Category: Neuroscience

The paralyzing combination of shame and ADD/ADHD

ADHD and ADD are controversial diagnoses. Some believe that they are not distinctive conditions in themselves and others believe strongly in the opposite – that they lie underneath many other personality disorders (BPD, NPD) and mental health issues (Anxiety, OCD, Depression).

The article below, written by US psychotherapist Rebecca Olmsted looks at how the misdiagnosis and misunderstanding of ADHD and ADD can lead to feelings of shame in a person who struggles with many issues typically associated with the conditions such as impulse control, the ability to focus or hyper-focus, procrastination, and other so-called “Executive Skills”. It can means that they strongly feel that there is something wrong with them, that they don’t fit in.  I will look at ADD/ADHD in further posts and also other ‘neuro-atypical’ conditions such as Aspergers and Autism. In the meantime, I am sharing Rebecca’s article which I feel highlights some of the issues surrounding these diagnoses.

 

It is a common experience for people with ADHD and ADD to feel misunderstood like something unexplainable is wrong with them. And the feeling that goes with that – which is often barely recognised – is shame.

“I don’t fit in”

Attention Deficit Hyperactivity Disorder. What a mouthful! Over the last ten years, our understanding of ADHD has changed quite a bit, and if it were to be named today, it might not even be called a deficit or a disorder. Previously considered a childhood problem, it is now recognized that ADHD continues into adulthood. Like shame, ADHD has many faces, but they all seem to stem from one constant – an impairment of executive function.

Executive function is the ability to track and manage sensory and mental input, making moment by moment decisions. It relies on short term memory– you can think of executive function as the air traffic controller of the mind. When it is impaired, the person has trouble getting things done, that “normal” people seem to accomplish without great effort. Shame can arise from feeling “I should be able to do this”. The person feels something is wrong with them. They feel different from others and often frustrated with themselves. Not knowing how to address the problem can also lead to a feeling of powerlessness.

What is shame? At its core, shame is the sense that something is fundamentally wrong with me (contrasted with the belief that I have problems to work on but that I am fundamentally okay). Shame is an emotion that blends with other emotions, such as sadness and anger, and almost any behaviour. Shame is a real chameleon – and to complicate the picture, not all shame is bad. But the shame we are talking about here is painful and debilitating.

Factors that may further complicate the picture (keeping in mind that ADHD is both under and over diagnosed and that many people feel “everyone has ADHD”):

  • The ADHD person may not be diagnosed. Without a diagnosis, it is difficult to address the practical and relational issues. Remember, in a shame state, the person thinks it’s their fundamental identity that’s flawed, not what they do.
  • The ADHD person may be diagnosed, but may feel stigmatized, or may feel that it is an “excuse” diagnosis. This indicates that in the past they have not gotten proper treatment and support. This can happen when people are medicated as children but haven’t received therapy, coaching or social support to deal with the negative self-image that can result from ADHD.
  • ADHD often co-occurs with other conditions, such as trauma, depression, anxiety, substance abuse, bipolar disorder, learning differences and sensory processing disorders.

All of the above can lead to feeling – and being – misunderstood.

While hyperactivity is part of the name of ADHD, there is also an inattentive type. Because they tend not to attract attention to themselves, people with the inattentive type often do not get help. In school, these students are often told that they do not perform up to their abilities. (Noticing that others are disappointed in you leads to shame). Both types hate being bored, and you could interpret both the daydreaming and the hyperactivity as avoidance of boredom. People with the inattentive type may be shamed by labels such as “bad at following instructions”, unmotivated, disrespectful, or even rebellious.

People with ADHD receive repeated negative messages about their ability or willingness to perform according to expectations, as Dr William Dodson explains. This usually starts in school and often continues into the workplace. Many people with ADHD have job dissatisfaction. This, despite the fact that many of them are hard-working and enthusiastic – some of the most inventive and intelligent people you meet. Difficulties at school or the workplace can be the source of a great deal of shame.

ADHD is an invisible disability with social implications. Most people with ADHD have been told many times that they should just try harder, without any recognition of how hard they are already trying. What appears to others as problematic behaviours, such as ” being disorganized”, frequently late, not listening, etc, may be perceived internally by the person with ADHD as just more reasons why they really are fundamentally flawed. The person with ADHD may be upset with themselves over their inability to “keep it together”. The process of explaining this difficulty to someone, a boss or even an acquaintance, who sees “disorganization” as an excuse for laziness or incompetence could easily be a shaming experience.

