Are We There Yet? The Problem of Boredom

Bored

The closest I ever came to murder (don’t worry, not close) was on a visit to Cambridge, MA. I’d posted an ad in Harvard Yard, searching for a companion to share the expense of my car ride back to Evanston, IL. Within a few days a pleasant-enough young woman and I set out for the Midwest. The plan required us to stop at the University of Michigan, where she was to begin grad school. I would then continue to Northwestern University on my own.

The 750 mile trip from the Boston area to Michigan takes about 13 hours, plus stops along the way, and more time if you decide to break it up over two days, as we did. It is not an interesting ride. After you get out of Pennsylvania, long stretches of flat ground and bland horizons dull your senses and stretch the time. The conversation didn’t enliven things unless you count the growing disquiet inside of me. A disquieting disquiet: rage.

Indeed, whatever my companion said or didn’t say (I can no longer remember any details) I became ever more irritated with her. As we closed in on her campus, I couldn’t bear being with her for five more minutes. Had Ann Arbor been just a few extra miles, I’d be doing hard time in a Michigan prison for murder. My imaginary plea to the judge? “The car ride, sir, was the cause. The boredom just got to me.”

Irritability and anger, not to mention disgust, are among the characteristics of boredom described in Peter Toohey’s excellent book, Boredom: A Lively History. The book is an easy read and relatively brief — the better, I assume, to avoid boring the reader.

Toohey tells us boredom is adaptive: it signals that we need to get out of the situation we are in and on to something less “toxic.” I’m sure you can create your own list of boring situations, probably not so different from those identified by the rest of us: watching someone else’s home movies, waiting in line, monotonous lectures and sermons, repetitive work, and the like.

I can actually identify the most boring day of my life. I was a college student, just having finished my junior year. The place was a non-air conditioned metal-stamping factory, the site of my summer job. I had two mind-deadening tasks. One was bending the backs of metal bucket seats using a simple machine. The other was assembling a small gasket. Each job took a matter of seconds. Once you learned how to do them you never got better and the assignment never changed. You just did the same thing interminably: for eight hours, five days a week, while swimming in a river of sweat.

I started by clocking-in at 7 a.m., which meant I had to awaken at 5 a.m. If I stayed out late the night before, I paid for it with the extra-strenuous effort alertness required. You know the sensation — each eye lid seems to weigh 600 pounds and even Arnold Schwarzenegger doesn’t have the muscle to keep one open.

The summer was hot and the factory absorbed everything the sun could give it. Water was essential to avoid dehydration. Nonetheless, it was peculiar to be drenched in perspiration at 7 a.m. even in a building where the thermometer registered over 100º Fahrenheit. Dutiful as ever, I did my best to keep from buckling. Three hours must have passed before I looked at the wall clock. Seven-fifteen a.m.! It seemed impossible.

Like a bad science fiction film, time had come close to stopping and eternity was nearer than the end of the work day. A second look at the clock revealed it was actually 7:14 a.m. and two muscular-looking gremlins were working to push the minute hand back.

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What produces boredom? Peter Toohey points to predictability, monotony, and confinement. He cites research suggesting low levels of the neurotransmitter dopamine can make one “boredom-prone,” needing to stir up excitement and break some rules in order to escape the internal torpor. Unmedicated children with Attention Deficit Hyperactivity Disorder are thought to be short on this substance. Consequently, they are at risk of misbehavior, alcohol or drug dependency, and criminal conduct. Extroverts are more boredom-prone than introverts, needing the external stimulus of an eventful environment to avoid the stolid state of stupefaction.

Even so, everyday boredom is something all of us encounter. A 2009 on-line survey sponsored by the website http://www.triviala.com/ found Britons complaining of six hours per week spent bored. But Toohey suggests another kind of boredom, an “existential” condition. This has variously been called ennui, world-weariness, and spiritual despair, and can spill into frank depression.

The existential variety of boredom is present in those who find life empty and meaningless, usually accompanied by a lack of close community or social connections. If you are familiar with French existentialist writers you’ve encountered Sartre, who even wrote a book called Nausea, a fictional riff on the condition. Toohey’s tome argues several historical factors have led to this. He cites the breakdown of religion as a source of life’s meaning and organization, the rise of individualism, and the way in which large cities inhibit the possibility of intimate human contact while shrinking the average man’s sense of importance (the last is my idea, not Toohey’s).

I’d add materialism to the list. We spend far too much time shopping for “things” with the expectation of receiving satisfaction in the package. Habituation happens as often for adults as for a child on Christmas day: having waited all year for a special toy, he (and we) discover that having it doesn’t deliver all that wanting and waiting promised us. Bored, the toy is shelved, while the adult version (say, a new car) loses its new car smell and the first-drive thrill.

