Peter was able to convince me of his sincerity in seeking help, and I took him on as a patient. I reviewed the school records his mother gave me, and I listened to both Peter’s and his mother’s account of his childhood. It was classic for ADD. In fact, one pediatrician had made the diagnosis of hyperactivity, but there had been insufficient follow-up. Peter’s academic performance declined through high school. Even though he was very bright—an IQ of 126, which due to ADD probably measured lower than it actually was—he could not do satisfactory work in high school, and he dropped out.
One problem led to another, and this handsome, smart, middle-class boy ended up in jail. After his release from jail he began to turn his life around on his own. Angry, cynical, and bitter on the one hand, he was also full of determination: to stay off drugs, to get an education, to make up for lost time.
The treatment for his ADD provided a key he’d been looking for. “Now I don’t even want to smoke dope anymore,” he said. “It’s like the medication takes away the urge.” He got a job and began attending night school as well. He set high goals for himself and got the highest grades in his class. His job reports were outstanding. His girlfriend, who had stood by him even through his days in jail, said she felt confident now that things would work out. But the most dramatic report on the effectiveness of the treatment came from Peter’s mother, who wrote me a letter that I excerpt here:
Dear Dr. Hallowell,
The last time your eyes passed over this handwriting, I was a mother filled with desperate hope. Peter was home this weekend for the first time since he has been on medication. It is really almost impossible to put the words down on paper that fill my heart.
The Peter that came home this weekend was the Peter who I always knew he was and wished he would let himself be. This was the first time in his life he actually sat down in a chair and carried on a conversation with his father and me.
My heart would always pound in my chest when he and his father would ever try to do anything together, or even simply talk. It would be like a time bomb ticking and you knew it would go off. I watched them talk, laugh, load a van together (they could never even do that without disagreement). His father’s reaction was, what a pleasure to have Peter home.
My reaction cannot be done justice in writing. He and I talked the whole time he was here—until 3 A.M. Sunday morning. There is this strange feeling I seem to have always had through all of the years, the nightmare times included. Maybe it is just a mother wanting that certain image, but I really have been, I feel, not your June Cleaver type. Under the rough edges, the long hair, Grateful Dead, the period from “hell,” I see and always have seen something very special in Peter, and now it is coming to the surface. Maybe it is something as simple as seeing him with Lorraine [his girlfriend], their laughter, their caring for each other, hearing plans for the future, of him heading for a field where I know his talent would be utilized.
To see your son you love heading on a collision course, involved with the wrong people, drugs, negative self-esteem, clashes with the system, prison, the heartbreak—any parent finds it hard to continue to keep putting one foot in front of the other, to keep their life going, but they have to.
Then, how does it happen? This young man, my son, finds an article in a woman’s magazine of all unlikely places, talks to his mother about it, and sends the article which leads to the knowledge that changes a life.…
The young man that came home this weekend, the peace and love that was felt by both of those parents who couldn’t give up, who refused to write this child off, who were given the strength to persevere …
It’s been a year now since I met Peter. He has remained drug-free. He is doing well.
ADD in the Creative Person
While creativity is commonly found in people who have ADD, we discuss it here as a separate subtype in order to highlight some of the issues involved in ADD and creativity.
A full definition of creativity and its psychological and neurological roots is well beyond the scope of this book. For our purposes we define creativity as a tendency to see life’s elements in new ways, a tendency to combine bits of personal experience into new forms, a tendency to give shape to new ideas.
Several elements of the ADD mind favor creativity. First of all, people with ADD have a greater tolerance of chaos than most. Living in distraction as they do, bombarded by stimuli from every direction and unable to screen out what is extraneous, people with ADD live with chaos all the time. They are used to it, they expect it. For all the problems this might pose, it can assist the creative process. In order to rearrange life, in order to create, one must get comfortable with disarrangement for a while. One must be able to live with the unfamiliar without, to use Keats’s phrase, any “irritable searching after fact and reason.” In bearing with the tension of the unknown or the unfamiliar, one can enable something new to come into existence. If one forecloses a thought too quickly, because it seems too weird or strange or disorganized, then the pattern or beauty that may be hidden within the fantasy will get lost.
When someone with ADD receives a stimulus of some sort—an image, a sentence, an idea, a person’s face, a question—he does not immediately put it in its “proper” place. He doesn’t even know where that place is. So, for example, the water bill gets filed with concerns over a fishing trip, and the next thing you know an idea is being generated that has to do with entrepreneurial fishing expeditions. The very uncertainty with which people with ADD react to most stimuli allows for these messages to metamorphose before they solidify in the mind. This tendency to get confused or to confuse things—so often regarded as a chief bedevilment of the ADD brain—can enhance creativity most advantageously.
