Driven to Distraction (Revised)

by Edward M. Hallowell

  Rather than see Edgar individually, I decided to see him with Amanda. It was as important for Amanda to understand what was going on as for Edgar. His capacity for insight was minimal at first, and his ability to observe himself was not reliable. Amanda became his coach, so to speak, reminding him of what he otherwise would forget. For most situations this kind of couples therapy would not work, because it identifies one member of the couple as the patient. But for ADD it is a realistic way to proceed.

  With Amanda’s help, and with the help of medication, Edgar was able, over time, to develop some capacity to reflect before acting, to find relaxation and focus by other means than fast cars, loud music, and marijuana, and to think before speaking. He even made an appointment to see the dentist. He often asked me to increase the dose of the medication, or to go at him harder in therapy. “I can take it, Doc. Sock it to me.” I had to explain to him that more wasn’t always better, and that some of his expectations for a “total overhaul,” as he called it, were a bit beyond reach just now.

  After six months Edgar and Amanda felt ready to move on. The question of when to end therapy for ADD is an open one. For some people the treatment lasts just a few sessions. For most people, however, it takes longer than that. The individual—or couple—must rethink a great deal of behavior, and a good therapist can facilitate this process. Also, it can take a while to find the right dosage of the right medication. Finally, the emotional adjustment to ADD can require psychotherapy. The average duration of treatment for adult ADD is about three to six months.

  I met with Amanda and Edgar together for one last visit. Edgar’s family had given him his job back, conditionally, and, as Amanda told me, they had indeed missed him.

  “Thanks a lot, Doc,” Edgar said, still chewing a piece of gum. “I never thought I’d say that to a man in your line of work, if you know what I mean.”

  “Edgar!” Amanda said, slapping his knee.

  “Do you know what you’re thanking me for?” I asked.

  “Of course, Doc,” Edgar said. “Of course I know what I’m thanking you for. I’m thanking you for doing a very respectable job of shrinking my head.”

  “Edgar!” Amanda said again.

  “That’s quite all right,” I said. “In fact, that’s an excellent compliment. But I was wondering if what we’ve been saying in here makes sense to you now that we’re finishing.”

  “I’ll tell you the truth, Doc. I can’t remember most of what you’ve told me. Amanda here, the rod and staff of my life, has written all kinds of things down and she reads them to me when we get home, and she makes lists and does all the things you’ve said we should do, and she sees to it that I do the things I’m supposed to do, including take the medication. But do I know what we’ve been doing here? I know I have ADD. That much I’ve learned. Don’t ask me what it means, except whatever it is, I feel much different now. Not as edgy. Not as out of control.”

  “Do you miss the pot and speeding in the car?” I asked.

  “The truth?” Edgar asked. “The truth is I don’t, if you can believe that. Can you believe that? In fact, it scares me to think of it now. But maybe that’s just because I’ve spent so much time lately with Amanda and you. We’ll have to see what tomorrow brings.”

  The last I heard, Edgar and Amanda were together, Edgar was working, and life was pretty good.

  There are many other issues that come up in working with couples and ADD. One of the most important, and least written about, is sexuality.

  The impact of ADD upon sexuality is poorly understood. However, we have seen many people in our practice, both men and women, who complain of either an inability to pay attention during sex well enough to enjoy it, or the opposite: a hyperfocused hypersexuality.

  Those who appear to be hypersexual may turn to sex as a form of intense stimulation to help them focus. Many adults with ADD are drawn to high-stimulus situations as a means of alleviating boredom or clearing their mind of distraction. Some get involved in physically dangerous activities, such as racecar-driving or vertical skiing or bungee-jumping or they get involved in risky activities like gambling or dangerous romances. They do these things as a means of focusing themselves; they focus around the high stimulation. For some adults with ADD, sex acts as a kind of stimulating medication, and they use it to find not only the pleasure of orgasm but the pleasure of being focused.

