Driven to Distraction (Revised)

by Edward M. Hallowell

  “That’s not quite true,” the psychiatrist interrupts. “He’ll still have to be held accountable, it’s just that now we’ll have a better idea of what he’s up against. It’s as if he’s been nearsighted all these years and now we’re giving him glasses.”

  “I don’t know,” Alex says, looking over at Tommy as if he had just robbed a bank, “it still all sounds like baloney to me.”

  Tommy leans back and gives his brother the finger. “You’re such a wimp,” he says.

  “You see?” Alex says.

  “Wait a minute,” Dad interrupts. “Let’s not start arguing again. We’ve done enough of that to last us a long while.”

  “So what do we do?” Tommy’s sister asks. “This family wouldn’t know what to talk about if we couldn’t talk about Tommy.”

  “That’s not true, Suzie,” Mom says.

  “Well, maybe it isn’t, but there sure will be some empty air time to fill if we’re not going to have fights about Tommy anymore.”

  “Who says we’re not going to have fights about Tommy?” Alex asks. “I didn’t say I’d go along with that.”

  “Nobody has said they’d go along with that,” the psychiatrist interrupts. “And Suzie makes a good point. Your fights about Tommy may have been serving a purpose and may be hard to replace.”

  “What kind of purpose?” Dad asks.

  “Well, for one thing they may be fun,” the psychiatrist says.

  “Fun? What do you mean, fun?” Mom gasps. “They’re horrible.”

  “I’m not sure,” the psychiatrist says, “but I think as horrible as they may be, they may also be a form of family entertainment.”

  “I think that’s true,” Suzie says, looking at Alex. “I can think of at least one person who likes them a lot.”

  “So what if I do,” Alex responds. “He’s got it coming to him.”

  “There may be other reasons to keep the fights going as well,” the psychiatrist goes on. “As long as Tommy takes the heat, it takes it off other people.”

  “You make it sound as if Tommy is just an innocent victim,” Dad says.

  “I don’t mean to,” the psychiatrist says. “I’m just suggesting you all might want to keep things the way they are rather than see things change.”

  Families, by and large, like most groups, resist change. If one member of a family wants to move away, this is often regarded as a betrayal, for example. If one member of a family is fat and tries to lose weight, often other members of the family will sabotage the effort. If one member of a family wants to get out of a role he or she has been playing for years, this is usually difficult to do because the rest of the family tries not to let it happen. If your role is clown, you remain the clown. If your role is responsible oldest child, you probably keep that role, within your family, for your entire life. If you are the black sheep, you’ll find it very difficult to change colors in the eyes of your family no matter how many good deeds you do.

  So it is with ADD. When the diagnosis is made and the family is faced with the challenge to change, this challenge is often met with great resistance. In the scene above, Tommy’s brother Alex voices the resistance, but he is speaking not only for himself, but for the family system as well. If you think of a family as an interconnected group, a system rather than a set of discrete individuals, it is easier to see how movement by one member sets off movement by another, as in a reverberating circuit. And in the family system one member can speak an opinion that everyone in the family holds to some extent but doesn’t have to voice as long as that one member stays in his role. In the example above, by expressing his skepticism and resentment at the diagnosis of ADD, Alex allows the other members of the family to be more understanding toward Tommy. Let’s see what happens when Alex wavers.

  “You mean I might not want Tommy to get this diagnosis because it will make me take more heat?” Alex asks.

  “Something like that,” the psychiatrist says.

  Alex grunts. “I think you may have a point there.”

  “Alex, are you feeling OK?” Mom asks with a forced smile.

  “Yes, Mom, I am. Can’t I have my own opinion without you questioning it?”

  “I think Alex is trying to beat us to the punch,” Dad says. “He wants to agree before we force him into it.”

  “Alex is trying to be noble,” Suzie says sarcastically.

  “Alex is full of it,” Tommy says, folding his arms. “Don’t trust him for a second.”

  By even tiptoeing out of his role, by even considering changing his assigned lines, Alex receives rapid-fire attack from every member of his family. He has a job to do, a role to play. If he doesn’t do it, even if he just wavers, the family gets uneasy and attacks.

  This kind of invisible process, common in families yet hard to pin down, can get in the way of the changes the family needs to make once ADD has been diagnosed.

  “Wait a minute,” the psychiatrist intervenes. “Give Alex a chance. Maybe he is opening the door to the possibility of change.” With some help from the psychiatrist Alex is allowed to leave his role as antagonist and skeptic for a while and look at the possibility that Tommy does have a bona fide medical condition that warrants a rethinking of family roles and family procedures. Although in this case Alex is the point person, it is a family decision. Once this happens, once the family gives its permission for change to occur, or at least to be explored, then the Big Struggle can begin to de-escalate, and a negotiated peace can be worked out.

