In my view, undiagnosed milder forms of the badly named entity we now call “Attention Deficit Disorder” are at the heart of a truly staggeringly high percentage of anxiety disorders. When the attentional component is not recognized (and believe me folks it almost never is), the medication will be wrong, the therapy won’t ring true, and the treatment will be ineffective.
Medication, Meditation, Procrastination and Disorganization: The Four Step Program for Adults With ADD and Depression
Over the years since the publication of “Getting Unstuck” I have been refining and solidifying my approach to the treatment of adults with ADD, with or without depression. I have arrived at a four-pronged approach: four key topics that are addressed with both information and experience.The topics are: Medication, Meditation, Procrastination and Disorganization.
For the purposes of this discussion, when we say “left- brained” and “right-brained,” we are talking about two complementary modes of thinking that are at first primarily located as electrical activity in their respective hemispheres. They do not always stay so tightly localized. In people who develop in a healthy manner and remain relatively untraumatized, the selves become increasingly complex and increasingly able to hold both thinking styles in mind at once.
Context is everything. Under the proper circumstances, attention in children and adults with ADD can be more than adequate. In fact, overfocus can be as much of a problem for people with ADD as underfocus. Attention Regulation Disorder or Attention Modulation Disorder might be a more accurate name. It’s not just paying attention that is the issue, it’s facility in the shifting of attention: paying attention to the right thing at the right time.
Complicated individuals need to be addressed with appreciation of neurophysiological differences (ADD, Asperger’s, LD), inherited depressions (bipolar and serotonin), acquired depressions (arousal and motivations), and interpersonal and occupational adjustment. Then the treatment needs to be bolstered and continued by a judicious application of mindfulness and other esoteric practices.
Remember please, above all, that over and over and over it has been shown that even small amounts of psychiatric care applied consistently over time routinely pays for itself, many times over, in decreased general health care costs. If we can recognize how cost-effective enlightened mental health care can be then to me it stands to reason we should invest in creating the most skilled broadly trained cadre of mental health prescriber-therapists we can. This is of course the hardest of hard sells, a pipe dream from The Attention Doctor.
When I ask them to allow me to teach them personalized mental exercises, and when I ask them to perform these exercises in a disciplined manner when they are not with me, I want them to understand why I am doing what I am doing. I want them to begin to learn about their brains, as I have spent my entire life learning about mine: by reading. […] There are 18 titles here, books that reflect my need to instruct myself beyond what was available to me as a psychiatric resident 30 odd years ago, books that inform and supplement any work that one might do to develop one’s brain. I’ve divided these books as I group them in my mind. If you’ve read more than a even just a few of them, you’ll know a lot of what I know, and therapy with me (or anyone else) will be far easier and more productive than you can imagine.
Surge in psychotic gun violence in America is the unintended consequence of the relatively recent financially-motivated Balkanization of mental health care. […] Therapists come in many varieties — very few have insight into how ongoing medication treatment should influence therapy when the patient has underlying Asperger’s or ADHD as well as several different types of affective disorders. Insight-oriented exploratory therapy without accurate diagnoses, accurate medication and adequate psycho-education is generally useless for such complicated patients. Therapy needs to be directive, pragmatic, problem-solving and integrated with varying symptom patterns. Only prescriber-therapists can do that, but we’re a dying breed.
The mind remodels the brain ceaselessly, and one way to think about this is to see the mind as a canvas upon which we continually paint our understandings and ideas. When I want to explain medication, mediation and hypnosis, I often say that medication is like the frame upon which we stretch the canvas; meditation is the gesso that prepares the canvas to receive the pigments, and hypnosis is the meaningful/beautiful/arresting images we can paint upon that properly stretched and properly prepared canvas.
Despite ever-mounting evidence of the profound and pervasive influence of attentional disorders in a range of public spheres, from depression to substance abuse, from the educational system to the penal system, these conditions remain poorly understood, inaccurately diagnosed, and ineffectively treated. This is due, in large part I believe, to the complicated relationships between ADD and procrastination, dissociation, and trauma.