Customer Reviews

Scattered: How Attention Deficit Disorder Originates And What You Can Do About It

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Having been in therapy longer than Woody Allen, I practice what Karl Menninger called `bibliotherapy'-i.e., reading widely and deeply in the field of mental or emotional disorders. Since I'm a voracious reader, and since I've been doing this for twenty years, I sometimes feel there isn't much left for a layman to learn, or at least nothing much that could be called new. But Dr. Mate's book is wonderfully helpful on two fronts: first, it is a "why-you-or-your -child-are-like-this" book, and second, it is a "and-here-is-what-you-can-do-to-allieviate-the-condition"book. Not cure it, mind you, just make the cards you drew a little easier to play.

On the first front, the neurobiology of ADD, Dr. Mate makes his point conclusively: this disorder arises first in the infant, in how he or she is wired-or not-and it occurs in the make-up of the hypersensitive baby, highly aware and from the very beginning suffering at the smallest slings and arrows life offers. Resilient children roll with the punches; ADD kids are flattened by them and get back up more slowly. Momma used to call this type "high-strung" and, boy, was she ever right. Dr. Mate even points out a study done on the vagus nerve of five-month old babies that turns out to be highly predictive of which of them will later, at fourteen months, prove to be "more reactive to maternal separation." In other words, ADD could as well serve as an acronym for Attachment Deficit Disorder. People who are hypersensitive have a disordered attachment to their caretakers that is pre-verbal and pervasive. One had better learn to deal with the fact that the fault is mainly synpatical, not social. My family doctor told me that my then-nine-year-old son suffered from severe separation anxiety because he hadn't been in pre-school or away from his parents enough. Fortunately, a more knowledgeable child psychiatrist said it was inborn so we could relax and quit blaming ourselves. Whew....

That doesn't mean that experiencing this hypersensitivity isn't damaging, even with a more-than-good-enough mother. Or that nurturing a hypersensitive child is easy. It is much more tiring and trying to deal with the ADD child than it is with his or her more resilient sibling.The ADD child triggers anxiety in even the most competent parent. So, it is on the second front, the practical things to do, that this book is most helpful, even hopeful. I return to it again and again (that is, when I haven't mislaid it in one of my more driven ADD moments) to remind myself what to do and what not to do to help myself and my similarly-wired son. For instance, the section on the counter-will-an idea I'd not heard before-made me understand why I am more often than not so suspicious of authority figures. I used to think it was very adolescent of me, and now Dr. Mate tells me it is, and that this is a component of ADD. It was from this notion of a counter-will that I began my search on ways to strengthen the will itself, so as to disengage this adversarial part of me, the counter-will, that aspect of us that doesn't trust. It has been an interesting and fruitful search and I am grateful to Dr. Mate for giving me new ways to think about this way of being in the world.

By the time the ADD child arrives at school, the disconnectedness is ingrained. We are attuned to every slight, intended or not. Other kids find ADDers just as trying as the grown-ups do-it takes a lot of energy to interact with a `wild child' who hogs the teacher's attention or a distracted one whose hypersensitivity presents the perfect opportunity to torture for fun and profit. I've yet to find an ADD adult who liked the social aspects of school, or didn't have horror stories about cruel peers and teachers...

The most important chapters for me have been the ones on medication and on self-parenting. The first, medication, gives the limits of pharmocological help for this disorder. It is very clear about what medicine can and cannot do and the importance of finding a knowledgeable physician. The second, self-parenting, seems like a Mobius strip until Dr. Mate takes apart the results of life-time conditioning and explains the qualities one needs-compassion for self and others, curiosity rather than blame or judgment-in order to embark on a course of change. Whether one has to structure things by herself, or has the good fortune to find competent professional help, Dr. Mate's book is of inestimable help on that journey.

In fact, every time my ADD tendencies pop up and I lose my copy of Scattered, I buy another. And now that my stepson has been diagnosed with ADD, I have an extra copy or two to give his suffering parents, though I would not be without this book.

Scattered is definitely a keeper.

