While features of many other chronic and troubled psychological states, such as depression, for example, low self-esteem and merciless self-criticism are so much part of the ADD personality that it would be difficult to know where ADD ends and low self-esteem begins.

How one treats one’s body and psyche speaks volumes about one’s self-esteem: abusing body or soul with harmful chemicals, behaviors, work overload, lack of personal time and space all denote poor self-regard.

Absolutely universal in the stories of all adults with ADD is the memory of never being comfortable about expressing their emotions. When asked whom they confided in when as children they were lonely or in psychic pain, almost none recall feeling invited or safe enough to bare their souls to their parents.

When I explore with my clients their childhood histories, emerging most often are patterns of relationships that required the child to take care of the parent emotionally, if only by keeping her inmost feelings to herself so as not to burden the parent.

At our second session, I asked Andrea, the fifty-year-old self-confessed failure at the game of existence justification, if she had truly never done anything worthwhile in her life. She was silent for a while. “I have tried to be kind to people,” she finally replied. “I have tried not to hurt people. I am creative in crafts. I teach people. I do a bit of gardening. But to me those things come easily. That’s just who I am. I didn’t have to work at them much. I mean, I’m not an accountant or a lawyer.” “Would you want to be an accountant or a lawyer?” “It’s not that I feel like doing those things,” Andrea said, again after a moment’s pause. “It’s that I think I should feel like doing them. I am still trying to get my father’s approval.”

In my undergraduate years and even beyond, I had little respect for my ability to write. I could use it to advantage—for example, my capacity for relatively elegant verbal flourishes inflated the value of some pretty thin essays—but I had little regard for it precisely because I felt it came naturally to me. “I don’t trust my words,” I would say. “They come too easily.” It never occurred to me that possessing a vein of talent did not mean that one could not work diligently at mining it.

The adult with ADD is buried under a mound of yeses, many of which are not true yeses at all, only no’s he dared not say. Life is one long exercise in trying to tunnel out from under them, a frustrating task since one keeps adding to the stack faster than one can take away from it.

If the child does not feel accepted unconditionally, he learns to work for acceptance and attention. When he is not doing this work, he feels anxious, owing to an unconscious fear of being cut off from the parent. Later—as an adult—when not doing something specific, he has a vague unease, the feeling that he should somehow be working.

The adult has no psychological rest because the infant and child had never known psychological rest.

Submerged beneath a surface rippling with superficial and childish impulses are truer impulses for meaningful activity, the assertion of her autonomy, the pursuit of her own truth and human connectedness. The deeper these have sunk, the less one knows who she is or in which direction her path lies. Attaining self-esteem begins with finding our true impulses and raising them to the light of day.

The reflexive shrinking away from intimacy undermines the ability of the ADD adult to find what he would find most healing: mutually committed loving contact with another human being.

Trevor has tried therapy here and there in the past. These efforts usually ended after a few sessions spent trying to identify the traumatic events that would have led to his confused and conflicting emotions around relationships. The problem was that he could not recall anything traumatic.

There are memories, the psychiatrist Mark Epstein explains, “that are not so much about something terrible happening, but, in the words of D. W. Winnicott [the great British children’s psychoanalyst] about ‘nothing happening when something might profitably have happened.’ These events are more often recorded in the soma, or body, than in the verbal memory, and they can be integrated only by subsequently experiencing and making sense of them.”

People with ADD are exquisitely sensitive to the merest hint of it, even if the hint is only a figment of their fearful imagination. It is triggered by any stimulus that ever so vaguely resembles rejection, even if no rejection is intended.

Especially men with ADD will, entering deeper into a relationship, keep half an eye on possible exits.

Many adults with ADD report that they quickly become bored with relationships, as with much else in life. They imagine this boredom of theirs to mean that something is lacking in their partner: the reality is that they are bored with themselves.

“It’s only when I am alone that I can really be myself,” said Frank, a fifty-year-old writer who came to see me in the immediate after-math of yet another abortive relationship.

