Book Review: Scattered Minds: The Origins and Healing of Attention Deficit Disorder.
Written by: Peter Curtis on 19 February 2023
Gabor Maté. Vermillion, 2019. ISBN 9781785042218.
Gabor Maté is a medical practitioner and therapist whose book Scattered Minds: The Origins and Healing of Attention Deficit Disorder is a refreshing and revelatory read about understanding the challenges of what is commonly labeled as a ‘disorder’. Every teacher should read it. We would agree that ‘managing behaviours’ which disrupt and threaten the purpose of teaching and learning because of a student’s inability to self-regulate and exercise control are among our foremost challenges. ‘Behaviours’ is a polite way to say what many outside our profession would call appalling.
An enlightened view understands that any behaviour, be it conscious or involuntary, is a form of communication, expressive of a desire or need. However, we are encouraged to believe that perplexing, and disruptive, troubling habits, like so much else, can be managed with a pill. The challenges for those suffering, and for their carers and teachers, can be overpowering. No surprise therefore, that AD(H)D, oppositional defiance disorder, and other associated behaviours, or comorbidities, receive the most attention in school settings.
Born a Jew in NAZI-occupied Hungary, Gabor Maté, as an adult, discovers that he too has ADD which, he explains, helped him a great deal in understanding his own triggers and patterns of behaviour and the impact that they have on those around him. His three offspring also have ADD. Proof of a genetic inheritance? He does not deny that there is a biological propensity or predisposition which heightens our sensitivity to the environmental factors that impact on us and which subsequently trigger our physiological and psychological reactions. An analogy is some people’s sensitivity to plants and foods resulting in allergies, whereas AD(H)D is a somatic and psychological reaction to external stimuli which results in sensory overload which then creates the neurological and chemical changes that occur in our nervous system.
The neurobiological and psycho-medical terms used to define AD(H)D as a disease rather than an impairment are impugned by Maté. Explanations crafted for popularisation so often explain away the mostly undesirable human traits as our genetic inheritance. The misunderstandings and suffering that are thereby produced turns us all into the victims of a pathology over which we have no control. Mass myopia affecting children in parts of Asia, for example, has nothing to do with genes but everything to do with very little outdoor play. Perhaps too, genetic explanations are clung to because parents who are already stressed-out and time-poor, can reduce their feelings of guilt.
Maté insists rightly that we must turn our attention to the environmental conditions in which we are immersed rather than look for the answers in our genes alone. The medicalised view is a narrow one, he argues, and it is this “genetic fundamentalism” that dominates our outlook and explanations for such ‘disorders.’ Our lives are a tangle of demands from family, at work or school. Under these pressures, we make myriad adaptations so to better meet the daily expectations made of us to consume, to conform and to contribute our labour.
There is dis-order, that is, an absence of order, which can be detrimental to daily living and to personal and professional relationships. Intentionally or otherwise, genetic determinism discourages us from giving full attention to the socio-economic forces that destabilise us. Big pharma is a maleficent contributor, actively researching and marketing individualised pill-popping solutions for everything. Shoving these solutions down our throats discourages us from appreciating more exactly how our lives are socially produced and conditioned.
Absence of a grounded critical view will mean that we fail to face-up to our challenges and responsibilities as adults and carers. It is easier to dismiss nuanced questions and to seek solutions to complex social and family dynamics if troubling behaviour is a consequence of each individual’s biological make-up. While the ‘c’ word, ‘capitalism’, is never stated, Maté condemns the culture it produces as a causal factor mostly because of the deleterious effect it has on our familial relationships, but also, on all our lives. He is right to do so. He describes the social roots of AD(H)D as one consequence of “this most frenetic of cultures.”
AD(H)D as a phenomenon needs qualification: the label does not describe what is actually happening; why is there is an inability to give attention to something? The ‘deficit’ is in the label because it mistakes the outward sign for the symptom. Safety and security are paramount for anyone to thrive, but for children particularly. From a child’s point of view, the deprivation of an emotionally secure environment provides a causal connection to reactive behaviours. Maté believes a more accurate description would be an “attunement deficit,” which is “the quintessential component” of the attachment process between children and those who are in the parenting role.
Self-regulation and control are not endowed, or magically bestowed upon us. Like speech, they are developmental processes which occur not only within our immediate family but from anti-social media. While such an observation may seem obvious, we need to inoculate ourselves by repeating it to absorb its truth. Maté makes the point that if we neglect to understand and articulate how our social relationships contribute to the AD(H)D origins then we will fail when exploring the possibilities for healing. Our struggles for social justice must engage too with these insights with all the urgency that mental health and social wellbeing demand.
The cultural revolution being materialised by digital technology depletes focused attention in us all while depriving us of the mental space to daydream. Immersed as we are in a bath of online hyper-activity, we are creating a culture of distraction and information overload. Just how digital technology and virtual worlds are changing our brains and personal relationships is complex. However, sufficient evidence has been accrued to sound the alarm on the deleterious effects of dopamine-producing hyper-stimulation on executive function.
The harm is especially evident when screentime dominates over human interactions and physical play in the early years of life. Maryanne Wolf, a neuroscientist and reading development expert, and author of Reader, come home: The reading brain in a digital world, calls this destructive cycle of treating the problem with the cause, the “dopamine lollipop.” Linda Stone, a high-tech consultant and past executive with Apple and Microsoft, coined the term continuous partial attention. This is a permanent state of crisis, compromising our ability to reflect, make decisions, and to think while being sold on ‘multi-tasking.’ We need to be alert to what digital technologies are disrupting or diminishing. As teachers, we witness daily the incapacity for the kind of sustained focus required for reading, studying a painting, or metacognitive thinking, be it for pleasure or otherwise.
Behaviour is a reaction to some provocation, although it can become habituated, but it does not occur outside of inter-personal or social relationships: “The situationality of AD(H)D reflects the input of the emotions, which play a powerful role in attention”. An underlying anxiety is common to these clusters of so-named disorders, with autism, AD(H)D, oppositional defiance and obsessive compulsion the common examples. When regarding childhood and adolescent behaviour, we must investigate what is occurring relationally and to their families. While such difficult and destructive behaviours are emotionally demanding, and time consuming, there is hope for healing.
Adult attunement, an essential aspect of parental/carer attachment, is critical to reducing anxiety and the behaviours that are consequently produced. The deficit is not only the inability to give sustained attention to something, a sign, but equally the absence of positive attention given to the sufferer. Their emotional needs are not being met sufficiently for them to feel safe and secure in their relationships. For instance, a baby’s healthy development is inordinately dependent upon regular eye contact with their attentive adult. If a carer’s attention is regularly consumed by their own screentime, we must expect a consequential deficit in the infant.
What is being asked of us who have the power and responsibility to change the terms of these relationships, and then, how do we engage? We must examine our own behaviours to gain insights into what we are doing that is a catalyst for undesirable reactions. Those with these disorders are likely to have a diet of negative emotional reactions to their behaviours from their parents and carers. Negative reactions are expressions of our frustration, exasperation, and anger, which are delivered as commands and punishments.
It is a repetitive and counter-productive cycle. There has to be a circuit breaker. Over half of Mate’s book is dedicated to discussing what can be done to meet these emotional and psychological demands. His reflections contribute to our understanding of what should to be done to assist young people and adults when they are learning how to improve their self-regulation and control. Our hope-filled purpose is to mitigate what indeed are anti-social behaviours, not only in their effects but also in their causes.
Peter Curtis is an educator in the ACT public school system. He has worked in early childhood and primary school settings for more than twenty years. He is currently working in a high school.
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