A Critical Review of an adhd classic: Driven to Distraction

Today’s post is a meditation on the title of one the one of the popular and well-received books on adhd, Driven to Distraction, Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood, written by Ned Hallowell and John Ratey. Driven to Distraction was first published in 1994 and revised and republished in 2011. It is one the best-selling books in the field and is a good entry point for many folks with adhd.

Driven to Distraction is a good book: both the authors are people who have their own adhd diagnoses, and it is written in straightforward language and with great care and empathy. It is a wide-ranging book that speaks to the difficulties that people have as individuals (adults and children), couples, and families. There are many case studies included, which give the reader a good and grounded sense of the difficulties attendant to adhd and the ways things can improve.

But there is a central issue that I have with the literature on adhd, and this is a problem with this book and with the field more generally. My issue is this: why distraction? Or perhaps the question could be asked in the following way: distraction from what?

The book is entitled Driven to Distraction, but distraction is taken as what I would call something like a primary phenomenon. A primary phenomenon simply means the place from which the analysis starts. Those who write about adhd start with distraction and hyperactivity and attention. But as I’ve written in the past, those are not primary phenomena but behaviours. And though behaviours are an important part of the story, they are not primary phenomena but the downstream effects of more foundational processes.

It is my proposition that until we answer the questions why distraction? or distraction from what?, we won’t get to the heart of the thing we call adhd. And if we don’t get to the heart of the matter, it’s going to be challenging to know what to do with oneself or friends and family and colleagues and clients who have the condition.

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FreudLet me ask one more question about the book’s title: my first question is why distraction or distraction from what? My second question is, why driven? Drivenness/drive is an important concept that dates from the very beginning of modern psychology, from the pen of Freud himself. The idea of human drive is meant to answer the question: why do we do the things that we do? What is the motive force and what orients us towards action? A drive in this tradition is meant to accomplish something, namely to correct a disturbance in the setpoint equilibrium of an organism. The technical term for this is homeostasis. When homeostasis is disturbed—i.e. an organism is no longer in a state of equilibrium—a drive kicks in to return it to its original state. The most straightforward example of a drive is thirst. Thirstiness is a drive towards to bringing one’s body back into a state of fluid homeostasis:

We physically work hard at something > we lose fluid from our bodies > we experience thirst > we are driven to replace those fluids > we drink fluids > we return to the state of homeostasis once the drive for thirst is quenched.

In the context of the physiological needs of an organism, drives seem uncontroversial, e.g. thirst, hunger, temperature, blood glucose, etc.: equilibrium is upset and the organism has all sorts of mechanisms to bring those systems back to setpoint. But more complex systems are… more complex. Our book title in question is a good example: what is the nature of a drive towards distraction? Why would an organism be driven towards a behaviour that we might say is antithetical towards its good functioning? Distraction isn’t necessarily bad or pathological, but it’s not ideal either. An organism that is driven to distraction is driven away from all sorts of behaviours that are in its best bodily interests. Let me show my work.

A distraction is a diversion of energies. I am currently working on this bit of writing. I am both learning something about the topic and am trying to convey something about it. Perhaps these are drives too? Working from the definition above, maybe we could say that the disturbance in my equilibrium is that I am interested in this topic, this book, because I recognize I am ignorant of something. This ignorance is an upset in my homeostatic sense of self, because I am a person who privileges knowing versus not knowing. This is not a judgement that one here is better than the other. Sometimes not knowing something might be advantageous to knowing. But for me, let’s say I have a bias towards knowing. If I have a drive towards knowing and communicating what I have learned to readers, where would the drive to distraction come in?

Driven

Let’s get more grounded: I am sitting here thinking, and reading, and writing. If drivenness is a way of explaining my work here, I am driven by a state of disequilibrium in my ignorance and am attempting to correct that state by finishing this and publishing it on the Nightingale blog. But I also have adhd and distractedness is a hallmark of that condition. So, I find my mind wandering: let me check social media, just for a second. Let me chase down the etymology of a word here and there. Now I’ve spent an hour on the history of the Latin roots of “distract.” I need to say something about the history of drive theory. Two hours later, after tracking down the Freudian roots of drive theory, I’ve chased some rabbit of an idea down some thought hole and find myself in another realm that has nothing to do with my interest in drives at all. Or maybe I decide to play a video game or eat or any of a thousand other things. I’m distracted. Was I driven to distraction? I don’t think so.

So if not driven to distraction, then why distraction? I think there are two related reasons. The first is that I think distractedness is a hallmark of adhd, not because those of us with the condition are driven towards it but because we experience our worlds in such a way that distractedness is more prevalent than the ways in which neurotypical people experience theirs. Why is this so? Distractedness is more prevalent, because people with this condition experience more of the world in a much louder way than our neurotypical kin. I wrote about this in the article, Feelings vs Emotions, Part I: Loud Bodies. The short version of that argument is this: those of us with adhd have a different and much louder experience of our environments: sensorial, spatial, object-oriented, relational, emotional, and existential. I even include in my definition of our environment our own memories. Taken as a whole, the world of a person with adhd has much more stuff in it than the world of a neurotypical person. Think of it this way: which scenario would be more distracting—a person sitting in a room in front of a computer working on a short essay or a person sitting in a room working on a short essay surrounded by a thousand objects and ideas and spectres that include all things you’re interested in and attracted to, plus all your difficult memories, plus the existential entities like illness and death and isolation, plus the workmen outside your window who don’t give a good goddamn about your writing and are making a complete racket (this last one is current as I write this sentence).