  On the other hand, those who cannot pay attention often accuse themselves—or are accused by lovers—of being “frigid” or “undersexed” or involved with someone else. In fact, they may enjoy sex a great deal but simply have problems staying focused while making love, just as they have problems staying focused during any other activity.

  One woman left me an anonymous note after a lecture I had given. It was the first time anyone had put plainly to me how distractibility can directly interfere with sexual activity:

  Dear Dr. Hallowell,

  I enjoyed your talk very much, and I wanted to ask you this question, or, more accurately make this comment during the discussion period, but frankly I was too embarrassed. So I am leaving you this note in the hope that the concerns it raises can be of help to other people.

  I am a forty-two-year-old woman. I’m quite attractive, if I do say so myself, and I love my husband. He is devoted to me. I am the woman of his dreams, he says. However, until I was diagnosed with ADD a year ago, I had never had an orgasm. In fact, my husband and I never had a satisfactory sex life. He had adored me from the start—I think that’s why he stayed with me. But sex between us? It was boring at best.

  For the longest while I thought the problem was that I was just frigid. I was raised a Catholic, and I figured I just never got past the impact the nuns had on me. But it tore me up inside. Because I had sexual feelings. I had them all the time. I just couldn’t focus them, in bed with my husband. I read lots of erotic literature, I had incredible urges toward other people, none of which I acted on—and I saw several different therapists to work on what I thought was my mental block. How could I feel so sexy, look sexy, dress sexy, be married to an incredible man, and yet think of tomorrow’s shopping list as he’s making love to me? Once in a while, I guess that’s normal, but all the time?

  The worst part was I really started to hate myself for this and to feel tremendously inadequate. I hate to say this, but I even thought of just running away—you know, the slow boat to nowhere. But I never would have left. The kids, my husband, I couldn’t leave them, although, as miserable as I was at times, I think they might have been happier without me.

  Then I got lucky. A friend referred me to a new therapist, and this woman knew about ADD. She made the diagnosis in two sessions and started me on treatment. What a difference! I have never read anywhere about how ADD affects sexuality, but in my case the change was incredible! Now I could focus, now I could be there. After a while I didn’t even need the medication. It was a matter of realizing that it was ADD, and not some inadequacy or hidden guilt on my part. Then it was a matter of taking steps to have sex at the right time, of providing soothing music to take over the daydreaming part of my mind, and of talking to my husband openly about it. He was really great. It turns out he had been blaming himself as much as I had been blaming myself.

  It is amazing how subtle, but how crucial, this discovery has been for me. I can’t help but think there are a lot of women out there who are simply distractible, but who think they are sexually inadequate or just bored instead.

  Now I can have orgasms, but more than that, I approach sex with enthusiasm instead of dread. I can be there, with my husband, instead of somewhere else. I have learned how to enjoy myself sexually. I would never have done this if I had not found out about ADD. The treatment has helped me in all areas of my life, but it has helped me sexually more than anything. My main problem was in staying focused, and I never knew it. I kept thinking it was something much worse, more complicated, and unfixable. And when I consider how relatively simple—yet powerful—the answer was, I wanted to
share it with you in the hope you will share it with others.

  Since I never had a chance to thank the anonymous author of that note, let me say now, thank you, wherever you are. Your note caused me to start paying attention to an aspect of ADD most of us have largely overlooked. So far, I have gathered a great deal of anecdotal evidence, full of inconsistency; but many people do indeed report that ADD affects their sexuality, either in the direction of nonresponsiveness or toward hypersexuality. Usually, treatment helps both groups of people.

  The woman in the letter provides a good example of a person who had felt she was nonresponsive. As an example of a person whose ADD led him toward hypersexuality, consider the case of Brian, a thirty-nine-year-old unmarried man who considered himself a “sex addict.” He constantly sought out flirtations or liaisons with women, and he felt that he was incapable of resisting any sort of sexual temptation. He was unable to maintain a long-term relationship because of his unremitting infidelities. Unlike some men who fit this profile, Brian was disturbed by his behavior. He wanted to settle down into one relationship and have a family. He did not want to be a “Don Juan,” as he put it, but he found that he could not resist the power of his attraction to women.