Second, one of the cardinal symptoms of ADD is impulsivity. What is creativity but impulsivity gone right? One does not plan to have a creative thought. Creative thoughts happen unscheduled. That is to say they are impulsive, the result of an impulse, not a planned course of action. One can set up conditions that maximize the chances of a creative moment occurring, chance favoring the prepared mind, but the actual idea, or phrase, or image comes, as it were, out of nowhere. Nowhere is where many ADD people live all the time. Neither here nor there nor anywhere in particular, but rather here and there, not in any one place, but all over the place, nowhere precisely. And it is out of nowhere, on the wings of impulse, that creativity flies in.
A third element that favors creativity among people with ADD is an often-overlooked capacity they have. This is the ability to intensely focus or hyperfocus at times. As mentioned earlier, the term “attention deficit” is a misnomer. It is a matter of attention inconsistency. While it is true that the ADD mind wanders when not engaged, it is also the case that the ADD mind fastens on to its subject fiercely when it is engaged. A child with ADD may sit for hours meticulously putting together a model airplane. An adult may work with amazing concentration when faced with a deadline. Or an adult with ADD may become obsessed with a project and complete it in a tenth of the time one would have predicted. This ability to hyperfocus heats up the furnace in the brain, so to speak, and melts down rigid elements so they may easily flow and commingle, allowing for new products to be formed once they hit the cool light of day. The intensity of the furnace when it heats up may help explain why it needs to cool down, to be distracted, when it is not heated up.
A fourth element contributing to creativity is what Russell Barkley has called the “hyperreactivity” of the ADD mind. Cousin to the traditional symptom of hyperactivity, hyperreactivity is more common among people with ADD than hyperactivity is. People with ADD are always reacting. Even when they look calm and sedate, they are usually churning inside, taking this piece of data and moving it there, pushing this thought through their emotional network, putting that idea on the fire to burn, exploding or subsiding, but always in motion. Such hyperreactivity enhances creativity because it increases the number of collisions in the brain. Each collision has the potential to emit new light, new ma
tter, as when subatomic particles collide.
The trick for the person with ADD is to harness these processes productively. Some people spend a lifetime trying. They burst with creative energy but like a live wire without a socket to plug into, they dispel their energy unchanneled. The child may dissipate his or her creativity just in making wise remarks in class, or the adult may have a long list of marvelous ideas but have no plan for enacting them. In the chapter on treatment we will discuss ways of marshaling this energy constructively.
ADD with High-Risk Behavior, or “High-Stim” ADD
“What is my ideal fantasy?” said one adult with ADD. “To live my day in a room with three TVs going, me holding the blipper, my PC running, the fax operating, a CD playing, portable phone held to one ear, the newspaper spread out before me, with three deals about to close.”
Such a search for highly stimulating situations is often a central part of the syndrome of ADD in adults and in children.
Some children with ADD always seek action. The roots of high-stimulation-seeking adult behavior can be seen in those children who are hyperactive (but not in the dreamy, nonhyperactive kids). The hyperactive child with ADD craves novelty and needs excitement. He tends to like life to be lively and fast-paced. If there is no conflict present, nothing to spice the scene up, he might create some. For example, the child might pick a fight with a sibling, not because he is angry but because he is bored. Or he might disrupt a quiet evening at home, not because he is upset but because he feels understimulated. Or he might make a clown of himself in class not because he is particularly witty or in need of attention but because he finds the class dull. The excitement and danger of causing an uproar in the classroom can far surpass any reward for being a “good” student. It is important that the parent or teacher understand this. Taking the behavior too seriously, letting the child get a big rise out of you, can backfire. The excitement of a strong reaction may be just what the child wants.
So it can be with the adult with ADD who seeks intense stimulation, often through high-risk behavior. While most people with ADD are easily bored and seek diversion quickly, the adult with high-stim ADD particularly abhors boredom. He—and it is usually a he—may seek high stimulation through relatively safe avenues—creating tight deadlines to work under; regularly engaging in heavy exercise; keeping many projects going simultaneously; carrying games or crossword puzzles around in case a moment of tedium arises; taking on very challenging work; living on the brink of chaos by not tending to checkbooks, appointment books, and the like; provoking testy conversations for the fun of it—or through more risky means, such as gambling, having dangerous romantic liaisons, making very risky business deals, putting himself in physical danger through such activities as vertical skiing (an extraordinarily dangerous and exhilarating kind of skiing that entails going straight down an almost sheer face of ice), bungee-jumping, car racing, or other high-risk activities of his own creation. A calm place or relaxing scene can stress such an ADD adult to the point of exhaustion. However, that same person paradoxically may find calm and relaxation in hubbubs of activity or in risky, even very dangerous situations.
Brian Jones, a thirty-seven-year-old insurance executive, is a good example. He shows up at the office at 6:30 A.M. after running six miles and spending twenty minutes on his Stairmaster. He is not a fitness freak; it’s just that without his morning workout he feels as if he would explode within the confines of the workday. As it is, his company uses him as a kind of human time bomb, strategically placing him in meetings that need an explosive element or with clients who won’t get off the dime. Behind his back the junior employees call him “Boom-Boom” because of his legendary eruptions. He’s always on the brink of getting fired or of being promoted.
