Book Review - Scattered: How Attention Deficit Disorder Originates and What You Can Do About It - by Gabor Maté M.D., 2000, The Plume Group, Penguin, August, 2000, pps. 348

Reviewed by John A. Speyrer

A loving parent who is feeling depressed or anxious may try
to hide that fact from the infant, but the effort is futile....It reads feelings clearly." p. 73

Scattered is a deep and delving dive into the origins of and how the disorder of Attention Deficit Disorder can be unintentially perpetuated in the family. Like so many other behaviors, both bad and good, it begins at home. A victim of the disorder himself, as well as being a parent to three ADDers, Dr. Maté is an excellent writer, so hopefully, the reader will pick up helpful ideas from his book on how to raise children with a minimum chance of having ADD or to begin the work of reducing or eliminating the symptoms of ADD.

With many short chapters supporting his case for its origins in the very early relationship between the infant and its parents, his book argues persuasively how the condition begins at home. It's a difficult book to review because it contains a plethora of information about the subject. The reader will be both agreeing and disagreeing with the author.

ADD reveals itself in many ways including, 'poor attention skills, deficient impulse control and hyperactivity.' (p. 11) being the most prevalent, but which symptoms are seemingly without end. Its seeds are planted very early in life - in infancy and yes, maternal/paternal interactions decidedly plays an important role in its establishment. Dr Maté writes, "...ADD children whose needs for warm parental contact are most frustrated, (and) grow up to be adults with the most severe cases of ADD." (p. 75) Another characteristic of the ADDs disorder is that he "tunes out" frequently.

Despite these symptoms, the author does not consider ADDs a medical disorder. He feels it more reasonable to view the symptoms as impairments which become reasonable when one the victim's history is better understood. Some are undoubtedly predisposed to acquire the condition. But it doesn't have to happen. It's a family affair. Later, when the input can be changed, you can have an incredible improvement in both reaction and behavior.

The author studies the subject from various viewpoints, the genetic, environmental, and neuro-anatomical, but soon hones into that special relationship between the infant and its mother. ADD does have a frustratingly large variety of symptoms, ranging from perpetual urgency, difficulty in focusing, emotional hurt, self-deprecating humor, unsuccessful relationship problems, low self esteem, restlessness, and lonliness. According to Dr. Maté, its three major features are poor attention skills, hyperactivity and deficient impulse control. Adults with ADD also have a myriad of symptoms.

The author does not believe that ADD is a genetic condition although "bad genes" are blamed for an altogether too high a incidence of the disorder. The author also feels that adopted infants have a higher chance of having ADD compared to non-adopted infants and children , but again he believes that we can't blame the correlation of heredity as a causative factor.

Dr. Maté writes that that..."The family atmosphere in which the child spends its early formative years has a major impact on brain development," he writes that such problems are more common when dysfunction and psychological problems predominate. The author argues persuasively that one should not place too much emphasis on the genetic explanation for any malady. He believes that one can argue, as does Canadian geneticist, Michael Hayden that even in "Huntington's disease there must be some protective factor in the environment" as some with the gene don't get the disease. Then there's epigenetics when the environment changes the rules.

Dr. Gabor's theory of the origin of Scattered minds seems to encompass theories when are seemingly aligned with regression therapy theory. By that I mean that he believes to have accepted the thesis that the origin of neurosis begins in the home and that its culprits are usually one's parents. So he does not accept, the current "in vogue" theories of ADD as being all in the genes.

His theory of "cure" seems to depend on, well actually re-designing the present de-facto neuro-anatomy by changing the ADD child's relationship with its parents. This is something for both the parents and the ADD victim to think about.There are many factors involved and a wide range of endeavors are suggested. Read the book and concentrate on the aspects which you find insightful and useful.

The author believes that the problem of fear of intimacy and of commitment are common ones in ADD sufferer's relationships. The author writes that is what ADD individuals really need --, that is attempting to develop the capacity for intimacy and of commitment, which absence is a common feature in ADDers. But why is it assumed that since such individuals cannot remember traumas that happened that he might not have had a lack of a necessary good in his early life? Indeed, most severe very early traumas are not remembered at all. The author notes the exquisite sensitivity of the ADD victim to feelings of rejection. Psychiatrist John Bowlby described the rejection engendered by emotional separation from the parents as "defensive detachment", felt and expressed as fear of intimacy during infancy, but whose real roots lie in the repressed hurt and the fear of ever feeling that pained feeling once again.