  He spent years in psychotherapy trying to get at the roots of his problem. He and his therapist explored the issue from many different angles. Was he acting out some unconscious hostility toward women by seducing them and then leaving them? Was he plagued by a basic fear of intimacy that lead him to seek a new person the minute he got close to anyone? Was he trying to bolster some sense of sexual inadequacy by proving to himself over and over again that he could attract women? In therapy he took up all of these possibilities, and others as well.

  When he came to see me, he and his therapist had decided that he was addicted to women. They wondered, based on an article the therapist had read, if seeing the problem through the lens of ADD might help.

  Indeed it did. In reviewing Brian’s history from childhood to adulthood, I found he had had problems with distractibility and impulse control all along. Many people with ADD find that certain forms of highly stimulating behavior help them focus, and they turn to these behaviors as a kind of unwitting self-treatment or self-medication of their ADD. Some people turn to gambling as a source of high stimulation and the concomitant focusing it provides. Some people turn to high-risk activities such as driving at high speeds or skydiving. In Brian’s case, he was using the high stimulation of romance to help him focus.

  The following guidelines or “tips” might be helpful in dealing with other issues of concern to couples in which one partner has ADD. These tips offer a starting point for discussion between the partners. The best way to use them is to read them out loud, together. Pause over each suggestion and discuss whether it might help you. As you do this, you can begin to set up your own way of dealing with ADD in your relationship. The keys to it all, as is the case with most problems in couples, are improving communication and resolving the power struggle.

  1. Make sure you have an accurate diagnosis. There are many conditions that look like ADD, from too much coffee to anxiety states to dissociative disorders to hyperthyroidism. Before embarking on a treatment for ADD, consult with your physician to make sure what you have is really ADD and not something else. Once you are sure of the diagnosis, learn as much as you can about ADD. There is an increasing body of literature on the topic. The more you and your mate know, the better you will be able to help each other. The first step in the treatment of ADD—whether it be your partner’s or someone else’s—is education.

  2. Keep a sense of humor! If you let it be, ADD can be really funny at times. Don’t miss out on the chance to laugh when the laugh is there. At that psychological branch point we all know so well, when the split-second options are to get mad, cry, or laugh, go for the laughter. Humor is a key to a happy life with ADD.

  3. Declare a truce. After you have the diagnosis and have done some reading, take a deep breath and wave the white flag. You both need some breathing space to begin to get your relationship on a new footing. You may need to ventilate a lot of stored-up bad feeling. Do that, so you won’t lug it with you everywhere.

  4. Set up a time for talking. You will need some time to talk to each other about ADD—what it is, how it affects your relationship, what each of you wants to do about it, what feelings you have about it. Don’t do this on the run, i.e., during TV commercials, while drying dishes, in between telephone calls, etc. Set up some time. Reserve it for yourselves.

  5. Spill the beans. Tell each other what is on your mind. The effects of ADD show up in different ways for different couples. Tell each other how it is showing up between you. Tell each other just how you are being driven crazy, what you like, what you want to change, what you want to preserve. Get it all out on the table. Try to say it all before you both start reacting. People with ADD have a tendency to bring premature closure to discussions, to go for the bottom line. In this case, the bottom line is the discussion itself.

  6. Write down your complaints and your recommendations. It is good to have in writing what you want to change and what you want to preserve. Otherwise you’ll forget.

  7. Make a treatment plan. Brainstorm with each other as to how to reach your goals. You may want some professional help with this phase, but it is a good idea to try starting it on your own.

  8. Follow through on the plan. Remember, one of the hallmarks of ADD is insufficient follow-through, so you’ll have to work to stick with your plan.