The unsolved problem is how to be oneself in contact with other people.

One gauge of persistent problems with intimacy in an ADD relationship is the couple’s sexual life—or the lack of it. “Non-existent” and “What sex life?” are two of the common replies my questioning around this subject tends to bring. The lack of sexual intimacy is in most cases an unmistakable sign of mutual emotional shutdown.

Also dampening sexual ardor is the propensity of the ADD adult, the male especially, to behave like an irresponsible child. This may lead his spouse to act like his mother—organizing his life, taking care of his emotional needs.

The couple find themselves chronically caught in the dense shrubbery of anxiety, control, resistance and oppositionality. One of the problems with such a mother/son relationship is, of course, that no mother in her right mind wants to sleep with her son; nor do reasonably healthy men fancy going to bed with their mothers.

I have frequently advised couples that if they truly want adult intimacy, they mutually need to give up the parent/child roles toward each other.

What we might call the law of equal development holds true even if the partners themselves buy into the mythology that one of them is more emotionally mature than the other.

Since ADD by definition implies underdeveloped emotional intelligence, any such relationship, also by definition, will begin with two people who have both been stuck at fairly early stages of emotional development.

By maturity, I mean here the degree of individuation, the capacity of the person to genuinely sustain herself emotionally during difficult times without having to be mothered or fathered by someone else.

Guilt is obsessively single-minded, knowing only one stimulus and only one response. The stimulus is this: you, child or adult, wish to do something for yourself that may disappoint someone else. This could be a true misdeed, such as stealing, or a human desire to act in accordance with your core impulses, perhaps by expressing a genuine feeling the parent cannot tolerate in you. Guilt does not know the difference. It hurls at you the same epithet for both misdeed and self-expression: selfish.

It may seem contradictory to acknowledge that in fact many people with ADD do act in selfish ways, particularly when it comes to their Addictions and compulsions of various sorts. How does that square with what has been said just now about the inhibiting effect of guilt and anxiety? I can attest that in some important aspects of my life—not all—I have always been a people pleaser, suppressing my truest self. I have also often behaved with narcissistic self-regard. The more the core self—the deepest impulses—is suppressed, the more compulsive are the attempts to compensate by satisfying superficial, infantile, instant-gratification impulses and desires.

Of all types of professional training, the one I consider most likely to be of benefit in ADD is Family therapy. The skilled Family therapist is not fixated on people’s dysfunctions and their difficult feelings. She helps clients acknowledge painful emotions but also helps them to see their problems in the context of the multigenerational Family system that they are part of.

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.

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.

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.

The adult with attention deficit disorder needs to know that the physical space she occupies can help to either harmonize or disorganize her Mind.

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.

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.

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.

I do not believe ADD leads to creativity any more than creativity causes ADD. Rather, they both originate in the same inborn trait: sensitivity.

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.

My confusion—and I see this in the ADD addict repeatedly—was that both behavior dependencies represented genuine parts of me, though exaggerated. The Addiction to music or books could masquerade in my own eyes as an aesthetic passion, and my Addiction to work as a service to humanity—and I do have aesthetic passion, and I do wish to serve humanity.

Only people who have not witnessed or personally experienced how helpful medications can be could maintain a categorical opposition to their use. The positive effects are often dramatic and immediate. One patient of mine, a fifty-four-year-old woman, came back excitedly after taking a low dose of the psychostimulant Dexedrine. “I never saw the trees,” she said. “We live across a park and have a beautiful view, but I never noticed before how green it was.”

A teenager for whom I recently prescribed Ritalin, a fifteen-year-old with a cunning sense of humor, approached her parents a half hour after taking her first dose. “I feel like listening to a boring lecture from a geography teacher,” she said. What she did, in fact, was watch the educational channel, a first. That evening she also had the first calm and intimate talk with her mother in years.

There is no reason to be afraid of them, however. More exactly, if we are to be reluctant to use them, it should be for the right reasons, not because of misinformation, such as that these drugs are addictive if used for ADD.

