VOLUME 35, NO. 15, April 20, 1999

Solace for a scattered mind

By Gillian Wansbrough

A doctor hopes to unlock the mysteries behind attention deficit disorder by examining his own history with the condition

"My mother and I had little opportunity for normal mother-infant experiences. These were hardly possible, given the terrible circumstances, her numbed state of mind and having to concentrate her energies on basic survival."

So writes Dr. Gabor MatÈ of life after being reunited with his mother in 1944, in his new book Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder (Knopf Canada).

After seeking refuge in a protected house in Budapest during the Nazi occupation, Dr. MatÈ's mother decided to temporarily send him to a relative living outside the ghetto. She remained behind until the Red Army took the city, while his father toiled in a forced-labour camp.

His mother's state of semi-dissociation during the difficult times and the ensuing separation disrupted the attunement, or "close moment-to-moment connection," between mother and infant. This, Dr. MatÈ believes, sowed the seeds of attention deficit disorder (ADD) in him, and later in his three children.

In his book, Dr. MatÈ presents a novel perspective on the origins of ADD, arguing that it is neither hereditary nor can it properly be called a disorder. He holds that ADD originates in infancy and is a response to conditions that fail to provide a necessary degree of emotional or physical security. Using his own experiences, he provides a means of identifying problems and the necessary tools for parents, and adults with ADD, to solve them.

Unaware until later in life that he had ADD, Dr. MatÈ struggled through the condition, completing a bachelor of arts degree before he was able to commit himself to his dream of becoming a doctor. He graduated from the University of British Columbia, interned in Montreal, and for seven years was the medical co-ordinator for the palliative care unit at Vancouver General Hospital. He also wrote a weekly medical column for the Globe and Mail and has written numerous political, social and cultural articles for a number of publications over the years.

"There are people with ADD who are high achievers, and I was one of them," he says.

He is a family practitioner in Vancouver where he handles an increasing number of ADD referrals. He also works at the Portland Hotel, a hospice housing unit that focuses on harm reduction for street prostitutes and people with HIV.

It wasn't until four years ago when he wrote an article on an acquaintance with ADD that he began to recognize the symptoms in himself. "It seemed to me that I had found the passage to those dark recesses of my mind from which chaos issues without warning, hurling thoughts, plans, emotions and intentions in all directions," he writes.

"I felt I had discovered what it was that had always kept me from attaining psychological integrity: wholeness, the reconciliation and joining together of the disharmonious fragments of my mind."

As a youngster he allows that he wasted a lot of time, left assignments to the last minute and had difficulty remembering things. In school he was seen as oppositional. As he grew older, he became more motivated, which prompted his return to medical school in his late 20s.

"In my adult life it meant a lot of disorganization, workaholism, juggling things at the same time, beginning things and never completing them," he says. Now he is more calm, values things differently and has learned to balance his workload.

He attributes the fact that his children have ADD in varying degrees to his workaholism and psychological absence. His kids, aged 23, 20 and 10, are coping well and have the necessary tools to deal with the ADD, he says.

Dr. MatÈ defines ADD by way of three major features, any two of which are enough to make a diagnosis: poor attention skills, deficient impulse control, and hyperactivity.

There is a lot of confusion about ADD, he says, and some people doubt its existence. He understands this skepticism, since the condition can be seen as an assemblage of fairly common human traits present in certain people in an exaggerated fashion, and attributes it to a lack of knowledge and investigation of the topic.

Among those who work with ADD and accept its existence, the genetic view predominates. "It's an easy one. It's the one medical science is familiar and comfortable with. You have change, you inherit that, you've got a disease. This is how most psychiatric problems are explained these days. Everything's genetic."

In fact, there are very few diseases that are truly genetic and many considered genetic actually aren't, according to Dr. MatÈ. What is not considered, he says, is the fact that genes are turned on and off by the environment.

"Right from the beginning I felt that the conventional explanation of it being a genetic, inherited quasi-biological illness just didn't fit." He attributes ADD to the failure of certain brain circuits to develop appropriately. "For the particular circuitry of emotional regulation and attention regulation, what you need is a calmly attuned, non-distracted, non-stressed contact with the primary maternal caregiver."

But genetics is not completely out of the picture. Dr. MatÈ surmises that what may be inherited is a heightened sensitivity to the environment. This is evidenced by the fact that in children with ADD, there is a high percentage of asthma, allergies, eczema, frequent infections, colds and colic. He reinforces, however, that predisposition does not equal predetermination.

"The people who will have trouble with it (his theory) are some parents who will think that they're being blamed. And, of course, that's not my intention. I'm not in a position to blame anybody given my own situation."

Because the biological viewpoint predominates, treatment is tied to pharmacological treatment. He has nothing against Ritalin (methylphenidate) in principle and considers it to be very effective in many cases, but says its use, coupled with behavioural management, ignores the broader issue of development.

"That doesn't help a person develop. It just helps them behave in a certain way. If you can either threaten them or reward them enough, they will do what you want them to do. But they haven't changed personally."

He thinks cases of ADD are on the rise, that it¼s not simply attributable to a greater awareness of the condition. In Canada, an estimated one million people have ADD. He sees socioeconomic stress, having less time to spend with one's family, interacting less with extended families and a diminished sense of community and belonging as contributing factors.

This, he feels, supports his case about the origins of ADD. If it were truly genetic, the number of cases would be constant. He compares it to what he sees as the socially induced increase in diabetes cases among native Canadians, which is four times the Canadian average.

He feels ADD is not being well managed in schools, since there is a lack of awareness and, when there is, it is seen as a problem rather than a challenge. Dr. MatÈ notes that in Quebec, the rise in Ritalin use in schools is the result of the cutback in funding for school psychologists and teacher's aids. "The less resources you can put into it, the more you have to resort to the chemical straitjacket."

In counselling patients with ADD, Dr. MatÈ asks them to express their goals and discuss what in their lives they would like to change. If an inability to focus is a major problem that interferes with functioning at school or at work, a medication trial is in order. "It can be dramatically helpful," he says. "You can give a person a smidgen of dexedrine and all of a sudden they can pay attention."

But again, this helps the symptoms while not addressing the range of psychological problems tied to the formation of the personality.

"The general view is that people with ADD have low self-esteem because they are prevented by neurological dysfunction from achieving things. I say it's the other way around, that low self-esteem is a cause of poor achievement, not a result of it."

He says addressing focusing issues is the least of the problem; barriers to intimacy and commitment must also be addressed. In fact, a person's whole life must be explored, according to Dr. MatÈ, an experience that almost always includes family therapy.

He is optimistic ADD can be overcome, and points to the evidence that neurological growth takes place in midlife and beyond. The challenge that remains, he says, is determining the conditions that facilitate growth and successfully promoting this development in both children and adults.

Gillian Wansbrough is a senior staff writer at the Medical Post.