Why does there have to be this turmoil? Can’t he [she] be happy with peaceful coexistence? Why does he [she] always have to fight? He [She] always has to Have a Problem.”
Here are three examples of “Let’s Have a Problem.”
Joshua and Betsy were married for three years before they entered marital counseling. Betsy forced Joshua to get help. Joshua didn’t see any problems and initially refused to see the therapist, but Betsy was beside herself. It seemed to her that they fought nearly all the time. She never felt at peace, never felt that they could have an evening or weekend where Joshua didn’t complain about something. Even though Joshua was successful in his own business, he frequently complained about his employees. Betsy, who also worked with him, saw that he would regularly select an employee to pick on or engage in some kind of battle. Betsy felt constantly stressed, but Joshua didn’t notice a problem. After an extensive intake interview, the therapist saw Joshua’s conflict-seeking behavior as only one of his many ADD symptoms, including disorganization, distractibility, and impulsivity. She referred Joshua for a psychiatric evaluation, but also worked with the couple on strategies to recognize and stop this destructive game.
Rosemary and Chrissy, mother and sixteen-year-old daughter, constantly fought. It didn’t seem to matter about what: it could be curfew, clothes, music, tone of voice—whatever. I met Chrissy when she was brought to our clinic for evaluation because of trouble at school. During the initial interview with Chrissy and her parents, I watched the two females go after each other. The tone between them was contentious, mutually irritating, and on edge. The father wearily told me, “This is how they live at home. Everything is an issue. Everything is a problem. They both hold on to their own positions and cannot let go. It’s as if they have to irritate each other. I often don’t want to come home because I know I’ll have to listen to their battles.” In the evaluation process Chrissy was diagnosed with Overfocused ADD (school struggles, inattention, impulsivity, restlessness, and oppositional and argumentative behavior), as was her mother who grew up in an alcoholic home, struggled in school, complained of low energy, disorganization, procrastination, and forgetfulness. After they were both treated for Overfocused ADD, the tension diminished dramatically. The need for conflict diminished and the father felt less stressed and more comfortable at home.
Wesley and David were brothers, nine and seven. Wesley was diagnosed with ADHD (Classic ADD) at the age of five, but the parents decided against treating him; they were afraid of the side effects of medication. The boys fought all the time. The parents knew that Wesley instigated most of the fights, but they didn’t know how to deal with the situation. They came in for family therapy when David started to complain of frequent headaches and stomachaches. When I talked with David alone he told me he felt upset a lot of the time. He said that Wesley punched or kicked him whenever they were in a room alone, he called him names, and he said terrible things about his friends. The parents’ decision to withhold Wesley’s treatment had a very serious negative impact on David. Through proper education on the risks of not treating ADD, they decided to try medication for Wesley, along with exercise, and dietary changes. David’s headaches and stomachaches went away when his brother stopped picking on him all the time.
A similar game to “Let’s Have a Problem” is “I Bet I Can Get You to Yell at Me or Hit Me.” Many people with ADD are masterful at getting others to scream, yell, spank, and basically get out of control. They get others so upset, that they cannot help but lose it. These negative behaviors provide quite an adrenaline rush, but frequently lead to serious negative consequences, such as divorce, fights at school, being fired from a job, and even abuse. Again, the game is unconscious, not planned. It seems as if the ADD person senses the most vulnerable issues for others and they work on them until there is an explosion.
Here are three examples.
Bonnie had been diagnosed with Inattentive ADD at age twelve. The only treatment she received was medication, which she took sporadically. Now at age fifteen, she struggled in school and had problems with her parents at home. Her father was frequently upset with her because of her disrespectful tone. She also fought with her mother and a number of her teachers. The parents were very angry at the school because one of the teachers had yelled at her to shut up and sit down in class a number of months earlier. The teacher was disciplined by the school for the outbursts, but she said that she just couldn’t take Bonnie’s lack of respect and disruptive behavior. During Bonnie’s initial evaluation in our clinic her father cried, saying, “I never thought I would have such negative feelings and behaviors toward my own child. I just start screaming at her because she says terrible things. She knows every hot button I have and she pushes them on a regular basis. Sometimes I understand why parents abandon their children. They just can’t take the negative feelings, the lack of respect, and the constant fighting.”