Another thought: “wage-slavery” of most modern work may rob us of the sense of pride and control, while reinforcing the notion of being small, disposable people who hardly matter. Contrast this to the old days, when a free man worked on a project he fashioned from start to finish. The act of total responsibility for creation or completion of a job contributed to a meaningful, engaged, and less alienated life, especially when others in his small community depended on his labor and his presence.

Of course, as Toohey is careful to point out, for much of human history the danger of daily existence and the work required to make a living left little room for leisure; and the sheer hardness of life offered minimal amounts of the idle time during which boredom and unsettling self-reflection might metastasize.

Contemporary living presents more entertainment, activity, and distraction than ever, without having eradicated boredom. TV channels and websites beyond numbering, exercise programs and classes — none of these seem capable of erasing the experience or the word from our day and vocabulary.

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Historically, many have looked to travel, sex, and alcohol as solutions to everyday boredom, not to mention getting back to work. Changing one’s routine and reorganizing one’s life can also help. Learning new things, exercise, and performing music are recommended. Communities of friends or association with like-minded people within social organizations provide prophylaxis against invasion by the B word: the sense of time stretching into an empty, endless void. Meditation can be helpful and keep each moment alive. TV doesn’t, by the way. Channel changing should tip you off.

How is it possible that we get bored with a plethora of internet sites to visit, criss crossing tweets, and movies to watch? We have plays to attend, games to play, and great books to read. Still we are bored.

Perhaps an evolutionary psychologist might point at those early humans who sat around and were entertained simply by twiddling their opposable thumbs. They weren’t interesting, didn’t attract mates, and failed to notice the hungry animal about to make them into a meal. In other words, we are not the descendants of early men and women who effortlessly defeated boredom.

Thomas Carlyle, the famous Scottish philosopher and writer, said, “I’ve got a great ambition to die of exhaustion rather than boredom.”

I lean toward Carlyle’s view, but suspect I am already too tired to make his goal my own. Exhausted first and bored soon after, the sound you just heard was me yawning.

Top image: A Bored Person by GRPH3B18. Below that is a photo of a Bored Young Girl by Greg Westfall. Finally, the Souvenir Seller, Moscow by Adam63. All are sourced from Wikimedia Commons.

 

The Causes of Insecurity

Shamed_Man

Insecurity is in the nature of being human. It is a commonplace, even if most people make a serious effort to disguise it. Too many things to know, too many to learn, too many rejections — most everyone has had significant experience of the things that undermine confidence. But, what makes for more than the usual amount of insecurity? What contributes to some people becoming “insecure?” Here are a few of its causes:

  • Temperament: Little human personalities can be different from the moment of birth. Just as not all children have the same color eyes or hair, neither do they have the same temperament. Pre-school kids have distinctive and lasting characteristics on such dimensions as being reactive vs. calm, tending to approach or avoid new situations, and being introverted or extroverted. While not guaranteeing fractured confidence as an adult, inborn qualities can make a contribution to it.
  • Overly Critical Parenting: Security can be undermined by parents who are too critical, neglectful, or frankly abusive. Sometimes neglect is unavoidable, as it tends to be in families where there are lots of children or the parents are working long hours outside of the home to put food on the table. But sometimes the insecurity develops because of something more subtle. If you are born to extroverted parents and you are introverted (while your siblings are more like your folks), you may feel like an odd-duck, not quite fitting in. If your dad was hoping for an athlete and you are an artist, the same sense of parental disappointment might be hard to miss.
  • Bullying: Kids can be targeted by the classmates for all sorts of reasons including the way they look, where they live, how they dress; and racial, religious, or ethnic differences. Gender matters too, especially if you are the sole female in a physics class with a wise-guy classmate who makes fun of you and a teacher who hasn’t the capability to stop it, as I witnessed back in high school.
  • Body Image: In a society filled with spectacularly beautiful advertising images, it is difficult to be plain; and worse yet, unattractive in any way. Too tall, too skinny, too fat — God help you. Too much acne, bad hair, a lack of finely-tuned motor coordination, same problem. Some of us continue to see ourselves in terms of that early self and struggle with the sense of insecurity produced back then.
  • Learning Problems: This can take the form of a learning disability, Attention Deficit Hyperactivity Disorder (ADHD), or even being average in a school filled with high achievers.
  • Multiple Changes of Residence: Being the new kid is not usually fun, especially for introverted young people who struggle with fitting in and finding friends. Insecurity can follow.
  • Parental Overprotection: When parents prevent their children from doing things that are simply a part of growing up, they can communicate to the child that he isn’t up to the task. Moreover, they rob the young one of the chance to grow from experience, learn what he needs to know in the social sphere, and become more confident. He may also be at risk of being seen as “different” by his peers, because he is the kid who “isn’t allowed” to do things most other parents freely permit.