I must say that my opinion regarding Dr. Mate's "Scattered" is... well... "Scattered!" On the one hand, it contains some of the most eloquently poetic descriptions of A.D.D. I've ever seen (some of which come directly from Dr. Mate's patients). One need look no further than the chapter headings to see how beautifully the ambiguity of poetry describes the A.D.D.experience- headings like "So Much Soup and Garbage Can," "Forgetting to Remember the Future," "A Surrealistic Choreography," "Severed Thoughts and Flibbertigibbets," and "My Marshmallow Caught Fire." In fact, on page 43, Dr. Mate offers one of the most poignant metaphors for A.D.D. I've read, in his description of the trees on the shores of Vancouver Island. Passages like this one make "Scattered" a worthwhile book to own, and I've recommended it highly to several people on that basis alone. But while "Scattered" delivers in grand style on the promise of the first part of its title (i.e. "How A.D.D. Originates"), it fails to deliver consistently on the promise of its second (i.e. "What You Can Do About It"). This unrealized expectation is established by the last sentence of the very same page referenced above (p.43), which reads: "Fortunately, as we will see when we come to the chapters on the healing process in ADD, neurological and psychological maturation can take place at any time during the life cycle, even in late adulthood." As well-established as the author's intentions are for the remainder of the book, what unfortunately follows is heavily and disproportionately weighted more towards offering specific advice to parents of A.D.D. children than towards offering practical solutions for the A.D.D. adult. In my opinion, Dr. Mate's message would have been far better-served by either: 1. Presenting the material in a more cohesive and balanced fashion or, 2. Presenting the material through two different books, each geared towards a separate audience.

It's not that the information itself is uninteresting or irrelevant, but that Dr. Mate so radically changes the focus of the discussion from addressing the needs of adults in general (Chapters 1 - 15) to exclusively addressing the needs of parents of A.D.D. children in particular (Chapters 16 - 24). The experience is not unlike someone at a party (who happens to have kids) speaking to you directly and then suddenly, without warning, turning their complete attention towards starting up a fresh conversation with someone else about mutual issues involving their children. This of course leaves you standing alone with a drink in your hand, anxiously waiting for the tray of finger sandwiches to make another round, while you wait for your former conversation partner to return and resume the discussion with you.

When the author does finally broaden his scope to once again include a general adult audience (Chapter 25), he does so not by fulfilling the promise of "What You Can Do About It" for the A.D.D. adult (as he had in the previous section for parents), but by returning yet again to descriptions regarding the origins and nature of A.D.D., thus moving the focus back onto the first portion of the title. In fact, the "What You Can Do About it" section for Adult A.D.D. that eventually appears is limited to a mere 23 pages (in a book containing a total of 323)! I find particularly significant that while part V is entitled "The ADD Child and Healing," (indicating practical solutions for parents to healing the A.D.D. child), part VI is simply entitled "The ADD Adult."

Adding to the level of frustration, these long-anticipated (though brief) 23 pages of practical solutions for the A.D.D. adult are joltingly interrupted by a very short chapter describing the relationship between the A.D.D. brain and addictions, once again describing the origins of the condition rather than offering solutions to it. Again, it is not the information itself (which is all certainly valuable), but the sometimes exclusionary way in which the information is presented, that I find to be most frustrating.

If you are looking for poignant and poetic descriptions of the A.D.D. experience, then I highly recommend "Scattered." However, if you want a more balanced presentation of a variety of theories regarding the origins of A.D.D., as well as practical solutions geared towards the A.D.D. adult in particular, then I recommend "Out of the Fog," by Kevin Murphy and Suzanne Levert as a better choice.

Dr. Mate is an extremely articulate writer, and his book is a worthy addition to any library of A.D.D. material. But from the standpoint of practical solutions, "Scattered" loses focus mid-way through, in that it attempts to address the needs of far-too-wide of an audience, thereby not only diluting the impact of its message, but also excluding a significant portion of readers in the process.

I applaud Gabor Mate for the remarkable contribution he has made to the literature on Attention Deficit Disorder in his book Scattered. Due to both personal and professional interest, I have read and recommended many books and articles on this topic. I find that Scattered has become the first book I recommend to colleagues, clients and anyone interested in learning about, or ruling out ADD. Feedback is consistent with my own reaction--this is a comprehensive and insightful book--an easy, informative, valuable, read for professional and lay people. The role of biology/nature is described so well that the non-scientific reader gains a new level of understanding. When it comes to the role of nurture/environment--Mate truly shines-- capturing the experience of ADD with an insiders wisdom and a refreshing openess, bringing the reader understanding, comfort, hope and pathways to healing. The material on parenting (ADD and the child) is excellent---could be part of a parenting handbook. His writing on change and growth and his understanding of what causes adults to struggle have value across the board --whatever the issues are. One does not have to have, or work with ADD to enjoy and benefit from Scattered.