If my attention is diverted to any of those thousand things described above, it isn’t because I am driven to distraction; it’s because my way of being-in-the-world is much more distractible. Anyone neurotypical person can try this out for themselves (this is a thought experiment. For legal reasons, I think I have to tell you not to actually do any of the things that follow): first, take a low dose of a drug that decreases the amount of dopamine in your brain… most antipsychotics will do the trick. Now, also decrease the amount of glutamate and gaba in your brain. These are two critical neurotransmitters that control excitation and inhibition in one’s brain. All three of these neurotransmitters are decreased in the bodies of people with adhd.

Once you have decreased the activity of these three neurotransmitters, set up your environment: turn on a TV and play a song in the background on a loop. It can be a song you absolutely love or a song you loathe. Now surround your computer with all the things in the world that you like and dislike, are in love with and terrified of.

Let’s focus on the latter for a moment, the things about which you are worried or terrified: do I and will I have enough money to support myself and my family? Is this pain in my calf the result of working out a bit too hard or is it the formation of a blood clot? My lease is coming up, and I probably need to start looking for a new place to live. Shit… what chances do I have if this pain turns out to be a blood clot, and I have to find a new place to live? How little can I actually live on? Could I sleep in the backseat of my car?

Fortune cookieEarlier, I wrote that there are two related reasons that make distraction more likely for a person with adhd. The first is that those of us with adhd inhabit and experience our environments in different and louder ways than neurotypical folks. This is what I might call the passive reasons people with adhd are more distractible. But there is also a more active way in which this is the case, which was hinted at above in my example of the anxiety about blood clots and housing, namely worries about the future, and, in particular, worries about the future of the thing on which I’m working. The future is the way we imagine and project ourselves and environments into the unknown. What is the fate of this thing I’m working on, and, by extension, what is my own fate?

Here’s the way this thinking might go: is this thing I’m currently working on any good? Are my ideas sound? Maybe my ideas are sound, but can I represent them on the page in a way that will be appreciated by anyone else? Maybe all this work will be for nothing, and no one will even read it? What’s the point of that? In the old days, I might have been worried that it might get some form of review, and some reviewer—smarter than me—will demonstrate how my thinking is dumb or bad or wrongheaded. In our contemporary world, I worry that someone will excerpt a sentence or paragraph and splash it all over social media demonstrating that the author is a mean dope. I am reminded here of John Roderick, who is the co-host of a podcast I’ve liked over the years called Roderick on the Line. Some might know him as the lead singer of the indie band The Long Winters. Readers might better know him as the guy who tweeted a story about his daughter and her struggle in opening a can of beans. The story quickly made the rounds, and he spent weeks getting dragged online. He became derisively known as Bean Dad.

This second reason for distraction is more active than the first, but the title of the book still gets the dynamic wrong. It’s not that one is driven to distraction. It’s the case that those of us who have adhd are actively disincentivized from completing our work. Why? Because finished work is work that can be judged… harshly. Finished work can’t be updated to reflect the things I have learned since its completion. This latter point is something I covered in an essay about perfectionism. If there’s a drive here, it’s not towards distraction but rather away from the disaster that one’s current work might become. A person with adhd always remembers some version of the lesson that anyone can become a Bean Dad.

Now… remember… this all part of our thought experiment. You’ve taken the medications that decrease your dopamine, glutamate, and gaba. You’ll probably be feeling fatigued and foggy. You might be feeling quite unwell… not unwell enough to be sick, but definitely not great. You might find that the distance between calm and frustration is much less than you’re used to. But don’t sweat it, because you still have your will and determination and discipline. That’ll keep you focused and in your seat.

Distracted
With all that out of the way—get to work. See how focused you are on the document on your computer right in front of you. Are you more likely to get distracted? The answer must be yes. Are you driven to distraction? I don’t think so. Distraction happens… not because people with adhd are less disciplined or care less or any of the other ways we are slandered towards an explanation of how we struggle to attend to things. Distraction increases in likelihood as one’s ability to keep the world at bay decreases. And distraction increases as we learn all the ways that things can go wrong.

I can imagine that some readers—certainly the neurotypical ones—might see my thought experiment as dramatic or extreme. But it represents the ways people with adhd experience their world. Those of us with adhd don’t lack attention or focus or discipline or care. We lack the ability to keep the noise of our environments at bay. Any organism that experiences their world as noisily as people with adhd would behave similarly. This is the reason behind my claim that adhd is not a pathology or disorder or disease. It is, rather, a way of experiencing the world. And once we understand that the difficulties attendant to adhd—and there are many difficulties—are not in the person with the diagnosis but are in the relationship of the person to their environment, then we can start developing environments that produce better outcomes.