EDITORIAL
A Doctor's Personal Look at Attention Deficit Disorder
The Vancouver Sun - Saturday, April 3, 1999

Stan Persky

A new book puts together the genetic, brain development and parent-child pieces of the puzzle about mind and behavior.

Vancouver family physician Gabor Maté wryly notes that he "was born in 1944 to Jewish parents in Budapest, Hungary, having made the miscalculation of entering the world two months before the Nazi occupation of my birthplace."

In Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder (Knopf Canada, 248 pp., $33.95) - an utterly sensible and deeply moving book written for a general audience - Dr. Maté offers an original and helpful theory about a condition whose diagnosis has spread like wildfire in North America. Until now, the medical profession has mostly proclaimed attention deficit disorder as a hereditary genetic disease and prescribed a drug called Ritalin by the bucketful.

If Dr. Maté is right about ADD, while being born in the proximity of a Holocaust isn't a necessary precondition for attention deficit disorder, it certainly contributes to making you a likely candidate. As it happens, Dr. Maté and his three children have all been diagnosed with ADD. In consequence, Scattered Minds isn't simply a theoretical discussion, but also a richly personal book in which Dr. Maté talks frankly about himself and his family.

Seen from the outside, ADD is a nebulous syndrome whose signs - scattered attention, inability to concentrate, memory problems, and disruptive, hyperactive responses - are simply extreme manifestations of the normal spectrum of psychological traits. Experienced from the inside, as an all too real condition, ADD is a contemporary form of psychological hell.

ADD is difficult to discuss, as Dr. Maté notes at the outset. "Attention deficit disorder is usually explained as the result of bad genes by those who 'believe in it, and as the product of bad parenting by those who don't" he reports.

"The aura of confusion and even acrimony that surrounds public debate about the condition discourages a reasoned discussion of how environment and heredity might mutually affect the neurophysiology of children growing up in stressed families in a fragmented and high-pressured society, and in a culture that seems more and more frenzied as we approach the turn of the millennium."

Scattered Minds is a genuine contribution to the reduction of that confusion, and its even tempered tone ought to soften the acrimony as well. "I do not think" Dr. Maté says, "it is a matter of bad genes or bad parenting, but I do believe it is a matter of genes and parenting.

Neuroscience has established that the human brain is not programmed by biological heredity alone, that its circuits are shaped by what happens after the infant enters the world...

"The emotional states of the parents and how they live their lives have a major impact on the formation of their children's brains...

"The good news," he adds, "is that major changes in the circuits of the brain can occur in the child and even in the adult life if the conditions necessary for positive development are created."

The reason he doesn't consider ADD a "disease" is because there's a big difference between genes directly causing a condition and a genetic disposition that may or may not be triggered by life experiences.

Unlike other mammals, a huge degree of human brain development occurs after the child is born. Much of the neural circuitry - the biological basis for the characteristic ways we have of responding to the world - develops, or doesn't develop in the case of ADD, during the baby's formative environment. That means that what goes on between the infant and his or her primary caregiver is crucial.

That's a matter of common sense; what's new here is Dr. Maté's suggestion that ADD may be sort of underdevelopment of areas of the brain circuitry that are affected by early environmental interactions.

A good portion of Scattered Minds is devoted to practical healing strategies. On the question of medication, Dr. Maté is a moderate: not necessarily a moderate: not necessarily drugs, and not drugs alone, but drugs if indicated. As important as any drug, though, Dr. Maté repeatedly prescribes love as the best medicine.

I began reading Scattered Minds with skepticism, worried that the emphasis on neuro-development was merely a "scientific" underpinning for the traditional and often reactionary demand for mothers to stay at home. Happily, it isn't that.

Rather, it puts together the genetic, brain development and parent-child pieces of the puzzle. His caution about "genetic fundamentalism,"his alertness to neuroscience and his wise humanism combine to yield the most plausible account to date of one the the current mysteries of the human mind and personality.

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