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  • Parental Expectations: For some parents, life won’t be complete until their children go to Harvard, become famous, and have a building named after them. Even an objectively accomplished person can be insecure if he feels he has failed to reach that standard, unless he throws off this requirement by dint of self-examination or therapy. In today’s civilized world, we compete with the best brains and ideas on an international scale, quite a change from most of human history, when you could easily feel great being a big fish in a small pond; that is, standing out for athletic or scholarly excellence in your tiny community.
  • Money: If your classmates and their parents have more money, nicer homes, or better clothes than you do, this can cause you to be noticed in an uncomfortable way and make you feel less worthy than the others.
  • Guilt: Do you have a secret? Do you feel guilty about something others don’t know about? Are you adopted or is your father alcoholic or your mother depressed? Such things can make you feel vulnerable, in the belief others would disapprove “if only they knew.” And if they do, the talk behind your back is predictable.
  • Being in Someone’s Shadow: While there are a great many good things about being the child or sibling of a person who is extraordinary, it can create a high bar to any kind of recognition or acceptance of you for your own sake, someone who has his own identity and is worth knowing even if he isn’t an Olympic champion or a captain of industry.
  • Blushing and Sweating: We all get nervous, but some of us do stand out in a visible way. President Richard Nixon was famous for the amount of perspiration he generated during the Kennedy-Nixon Presidential Debates in 1960, so much that most people who saw him on TV thought he lost, but the majority of those who only heard him over the radio thought he won. Whatever insecurity you are prone to can be amplified by knowing your discomfort will sometimes shine like a lighthouse beacon.

lighthouse

  • Isolation: Children whose living conditions offer little opportunity to socialize with same-aged kids are at a disadvantage. The talented and extroverted among them are more likely to have confidence when they enter the social arena, while the introverted may have more difficulty. Living at a distance from other kids your own age or being home-schooled can fuel this problem. The distance also doesn’t afford the opportunities of living in challenging social situations that contribute to a growing sense of competence and mastery. Once behind the curve, whether through the peculiar circumstances of childhood or your own avoidance of challenges as an adult, you might come to feel you are now too lacking in practice and even further behind others in any number of work, social, or sexual situations.
  • Life Failures: The frustrations of life can take their toll. Confidence might be undermined by too many jobs lost, goals unfulfilled, rejections, and relationship failures.
  • The Depredations of Aging: If your self-image depends largely on just one thing, a loss of that thing can make a big difference in your sense of security. Athletic prowess fades, as does beauty. Worse yet, the former prom king and queen can discover their bodies no longer demand positive attention (or perhaps now get the wrong kind of attention). Some feel mocked by the photos of their youth.
  • Instinctive Biological Insecurities: Evolution contributed to our tendency to pick up on the signs revealing disapproval or anger in others. Those pre-historic humans who didn’t notice their compatriots were unhappy with them risked being thrown out of a protective group. Worse still, they failed to detect hostility in their enemies. Only individuals who were sensitive enough to notice passed their genes to us. For more on this, read Insecurity and Our Preoccupation with Appearances/

None of these factors will undermine every person. Many of them interact with one another, making confidence more difficult. But getting over what is past and challenging yourself to master new and difficult situations tends to be productive. Therapy can be helpful in coming to terms with a history anchoring you to the ocean’s bottom, as well as a present that looks too daunting given your internal shakiness. The important thing is moving forward.

Metaphorically speaking, humans are like the Great White Shark, which must swim in order to breathe: either we keep moving forward or we die.

You might also find this of interest: On Being Insecure and Alone/

The top image is called Shamed Man by Victor Bezrukov, The second photo is called Cutest Girl Ever by Lindsay Stark. Both are sourced from Wikimedia Commons.

Avoiding Life’s Pain: Drugs, Deadening, and the Defeat of Therapy

anesthesia

Having been raised in a secular home, I remember being shocked the first time I saw a religious carving in someone’s abode. It happened in my next-door-neighbor’s house. There he was, Jesus Christ, impaled right on the kitchen wall. Lunch was an ordeal given that Jesus was suffering just over my shoulder. For me I mean. My buddy and his mom didn’t seem bothered.

Since they were raised with crucifixion images all around, some indifference to the human sacrifice might have been expected of my hosts. The effect was similar to that produced by watching the first story on the TV news day-after-day, chosen by TV producers who use the mantra “If it bleeds, it leads.” We have all been desensitized by images of dead bodies, burnt flesh, undernourished children, and violence. Words like inured, deadened, habituated, and coarsened also come to mind; as well as accustomed, toughened, and hardened.

Drugs, alcohol, and antidepressant medication can play a part on the road to both callousness and self-protection. And, as I shall try to show, the question of how much of life to let in — how much to “feel” — is a big one for those in therapy and for all of those outside of it, as well.