  9. Make lists. Over time, lists will become a habit.

  10. Use bulletin boards. Messages in writing are less likely to be forgotten. Of course, you have to get in the habit of looking at the bulletin board!

  11. Put notepads in strategic places like by your bed, in your car, in the bathroom and kitchen.

  12. Consider writing down what you want the other person to do and give it to him or her in the form of a list every day. This must be done in a spirit of assistance, not of dictatorship. Keep a master appointment book for both of you. Make sure each of you checks it every day.

  13. Take stock of your sex lives in light of ADD. As mentioned earlier, ADD can affect sexual interest and performance. It is good to know the problems are due to ADD, and not something else.

  14. Avoid the pattern of mess maker and cleaner-upper. You don’t want the non-ADD partner to “enable” the ADD partner by cleaning up all the time, in the manner that the nonalcoholic spouse may “enable” the alcoholic spouse by covering up all the time. Rather, set up strategies to break this pattern.

  15. Avoid the pattern of pesterer and tuner-outer. You don’t want the non-ADD partner to be forever nagging and kvetching at the ADD partner to pay attention, get his or her act together, come out from behind the newspaper, etc. People with ADD frequently need a certain amount of “down time” every day to recharge their batteries. It is better that this time be negotiated and set aside in advance rather than struggled over each time it comes up.

  16. Avoid the pattern of victim and victimizer. You don’t want the ADD partner to present himself or herself as a helpless victim left at the merciless hands of the all-controlling non-ADD mate. This dynamic can evolve easily if you aren’t careful. The ADD person needs support and structure; the non-ADD mate tries to provide these. Unless there is open and clear communication about what is going on, the support and structure can feel like control and nagging.

  17. Avoid the pattern of master and slave. Akin to number 16. However, in a funny way it can often be the non-ADD partner who feels like the slave to her or his mate’s ADD. The non-ADD partner can feel that the symptoms of ADD are ruining the relationship, wrapping around it like tentacles, daily disrupting what could be, and once was, an affectionate bond.

  18. Avoid the pattern of a sadomasochistic struggle as a routine way of interacting. Prior to diagnosis and intervention, many couples dealing with ADD spend most of their time attacking and counterattacking each other. One hopes to get past
that and into the realm of problem-solving. What you have to beware of is the covert pleasure that can be found in the struggle. ADD is exasperating; therefore, you can enjoy punishing your mate by fighting with him or her. Try, rather, to vent your anger at the disorder, not at the person. Say “I hate ADD” instead of “I hate you,” or say “ADD drives me crazy,” instead of “You drive me crazy.”

  19. In general, watch out for the dynamics of control, dominance, and submission that lurk in the background of most relationships, let alone relationships where ADD is involved. Try to get as clear on this as possible, so that you can work toward cooperation rather than competitive struggle.

  20. Break the tapes of negativity. Many people who have ADD have long ago taken on a resigned attitude of “There’s no hope for me.” The same can happen to both partners in the couple. As will be mentioned in many places throughout this book, negative thinking is a most corrosive force in the treatment of ADD. What I call the “tapes of negativity” can play relentlessly, unforgivingly, endlessly in the mind of the person with ADD. It is as if they click on as the sun rises and click off only when the unconsciousness of sleep shuts them down. They play, over and over, grinding noises of “You can’t”; “You’re bad”; “You’re dumb”; “It won’t work out”; “Look how far behind you are”; “You’re just a born loser.” The tapes can be playing in the midst of a business deal, in the reverie of a car ride home, or they can take the place of making love. It is hard to be romantic when you are full of negative thoughts. The thoughts seduce you, like a satanic mistress, into “loving” them instead. These tapes are very difficult to break, but with conscious and sustained effort, they can be erased.

  21. Use praise freely. Encouragement, too. Begin to play positive tapes. Find something positive to say about your mate or about yourself every day. Build each other up consciously, deliberately. Even if it feels hokey at first, over time it will feel good and have a sustaining effect.