  Once the fist of the Big Struggle has unclenched, then the family can begin the commonsense process of negotiation. The two keys to reaching this point are first, making the diagnosis of ADD, and second, persuading the family unconscious to grant permission for there to be change within the family system. How do you talk to the family unconscious? How do you get it to grant permission to change? The methods a therapist typically uses include interpretation, which the psychiatrist did in the example above when he suggested there might be reasons the family did not want to stop fighting with Tommy, or confrontation, as when the psychiatrist said to the family, “Wait a minute. Give Alex a chance.” In this instance, the psychiatrist was confronting the family before the members could stop Alex from stepping out of his role. Other techniques the therapist may use include direction, support, and suggestion. These may or may not take place within family therapy. Usually, some kind of family meeting or family-therapy session helps to get change going. A family need not feel it must go into family therapy to negotiate change, but it would help if the family was aware of some of the pitfalls in family negotiation. Whatever the course of action, you should be aware that there is such a thing as a family unconscious, and that it may try to sabotage the most constructive and well-meaning efforts toward change.

  As the family is trying to change, the watchword should be “negotiation.” Although it may be quite difficult at first, the family should try to bear the tension of reaching consensus, of listening to and putting up with each other long enough for everybody to feel heard and for everybody to have taken part in reaching the final solution. It is easier to hold people to a negotiated settlement than a dictated one.

  For example, at a later session with just Tommy and his parents, Tommy’s mom began, “We really have to come up with a plan about homework.”

  Tommy slumped down in his chair. The psychiatrist noticed this—it was hard to miss—and simply said, “Let’s try to have this discussion in a new way.”

  Tommy and his parents looked at the psychiatrist for a moment, then at each other. There was a pause, as anxiety mounted. “OK,” Tommy’s dad said. “I’ll take the lead on this. I think I can see how my way has not been the smartest way. What can I tell you? It was how I was brought up. My father was just as dumb and stubborn as I am. If I didn’t do what he told me to do, he took off his belt and hit me with it until I did what he told me to do.”

  “Did that method work?” the psychiatrist asked.

  “Oh, sure,” Dad said. “In t
he short run. I did what he told me to do. But I learned to hate the son of a bitch. I’ve forgiven him now, I guess, because he was just doing what he knew, probably just what had been done to him. But it cost us a relationship. I still can’t talk to him. I just can’t imagine talking to him about anything that matters. So we have really stilted conversations that both of us can’t wait to end. Then we go off and wish we had a better relationship with each other.”

  Tommy was looking at his father, obviously interested. “You never told me about that, Dad,” Tommy said.

  “No, I guess I didn’t,” his father said. “But I don’t want to make the same mistake with you. And I won’t, damn it. Don’t get me wrong, kiddo, I have never hit you with a belt and I do not intend to let you manipulate me into doing whatever you want, but coming here has made me think about some things, and I really don’t want to end up not talking to you. I don’t know why, but I like the look of your ugly puss and the sound of your squeaky voice.”

  “Hey, Dad, I just love your forty-inch waist,” Tommy said.

  Tommy’s mother sat watching and listening. At one point, when neither her son nor her husband could see her, she nodded approvingly at the psychiatrist.

  “Thirty-eight,” Dad said.

  “OK, I’ll give you two inches. So you also want homework?” Tommy said.

  “Yes. I would say you should want homework, but I know you don’t. So what do you want?”

  “Free time, money, girls, music, and fast cars,” Tommy said with a big grin.

  With these positions as starting points, Tommy and his dad, with Mom’s silent encouragement, started to negotiate a plan they could each live with. The key to doing it was to establish a tone of support and cooperation first, and not come at the negotiation struggling.

  Unfortunately, what often happens in families is that the ADD so threatens the parents’ sense of control that one parent or the other—or both—overreacts to the threat by trying to control every last detail. This person insists on dictating how everything should be done, as well as when, where, and why. As appealing as enlightened monarchies may be in the abstract, in families torn by ADD they rarely work well. This is for several reasons. First, monarchs are usually not as enlightened as they think they are. Second, members of the family understandably resent constantly being told what to do. And third, such a controlling hand serves to raise, rather than reduce, tension and conflict within the family. For example, in the session above, had Tommy’s dad led off by saying something vaguely combative or confrontational like, “Now see here, Tommy, you have got to know that we are in charge, and you have got to live by our rules,” it is unlikely the session would have gone well. The sides would have polarized. Tension would have risen, and, even if Tommy did partially agree with what his father was saying, he never could have acknowledged that out of fear of losing face.

  Negotiation, of course, is at times impossible. And with younger children it is often not desirable. Younger children with ADD especially need structure and limits. They want them, and they will test parents until they get them. With a younger child it makes more sense to say, “We’re going to McDonald’s,” than to say, “Which of the five fast-food restaurants in this area would you like to go to tonight?” A younger child gets caught up in the stimulation of making such a vast decision. He or she gets preoccupied with all the options and excited by all the possibilities, and could take an hour or two to decide where to have dinner. It is best in these moments to use one’s common sense and intervene decisively. “We are going to McDonald’s,” may be met with protests, but it is also met with an inner, unspoken sense of relief.