"A 1982 study found that "the rate of adoption among ADD patients in the clinical population was 8 to 16 times the prevalence of adopted children in the population at large." [p. 52]

Seemingly, an extreme case of ADDS might result in bachelorhood or spinsterhood for life because of an extreme marriage phobia. Another example with a closer relationship to ADD might be dread or intolerability of being bored which the ADD victim may apply to his relationships. (p. 263). In some cases the dread or the fear of losing one's sense of being in the relationship from which alienation may soon develop, especially in men, and especially in sexuality.

"The relationship with the parents is the earth, the rain, the sun and the shade in which the child's mental development must blossom." [ p 146 ]

Dr. Maté is convinced that it is possible to re-program the brain to undo the early traumas it has experienced. He believes that despite the impact of nurture, later in life, an enriched environment can work wonders even to the extent of re-shaping the brain's anatomical structures and neuro-transmitters. He believes its never too late to influence one's biological environment. Thus, changes in neuro-chemistry can mold a developing brain and re-mold a brain which has already developed. He quotes Dr. Marian Cleeves Diamond: "Perhaps the single most valuable piece of information learned from all our studies is that structural differences can be detected in the cerebral cortices of animals exposed at any age to different levels of stimulation in the any age studied, we have shown anatomical effects due to enrichment or impoverishment." [p. 142]

Neuro-plasticity is the key thesis here, yet I wonder why the environmental changes in the environment of mild psychopaths and drug addicts seem to resist this appeal to change its neurological ideation and thus behavior. But, the author also quotes neuroscientist Joseph Ledoux who believes that that some types of learning "may represent an indelible form of learning." (p. 253). He also quotes Antonio Damasio as concurring with this belief. Ergo, ADD behavior can be intentially and imperceptibly changed by the choices of new behavior. But Maté believes that the wound of the child, which reveals the presence of the early neurological wound - the residual effects of the relationship between the caregiver and the infant or else possessing inadequate psychological defenses against feeling that early love deficiency. All of which can all contribute to a change for the better. Here I want to inserts many "yes, buts."

Relationships can be a minefield for both the ADD youngster and the adult ADDer. Rejection is a problem and seemingly contradictorily since so can acceptance be problem. Wanting someone who doesn't want you is the stuff of the hurts found in songs of romance and of novels, but for the adult ADDer (and not so adult ADDer) as they may also be sensitively pained when the sought for person becomes interested in a relationship at a deeper level than was intended. 'Can't be with them and yet can't be without them' is their motto. The old bug-a-boo of the promise of the closeness of intimacy can chase away many an ADD victim from satisfying relationships - not just from more casual ones.

John Bowby feeling for the infant the defensive detachment as feeling " hurtful was it for me to experience your absence that I will encase myself in a shell of hard emotion, impervious to love -- and therefore to pain. I never want to feel that hurt again." (p. 263).

In Scattered, the author well dissects the 'bug a boo' of genetic implications and its friend, concordance of genes in identical twins, but that was argued before the intrusion into the discussion of epigenetics, wherein all results can be explained (away?) by seemingly emphasizing the significance of the factors in the environment as a molder of behavior which was hitherto considered strictly genetic. As have others, Dr. Maté, also spends time observing the implication of identical twin discussion as a factor in ADD, with the 9 months which may be characterized in some as a time of over-bombardment with cortisol if the environment is not what it should be, which can have effects into old age and even preventing some, due to illness, from arriving at that place.

It's easy to suggest that such couples should give up the parent-child relationship which can be so destructive to an adult relationship but not easy to let go of the behavior of the early interactions. Maté believes Its a hopeless situation for an adult ADDs sufferer to advance in letting go early derived behaviors without the help of a professional therapist.

He is adamant. "if we can actively love, there will be no attention deficit and no disorder." p. 323.

The Primal Psychotherapy Page's Index Page