Mate offers a very fresh, insightful interpretation of ADD as a cognitive vulnerability that may or may not manifest itself, or manifest itself in varying degrees depending on one's environment. In this sense, the book takes a ecological approach to the problem; ADD, according to the author, is not biological determinism and it's not cultural construct and it's not some conspiracy to keep certain children in their place and it's not a pharmaceutical ploy for more business. Anyone who has taken prescribed Ritalin knows it's about the cheapest prescription drug on the market (and has been around nearly the longest). The author simply points out that according to current and provisional informed research (and research can only be provisional unless we can stop time), the idea that symptoms of ADD are a result of many forces--chemical, environmental, cultural, and developmental--just makes sense. Since Mate's analysis is moderately complex in comparison to most analyses in most popular ADD books, it may turn off those who want a quick pat explanation to the "disorder." The author is a doctor with ADD; so his analysis is both research oriented and phenomenological. He is also smart enough not to use the word "prove" in his book because he knows he isn't proving anything: he is simply making his own best inferences based on current knowledge. He makes sense; and he adds to the current literature on the subject. If you have been diagnosed with ADD, you will nod your head in agreement through much of the book. The author also has a gift for writing, having been a former English teacher. Thus, his language is on a level of sophistication which does justice to the subject, and lends his observations authority. This is far different from the "cookbook" breezy style of so many other authors who address the subject.

The ADHD world seems to have split into several definable camps -- the neo-Darwinist doomsayers like Barkley who say flat-out that ADD is "of no value whatsoever" and is purely a sickness; the deniers like Breggin and Rush Limbaugh who think it's a conspiracy by doctors or liberals; the geneticists like Comings who suggest ADDers shouldn't breed to keep from contaminating our gene-pool; and those like Lucy Jo Pallidino who consider it a "context disorder," a collection of traits that may be useful in some times and places but is generally not a good match for the way our schools are currently set up (I consider myself in this category).

Now comes Gabor Mate, an insightful, no-nonsense, and thoroughly compassionate physician who provides an overview of all these perspectives and comes to the marvelously humane conclusion that ADD/ADHD is neither nature (genetics) nor nurture (parenting/environment) but, rather, the result of the collision of a predisposing nature with an ADD-hostile life situation, family, school, or job. How refreshing!

Gabor Mate has made a valuable contribution to the ADD/ADHD world, and this book not only offers thoughts on what it is and where it came from, but also is chock full of useful, real-world solutions for the problems people with ADD confront in a world increasingly run by bureaucrats and farmers.

Highly recommended!

--Thom Hartmann

Dr. Mate, who has ADD himself and who is the father of three children with ADD, provides information about brain development and theorizes that ADD results from problems in bonding that effect brain development. He discusses addiction as related to ADD and the lack of bonding. He provides a method of treatment that addresses the underlying dynamic rather than dealing more superficially. As someone with ADD myself, experience in working with autistic and learning disabled children, and a strong interest in curative emotional relationships, I have found this book incredibly insightful and useful. It is strongly recommended to professionals as well as clients and families. It is written with respect and compassion and refrains from blaming parents for their children's difficulties.

Five years ago, I picked up this book and, mesmerized, read it in one sitting. With content so rich and insightful, I felt perhaps I should stop and absorb each chapter before continuing. Yet Mate's elegant writing was too captivating and flowing to put down.

Today, it is the book in my extensive ADHD library that I turn to when I need reminding of some core concepts, such as "counterwill," Mate's term for oppositional defiance. So many other books about ADHD float on the surface or focus on medical treatment options. While I would be the last person to minimize the importance of medication -- I've seen in too many people medication's dramatic effects and their immense gratitude -- there is so much more to understanding ADHD.

For example, here is an excerpt on Counterwill:
"Children with attention deficit disorder are often characterized as stubborn, oppositional, cheeky, insolent, spoiled. "Wilful" is a description almost universally applied to them.... ADD children can hardly be said to have a will at all, if by that is meant a capacity which enables a person to know what he wants and to hold to that goal regardless of setbacks, difficulties, or distracting impulses....

