Hallowell, Edward M. Entries


Inspired by Amanda's and Jason's charming Lovebirds Swap, my partner David and I have decided to do our own leisurely reading project over the next year or two. On no particular schedule, we'll be alternating a book suggested by him with a book suggested by me, and discussing the chosen books here in conversational format. David reads a lot of popular nonfiction on psychology and brain function, and this first installment is his suggestion: Edward M. Hallowell and John J. Ratey's 1994 introduction to Attention Deficit Disorder.

Emily: So, perhaps we should start with a bit of an introduction for the readers. Driven to Distraction came out in 1994, at which time there was a lot less cultural awareness of ADD than there is now. He and his colleague Ratey are giving a broad overview on the disorder from a perspective of their own psychiatric practices.

David: Indeed! Also, we might point out that there has been considerable scientific work in the field since then, which has various ramifications, especially for those of you who have, or think you might have, ADD.

Emily: Yeah, don't diagnose yourself based on this blog post, haha! Go see a professional if some of these symptoms sound familiar. Speaking of which, do you want to talk about how you came upon this book and/or your own experience with ADD?

David: Well, throughout much of elementary school, I struggled both socially and academically. I won't go into the whole story here, but I will say that my trajectory was very typical of a person with ADD, and I probably would have been diagnosed much more quickly had I been born a few years later. I was "very bright," as many teachers and other adults in my life were quick to point out, but also seemed to "have trouble applying myself." By the end of middle school, my parents—having unsuccessfully though persistently tried many avenues for dealing with my situation—finally got a recommendation for a Dr. Jeffrey Pickar at McLean's Hospital, who administered a series of tests, trying to determine if I might have any identifiable, and hopefully treatable, conditions underlying my predicament. His results were definitive, and to me, a hugely significant vindication: I had ADD, and Obsessive-Compulsive Disorder.

Emily: That feeling of vindication is something Hallowell writes about being very common when people are diagnosed with ADD.

David: Yes. I think that a lot of people, looking at it from a distance, might wonder about this, might imagine that it would be kind of devastating, something like being diagnosed with a crippling disease. I certainly don't want to downplay the degree to which ADD can be crippling, but what I heard when I got the diagnosis was something like, "David, you were right all along! You are smart, you have been trying as hard as you can, but there is something which has been holding you back, something beyond your control, no matter how much your teachers punish you, no matter how much your schoolmates bully you. You were doing the best you could."

Emily: It's not like one is going along perfectly comfortably, and then out of left field comes a cancer diagnosis or similar. You, and most of the people in Hallowell's book, were already aware of a serious problem before the diagnosis. It just gave you something of an explanation and starting-point from which to begin to cope.

David: Right! My reaction was something in the vein of, "IN YOUR FACE, WORLD!"

Emily: Haha! So, is that diagnosis when you were introduced to this particular book?

David: Well, no. Sometime after getting and beginning to understand my diagnosis, my mother began what she now refers to as "bibliotherapy," wherein she tried to educate herself more thoroughly about my conditions. I remember seeing the book on her nightstand around that time, but didn't start reading it myself until sometime last year. It was in the midst of my own sort of bibliotherapy, which was driven by a more general interest in the workings and malfunctions of the brain—especially, but not exclusively, my own.

Emily: I was surprised how interesting I found Driven to Distraction - even though it is an overview for the general public, and even though I have lived for ten years or so with an ADD sufferer, there was plenty of information here that surprised me.

David: Oh? I'm glad to hear that you found it interesting. I'd be interested to hear what surprises stand out in your memory.

Emily: Well, one of the points Hallowell stresses is how many different manifestations ADD can take; it really can look completely different in different people. So that some of the symptoms he talked about seemed completely opposite my experience of you - for example, the common ADD symptom of constantly searching for high-stimulation situations. And also the ADD tendency to get impatient when people don't "cut to the chase."

David: Yeah! True enough.

Emily: Whereas you are FAR more patient with rambling interactions than I tend to be. And of the two of us, I am the person far more likely to want to hurry a given decision to closure, whereas you prefer to shop around. The opposite of one might expect given your ADD diagnosis.

David: Ha ha! Yes. ADD is a real cuttlefish of a disorder. And the name—Attention Deficit Disorder—is, if not an outright misnomer, at least quite deceptive.