While they are subject to abuse, as are other legitimate medications, their administration in medically prescribed doses does not induce addiction. A better case can be made that they may prevent addictions, by correcting some of the biochemistry that predisposes a person to substance abuse, as described in the previous chapter.

Drugs, of course, do not alter the major issues a person needs to struggle with. In some cases they can be of tremendous help, and in others their benefits are more limited. In no case do they resolve the basic problems of low self-esteem, fear of intimacy, driven lifestyles and lack of self-knowledge. The medications, if taken, should be used with the specific purpose of reducing distractibility and improving concentration and focusing, not of changing people’s lives.

Not infrequently, the ADD adult may be suffering from chronic low-grade depression or anxiety. If this is the case, the psychostimulants may not help, or in some cases may make matters worse. If depression or anxiety is present, it needs to be addressed first, or at least at the same time.

The most serious problem with the widespread use of medications in the treatment of attention deficit disorder is that very often—probably in the vast majority of cases—they are the only form of intervention consistently pursued. Yet in themselves they do not promote long-term positive changes.

Attention deficit disorder is not primarily a medical problem. Neither its causes nor its manifestations are due to illness.

People have, with the help of so many conventions, resolved everything the easy way, on the easiest side of the easy. But it is clear we must embrace struggle. Every living thing conforms to it. Everything in Nature grows and establishes itself in its own way, establishing its own identity, insisting on it at all cost, against all resistance. We can be sure of very little, but the need to court struggle is a surety that will not leave us. – RAINER MARIA RILKE, Letters to a Young Poet

“I HAVE SPENT my whole life pretending to be normal,” said fifty-year-old Elizabeth, an interior designer. The pretense of normality is familiar to any adult with attention deficit disorder. She works at fitting in by toning down the strength of her feelings about matters that others seem to think unimportant, by struggling to suppress her intensity and by feigning an interest in what bores her to tears. The game is precarious. No matter how clever the alien becomes at attempting to pass as an earthling, some telling awkwardness in his manner, some fatal expression of his true nature will, in unguarded moments, betray him for what he is: different.

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.

I have learned through my own process that a goal in life cannot be the avoidance of painful feelings. For people like me with ADD, and for everyone else, emotional pain is a reality. It does not have to exclude joy and a capacity to experience the beauty of life.

Throughout this book, I have insisted on the connection between human relationship and attention. Love, it turns out, is intimately related to attention.

Adults with ADD face the most difficult task of all: learning how to be loving toward themselves. This is the greatest struggle because it requires that we gradually shed the defenses we have come to identify as the self and venture into new territory.

My path to diagnosis was similar to that of many other adults with ADD. I found out about the condition almost inadvertently, researched it and sought professional confirmation that my intuitions about myself were reliable. So few doctors or psychologists are familiar with attention deficit disorder that people are forced to become self-cultivated experts by the time they find someone who can make a competent assessment.

With an impatience and lack of judgment characteristic of ADD, I had already begun to self-medicate, even before the formal diagnosis. A sense of urgency typifies attention deficit disorder, a desperation to have immediately whatever it is that one may desire at the moment, be it an object, an activity or a relationship.

I took Ritalin in a higher than recommended initial dose on the very day I first heard about attention deficit disorder. Within minutes, I felt euphoric and present, experienced myself as full of insight and love. My wife thought I was acting weird.

I was not an undereducated teenager eager for kicks when I self-administered the Ritalin. Already in my fifties, I was a successful and respected family doctor whose columns of medical opinion were praised for their thoughtfulness. I practice medicine with a high value on avoiding pharmacology unless absolutely necessary, and needless to say, I have always advised patients against self-medicating. Such striking imbalance between intellectual awareness on the one hand and emotional and behavioral self-control on the other is characteristic of people with attention deficit disorder.

The hallmark of ADD is an automatic, unwilled “tuning-out,” a frustrating nonpresence of Mind.