  The art of negotiation, a key to the family management of ADD, should be introduced at an early age, but not relied upon with younger kids. Sometimes they are just unable to bear the tension it requires. At other times they will turn negotiation into argument and find it to be a lot of fun. Argument is stimulating, and people with ADD love stimulation. A child with ADD who is bored may instigate a family fight, just because he enjoys the stimulation of it. When this happens it is fair to exercise parental control and say, “We’ll do it my way because I said so,” and engage in no further discussion until the situation has calmed down.

  As children grow older, negotiation becomes more important in all families. Negotiation is key to managing any family’s or any group’s behavior. But getting on the track to negotiation in a family with ADD is very difficult. Don’t get discouraged if you keep falling back into a struggle as you try to negotiate. First, bear in mind that it is in the nature of the person with ADD at any age to prefer a struggle to a negotiation because a struggle is often more stimulating. It can be more exciting to have a family fight than to act reasonably and cooperatively and peacefully. It may be more fun to throw mashed potatoes at your sister than to pass the bowl politely. Most people with ADD love excitement and stimulation. So the Big Struggle is usually more inviting—more engrossing—than some boring negotiation.

  Second, the process of negotiation is inherently difficult for someone with ADD because it entails bearing frustration. This is difficult for all people. But it is particularly difficult for the person with ADD who would rather deal with frustration by blowing it off, or by reaching closure too quickly—even if that means sabotaging his own interests—than by the excruciatingly painful ordeal of bearing with it. Like sitting still in class, it is almost impossible for the child or adult with ADD to sit still with frustration. (A practical suggestion here is to encourage the person with ADD to pace about the room while the negotiation is proceeding.)

  With those cautions, are there some general principles that will aid in negotiation in families? One of the best books written on the art of negotiation comes from the Harvard Negotiation Project. It is Getting to Yes: Negotiating Agreement Without Giving In, by Roger Fisher and William Ury. Originally intended for application to business and diplomacy, this book is better than almost any psychology or family-therapy text for learning how to negotiate effectively in families.

  The authors recommend a method of negotiation they call principled negotiation or negotiation on the merits. The method rests on four basic points:

  1. “People: Separate the people from the problem.”* The idea here is to get people’s ego and pride disentangled from whatever the problem is so that the problem can be attacked without fear of attacking any person in the process. If the person is attached to the problem, the person may never change his mind, no matter how reasonable the solution, because he doesn’t want to lose face.

  2. “Interests: Focus on interests, not positions.” This is what separates negotiation from debating. A debating team defends—or attacks—a certain position, no matter what. It is its sole interest to do that. Like an infantry, its position is its interest. Negotiation should never become debating (or trench warfare). In negotiation people have many interests, and it is the interests, not some debating position, that need to be satisfied. Indeed, one’s position may sometimes go against one’s interests and one does not want to be so identified with one’s position that one cannot change it. This is particularly true with adolescents, who can back themselves into a corner during an argument so that they end up, out of pride, defending a position they really don’t want at all.

  3. “Options: Generate a variety of possibilities before deciding what to do.” This is particularly important in ADD families, because it is the tendency of the person with the ADD to bring premature closure to the discussion just to avoid bearing the tension of the discussion itself. Don’t feel everything has to be wrapped up in one meeting. Get the problem out and then let everybody take a few days to think about it, to come up with various options and solutions. It is much easier to think freely when you are not under pressure. Be very careful not to bully anyone into some agreement too soon.

  4. “Criteria: Insist the result be based on some objective standard.” This allows the members of the negotiation to appeal to some standard other than their own will or opin
ion. Examples of objective standards that might be useful in family negotiations would be: What do other families in this area do about this problem? What does the school recommend? What would the open market pay for this service or item? What is the relevant medical information regarding the safety of this activity? What sort of practice schedule does the coach recommend? What does the law say? Is there an agreed-upon set of values or a religious concept that could help the negotiation?

  Often in family negotiations parents switch back and forth between “hard” and “soft” negotiation. One day, or one moment, they will be setting strict limits and proposing severe punishments. The next day, or the next moment, they feel unhappy about their “hard” position and switch to a “soft” one, which also becomes ineffective. One day Tommy is being thrown out of the house, and the next day his mother may bake cookies for him in an effort to prop him up. In principled negotiation, as described by Fisher and Ury, the idea is neither to be soft nor hard but to negotiate on the merits, on the principles and issues, always looking for ways of finding mutual gain, and where interests conflict, reconciling them on the basis of some fair standard rather than strength of will or power.

  For example, in Tommy’s case it was important to get past the power struggle between Tommy and his parents and into the problem of managing school performance. As long as the power struggle predominated, as long as the people were attached to the problem, to use Fisher and Ury’s terminology, the Big Struggle would go on. Once Tommy and his dad were able to meet amicably on some common ground, true negotiation could begin.

  After Tommy’s family had worked out their plan, something happened that often happens in families with ADD. One member of the family tried to rekindle the struggle. Tommy had agreed to go over his homework every other day with a tutor. One night at dinner Tommy’s brother, Alex, decided to tease Tommy about having to see a tutor. “Tutors are for retards,” Alex said.