Scattered Minds: The Origins and Healing of Attention Deficit Disorder

Maté criticizes the medical establishment for its unfamiliarity with ADD and for treating it as a medical ailment instead of a developmental condition. He believes that the American Psychiatric Association’s overreliance on the Diagnostic and Statistical Manual of Mental Disorders (DSM) prevents a more nuanced understanding of ADD. The DSM, Maté says, is more interested in categorizing observable signs of the condition (which Maté says it erroneously calls “symptoms”) than in understanding the emotional experiences of those who experience ADD: “The DSM speaks the language of signs because the worldview of conventional medicine is unfamiliar with the language of the heart” (8). Moreover, Maté believes that the physiological correlates of ADD are neither fixed nor strictly hereditary: The role of genetic predisposition pales in comparison to the impact of the environment when it comes to neurophysiological malfunctions.

Maté’s skepticism is especially evident in his conceptualization of ADD as what happens when the brain gets “stuck” in a particular developmental phase. For example, Maté argues that all young children pass through a phase of chronic sympathetic nervous system arousal; when this phase extends into later childhood and adulthood, it becomes the “hyperactivity” commonly associated with ADD. By reframing the symptoms (or signs) of ADD as “normal” processes that have become maladaptive, Maté challenges the idea that ADD represents a fundamental genetic disorder.

This reconceptualization has implications for the treatment of ADD. For example, Maté is highly skeptical of the lopsided role that pharmaceuticals play in treatment. Ritalin, Maté says, has become the first and primary response to an ADD diagnosis, preventing investigation of the deep-rooted emotional sources of the conditions. His personal experiences with Ritalin were initially positive, but ultimately, the side effects outweighed the behavioral benefits. Forcing medication on children is particularly harmful, he says, and all too common. These treatments prioritize behavior modification over healing and reinforce the notion that the child can only be accepted if they behave differently. Similarly, Maté believes that an overreliance on treating behaviors is at best a stop-gap response and at worst reinforces the hypersensitive shame apparatus of the ADD brain. Overall, the illness model tends to frame ADD as a problem with the individual, whereas Maté believes it has much to do with environment and that its treatment must as well. He therefore concludes that parents and teachers should discard the illness model and embrace the idea that children with ADD are reflecting a deep insecurity that they feel in relationship to their parents, teachers, and peers.