Jesse, age six, had parents who did not believe in spanking. They were well-educated people who discussed how they would raise their child even before he was born. Yet, even though they didn’t want to use spanking, they often found themselves on the edge of losing control. They yelled more than they wanted to, and they found themselves using physical punishment on impulse because they would get so frustrated with Jesse’s misbehavior. Jesse was impulsive and seemed driven to turmoil. The parents found out that when they yelled or spanked him his behavior would be better for a while. The mother told me, “If we have a bad morning at home, he has a good day at school. If we have a kind, loving morning at home, then he seems to have a bad day at school.” I diagnosed Jesse with Classic ADD; he had the full cluster of symptoms. Besides treating him medically, I worked with his parents on effective parenting strategies. I warned them that as soon as they stopped yelling at Jesse, he would get worse for several weeks. It was as if he was going through adrenaline withdrawal. The parents yelling, screaming, and hitting were stimulating to him, and he, unknowingly, used their anger to feel more alert, which is why he did better in school if they had a bad morning at home.
Evan and Alexa, ages fifteen and twelve, were a brother and sister at war. Evan was diagnosed with Classic ADD when he was ten years old and Alexa had only recently been diagnosed with Overfocused ADD. The parents brought them to our clinic for medication and family therapy evaluations. Both siblings seemed to be masterful at upsetting the other one. There were frequent screaming, shouting, and physical fighting episodes. It seemed to the parents that both of them were involved in starting fights, and they had been at odds for as long as they could remember. On one occasion—the one that precipitated the referral—Evan came into Alexa’s bedroom to borrow a CD. Alexa screamed at him to get out. When Evan refused, she threw a speaker at him. When the speaker hit his arm, he attacked her, leaving bruises all over her body.
It is essential to stop playing both “Let’s Have a Problem” and “I Bet I Can Get You to Yell at Me or Hit Me” if an ADD person is to live happily with others. One of the more interesting phenomena I’ve noticed is that when I teach parents, siblings, and spouses to become less reactive, to not feed the need for adrenaline with anger, the ADD person may initially get worse. It seems as though the ADD person goes through withdrawal when others become more understanding or more tolerant, at least initially. When they can no longer get the adrenaline anger rush, they go after it full force. Unconsciously, they seem to say to themselves, “I have been able to get my adrenaline fix from you for a long time, I know I can make you yell at me,” and then escalate the outrageous behavior. But if a parent, sibling, or spouse can remain nonreactive for a long enough period of time, the conflict-driven behavior usually significantly diminishes. Like a drug addict (I’m talking about adrenaline junkies) they will periodically test the “nonreactive skill” of the people in their environment by seeking intense emotional reactions. Others have to remain on guard to keep these negative behaviors away.
Psychiatrist and brain imaging specialist Mark George demonstrated, in a landmark study, that negative thoughts have an overall stimulating effect on the brain. Using functional brain imaging studies, he looked at brain activity while people were thinking about something neutral, something positive, and something awful. The neutral thoughts did not change brain activity. The positive thoughts actually cooled overall brain activity, especially in the limbic area of the brain (certainly not good for ADD folks who have poor brain activity). The negative thoughts brought overall brain activation, especially in the limbic areas (making them more depressed) and in the prefrontal cortex (helping them focus).
Clinically, I have seen that many ADD people seem to be experts at picking out the most negative thoughts possible and staying focused on them for prolonged periods of time. It is almost as if they need the negativity to have the mental energy to get work done. When I started to talk about this idea to colleagues at my clinic Jonathan, a marriage, family, and child therapist who has ADD, said, “I think I do that myself. I wake up thinking about the most horrific things that could happen during the day. I feel anxious, but it motivates me to get up and get moving.”
You have probably noticed the people who play this game at work. If ten good things and one bad thing happen, most of the thoughts are focused on the bad thing. These are the people at work who complain, gossip, find fault, undermine, and pit people against each other. As managers, they are often the ones who notice the negative much more than the positive.
The negativity that is often associated with ADD frequently ruins lives. Few are drawn closer to people who are negative, complaining, or filled with anxious thoughts. Many ADD people who unknowingly play this game end up isolated, lonely, depressed, and even more negative. People who are isolated from others have a higher incidence of both physical and emotional problems.