On weekends Brian goes on the prowl in search of action. He has tried vertical skiing, which he loves. He has raced Formula One cars. He skydives regularly. Sometimes he’ll just drive around town playing chicken with traffic lights, speeding through stop signs, taking safaris down one-way streets, anything to combat what he calls “the endless redundancy of everyday life.” He loves to gamble, and he’s been pretty lucky. However, of late, he’s taken to making blind five-hundred-dollar bets at the racetrack: he puts down his wager without even looking at the racing form, picking a horse with nothing but whimsy to guide him. He came for a consultation after losing four of these bets consecutively.
“It’s not the losing per se that bothers me,” he said. “What bothers me is how much I like the action. I mean, Doc, I don’t just like it. I love it. I want to go back and make a hundred-thousand-dollar bet blind. Now that much could get me into big financial trouble fast. But I want to do it. I imagine it’s like someone who’s having an affair with someone they know they shouldn’t, but they just can’t hold back, it’s got such a grip on them. I’ve finally found something that gets my attention. It gets my juices flowing like nothing else, but in a strange way it also calms me and relaxes me. All the other distractions of my life, the little mosquitoes that are buzzing around my brain trying to bite me, they all go away when I’m at the track. I mean, after I put that bet down, I’m there. I’m alive. I can see and hear. After that, everything else seems dull. I have to really hammer myself in the morning to get myself to work now.”
Brian had adult ADD. He responded well to treatment, which included medication and psychotherapy. The medication helped him focus, thus reducing his appetite for high stimulation, which he had been using as a focusing device. The psychotherapy helped him identify and stay with his feelings a bit, rather than having to blast past them. One of the reasons people like Brian seek high stimulation is that they cannot bear the tension of an ordinary feeling for very long. If they feel sad or lonely or afraid or above all bored, they swing into fast action for relief. Once medication helped him focus, Brian used psychotherapy to learn to stay with an emotion. He began to find that his emotions could be stimulating in their own right, and in a safe and useful way.
He has given up gambling and is working on ways of modulating his appetite for high stimulation so that he can enjoy the pleasures of ordinary life. He has not become a boring person, which was his fear, but his means of sustaining interest in life have changed.
Problem gambling is a common disorder in this country, afflicting some 3-to-5 million people. We do not yet have any reliable figures as to what percent of problem gamblers have ADD, but a rough estimate would be 15 to 20 percent. A corollary to problem gambling, which is also associated with high-stim ADD, is chronic overspending. Just as lotteries have brought ease and convenience to gambling, so have credit cards made overspending insidiously easy. The overspender is often relieving some bland ennui with the excitement of a blitz through the shopping mall. For both the gambler and the overspender, treatment can avert financial disaster.
Any of the following might be a tip-off for high-stimulation adult ADD:
Chronic, high-risk behaviors of any sort
Type A personality
Thrill-seeking personality
Addictive behaviors
Explosive temper
Exercise addiction
Irascible impatience
Habitual gambling
Violent behavior
Accident-proneness
Repetitious whirlwind romances
Chronic overspending
Other disorders of impulse control like kleptomania and pyromania
The essence of this subtype of adult ADD is the hunger for intense stimulation. Once you understand the tendency and have a name for it, you can feel it when you are with persons who have it. They radiate energy and create zones of action wherever they go. It is as if they carry within them a radioactive element, emitting energy at all times. They are always trying to strike up the band, go for the gusto, seize the moment and make it last. They will make deals in the midst of siestas, turn the vacation house’s back room into a newsroom or a business center, make banquets out of leftovers, leave conversations in mid-s
entence to go pursue an idea, or bring a brass band to an after-funeral party. These people can be a lot of fun to be with, and they can be very trying as well. As with Brian Jones, they can be productive and successful, but they can also be on the edge of ruin. They can be the ones who “dare to go where no man has gone before.” However, they can also be in danger when they go there. They may be in need of help.
While we do not understand exactly why the danger or thrill is so appealing to a certain kind of adult with ADD, we do see the pattern often. It may be that the thrill or danger helps focus the individual in a way similar to that of stimulant medication, inducing changes at the neurotransmitter level. Stimulant medications, the standard medications for ADD, enhance the release of epinephrine (adrenaline) in the brain. High-risk behavior does the same thing. Hence such behavior may constitute a form of self-medication.
In addition, a high-risk situation may supply the extra motivation that we know can help with focusing. When one is highly motivated, once again there is a change at the neurotransmitter level that enhances focusing. Situations of danger can do this particularly. As Samuel Johnson said, “Depend upon it sir, when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully.”
Whatever may be going on, it is important that we consider ADD in adults who tend toward thrill-seeking, dangerous risk-taking, or a chronic inability to relax or have fun in the absence of intense stimulation. Even those people we simply chalk up to having the well-known Type A personality may have covert ADD. While psychological conflict can certainly contribute to such behavior, psychodynamic therapy alone may miss the biological component. Without taking into account the biology, the therapy may be ineffective.
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