Take one example. How are we expected to react to the TV news story of a murder? Should it be a matter of curiosity, the same kind that causes us to slow down on the highway to check-out an accident? Should we empathize with the pain of the afflicted? Should it provoke our action to prevent future calamities of the same kind; or reach out to the victims featured in the news story? Should we immediately feel a sense of gratitude that it didn’t happen to someone we love?

How is one of the faithful expected to react to the image of Christ on the cross? Is it supposed to just blend into the kitchen wallpaper? Or, should one react as if seeing it for the first time, aware of the horror of it, and the measure of sacrifice proclaimed to be done for all of humanity?

A Wood Carved Baroque Crucifix in St. Oswald's Church, Kastleruth, Germany by Wolfgang Moroder

A Wood Carved Baroque Crucifix in St. Oswald’s Church, Kastleruth, Germany by Wolfgang Moroder

Therapy confronts this dilemma. Simply put, it faces the problem of how to live in a world where emotional injury is inevitable. Most people come to treatment feeling too much. Part of the counselor’s job will turn on the question of openness to both pain and pleasure. The intimacy that we all want requires some amount of that openness, otherwise the closeness cannot happen. But, by permitting vulnerability, we suffer more when we have loved and lost; or lost anything or anyone we value. Consciously or not, man comes to a crossroads where one path leads to a deadened life and the other to one alive with pain and pleasure. You choose.

People vary in their sensitivity to even the vicarious experience of life’s emotional afflictions. Those variations are at least partially determined by the individual’s nature. I recall evaluating a teenager who appeared to have had an unremarkable childhood: no abuse, good parents, only the garden-variety of growing-up challenges. Yet, she wanted to keep a distance from others, in part because she felt their pain too acutely. Indeed, she was unable even to watch the TV news because the kinds of stories I mentioned earlier brought tears.

There are a great many ways to deaden oneself to depression and lesser states of sadness. Therapists are well-advised to find out whether their clients are using significant amounts of alcohol or drugs while they attempt therapy. Since counseling deals with emotion, those substances can keep the soft and sensitive parts inaccessible to even an expert therapist. If past losses need to be confronted, the grieving-project can be stalled by the artificial numbness or buoyancy of chemically induced mood alteration. Even antidepressants sometimes create the same challenge to reaching the wound so that one can treat it.

Therapy is difficult. Courage is required to deal with the pain, along with a therapist who can provide the most easeful way forward. Counseling can be a tightrope walk for both the sufferer and the healer: too much pain and the treatment will be as bad as or worse than the illness, too much anesthetic and there will be no cure at all; instead, a dependency on the joint or wine or antidepressant, perhaps in perpetuity.

At this point you might ask why a chemical solution to pain would be so bad. Indeed, for those who have a biologically-based mood disorder, psychosis, or Attention Deficit Hyperactivity Disorder (ADHD), medication may be essential. But what of those for whom drugs or alcohol or medication represent an avoidance of “real life,” an escape from the job of confronting their own internal discomfort? Let me give you an example.

The woman in question had an admirable life in objective terms. Nice family, nice career, large nest egg. She was haunted, however, by her long deceased, disapproving father. Though he’d been dead for 20 years, not a day went by without thinking about him. She tried therapy because she was depressed, but her therapist never inquired about possible drug use and the patient didn’t report it. Yet, nearly every evening for those same decades she’d lived in a cannabis-induced haze and continued to do so during her treatment.

Therapy tried to focus much of its attention on her relationship with her dad, his lack of affection, and his failure to praise her considerable accomplishments. The therapist hoped that this woman could break through to a depth of feeling (both sadness and anger at the father) that would free her from the sense of inadequacy she struggled with every day. The psychologist believed that by getting her to re-experience the intensity of her injury, she would recognize its unfairness and her father’s indefensible cruelty, not just intellectually but with her whole being. Perhaps then she would no longer blame herself.

It didn’t happen. One suspects that the treatment failure — the defeat of this woman’s therapeutic project — was due to her marijuana use, a kind of self-medication that took the edge off the worst of her pain. It kept the patient just above water, but didn’t allow her (or the therapist) to go below sea level to the grip that her father had on her — a dead hand that metaphorically threatened to drown her. Had she not been smoking pot, it is possible that further exploration below the surface and into the depth of her pain would have released the dreadful downward pull of a ghost’s grip, permitting the grieving needed to free her from his verdict that she was worthless.

There is yet another reason to be concerned about an anesthetized life and reliance upon those substances that can be bottled, injected, and smoked; quite apart from the potential for addiction and bodily destruction. Yes, the blitzkrieg of life is a challenge to an undistracted, full-frontal awareness of your suffering at every moment. But if life is indeed sometimes simply “too much,” we must still choose carefully how to cope with that difficult reality so that the remedy isn’t also “too much” in a different way.