Some time ago, one of the physicians who worked in my office went through a period during which he was one of the most negative human beings I had ever met. He always had a sour look on his face. Every time I saw him he complained nonstop about office procedures and personnel. He was negative with patients. He hadn’t exhibited this behavior when I hired him. I found myself avoiding him in the hallway and feeling frustrated by his behavior. After several weeks of this behavior I told him to come into my office. He started the meeting by complaining about a front office issue, without first wanting to know why I asked to see him. Immediately, I stopped him, saying, “I don’t know what is going on with you, but something is different. You complain nonstop about nearly everything. People are avoiding you and patients don’t want to see you anymore. I feel we have a serious problem on our hands.” The doctor then told me that he had ADD and that he decided to stop his treatment a month ago. He didn’t know why he stopped it, but he felt he was struggling more socially and at work. I told him that as his boss I couldn’t advise him on his treatment, but if the negativity and complaining didn’t stop he would have to leave. I gave him a three-month trial period to straighten out. He immediately started taking his treatment again and the negativity problem subsided.
Many people with ADD, who play the game of “My Thoughts Are More Terrible than Your Thoughts,” end up divorced, fired, asked to leave school, isolated, and lonely because the negativity pushes people away. Be careful with negativity. If you use it as a stimulant you might want to get your medication adjusted or increase your exercise. This is a damaging and dangerous game.
Another common game played by many people with ADD is “It’s Your Fault.” This may be the most dangerous ADD game of all. In this game the ADD person reasons that he (or she) has little, if anything, to do with the problems in his own life; everything is someone else’s fault. Frequently, I hear that these people do not perform properly at school, work, or within their families because of “the lousy boss, the ineffective teacher, or the mean brother or sister.” This game can completely ruin a life. Whenever you blame someone else for the problems in your own life you become a victim of that other person and you have no power to change anything. Without a sense of personal power people often feel overwhelmed and hopeless.
Billie Jean came into my office complaining about nearly everything in her life. Her husband mistreated her, her children neglected her, her boss was mean to her, and her doctor (not me thankfully) didn’t take her seriously. When she was late to an appointment it was because of traffic; when she missed a payment it was because she hadn’t gotten her mail. There was just an excuse for everything. Gently, I started to ask her what she could do to make these situations better—with her husband, children, job, and organizing her life. I felt it was critical for her emotional health. Unless she took responsibility for her emotions and reactions, she would always be at the mercy of others. I felt that her tendency to blame was a way to become angry and entitled so that she could use the anger as a stimulant. I began teaching her this concept, which, through therapy, she recognized as a common operant factor in her life. Eliminating blame and asking herself, “What can I do to make the situation better?” was one of the most important parts of her healing process. For example, she used to frequently complain that her children treated her with disrespect. She would yell, scream, cry, and carry on about how badly she was treated. When she asked herself, “What can I do to make the situation better?” she realized that her lax, but hostile parenting style (with poor follow-through—very common in ADD mothers) actually contributed to the problem and that she had to become firmer with the children—without the emotional outpouring that only made the situation worse. By taking responsibility and charge of the situation she was able to make a very positive difference.
It is very important to watch out for the “It’s Your Fault” game. It may ruin your life.
Opposition probably also increases adrenaline in the ADD brain. Many people with ADD, especially Type 3, tend to be argumentative and oppositional with people in their lives. These negative behaviors often cause tension and turmoil in families, relationships, or at work. Many parents tell me that they are very tired of arguing with their children. This game has one simple rule: The first response or reaction to any request is no, no way, never. I frequently ask my patients this question: “How many times out of ten, when your mother (father, teacher, boss) asks you to do something, will you do it the first time without arguing or fighting?” Many of my patients tend to look down at the floor when I ask this question. They quietly say, “Not many times, maybe two or three times out of ten.” I then ask them why. What is the need to oppose? They tell me they have no idea why they do it. It is not their goal to be oppositional.
Some time ago, I had a very interesting session. I saw a ten-year-old boy for the first time. He came into my office with his mother. He immediately sat down on my blue leather coach and put his shoes on the coach (which didn’t bother me, I figure if you see difficult kids you have to have an office that will stand up to them). But the shoes on the coach did bother his mother. She told him to put them down. When he refused, she put them down on the floor. He immediately put them back up on the sofa. She looked at me in frustration and then moved her son’s feet back on the floor. He put them up. She put them down. He put them up again. She put them down again and slapped his leg. This went on and on. I watched to see the interaction between them. He wanted his way. She was determined not to give in, but she engaged in the same repetitive ineffective behavior. She would have been better served by cutting the oppositional behavior right away and giving an immediate, unemotional but firm consequence. After about ten minutes of this behavior I asked the boy if it was his plan to upset his mother. He said no. Then I asked him why he had to do the opposite of what she wanted. He said, like so many of these kids do, “I don’t know.”