Emily: Right! Hallowell discusses how the syndrome is really more of an attention regulation problem, not a deficit—so that people with ADD often have the capacity to go into "hyperfocus," where they become intensely wrapped up in a project they're working on, for hours, days or even weeks at a time.

David: We ADD-ers can hyperfocus—almost by definition DO hyperfocus—when we are On A Case, quite to the exclusion of any external stimuli, any awareness of the passage of time, etc., etc.

Emily: Yes, that's a symptom I definitely have seen in you. You'll get totally wrapped up in something you're working on, like coding or recording projects. Or the time back in 2002 when you laboriously constructed a chart of hex color values by going through and testing each six-digit permutation yourself.

David: Yeah, that laboriously constructed chart is a great example of a Very ADD Thing To Do. It's a little hard to say exactly why, but the combination of seeming to need to learn the "hard way," the hyperfocus, the compulsive nature of the task... It's something I thought of bringing up as well.

Emily: The other thing that struck me as eerily relevant? May I bring up the piles?

David: You may!

Emily: Hallowell transcribes the speech of one of his ADD patients as the patient describes his home office. The man writes:

Everything I do goes into a pile. There are little piles and big piles, stacks of papers, stacks of magazines, stacks of books, stacks of bills. Some stacks are mixed. It's like a field, little piles with white tops scattered everywhere like mushrooms. There's no real organization to any of it. I'll just think that pile looks a little small, I can add something to it, or this space needs a new pile, or these things I'll move over to this other pile.

Hallowell himself comments:

These examples reflect the stuff adult ADD is made of. Peter's piles are particularly emblematic. So many adults with ADD have piles, little mess-piles, big mess-piles, piles everywhere. They are like a by-product of the brain's work. What other people somehow put away, people with ADD put into piles.

David: Very true!

Emily: So, as you and I have often made the dorky joke that your operating system supports "PileMaker Pro," this was very familiar to me. But I also thought Peter's description was interesting because of how he describes relating to the piles. Later in his quote he says he's "in synchronicity" with them. Do you have a particular relationship with your piles?

David: I do. This would probably be a good time to bring in my co-morbid conditions, OCD and Anxiety. Without getting too deep into definitions, I'll just say that ADD does commonly coexist with other disorders and conditions. For me, personally, there is a touch of the ol' hoarding mixed in there.

Emily: In fact Hallowell devotes a whole longish chapter to different co-morbidities and how they tend to manifest.

David: Yeah, and, as with so many things, the whole often manifests as more than the sum of the parts. Also, I have a very acute visual/spacial sort of talent, if you can call it that, which, I think, kind of enables my PileMaker Pro organizational replacement system. I don't know if Peter is selling himself short in the above quote, but for me, the piles are not totally random. I have a sense of the Piles, so long as they are not removed from their original place of residence. If I need something, I can usually locate it quite effectively by sort of triangulating, mentally.

The problems arise when I "clean up," which often consists of moving the piles from a public area (the living room) to a private area (the bedroom), and sometimes even combining piles, if I'm really going to do a thorough job of it. At that point, unless I can find some distinguishing visual characteristic of a pile, one which I associate with the item I'm trying to locate, it becomes very difficult to find anything.

Emily: In Peter's example, it's almost like he's deciding on the distribution of items into the piles based on aesthetic appeal. And you're saying you kind of attach visual tags to piles as memory aids?

David: Exactly. And I do so at a very instinctive—or, at least, below-conscious—level. That is a big part of my "magic" with regards to my role as your Accio spell. (I'll let you explain that one.)

Emily: Haha! It's true, you can usually find anything in the house, whereas I can never find anything. We have another dorky joke that I, like the Harry Potter characters, can say "Accio hairbrush!" and the hairbrush will come flying to me in David's hand.

David: If I have seen objects in physical relation to one another, especially within a defined and relatively static space such as our condo, it is usually quite easy for me to recall an object's location by observing in my mind's eye which objects it is spatially attached to.

Emily: It occurs to me vis-a-vis Hallowell's description of the typically ADD search for high-stimulation, which for the most part I don't see in you—do you think the piles are related to that? It certainly makes your study more "high stimulation" in that all the piles make a lot to look at.

David: Ha ha! It does, doesn't it!? Unfortunately, that particular kind of stimulation—visual clutter—seems to exacerbate, rather than quell, my distractability, so I think I'd be better off without it in any case. I don't know if it's a sort of self medication, though... could be.