The death of pain means the death of life itself. Our defenses against feeling the bad also can prevent us from feeling the good. The question of anesthesia’s uses and misuses must be faced: whether to use it, how much to use it, and when to use it; reminding ourselves that the more anesthetic, the more we become inured to everything, the good and beautiful and poignant, as well as the painful. And the more we simply watch, sit back, and let the best of life pass us by.

The Crucifix is sourced from Wikimedia Commons.

Too Many Balls in the Air: The Frustrated and Frustrating Life of ADHD

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He was dynamic, outgoing, and enormously entertaining.

He was creative, full of ideas, and energetic.

And he was one of the most frustrating people you would ever care to be around.

About whom do I speak? A bright, charming man with Attention Deficit Hyperactivity Disorder.

ADHD is more complicated than you might think. Although there is much written about it, I want to cover a few of the things that can be missed about the condition. But first, let me explain the name and define it.

There are three types of ADHD (Attention Deficit Hyperactivity Disorder):

  • 1. ADHD, Predominantly Inattentive Type. This used to be called ADD, but technically speaking, sufficient inattentiveness is considered a category of ADHD, even though little hyperactivity may be present. These are the folks who seem to be listening, but are lost in space; easily taken away by a tune, a sound, or an idea; the people who miss the details and forget the assignments.
  • 2. ADHD, Predominantly Hyperactive-impulsive Type. This is what most people think of when they hear or read the four letter acronym ADHD. People with this diagnosis are characteristically talkative, active, intrusive; a bundle of unmanaged, impulsive activity.
  • 3. ADHD, Combined Type (meaning it includes the symptoms typical of the first two categories); too many balls in the air, for sure.

What about the man I mentioned at the top; a person who had the “combined type” of ADHD?

He had lots of energy and ideas, so people found him engaging. But it wasn’t a very productive sort of energy. He would begin things, but not complete them. He was disorganized — losing keys and papers, and forgetting appointments. He promised to do things, but couldn’t be relied upon to do them as quickly or as well as expected, if at all.

This man (let’s call him A.T.) went nowhere fast; very fast. A.T. looked liked the “Energizer Bunny,” but mostly traveled in circles.

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He tended to over commit himself, taking on more tasks than he could handle effectively, chronically underestimating what he could accomplish in the time available. A.T. was routinely late for appointments, and made decisions quickly, without fully considering the longer term consequences of his actions. Bored easily, distracted more easily, and prone to procrastination, he knew that he wasn’t what others hoped for and expected. Although he was full of promise, his reputation was that of someone who was a thoughtless, irresponsible underachiever — an individual who needed minding.

Employers were disappointed, co-workers were frustrated by A.T., and his spouse was driven just a little crazy, feeling that she couldn’t depend on her partner. She’d married someone who was exciting, only to find that the excitement he produced was more of the “Oh, no!” kind that made her sweat when she discovered he was late to pay a bill or pick up the kids. Not surprisingly, she started to see him as just another one of the kids, as their partnership turned into more of a “disapproving mother/resentful child” relationship than either of them wanted.

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Before I tell you about A.T.’s treatment, let me say a few things that might not automatically come to mind about the condition and its consequences:

1. Hyperactive/impulsive ADHD individuals can sometimes look like they are world beaters, but mostly beat themselves; indeed, they are often chronic underachievers. If you are planning on forming a working group or partnership with such a person, don’t be fooled by a positive first impression of excitement and energy. You will almost certainly be disappointed down the road.

2. ADHD, even today, is sometimes not detected in schools. There are several reasons:

  • The inattentive form of this condition may well produce school failure, but not misbehavior. Inattentive children are often quiet and relatively well-behaved, unlike their hyperactive-impulsive counterparts.
  • School personnel may incorrectly attribute ADHD-like behavior to laziness or oppositionality. Moreover, school systems, even when they do formal evaluations, are frequently reluctant to identify problems that require additional resources and personnel, which they are hard-pressed to provide given their limited funds.
  • An ADHD child who is bright can compensate (to some extent) for his attentional problems by relying on his excellent intellectual abilities, at least for a while. Eventually, however, many of these children (as they age and school begins to demand more of them) find out that advanced intelligence is no longer sufficient to permit success.
  • There is no single standard measure that reliably identifies ADHD. Evaluators commonly use some combination of paper and pencil tests, clinical judgment, and attentional measurements. Intelligence (IQ) and neuropsychological tests can easily miss some of the most clinically obvious cases of this condition.

3. The fact that ADHD children are able to become “hyperfocused” on things like computer games or other tasks that they find especially interesting, does not invalidate the diagnosis of ADHD. Indeed, this sort of selective attention is seen fairly often.