What to do about it? Find your tribe, get some therapy and or coaching

ADHD is not a lifelong sentence to disappointment! It is a very treatable condition and can be the source of great joy.

Personality traits that often go with ADHD are enthusiasm, creativity and resilience.   People with ADHD are often very hard workers. A strength-based approach is like a breath of fresh air to a person who’s been shamed.

In therapy, we work on counter-shaming, going back to the root experiences that somehow got turned into a negative self-image. Building on strengths and coming up with strategies to deal with communication problems, organization. We are so fortunate today to have a plenitude of resources for dealing with ADHD. Here are a few:

Magazine              ADDitude magazine

Podcast:                 ADHD Rewired with Eric Tivers, Distraction with Dr Ned Hallowell.

Website:                Totally ADD

Youtube:                How To ADHD

Books:                    The Disorganized Mind, by Nancy Ratey,  You Mean I’m not Lazy, Stupid or Crazy?, by Kate Kelly and Peggy Ramundo

 

 

Neuroplasticity

9 Quotes on Neuroplasticity

Neuroplasticity refers to the brain’s ability to adapt. Unlike computers, which are built to certain specifications and receive software updates periodically, our brains can actually receive hardware updates in addition to software updates. Different pathways form and fall dormant, are created and are discarded, according to our experiences.

When we learn something new, we create new connections between our neurons. We rewire our brains to adapt to new circumstances. This happens on a daily basis, but it’s also something that we can encourage and stimulate.

9 Quotes on Neuroplasticity

Check out these 9 interesting, engaging, and sometimes entertaining quotes about neuroplasticity.

Andrew Weil:

“Among other things, neuroplasticity means that emotions such as happiness and compassion can be cultivated in much the same way that a person can learn through repetition to play golf and basketball or master a musical instrument, and that such practice changes the activity and physical aspects of specific brain areas.”

Elizabeth Thornton:

“Because of the power of neuroplasticity, you can, in fact, reframe your world and rewire your brain so that you are more objective. You have the power to see things as they are so that you can respond thoughtfully, deliberately, and effectively to everything you experience.”

Santiago Ramón y Cajal:

“Any man could, if he were so inclined, be the sculptor of his own brain.”

Craig Krishna:

“Meditation invokes that which is known in neuroscience as neuroplasticity; which is the loosening of the old nerve cells or hardwiring in the brain, to make space for the new to emerge.”

Norman Doidge:

“Everything having to do with human training and education has to be re-examined in light of neuroplasticity.”

Donald O. Hebb:

“Neurons that fire together wire together.”

Douglas Rushkoff:

“Brains are tricky and adaptable organs. For all the ‘neuroplasticity’ allowing our brains to reconfigure themselves to the biases of our computers, we are just as neuroplastic in our ability to eventually recover and adapt.”

Michael S. Gazzaniga:

“Our brains renew themselves throughout life to an extent previously thought not possible.”

Susannah Cahalan:

“Our minds have the incredible capacity to both alter the strength of connections among neurons, essentially rewiring them, and create entirely new pathways. (It makes a computer, which cannot create new hardware when its system crashes, seem fixed and helpless).”

An image the human brain's default mode network, Credit: Marcus Raichle, Washington University

Neuroscience: The Default Mode Network

(An image the human brain’s Default Mode Network, Credit: Marcus Raichle, Washington University)

The Default Mode Network plays a key part in our sense of self, attachment style and mood. This article taken from Sarah Peyton’s book Your Resonant Self explains where it is located in the brain and why it is so important.

What is the DMN?

The Default Mode Network (DMN) in the brain, is active when we stop doing something (and we are not in the task mode network, TMN). When the brain is not focused on a challenging or attention-grabbing task, we are no longer paying attention to the external world and the parts of the brain associated with this network light up. Our brain automatically brings together memory and thought and integrates both of these with our sense of self. Some scientists have said that the DMN is where the ‘self’ is located; it is the “me myself and I” network. It is self referential, self-other referential, future referential and past referential. It is universal to all humans and it is active immediately, as soon as we stop focusing on externals. It is not only the part of the brain where we “mind wander”; we use the DMN intentionally too. We do this when we are reaching for autobiographical memory, thinking about the future, using our imagination or empathising with someone. It can be active from the moment we wake up; it is the background of our days and is with us continually, even under anaesthesia as well as when we fall asleep at night. It is said to be the night garden in which our night dreams grow. It changes during the day as we integrate the day’s events, and this may be why the way we feel when we wake up can be so different from how we feel when we fall asleep. Interestingly, studies have shown that the two main activities where the DMN is completely switch off is when we play video games or when we smoke.