So, why, you might be asking yourself, don't I just FILE things in the first place, instead of PILING them? Wouldn't that make everything so much easier?

Emily: Yes. I might be asking myself that, indeed.

David: Since I have this "talent" with visual association, having things "hidden away" in a file is disturbing to me on several levels. If I can't see it, and can't associate it with its visual/spacial surroundings, it becomes lost to me on a very deep level. Being in a file cabinet is like being in an institutional building, or a series of suburban cul-de-sacs: everything looks the same.

Emily: Hmm, interesting. That brings up another suggestion Hallowell has for people with ADD, which is to use color and visual cues to "spice up" their filing and time-management systems.

David: Yes! It's not that I can't learn to organize logistically rather than spatially, it's just that it doesn't come as naturally to me. And, it takes effort and strategy to learn this new system, and set up new kinds of aids and compensations; effort not necessary if I were to continue with the piles "system."

Emily: Which, yet again, is a point Hallowell makes: that ADD people have to exert more effort, and on a more conscious level, to pick up coping mechanisms that people without ADD kind of absorb by osmosis. But that doesn't mean it's impossible for them to learn those techniques.

David: Totally! Another thing to bring in here is the common ADD trait of problems with what is called "working memory." Working memory, as I understand it, is sort of one's mind's desktop: the memory designated for attending to items currently or imminently needed for the job currently or imminently at hand. And this is particularly interesting to me, as it brings the psychological ramifications of the disorder—the things my brain has learned about its own workings—front and center. At some level, I know that I have trouble remembering to do things. Therefore, my brain recoils from the idea of putting a crucial item (a bill, for example) somewhere it suspects I'll forget about it, and consequently, forget to deal with it. So, in order to truly deal with the issue of piles, one must not only clean up the mess, but put in place—and crucially, learn to trust—a new system for remembering to complete important actions.

Emily: That makes a lot of sense. It's like what Hallowell says in the section on ADD with Anxiety—which, incidentally, reminded me strongly of you. Hallowell talks about how, when something "startles" the ADD-with-Anxiety brain (a "startle" can be caused by any transition throughout the day, from going on one's lunch break to completing a task) there is a mini-panic because the brain doesn't know how to organize itself now that its former point of focus is removed. So it latches onto the "hottest," most pressing object available, which is often a source of anxiety. The anxiety becomes an organizing principle, even if a counterproductive one. Which reminds me of what you've been saying about your piles—your brain doesn't trust the filing system, so it's trying to organize around the idea of keeping everything it might possibly need within visual contact at all times.

David: I think that's an interesting comparison. It's not necessarily totally analogous, but it strikes me that there is a very similar bend in the underlying logic.

Emily: Yes. So, another thing I really appreciated about Driven to Distraction was Hallowell's sensitivity around the issue of "what is normal?" or put another way "Is this a real disorder?""

David: This is a very important, and very vexing point. I, personally, find it to be one of the most interesting and meaty points, as well.

Emily: I agree. I mean, just thinking about the extent to which people use "ADD" as shorthand for the standard, high-distraction lifestyle expected of us in the Western world is pretty revealing. I appreciated Hallowell's acknowledgment that everyone sometimes feels in the ways he describes, but that this cultural state isn't the same as actual ADD, which is a real, neurological disorder.

David: Right. So, several things about that. One of them is the individual's experience of him- or herself. As we were talking about just earlier today, it can be very difficult for a person who has been diagnosed as having a particular problem to figure out—just internally, for his or her own benefit and satisfaction—where He or She as a person (or personality) leaves off, and where The Disease picks up.

Another issue is the subjective nature of the diagnosis in the first place. This is something that Hallowell addresses somewhat in Driven to Distraction, and it's also addressed by Peter Kramer in Listening to Prozac. Kramer refers to it, if I remember correctly, as "the brackets of normalcy," and he spends quite a bit of time in various sections of his book talking about how and why those brackets sometimes shift. These kinds of mental illnesses—ADD, OCD—are defined relative to their surroundings, relative to the established vision of "normal," which necessarily relies on the behaviors of the surrounding culture and individuals for definition.

Emily: I wondered a lot about cross-cultural diagnoses while reading Hallowell, since the definition of "normal" levels of distractability and scattered-ness is surely different in different cultures.

