Scattered Minds: The Origins and Healing of Attention Deficit Disorder is a self-help book published in 1999 by physician and speaker Gabor Maté. Maté, who worked in palliative care for many years in Vancouver, Canada, uses a mixture of case studies and his own personal experience as a husband and father to present a new, attachment-based framework for understanding attention deficit disorder (ADD). The book critiques modern medicine and directly challenges many of the psychiatric assumptions about the nature and origins of ADD, exploring themes of Skepticism of the Illness Model in ADD Awareness and Treatment, The Centrality of the Attunement Relationship to the Development and Healing of ADD, and The Physiological Impact of Social Pressures on the Family.

This guide refers to the edition published by Avery, an imprint of Penguin Random House, in 1999.

Content Warning: This guide discusses mental health conditions and disorders including attention deficit disorder, addiction, depression, and anxiety and briefly mentions suicide.

Summary

The illness model, Maté says, treats ADD as a series of genetically predetermined behaviors that can be eliminated via medication. Maté’s skepticism of this model stems from the belief that genetic inheritance is inadequate to properly explain the development of neurochemistry and the structures of the brain. In his view, ADD cannot be addressed without understanding the emotional factors that shape an individual’s brain during the preoperational phase of development.

Maté’s understanding of ADD stems in part from his own experience. His own diagnosis came as an epiphany for him, helping him to understand his struggles and habits in a new, compassionate light. He began taking medication that helped tremendously for a while but had diminishing returns. Soon, the medications made him depressed. Maté began recognizing the need for a more thorough psychological understanding of ADD—one that went deeper than the prevalent one-dimensional genetic understanding.

ADD is a misunderstood condition, Maté says, in part because it involves the subjective emotional experience of the patient. The misconceptions surrounding ADD made it difficult for Maté to receive adequate care. By listening to patients and researchers over many years, Maté has identified a series of similarities between ADD patients that speak to unmet emotional and developmental needs. The American Psychiatric Association and the writers of the Diagnostic and Statistical Manual of Mental Disorders, Maté says, are more interested in categorizing and medicating people than listening to them. It is precisely this attitude of listening, Maté says, that will help build a more comprehensive understanding of ADD.

Maté identifies a series of symptoms of ADD that are directly related to functional developmental phases of infancy. Maté uses John Bowlby’s attachment model and Erik Erikson’s psychosocial stages of development as a base from which to understand infant attunement relationships with a primary caregiver. For virtually every ADD symptom, such as hyperactivity, time blindness, and defiance, Maté produces an example of early childhood development that corresponds. It is the disruption of these normal phases, Maté argues, that causes impairments to develop. If these disruptions are severe enough or if the child is sensitive enough to the stimuli, the child’s brain will not develop certain healthy coping capacities. If the disruption is extreme, Maté says, the child is said to have ADD. This conception makes ADD out to be a difference of degree rather than kind, explaining why the symptoms of ADD are widely distributed even beyond the ADD population.

Maté believes that the inherited component in ADD is sensitivity, which he says underlies all the symptoms of ADD. However, Maté doesn’t define ADD as emotional sensitivity alone. Instead, he believes that this predisposition for sensitivity must be combined with an emotional trigger, such as a severing of the attunement relationship between an infant and the infant’s primary caregiver. By “attunement relationship,” Maté means the development of a harmonious emotional language between the child and the primary caregiver; it is central to the infant’s ability to develop a self-concept, to begin exploring their surroundings, and to learn the natural social consequences of their actions. If this relationship is not established, the child will lack the ability to emotionally self-regulate and will struggle to maintain motivation and will.

One of the main obstacles to the establishment of attunement, Maté says, is the breakdown of civic society. Maté believes that the rising incidence of chronic stress, ADD, and addiction reveals a sickness that reaches the root of our social institutions. Schools and daycares no longer have the resources to provide adequate care, Maté points out, while parents have to spend more and more time at jobs with stagnant wages. These pressures on the family create a powder keg that makes lack of attunement and the resulting developmental impairments inevitable.