Some researchers believe that those games provide rewarding stimulation in the form of frequently changing images, sounds, and challenges; as well as the success of achieving points or increasing levels of success, thus “capturing” the attention and imagination of the ADHD youngster. By comparison, the real world school room seems boring. Recommendation? Limit your child’s screen time, even in front of regular TV shows.

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4. Although many people are hesitant to take medication, ADHD is a diagnostic category that is especially responsive to psychotropic medication. Hundreds of studies support the effectiveness of such treatment for about 85% of children with this condition according to Russell Barkley’s authoritative 2006 book Attention-Deficit Hyperactivity Disorder. In a 2007 paper by Elliot and Kelly — “ADHD medications: an overview” published in the journal Attention — the authors state that “No medicine available to psychiatrists produces a more rapid and dramatic effect more safely than the proper dose of a stimulant to a patient with ADHD.”

5. If medication does work, it will likely be needed on a continuing basis, not as a temporary fix. The irony is that stimulant medication, which will cause internal agitation in those who are not suffering from ADHD, actually permits the person with the condition to focus more and become less prone to the hyperactivity/impulsivity that had been a problem.

6. ADHD is correlated with a greater risk of developing a Conduct Disorder, typically characterized by antisocial misbehavior and defiance of authority. Not surprisingly, such individuals often abuse alcohol or drugs (not only as an act of rebellion, but also as a self-medication designed to calm their hyperactive state). Adolescents and adults who have ADHD are thought to make up at least 25% of the population of prisons according to Barkley.

In all these examples, the impulsive, ill-considered behavior that is typical of ADHD takes a fearful toll. Such individuals are easily bored, requiring intense and novel reinforcement (rewards) to motivate them, and are prone to “sensation-seeking” — looking for extreme excitement that their condition seems to make them crave. Indeed, one patient of mine reported driving at speeds approaching 100 MPH on city streets simply for the feeling it produced in him. Nor did he think he was at much risk (or putting others at much risk) in doing so, thus demonstrating the poor judgment characteristic of those with the hyperactive-impulsive form of ADHD, as well as their tendency to disregard rules and authority figures.

7. While many general medical practitioners (GPs) can prescribe medication for ADHD quite well, some are hesitant to do so, sometimes due to lack of training or inexperience with this particular diagnosis. Cautious GPs will prescribe psychotropic medication, but are prone to giving doses that are too small. It is generally best to see a psychiatrist in such cases; that is, someone who specializes in the prescription of medication for psychiatric disorders.

8. The frustration that ADHD produces in school children can make them give up (and eventually drop out), believing that nothing they can do will make any difference in their performance. Some of them will become avoidant of academic or other work tasks because they believe that they will fail, thus producing a self-fulfilling prophecy. Many will get angry at the teachers, bosses, and parents who so often are reminding them of their inadequacies. Thus, ADHD fuels other behaviors that make a good life difficult.

What happened to our friend A.T?

You’d think it was simply a matter of telling him of the benefits of medication, wouldn’t you?

Not so fast.

He was one of those folks who was uncomfortable with the “idea” of having to be reliant on medicine. He told me that he didn’t “believe” in medication, as if it was a matter of religious faith.

A.T. was also quite narcissistic; in denial concerning his own responsibility for the things that went wrong in his life. Similarly, he had no trouble blaming others including bosses and wives. Not to mention that he drank too much and didn’t acknowledge that it was a problem. Indeed, he had only come into treatment at his spouse’s insistence.

One of the challenges of psychotherapy is the fact that few people fit “pure” diagnostic types. Instead, one must be aware of all the complicating factors that can make effective therapy difficult. This man’s narcissism, denial, and alcohol abuse certainly created just such complications.

Had A.T. been more motivated and self-aware, less prone to denying the misery he was creating around him, a cognitive-behavioral (CBT) approach to his ADHD could well have helped, even if he chose not to take medication.

CBT programs include formal guidance in planning and organizational skills, assistance in problem solving and decision-making, help in reducing the number of distractions in the environment, practice in new thinking skills, training in ways to reduce procrastination, and advice to help you cope with failure. Homework is required between sessions.

The program described by Steven Safren and his associates in the work book Mastering Your Adult ADHD, developed by psychologists at Massachusetts General Hospital and Harvard University, was able to produce significant improvement in about 50% of those patients who continued to have clear problems even after being treated with medication.

So, if you have ADHD, medication and CBT provide reasons for optimism that things can get better.

Just don’t drop the ball!

Thumbnail for version as of 15:40, 14 September 2005

The top image is the Carbon Cycle created by the U.S. Government Department of the Interior. The one that follows is the Tux Crystal Linus Award by Nevit Dilmen. The next photo was created by Thomas Pusch and is called Scolded By Mama. The fourth picture is of Two Men Playing a Computer Game by Love Krittaya. Finally, a picture of a Geode  by Whitsoft Development. All are sourced from Wikimedia Commons.

