What I've Learned From A.D.D

That insight has been tremendously freeing, for myself and my patients, and it has also led the mental health field to novel, effective treatments for brain disorders. I use the word "brain" intentionally, to emphasize that in many ways our personality is hardwired. Yet just as important is the fact that biology is only part of the story. We're all born with a set of genes, but how those genes get expressed depends largely on life experience and the way our environment interacts with our biology. If we understand this, we can "manage" our brains more deftly, using methods that range from medicine to lifestyle changes. Diagnosing and treating ADD—in my own life and those of hundreds of patients—has shown me just how remarkable these interventions can be. I have seen more than a few teetering marriages right themselves when the couple understood it was ADD, not bad character, causing their troubles. I have also seen many careers that had been languishing in the bin labeled "underachiever" suddenly take off after diagnosis and treatment of ADD. Scores of students have been able to rescue their academic careers after diagnosis and treatment. It is a powerful diagnosis: powerfully destructive when missed and powerfully constructive when correctly picked up.

ADD has taught me to look at people differently. These days, when I meet someone I often ask myself the question, "What kind of brain does he have?" as a way of trying to understand the person. I've learned that brains differ tremendously from person to person, and that some of the most interesting and productive people around have "funny" (i.e., highly idiosyncratic) brains. There is no normal, standard brain, any more than there is a normal, standard automobile, dress, or human face. Our old distinctions of "smart" and "stupid" don't even begin to describe the variety of differences in human brains; indeed, these distinctions trample over those differences.

Today we know more than ever about the brain—but in learning more we have realized how little we actually know. With sophisticated brain scans that map the activity of networks of neurons we can peer inside the once impenetrable armor of our skulls and learn just how brains act when they are seeing, thinking, remembering, and even malfunctioning. And yet the vast territory of the brain still stretches out before us uncharted, like the sixteenth-century maps of the New World we used to see in our fifth-grade history books. Although we are coining new terms all the time (like emotional intelligence or post-traumatic stress disorder or even attention deficit disorder), although we are discovering new neurotransmitters and brain peptides that reveal new connections and networks within the brain, and although we are revising or throwing out old theories as new ones leap onto our screens, any honest discussion of mental life must begin with the confession, "There's so much we still don't know."

Disorder and Metaphor?

What do these philosophical flights of fancy have to do with ADD and me? A few years ago ADD burst upon the American scene the way psychiatric disorders sometimes do, emerging as a riveting new metaphor for our cultural milieu. In the 1930s we embraced neurasthenia; in the '50s W. H. Auden coined the term "the age of anxiety"; in the '70s Christopher Lasch dubbed us the "culture of narcissism." Now, ADD has emerged as a symbol of American life. This may explain why Driven to Distraction and Answers to Distraction, two books I wrote with Harvard psychiatrist John Ratey, M.D., found a surprisingly wide and vocal audience.

At the same time, there has been some misunderstanding because of the sudden popularity of ADD. Scientists rightly get upset when they see extravagant claims being made that studies cannot justify—claims, for instance, that up to 25 percent of our population suffers from ADD. (The true number is probably around 5 percent.) And ordinary people are annoyed because they feel this diagnosis has become a catchall excuse—clothed in neurological, scientific language—for any inappropriate behavior. ADD can seem to undercut our country's deep belief in the work ethic. "Why didn't you do your homework?" "Because I have ADD." "Why are you late?" "Because I have ADD." "Why haven't you paid your income tax in five years?" "Because I have ADD." "Why are you so obnoxious?" "Because I have ADD." But, in fact, once ADD is properly diagnosed and treated, the opposite happens: The sufferer is able to take responsibility more effectively and becomes more productive and patient. The student who always forgot his homework and was constantly penalized for doing so is able to remember his homework—after his ADD is treated. The same is true for the adult in the workplace, who, once his ADD is treated, is finally able to finish the project he has so "irresponsibly" neglected, or the academician who is at last able to complete her Ph.D. dissertation.