“I feel like I am a human giraffe” is how one man described it, “as if my head is floating in a different world, way above my body.”

Completely lacking in the ADD Mind is a template for order, a mental model of how order comes about.

Like many others with ADD, I have little ability to conceptualize in three dimensions or to divine the spatial relationships of things, no matter how well they are explained.

A facility for focusing when one is interested in something does not rule out ADD, but to be able to focus, the person with ADD needs a much higher level of motivation than do other people.

What can be immobilizingly difficult is to arouse the brain’s motivational apparatus in the absence of personal interest.

Some adults with ADD have told me that they speak so quickly partly because so many words and phrases tumble into their minds that they fear forgetting the most important ones unless they release them at a fast rate.

The individual with ADD experiences the Mind as a perpetual-motion Machine. An intense aversion to boredom, an abhorrence of it, takes hold as soon as there is no ready focus of activity, distraction or attention.

The oldest person to whom I have prescribed a stimulant was an eighty-five-year-old woman who, on taking Ritalin, was able to sit still more than fifteen minutes for the very first time in her life.

People report unfinished retainer walls begun over a decade ago, partly constructed boats taking up garage space year after year, courses begun and quit, books half read, business ventures forsaken, stories or poetry unwritten—many, many roads not traveled.

Men and women with ADD have about them an almost palpable intensity that other people respond to with unease and instinctive withdrawal.

There is little doubt that a significant percentage of prison inhabitants have ADD or some other preventible disorder of self-regulation.fn1 Little doubt, too, that prison conditions could not have been more diabolically designed to exacerbate all these mental dysfunctions.

ADD defies categories of normality or abnormality. If anyone who exhibits any trait of it were to be diagnosed with ADD, we might as well put Ritalin in the drinking water and sign up most of the industrialized world for group psychotherapy. As Drs. Hallowell and Ratey point out in Driven to Distraction, ADD is a diagnosis not of category but of dimension. At a certain point on the human continuum, the characteristics associated with ADD become intrusive enough to impair a person’s functioning to one degree or another.

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.

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.

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.

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 is not until the age of seven or so, Jean Piaget found, that children begin to have a full understanding of time as a continuous flow.

“The preoperational child, in his egocentric manner, believes that he can stop time, speed it up, or slow it down.”

In attention deficit disorder, the circuitry of time intelligence is underdeveloped.

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 hardy 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.

Studies do show that if parents or siblings have ADD, a child in that family will have a greatly increased statistical risk for having ADD as well. ADD is also found more commonly in people whose first-degree relatives are alcoholics or suffer from depression, anxiety, addiction, obsessive-compulsive disorder or Tourette’s syndrome.

Of all environments, the one that most profoundly shapes the human personality is the invisible one: the emotional atmosphere in which the child lives during the critical early years of brain development.

Psychological tension in the parents’ lives during the child’s infancy is, I am convinced, a major and universal influence on the subsequent emergence of ADD.

People with ADD are hypersensitive. That is not a fault or a weakness of theirs, it is how they were born. It is their inborn temperament. That, primarily, is what is hereditary about ADD. Genetic inheritance by itself cannot account for the presence of ADD features in people, but heredity can make it far more likely that these features will emerge in a given individual, depending on circumstances. It is sensitivity, not a disorder, that is transmitted through heredity. In most cases, ADD is caused by the impact of the environment on particularly sensitive infants.

Sensitivity is the reason why allergies are more common among ADD children than in the rest of the population.

Since emotionally hypersensitive reactions are no less physiological than the body’s allergic responses to physical substances, we may say truthfully that people with ADD have emotional allergies.

People with ADD are forever told that they are “too sensitive” or that they should stop being “so touchy.” One might as well advise a child with hay fever to stop being “so allergic.”

The existence of sensitive people is an advantage for humankind because it is this group that best expresses humanity’s creative urges and needs.

Sensitivity is transmuted into suffering and disorders only when the world is unable to heed the exquisitely tuned physiological and psychic responses of the sensitive individual. ADD is not a natural state. It is, to adapt a famous phrase of Sigmund Freud’s, one of civilization’s discontents.