Multitasking: You Are Missing More Than You Think

H A R M O N I C A   F R A N K

I knew the world was in trouble about 20 years ago when I watched a psychiatrist (yes, a psychiatrist) talking on two telephones at once, one in each hand, held up to each of his two available ears.

God help him if he had more hands and more ears and more phones.

Its called multitasking and, trust me, you can’t do it as well as you think. At least, unless you are in the smaller than 3% of the population that some researchers believe are “supertaskers.”

For the most part, scientists have looked at the negative effects of multitasking on concentration and focus, the way it tends to increase stress, and the addiction-like stimulation that attaches to computers and other digital devices. Is it a wonder that so many children are diagnosed with attentional problems? Some researchers suggest that their brains (and ours) are increasingly being rewired to the point of having our concentration drawn away from its original target by novel, but irrelevant information and other distractions.

The result? Impatience, fatigue, and a fragmentation of lived experience.

Think about it.

How many things do you really concentrate on to the exclusion of just about everything else?

My guess is, for example, that you do lots of things while watching TV: listening to music (sometimes turning off the TV sound of a sporting event you only want to see), holding a conversation with your child or spouse, reading a magazine, eating, text messaging someone, etc.

This becomes so routine, so normalized, that we are not particularly aware of how many things we take-on simultaneously and the fact that none of them capture our full attention. Later, if asked to recall what we did, we just might have some trouble. And a person who really wants to talk with us while we are preoccupied with all the other things I mentioned, will find himself frustrated or, at least partially, ignored.

When was the last time that you really savored a single bite of food? If you were heavily involved in conversation or on the computer you probably didn’t.

When was the last time that you really drove your car in a mindful way? Felt the vibration of the car on the road, the tactile sensations produced by your body against the seat and your hands on the steering wheel, the variegated sky ahead, the differing sounds of the other cars, the changing shapes and shadows on the highway, the slight alteration in position and muscle movement when you pressed on the brake? No radio, no CDs, no texting or talking on the phone, no conversation of any kind, no day dreaming; just you and the machine and the highway.

When was the last time you listened, really listened and watched your conversation partner? Focused intently on the tonal quality of his voice, his inflections, the changing expression of his face, the way he used his hands, the volume of sound he produced, when he took his breath, not to mention what he was saying? Or were you distracted by other sights and sounds, your own sense of impatience; and the chatter going on inside your own head wondering what to say next, when you needed to get home, how soon you could eat, or the presentation you had to make the next day.

Is it time to slow down? I know, you might feel that you can’t. But is multitasking really making you more productive? Is it enhancing the quality of your life? Or, to paraphrase Wordsworth’s comment long before the computer-age: “Getting and spending (and surfing), we lay waste our powers.”

As a therapist it is essential for me to pay attention to what my patients say and don’t say, how they look and how they move; small changes in their facial expression, tone of voice, and mood; the hint of a tear coming to their eyes, the crispness and energy of their gait. And, if I do this, they will usually be freer to be open and trusting; and more prone to validate their own feelings — think of their words and emotions as having value, because someone else does.

I must bring my own intensity and focus, be in-the-moment with my patient, mindful of everything related to him; and certainly not preoccupied, day dreaming, thinking about my next meal, worrying about some other patient, or texting another individual while I half-listen to the person sitting across from me.

Although not always perfectly successful, I try to be an enemy of routine.

You would not and should not go to a therapist who does less than keep this kind of focus. So why would you live so as to fragment your own focus by doing so many things at once that almost nothing fully engages you and produces your own personal life satisfaction?

I imagine that you are reading this on a computer that you own. But might it not be just the other way around? Might it be that the computer (and other digital distractions) “own” you?

What would your life be like if you practiced, more and more, being in-the-moment, attentive to just what is present at that time and place — making a living-space for yourself so that you can really live — not just plow through the day in its attention-absorbing, mind-sucking, soul-deadening, endless haste over things that won’t matter to you in 10 minutes or 10 days or 10 years?

You can start so simply. Just one bite of food, savored for color, texture, the sensations on your tongue, the taste and aftertaste — slowly.

The news on the radio or TV or AOL will wait. The “Vice President in Charge of Looking Out the Window” will take care of the weather. The CD or downloaded music can be accessed at another time. The incoming text message is almost certainly not that urgent. The phone can be turned off.

We hear lots about traffic accidents caused by ADHD teenagers, who are driving, texting, talking to the person in the passenger seat, combing their hair, putting on nail polish, listening to the radio, and conversing on their cell phone, all at once.

Why would one want to be an only marginally less distracted, fragmented (and dangerous) version of that person? Out of touch with the world and oneself?

