Monday, November 10, 2014

Don't Cure the Neurosis, Find the Right Job For It

I’m a weaver, and I belong to a weaver’s group that meets monthly. We regularly joke about how weaving is a good occupation for people with obsessive-compulsive disorder because it requires attention to detail and the ability to spend hours at a stretch doing repetitive tasks. For example, I’ve just finished a piece that had 1296 threads: first I had to measure out 9-yard lengths of yarn 1296 times, then each of those threads had to be threaded through the loom twice. And this was before I could start to weave! Often people ask me how I have the patience to do this—for pleasure—and I reply that I love to weave and this is just part of the process. But I can also see how I have the kind of personality that permits this type of detail work.
At our last meeting one of the weavers said, “Don’t cure the neurosis, find the right job for it!” This struck me as a profound insight, particularly for our society that is anxious to cure every slight deviation from some concept of “normal” that we’ve established. I’d just amend it to say, “or the right lifestyle.”
Twenty-five years ago I taught art at a private grade school. There was a boy with ADHD in first grade. This was the first time I had encountered someone with the diagnosis. His teacher was very wise; she let the boy sit on the floor and play with blocks during lessons while all the other students had to sit at their desks. By doing this, he could listen and attend to what she was saying, but if he’d been forced to sit at his desk he’d have been incapable of paying attention. What impressed me most of all was that she’d managed to explain it to the other kids so they were all okay with the setup. I loved this boy and had a great relationship with him; he was quite perceptive and intelligent.
What I learned from this experience was that maybe it’s incorrect to say there is something wrong with many of the children with ADHD. Maybe there’s something wrong with our cultural norms. Maybe the way school is structured is just not right for some children, for example. This perception has just been strengthened as ADHD has become an epidemic. How could there be something wrong with that many of our children?
Last week the New York Times published an article by Richard A. Friedman, “A Natural Fix for A.D.H.D.” Dr. Friedman is professor of clinical psychiatry and the director of the psychopharmacology clinic at Weill Cornell Medical College. His article suggests that my perception may be true.
Dr. Friedman writes that ADHD is currently the
most prevalent psychiatric illness of young people in America, affecting 11 percent of them at some point between the ages of 4 and 17. The rates of both diagnosis and treatment have increased so much in the past decade that you may wonder whether something that affects so many people can really be a disease.
 Dr Friedman argues that the traits that describe ADHD could very well have been adaptive—beneficial—to people living in Paleolithic times.
Consider that humans evolved over millions of years as nomadic hunter-gatherers. It was not until we invented agriculture, about 10,000 years ago, that we settled down and started living more sedentary — and boring — lives. As hunters, we had to adapt to an ever-changing environment where the dangers were as unpredictable as our next meal. In such a context, having a rapidly shifting but intense attention span and a taste for novelty would have proved highly advantageous in locating and securing rewards — like a mate and a nice chunk of mastodon. In short, having the profile of what we now call A.D.H.D. would have made you a Paleolithic success story.
He goes on to describe a 28-year-old patient of his who had a boring desk job at an advertising firm. He was miserable, and was diagnosed with ADHD due to his inability to focus. But then he quit his job and got another that required a lot of travel—and his ADHD disappeared.
My patient “treated” his A.D.H.D simply by changing the conditions of his work environment from one that was highly routine to one that was varied and unpredictable. All of a sudden, his greatest liabilities — his impatience, short attention span and restlessness — became assets. And this, I think, gets to the heart of what is happening in A.D.H.D.
I’m not arguing that neuroses don’t cause problems. They do. I’m also not arguing that medication hasn’t brought relief to many people. It has. What I am suggesting is that perhaps for many people we’re misinterpreting what the actual problem is. Because the way you frame the problem determines the types of solutions you will seek. When we say that a neurosis is an individual’s problem, then that means we have to fix the individual. Drugs are the current choice. But drugs have costs; in the case of ADHD, no one knows the long-term consequence of giving stimulating medications to children whose minds are still developing.
What if, instead, we recognized that there is a large variation in human personalities, and as a result we widened our concept of normal to encompass a much broader range of types, including many of the currently pathologized variants (see note below)? Then we could envision different types of solutions, including addressing the individual’s environment.

Note: I read some material on ADHD as I was writing this blog post, and I came across a clinical guide to ADHD on the National Institute of Health website. In Chapter Four, there was a passage about how children with ADHD felt about their behavior, and I found it interesting that they “frequently” discussed their ADHD-related behavior in positive terms:
Children in this study identified a range of behaviours similar to those listed as symptoms indicated in DSM-IV and ICD-10. The most frequently discussed types of behaviours were impulsiveness, physical aggression and hyperactivity. Children felt that these types of behaviours were particularly annoying to others. 
Behaviours identified as symptomatic of ADHD were frequently discussed in terms of their positive dimensions by children in the study.

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