The unconscious game of “No, No Way, Never, You Can’t Make Me Do It” can ruin someone’s life. The level of opposition often drives others away, causing them to make negative judgments about you and emotionally push you away. While writing this book, I went to Israel to speak at an international ADD conference. While at the conference I had the pleasure to spend time with a family who had come to see me in California. The eleven-year-old boy had been depressed when he came to my clinic. Through his history and our scans we were able to properly diagnose him, put him on the right treatment, and help the family with the right behavioral strategies. He made a wonderful improvement. The child and his mother joined my daughter and me on a trip to Jerusalem. We went to the Church of the Holy Sepulcher and traced the steps of Jesus through the Stations of the Cross. The souvenir shops caught the boy’s attention. He wanted a chessboard. The mother said no. He asked again. She said no again. This went on for about thirty minutes. I watched. Finally, the boy asked me how he could get his mother to get him a chessboard. I said, “You don’t want to hear my answer.” He said he really wanted my help. I told him (with his mother listening), “If your mom gets you what you want after she has already told you no fifteen times, then she is teaching you to get your way by irritating other people. You’ll be difficult and no one will want to be with you, because you will have to have your way.” He put his hands over his mother’s ears so she wouldn’t hear any more of my advice. Later he said, “Dr. Amen, you are right. I don’t like people who are pests. I’ll try not to be one.”
You cannot let people badger you or irritate you into getting their way. If you allow this game to work, it sets up serious social problems. No one likes someone who argues with everything you say or opposes you most of the time.
Another destructive ADD game is one I call “I Say the Opposite of What You Say.” This game is similar to “No, No Way, Never, You Can’t Make Me Do It,” but it involves speech more than behavior. The people who play this game take the opposite position as the other person in the conversation, whether they believe in the opposition or not. For example, if your spouse complains that you do not listen to him (her), you deny it and then say that he or she does not listen to you. If a parent tells a child to clean his messy room he is likely to say that his room isn’t messy. If a person takes a view on a political position, you will take the opposite position (even if it is against what you really believe). The need to oppose seems to be more important than the truth. The back and forth disagreement brings more adrenaline, stress, and irritation to the table. Watch out for this game. It pushes people away from you.
It seems to me that many politicians are masters at this game. I have often thought that many politicians had ADD. If a Democrat has a good idea, the Republicans will automatically put it down; and if a Republican offers a helpful plan, the Democrats will automatically look for ways to shoot holes in it. Cooperation is so foreign to the political process it is a wonder anything actually gets done. Unfortunately, this same dynamic happens in many ADD homes. The lack of cooperation stresses so many family members.
Many of my patients struggle with the game of “I Say the First Thing That Comes to Mind.” I have heard a number of my patients say, “I am brutally honest.” They wear this trait as if it is a badge of courage. I usually reply to them that brutal honesty is usually not helpful. Relationships require tact.
Recently, I walked into my waiting room to greet an eight-year-old patient. I was about ten minutes late for the appointment. When she saw me she said, “Well it’s about damn time.” Her mother looked horrified and apologized for the little girl’s comment. Living in an ADD household, I know comments like that were just part of the terrain.
This game causes many, many problems. When you just say the first thing that comes to your mind, you can hurt someone’s feelings, infuriate a customer, or give away secrets that were entrusted to you. One of my patients was charged with bringing a friend to his surprise party. On the way to the party he inadvertently started talking about how much fun the party would be. When he saw the look on his friend’s face he was horrified that he had ruined the surprise.
It seems that many people with ADD also play a deflection game titled “Let’s Call It Even.” In this game, whenever someone else has a complaint or criticism, the player also takes on the complaint as his own. For example, if a husband is unhappy that the house isn’t clean, the wife may complain that he doesn’t help enough. If a wife complains that her husband doesn’t listen enough, the husband will complain about the same thing. If a sibling says that her sister goes into her room and takes things, the sister will say she does that because her sister does that too.
Many couples that I have seen through the years have described a fascinating ADD game I call “Fighting as Foreplay.” In this game there is an intense fight, then a period of making up, which includes making love. The swing of emotions is quick and dramatic. One minute you are fighting, talking about divorce and ready to leave the relationship, the next moment you are making wild passionate love and feeling blissful. It’s confusing to the participants, but makes some biological sense. The fight is needed for stimulation. Once stimulated you are ready for love.
All of these games are very destructive in ADD relationships. The first step in eliminating these games is to notice them, then use the treatment guidelines in this book to feel better and help eliminate the games ADD people play.