A few years ago I saw a cartoon that looked something like this: a middle-aged couple, obviously married for many years, were sitting together. The husband was trying to read his newspaper and watch TV while his wife talked. Then the husband spoke: “I’m sorry dear, but I was distracted and missed what your were saying. Can you repeat everything you’ve said since we got married?”

Really.

The above image is of “Harmonica Frank” Floyd, who is seen playing two harmonicas, one using his nose and one using his mouth. He also was reportedly able to play the harmonica and sing simultaneously. Today we would call Frank a “supertasker.”

What Children Need From Parents: Part I

A 15-year-old treated by me many years ago is a good example of one of the things that parents need to provide their children.

I’ll call him Ike (not his real name), a slender, silly kid with sandy hair. His family was middle class, hard working, and honest. Unfortunately, Ike lacked the latter two qualities. He was a minor league juvenile delinquent, prone to shop lifting, cutting classes, curfew violations, and occasional drug use. Ike was a poor student thanks to a lack of effort,  an Attention Deficit Hyperactivity Disorder condition that featured notable impulsivity, and the unfortunate fact that he wasn’t very bright. This teenager treated school as  diversion from his major life tasks of having fun and causing trouble. He rarely thought of the long term consequences of his behavior, instead choosing to do whatever felt right in the moment and whatever action seemed likely to produce some immediate payoff, the future be damned. Outpatient therapy had failed to make a dent in any of this, so his parents ultimately brought him in for whatever a psychiatric hospital could do to redirect Ike’s life and get some control over things.

Years ago it was often possible to keep a teenager in the hospital for several weeks or months if he needed it. Insurance policies were different and more generous then. And so, given the total control over someone’s life that a psychiatric adolescent treatment unit provided, you could produce changes in some very rebellious, out of control kids. Ike was like that. Eventually he figured out that the only way to get out of the hospital was to conform his behavior to the required standard.

While his parents participated in family therapy during his hospital stay, they remained uncomfortable with the job of setting limits on Ike. Neither one was very secure or self-confident and Ike fueled that insecurity by his behavior. Both parents were prone to feeling guilty when they punished him because of their own unresolved childhood issues, and Ike knew how to “play” them and get them to back off of threats and attempted punishments. These adults needed their son’s approval and good will too much for his, and their, good. Ike was running the show before his hospitalization. He knew it, they knew it, and his “will” was stronger than their wills were. If he complained and pleaded long enough, one or the other parent would typically break down and give him what he wanted. Despite the fact that family therapy hadn’t succeeded with the parents, Ike ultimately behaved himself in the hospital and had to be discharged even if his parents didn’t seem to have a better handle on how to deal with him in the real world. So, I crossed my fingers and hoped for the best.

As often happens after an adolescent is discharged from a psychiatric hospital, Ike and his folks went through a honeymoon period. But after a couple of months, he resumed his misbehavior and things weren’t much different from the way they had been the moment that Ike had first stepped into the hospital. So it was on the first day of his second stint in confinement (yes, his parents took him back and readmitted him), that I recall having the following conversation with Ike:

GS: “So, Ike, how does it feel to know that you can pretty much do anything you want when you are at home? How does it feel to know that your parents really can’t control you?”

Ike: “Terrific!” (Said with a big smile).

Silence ensued. I was quiet and just sat there with Ike for perhaps 30 seconds. Then, Ike spoke again and surprised me.

Ike: “And scary.”

This was the truth of it. Even Ike, who was one of the least thoughtful and least self aware patients I’ve ever treated, realized that if he could get away with anything he wanted, that wasn’t a good thing. Even Ike knew that if he was driving the bus, the bus was in trouble. Even Ike knew that he needed someone to rein him in, to set a good example, to steer him in the right direction, and to prevent him from doing some of the things he would do impulsively, recklessly, and thoughtlessly.

What then do children need? Parents with the will power, strength, consistency, motivation, intelligence, resilience, and the self confidence to set and stick to limits, take charge, and make sure that the combination of a child’s poor judgment and impulsive or rebellious behavior doesn’t rule the day. Ike was the problem, but without his parents getting a grip on their own lives and finding the strength and confidence to assume the proper role in the home, Ike wasn’t going to get better any time soon. And even though Ike would have and did resist a more assertive, consistent, and confident approach from his parents, he knew that he needed it.

Some children are easy, some more challenging for parents. It is our job in the latter role to figure out what each of our children need and provide it. Not all children are the same and not all of our children need an identical approach from us. Ike would continue to misbehave until his parents figured this out.

The strength that I’m talking about isn’t the only thing that children need from parents, and from time to time I’ll write about some of the other requirements. The good news is that if Ike, at age 15, was able to figure out what he needed, nearly all adults can too. From that point on, good things are possible.