At times in the first year of life, new synapses are being established at a rate of three billion a second.

This sharing of emotional spaces is called attunement. Emotional stress on the mother interferes with infant brain development because it tends to interfere with the attunement contact.

Attunement is necessary for the normal development of the brain pathways and neurochemical apparatus of attention and emotional self-regulation. It is a finely calibrated process requiring that the parent remain herself in a relatively nonstressed, non-anxious, nondepressed state of mind.

Infants whose caregivers were too stressed, for whatever reason, to give them the necessary attunement contact will grow up with a chronic tendency to feel alone with their emotions, to have a sense—rightly or wrongly—that no one can share how they feel, that no one can “understand.”

Those ADD children whose needs for warm parental contact are most frustrated grow up to be adults with the most severe cases of ADD.

The letters ADD may equally well stand for Attunement Deficit Disorder.

No matter whom they had consulted, not one of the couples I have seen in my practice had ever before been encouraged to look closely at how their emotions, lives and marriages might affect their children. Their idea of stress is financial disaster or serious illness or death in the family, or perhaps a nuclear bomb going off outside their home. It seems to them just normal human existence to live at a hectic pace and in tense relationships, nerves stretched taut as piano wire. Sensitive children, as all children with ADD are, will be particularly affected.

On occasion, when I probe the history of their child’s earliest months and years a parent may say, “Oh, but the divorce didn’t come until my son/daughter was eight years old”—an interpretation that misses something important. It is not divorce per se that is emotionally most wearying for the child: it is the long-term tensions and emotional heaviness that precede every divorce.

AS A PRACTICAL matter, the use of medications in treating attention deficit disorder is straightforward. It’s how they are currently employed and their status as first-line treatment that are complicated.

One of the barriers faced by adults with attention deficit disorder in their quest for self-esteem is that they do not really know who exactly that self to be esteemed is.

Since having a strong core self relies on acceptance of feelings, being out of touch with the emotional side puts a person out of touch with herself. What then remains to be esteemed? Only a false self, a concoction of what we would like to imagine ourselves to be and what we have divined others want us to be.

When they look Inside themselves, they discover a frightening emptiness, a vacuum, an absence of a true self or of intrinsic motivation. Many a time I have heard ADD adults say, “I don’t know who I am,” or, “I don’t know what I want to do in my life.”

patients who do not know just how down their moods had been until medications or some other mode of therapy lifts the weight of depression from their shoulders. When I first took an antidepressant in my mid-forties, I was amazed at the difference. Curiously, I felt much more like myself. It was as if a fog had evaporated and I saw that for years previously I’d had only periodic glimpses of a life not burdened by negative feelings. Family strife and parental depression contribute to the child’s ADD problems not just because of their negative influence on attunement during brain development. Stressed or depressed mothers are found to be more short-tempered, more controlling and more angry with their children. Depression, particularly in the mother, also evokes an aggressive response from many a young child, quite probably due to the child’s rage at what she unconsciously interprets as the emotional withdrawal of the mother. One mother of an ADD child told me that when she had been depressed, her daughter, then a toddler, became inexplicably aggressive toward playmates or

Parents of ADD children, in other words, seem to be relatively alienated from their own families of origin.

Parental love is such a wise and powerful force of nature that when parents extend themselves in an effort to understand who their children are and why they do what they do, the right words and actions will follow almost of their own volition.

We can let go of what we understand; we cling most ferociously to aspects of ourselves that remain hidden to us and whose power we do not comprehend. A person learns to become aware of the tone in which he addresses his inquiries to himself: am I conducting an inquisition against myself or a helpful, insight-oriented interview?

Self-acceptance is not a pie-in-the sky abstract concept, because there is no abstract self floating around, begging to be accepted. The self is as we experience ourselves: happy one moment, anxious the next; confident in the morning, guilty and ashamed in the afternoon; giving now, needy then.