 

Scientists are still trying to find out exactly which parts and regions of the brain are involved most often. What is most important to know is that the parts of the brain that we use for this automatic integration of self and social connections are almost entirely different from the parts we use when we are concentrating on getting things done in the external world. For example, when we learn to do something new and are not therefore using procedural memory, the DMN goes offline as focused attention comes online. As the task becomes more automatic, the DMN starts to become active again. We could say that familiarity or boredom can be one of the prompting factors to the DMN coming into use.

 

(Figure of the seven different major networks and way the brain uses itself depending on what we are doing taken from Your Resonant Self by Sarah Peyton). Notice how different the DMN is form the others. Especially notice the DAN (Dorsal Attention Network). This is the network that most completely turns off the DMN; it come online when we are doing new or absorbing things like video games

 

DMN: Social Attachments & Predictions

Our social world as humans has become so incredibly complex. Our DMN is always trying to help us to stay afloat socially and keep our important attachments. It is trying to support our wellbeing. Memories don’t just help us to remember things; our DMN seems to use them to make predictions about what is going to happen next and what people are likely to be intending or thinking that helps us grow and move within our families and social groups. It also helps us, from when we are very young, ensure that we got our basic needs met, most especially attachments to important figures in our lives (when we were younger, our parents).

 

The DMN: Anxiety, Depression & Trauma

Many things change the way our DMN interacts with our externally focused brain including anxiety, trauma and depression. A ‘healthy’ DMN, which helps the brain integrate the experiences of life, requires that all regions of the DMN be interconnected and functional. When these interconnections between the DMN regions are disrupted (which can happen due to trauma, anxiety, depression and other illnesses that disrupt brain and neurotransmitter function), we can expect the brain to start spinning “negative” and self-debilitating thoughts whenever it is trying to rest. With early childhood trauma, the DMN can default to self-blame and self abuse rather than neutrality. People can be in the habit of walking around unconsciously berating themselves (or blaming others). If people feel badly about themselves, then this emotional tone can run through their automatic thoughts, can come like a knife in the dark whenever consciously directed activity stops.

 

The DMN: When it Becomes Toxic and Savage  

The main problem with such a savage DMN is connectivity. When certain brain regions are not corrected as they should be, negative thoughts and interpretations of life and the sense of self can grow. The more emotional pain and neglect a person has survived, the more likely it is for the DMN to be toxic and savage and for a harsh inner critic to take over. What is needed to correct these faulty connections and change the tone of a ruthless DMN is warm, responsive nurturing. It is often not what has happened to us, it is how it has been reacted to by those around us. If we receive a warm and nurturing response, we are more likely not to experience such disconnection and disintegration in the brain and nervous system. When people are in the grip of their own savage self-dislike, they can’t believe that they cared for by others, so they cant reach out to people and isolation is more likely. Changing the tone of the automatic way people speak to themselves is essential to making the mind and body a safer space to inhabit.

It is possible that part of the ongoing stream of distraction in our world helps people to manage the traumatised and unkind self-talk that starts as soon as they are quiet. This can happen unconsciously, which is why it is important to learn about and understand the DMN.

 

The DMN: Compassion & Meditation

The life that we live when we have integrated self compassion (when we can be gentle and warm with ourselves and others) feels very different from one lived inside a savage DMN.

It is important to know that, though mindfulness meditation is supposed to integrate the brain, the network used for meditation and the DMN can remain distinct. It can explain how somebody with years of meditation practice can still have a savage DMN that comes into play when they come off the cushion and why it is important to focus on both these aspects of the brain to heal a toxic and savage DMN.

Even If that inner critic is still trying to convince you that it is selfish to start caring for yourself, consider this: the ongoing self attack of living with a savage DMN is a sign that we may be living with PTSD. Research is showing that the different names we give to anxiety, social anxiety, general anxiety, PTSD, OCD and panic each have their own way of taking over our DMN and giving us a hard time.

The important thing to remember is that our brains don’t develop easily when we are not able to see and treat ourselves with affection. If no one we know has ever really held themselves with warmth, then we don’t have a model of how to do this. However, no matter how old we are, we can turn our compassion for others back towards ourselves and follow the invitation to self-care.

Below are links to more information on the DMN 

Science Direct Articles

Neuroscientifically Challenged

The Meditation Blog

Dan Harris, The Big Think