Scattered Minds: The Origins and Healing of Attention Deficit Disorder

Working as a psychologist with high performers I regularly see clients with ADHD. Sometimes diagnosed but also, as wait times for adult diagnosis can be very long or very expensive, suspected. I find even if someone just suspects they may have it then it can be helpful to work as if they do – helping to put in place external scaffolding, support or strategies that make life feel smoother and easier to navigate.

I am working on understanding the impairment much better at the moment and one of the books I was recommended was Gabor Mate’s Scattered Minds. The book is an international bestseller for a reason; it is easy to read, clear and compassionate and pitched at a good level with just enough science, lots of sociology and some clear ways to help yourself or others.

There are a few quotes that I loved:

• “ADHD is not a problem of knowing what to do – it is a problem of doing what you know.”
• “Never at rest the mind of the ADHD adult flits about like some deranged bird that can light here or there for a while but is perched no-where long enough to make a home.”
• “It would be nice to get a break from myself for a little while.”
• “The sense of always being on the outside looking in.”

The book was published in 1999 and it feels dated. Mate calls it ADD whereas today it has been classified into a number of different types but most generally talked about as ADHD. I’ve changed it in this review so it makes more sense in 2022. I also found the science behind the genetic and biological elements of the impairment more compelling than the evidence he gave on it having such a strong environment aspect. The environmental aspect (basically that difficult family dynamics will trigger a predisposed ADHD likelihood) felt far more anecdotal.

He lists a number of symptoms or behaviours that might be seen in someone with ADHD:

• Pain and tension
• A sense of being cut off from the physical present
• Low self-esteem
• Needs more motivation to do things than others might
• Plans never fully realised and intentions unfulfilled
• Impulsivity & poorly controlled emotional reactivity
• Hyperactivity – the mind and body in perpetual motion.
• Addictive tendencies
• Tuned out absent mindedness
• Hostile rejection of self and those closest to you
• Time-blindness by under-estimating the time it will take to do things.
• Chronic incapacity to consider the future
• Low frustration tolerance
• Hoarding

Impairment

Mate talks about ADHD not a disorder but an impairment. He says that ADHD reflects biological malfunctions in certain brain areas but many of its features are connected to a person’ physical and emotional experiences of the world. “When certain genetic material meets a certain environmental ADHD may result.” Mate suggests there is an inherited predisposition but no predetermination. He is clear that it is not that a disorder that develops but that certain important brain circuits do not develop and this interferes with the conditions required for the healthy development of the prefrontal cortex.

Attachment

This highlights the strongest theme in the book: he suggests that while there is a genetic element it is upbringing that really ‘triggers’ ADHD. His work focuses incredibly strongly on attachment theory and he says that from his work with adults he can see where there have been psychological tensions in the parents lives during the child’s infancy and they do not have the relationships that they need. He says family dynamics are important because when the dynamics are complex or insecure they can make strong attachment harder. Those families who have moved a lot, include someone very stern who prompts others to walk on eggshells, have alcoholism or suffered from major depression will contribute to lower levels of attachment and this can have a negative influence on our brain development. This theory is so strongly promoted I was left wondering if he sees ADHD as an attachment disorder?

What I really reflected though was that many of the suggestion for the ways you should specifically parent a child with ADHD would actually be beneficial for many children. I tried a couple of the tactics with my 5-year-old (things like instead of being nagged to join in their play actually ask if you can join in, or treating a temper tantrum as a fear response) and could instantly see a welcome change in behaviour.

Suggestions include:

• The parent taking responsibility for the relationship; demonstrating daily that they want the child’s company. They do not wait to be invited in – they ask to join in. “The hunger in a child is eased by the parents seizing every possible opportunity to devote positive attention to the child precisely when the child has not demanded it.”
• The parent not judging the child to pointing out faults, mistakes, shortcomings as shame will cut off the child.
• Praising the child, but in measured terms, when it is deserved.
• Refraining from criticising, giving orders or expressing opinions.
• Not trying to protect them from sadness or failure – emotional distress is required to thrive as an adult. It takes a lot of loving to help a child except sadness to know that it can be endured and that sadness like all other states will pass.
• Remembering that temper in the AHDH context is an automatic anxiety response. It is the reaction of a person who cannot tolerate the feelings of anxiety. If we sooth the anxiety the temper should calm.

The book also covers the specific behaviours we would see in children, the markers of low self-esteem that arise (and how to handle those), the issue of ‘counterwill’ and how to support teens who are showing that, the impact of implicit memory (and why the attachment issue is so important), how to self-parent yourself if you have ADHD and addictions (which have been found to be higher in those with ADHD).

I felt while the book was dated and single-sided it have some helpful techniques and feels like a strong starting place to go and look for more recently researched information.