"...Counterwill is an automatic resistance put up by a human being with an incompletely developed sense of self, a reflexive and unthinking going against the will of the other. It is a natural but immature resistance arising from the fear of being controlled. Counterwill arises in anyone who has not yet developed a mature and conscious will of their own. Although it can remain active throughout life, normally it makes its most dramatic appearance during the toddler phase, and again in adolescence. In many people, and in the vast majority of children with ADD, it becomes entrenched as an ever-present force and may remain powerfully active well into adulthood. It immensely complicates personal relationships, school performance, and job or career success."

[...]

Passages such as that completely unlocked the door to understanding for me. When it comes to ADHD, I've learned, what's "obvious" on the surface seldom holds water under close scrutiny. Despite having read dozens of books and articles on ADHD, I've not seen this perception on counterwill expressed and yet, from my observation, it is bedrock truth. And, it is only one of the profound concepts Dr. Mate exlains.

Otherwise, I find certain assumptions on Dr. Mate's part highly disturbing. As for the nature/nurture issue, for example, we know so little about genetic expression. Last time I looked, at least 7 genes, in various combinations and subsets, are thought contributory to ADHD. Perhaps it will be 10-20 years or more before we understand this highly heritable condition. I do know many mothers of children with ADHD who say that, even in utero, the child was clearly hyperactive. Some cases are less clear-cut. There are no hard and fast answers here. And it would be turning back the clock a century to revert to "blaming the mother."

That said, recent genetic studies reinforce Dr. Mate's theories in part, showing that the presence of a "behavior"-related gene does not guarantee its expression. For example, the recently discovered "shyness" gene seems to express in children who have it only under stressful conditions. (You can read more about this in a Jan 2006 Wall Street Journal's "Science Journal" column.) The idea is not to make parents feel guilty, as some have suggested, but to expand our knowledge and help future generations of children as much as possible. For instance, the epigenetic factors are good reason to encourage parents of children with ADHD to undergo screening for ADHD themselves. Studies have shown the often deleterious effect of living with a parent's untreated ADHD.

To summarize: This is an elegant, interesting read. But I would be more skeptical of Mate's outdated "blank slate" perspective. The fact is, none of us is born with a perfect body, and the body includes the brain, the most complex and highly vulnerable organ. To assume that we are born perfect, and it is life experience that causes ADHD and other brain issues....that's in the 19th Century, as far as I'm concerned. And that attitude holds people back, preventing them from benefiting from 21st Century strategies.

Gina Pera, author
Is It You, Me, or Adult A.D.D.? Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder
ADHDRollerCoaster.com

Reading this book was the best thing that ever happened to me. For me as a 49-years-old with only recently diagnosed ADD, it is of more therapeutic value than a good 17 years of psychotherapy have been. One reason is that I feel understood for the first time in my life. Another reason is formed by Maté's clear explanations on how to treat myself in order to make room for personal growth and development. In short: a jewel.

Do you wonder why you do and feel all of the weird things you do and feel? If it's due to Attention Deficit Disorder, you'll be thrilled with this compassionate, user-friendly book. Dr. Mate is personal, clear, and non-blaming in his explanations, insights, and suggestions for healing. His approach to medication usage is conservative but balanced. He and several of his children have ADD, and he shares honestly about his struggles with the symptoms. The book offers an excellent tapestry of the neurological and the psychological. I found that I now had an understanding of the "neurology behind the psychology."

This phenomenal book, Scattered, by Dr. Gabor Mate, goes beyond causing us to totally rethink anything we thought we knew about Attention Deficit Disorder. Dr. Mate introduces us to an eye- opening concept that the cause of ADD is that children (he explains that it's due to what is called a lack of attunement between parent and child) are often not registering and processing the love of even the most caring parents. The author does a masterful job of explaining why this is so. Suddenly, one appreciates just how much knowledge and awareness must go in to the complex job of parenting. Dr. Mate truly has a gift for sharing this information in a way that will mesmerize readers of this inspiring book. After reading Scattered, many will no doubt come to the realization that they, or someone they love, may suffer from ADD or Adult ADD. I owe Dr. Mate a debt of gratitude for clarifying why so many people are experiencing such hurt and pain. Needless to say, I recommend this book as being crucially important for anyone who has reached a point of desperation in terms of understanding the cause of their emotional problems. This book should be mandatory reading for every teacher - for anyone who works with children. Thank you, Dr. Mate for your intuitive insights and this groundbreaking work that could change the world by impacting on all the generations to come.