David: Right! And, I personally find this to be a very challenging aspect of self-definition, and self-identification with my disorders. There are some aspects of what is considered "disordered" that I find to be valuable, even as compared to their equivalent "normal" counterparts in our society.

Emily: I liked Hallowell's take on that phenomenon, that he acknowledges that there can be strengths that come along with the liabilities of ADD.

David: Yeah. I think it's really good that he emphasizes that, and I kind of wish he spent more time giving specific examples. There's so much negative messaging that people with ADD receive en masse and individually, both before and after they get the diagnosis, that I think it's really crucial to ongoing mental health and self esteem to actively look at and cultivate the "good" parts of the disorder (depending on context, of course).

Emily: In that spirit, there was a little passage in Hallowell that reminded me of you in a positive way. He's discussing a patient of his in who had the "daydreamer" variety of ADD, and he writes:

People with ADD do look out windows. They do not stay on track. They stray. But they also see new things or find new ways to see old things. They are not just the tuned-out of this world; they are also tuned in, often to the fresh and new.

That strongly reminded me of the experience of taking walks with you. You are always the "noticer" on walks, making observations of little unusual details that most other folks miss.

David: Thank you, Sweetie! I think that that is tied in with my ADD, and it is something I find valuable. This highlights one of the difficult choices brought up by the possibility of treating the disorder: Will you loose the stuff you like, along with the proverbial bath water? I think it's an experiment each individual has to undertake (or not) on his or her own. And then the decision about whether or not to take psych meds adds whole other layers of complication. It's an emotionally and ideologically contentious decision to begin with, and then it's combined with a diagnostic process subject to the values of a specific time and place, values about which the individual seeking treatment might have deeply mixed feelings.

Emily: Yes. Hallowell is generally pro-meds, but I liked that he a) doesn't present them as the be-all and end-all of treatment, and b) fully acknowledges that everyone's process is different and that, while meds are often very effective, many patients have also had good results from pursuing a non-medicated route of behavior modification, open communication, and coping mechanisms. So it's not like the decision about whether or not to pursue treatment is only one of whether or not to pursue medication.

David: Right! That's a good point, and I agree that he presented a pretty good balance of options in the book. One more thing about my own observations re: treatment with medication. I'm a fairly analytical, self-observatory person, but I have found it to be fascinating and illuminating to see that some problems which I had attributed to laziness, character flaws, and the like (with all the guilt and baggage that goes along with that) have actually responded to medication.

Emily: Interesting. Do any particular examples leap to mind?

David: Well, lateness has been almost a life-long problem for me, and it turns out that my disorders have a huge impact on my punctuality in both obvious and subtle ways. I also remember feeling like, the first time I got on a good combination of medications, my homework was somehow just "getting done." It was kind of a crazy feeling: doing my homework had been a problem for me for literally over half my life, and then, all of a sudden, without me feeling like I was actually doing anything differently, it was just... "getting done." I kind of couldn't believe it.

Emily: Yeah, no doubt! It must have felt like magic.

David: It kind of did! And, that actually brings up another interesting tangled web of emotions I (and I think many other people) feel when thinking about medication: Having been told, in various direct and indirect ways, and at least partially having believed, for so long that it was somehow my fault that I was having these problems, I felt quite deeply that the corollary to that was that it was my responsibility to deal with them, fix them. Having that responsibility usurped by a chemical is deeply confusing, even as it is a deep and multi-layered relief.

Emily: Hallowell describes a number of patients with similar or related feelings around medication. Like it was somehow a "cheat" or an admission they couldn't fix the problem by themselves.

David: Right. Other people can do the things that I am being told to do, and I am shirking part of my responsibility by giving myself this "unfair" advantage. (It's somehow easy to ignore that a) I started out with an "unfair" disadvantage; and that b) I don't know those Other People well enough to understand their process, or their tools, or their crutches.)

Emily: It's a difficult thing to sort out.

David: Very!

Emily: Well, this has been a great conversation; thanks for the interesting first pick in our reading project.

David: I'm so glad you liked it! I started Gilead this very morning, and I already love it; I'm looking forward to next time.


Up next in David and my joint reading project: my first suggestion, Marilynne Robinson's Gilead.

June 2012

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link to Wolves 2011 reading list
link to more disgust bibliography