Guilt is a prime example of an emotion ADD adults would crawl through jungles to escape. It is sometimes difficult for people to understand that their psychological safety does not lie in avoiding the feeling of guilt at all costs but in learning to live with it.

“I’m a people pleaser” is the routine self-description of ADD adults. “I’m always so conscious of what the other person might need from me. I feel guilty if I disappoint someone. I can never say no.” Or, “I am the kind of person whom everyone calls to tell their troubles to. I can’t do that myself, though. I would feel guilty, thinking of all the people in the world who have suffered much more than I can even imagine. I shouldn’t need help.”

Better if people learned to accept the guilt but to judge its message for themselves. It can’t help being there. It speaks the voice of intricately wired implicit memory circuits. A person cannot forcibly get rid of it, and can only temporarily buy its silence by obeying. She might as well welcome it as a sign of growing self-nurturance. At least in the beginning of growth, if she does not feel guilt, she is probably ignoring her truest self.

A loving mother and father can make themselves available to spend time with their child, to hear her story, to help her express her feelings, to mirror her emotions, but the adult needs to find a parent substitute. The people trained to do such work are counselors and psychotherapists.

The purpose of psychotherapy and counseling is not that the therapist either heals the “patient” or advises him what to do with his life. The goal is to mature and to individuate, to become a self-respecting person in his own right. In other words, the goal is not to be “cured” but to develop.

In the medical model, the patient presents the doctor with the symptoms; having elicited the necessary information, the doctor makes the diagnosis and prescribes, administers or performs the cure. This approach works for a broken bone but not for a wounded psyche, for an inflamed appendix but not for inflamed emotions.

Family therapy refers to the approach of the therapist, the training he had. A single adult can see a family therapist by himself; in the case of couples, both would attend.

People with ADD tend to have trouble recognizing, let alone respecting, their gut feelings.

I have often seen clients who had stayed on with a particular psychiatrist, psychologist or other therapist for months or years, long after they became aware of feeling that they were not being helped, or even that they were having a negative experience. Their fear of those old servants guilt and anxiety kept them there. Better to have stayed with the guilt and the anxiety and left the therapist.

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.

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.

A person cannot become sane in the midst of the chaos she perpetuates around herself.

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.

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.

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 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.

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.

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.

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.

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.

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.

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.”

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.

Adults with ADD should at least consider giving themselves some daily opportunity for contemplative solitude.

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.

All Addictions are anesthetics. They separate us from the distress in our consciousness. We throw off our familiar and tired consciousness to assume another mind state we find more comfortable, at least temporarily. Desperate to be out of our mind and unaware, we surrender to the Addiction, to be lulled into a walking sleep.

There have been times when my workaholism did not satisfy my need for oblivion. I needed more and found it in pursuits that vicariously fed my creative and spiritual needs—vicariously, because the driven ADD personality has no idea what his true needs are and must find for them some displaced, symbolic expression.

My route was the compulsive buying of classical records and compact disks, alternating with—or conjointly with—the frenzied purchase of books. On the surface these may seem like innocent and even admirable pastimes—as they would be if undertaken consciously and in moderation. The addict has no such control. The compulsion beckons; the addict runs to serve it. Gradually, in each orgy of buying, I felt myself shrinking into a ghost of myself, full of self-contempt and apologetic for my existence.

The effects on my family life were devastating, not because of financial privation or even primarily because of the time I spent away from home while haunting the stores. The major effect was that I could not be present—in both senses of being at home or attentive to my family—whenever I was in the grip of the fever.

Inwardly, I could think of nothing but the music. Naturally, I hated myself, and the more I did, the harsher, more controlling and more critical I became with my sons and my daughter. We cannot endure seeing the needs of other people, least of all those of our children, when we are preoccupied with serving our own false needs.

The Addiction, in a strange way, makes the addict feel more connected to life. The downside is that it separates him further and further from himself. He is feeding only his appetite, not his hunger.