November 11, 2000
Psychiatrist Edward Hallowell has been called a luminary in the field of attention deficit disorder, a worry guru, and the avatar of family connection. He is the author of seven books, a member of the faculty at Harvard Medical School, and the founder of The Hallowell Center for Cognitive and Emotional Health. He travels the country talking about learning disabilities and the importance of human connectedness. He has a wide, likeable face and a relaxed demeanor and seems comfortable in front of a live audience and a television camera alike.
But once he was just Ned Hallowell, a young man facing his first day of medical school with a bad case of nerves. He remembers sitting through three screenings of The Sting at the Joy Theatre on Canal Street on the afternoon before he entered Tulane Medical School's class of 1978. It was a great movie, but not that great. It was, however, a distraction from his worries. He had a bachelor's degree in English from Harvard and had always wanted to be a writer.
But he didn't want to starve in a garret somewhere. He wanted to have children and support a family. An uncle who was an orthopedic surgeon told him medicine could be really fun, so he took an organic chemistry course over the summer and decided he could handle the science. Now he was a thousand miles away from the center of the universe.
To him, that was New England. It was his large extended family and the exclusive schools where he'd been educated. Ned Hallowell had spent time in another steamy Southern city before hitting the streets of New Orleans. But his experiences in Charleston, S.C., hardly served to endear the sweatier latitudes to his heart. When he was a child, his loving but troubled parents divorced. His mother remarried an older man, a literary alcoholic who moved his new wife and stepson to Charleston.
The worst things that ever happened to Ned Hallowell happened in that lovely, genteel town. His mother drank. His stepfather, whom he called "Uncle Noble," drank. When Uncle Noble drank he would beat up Hallowell's mother. One night, Uncle Noble woke Hallowell up at 3 a.m. so the boy could witness a high-stakes craps game being shot against the naked backside of his sleeping mother. Hallowell and his stepfather fought every day until he was sent away to boarding school back in New England. In Ned Hallowell today, there is an astonishing lack of bitterness about his rough childhood.
He says this is because, despite the discord in his family, there was no lack of love. "I had a connected family. My evil stepfather was pretty evil, but my mom and dad loved me tremendously. They weren't up to the task in some ways, but they did the best they could. They gave me that sense of unconditional love that I think kids need more than anything else. Even though my mom was lost to her drinking and my dad was crazy, I never doubted they loved me."
Even so, like many young adults, Hallowell felt the need to put some distance between himself and his family. That's why he chose to go to medical school outside of New England. And while he didn't consciously choose New Orleans for its similarities to Charleston, the city provided an environment conducive to emotional recovery from the damage done in that other steamy Southern town.
"Coming to New Orleans was just a wonderful infusion of culture," he says. "The city embraced me in a way that was very healing. I established my independence. I got away from my family and was on my own. It was really a turning point for me. Since then I've become a much happier person."
He loved the whirl of restaurants, bars, parties, and Mardi Gras celebrations, and all the things that made New Orleans fun. But the moments that had the biggest impact on the young medical student took place in New Orleans' Charity Hospital. One hot August when the hospital's air conditioning had gone out, he was assigned to the delivery rooms. It was a busy season when the residents had their hands full with complicated deliveries, so medical students handled the more routine deliveries.
"I can't tell you what it's like when that baby comes out," he says. "At the moment of birth, it's miraculous. You feel a spirit entering that room. In the midst of blood and goo and all kind of confusion, there is this explosion. Everybody who's there can feel it. The whole room changes. There's this light that just comes into the room and you are delivering it for that mom and for that child." Hallowell's faith in God had taken a beating when he discovered reason and skepticism in college.
But now, in medical school, it returned. "In medical school I began to get in people's lives in a real way. I began to see people overcoming suffering. And then as I began to practice I began to see these amazing changes in people's lives. Where did it all come from? I don't know. I believe in God. If I had to translate that into secular terms, it is the power of love."
Those shifts in the delivery room prompted Hallowell to consider becoming an obstetrician, but in the end he found his place in psychiatry. It was a natural fit for him, a former student of the humanities and the son of a father with bipolar disorder. "I really love to get into other people's lives," he says. "I have a need for it, I soak it up."
Hallowell returned to Boston to do his residency at the Massachusetts Mental Health Center, a state-run mental hospital that serves many indigent patients. It was there, at the age of 31, that Hallowell recognized himself in a description of Attention Deficit Disorder given during a neuropsychiatry lecture. As a child he'd been a chronic daydreamer, full of energy, impulsive, distractable, bright but unable to pay attention to any one thing for very long.
He was still like that as an adult. It was a considerable relief to find out there was a name for his condition. He'd long assumed that there was just something slightly wrong with him. Yet ADD had never been a terrible handicap for him.
"I can compensate for it very well," Hallowell says. "I learned how to deal with my learning disorders in the fifth grade. I went to a very structured school. And I learned how to make index cards and lists--the whole discipline of organizing large bodies of information."
Later, after establishing his practice, he would begin to see many patients with ADD but found there was a lack of good information for the general reader. "I was seeing a lot of it and nobody was talking about it," he says. "Even in the professional literature there wasn't much." Eventually he would write, with the help of fellow psychiatrist John J. Ratey, one of the classic books on ADD.
The best-selling Driven to Distraction reassured readers that ADD didn't have to be a terrible burden and that the condition even had its good side. The popular response to this message was overwhelmingly positive.
"ADD people tend to be creative, tend to be energetic, tend to be very innovative. They tend to see things in different ways," he says. "All that has helped me. Used in the right setting, ADD is very adaptive. It's a trait, not a disorder. There are people in very high places who have it. Depending on how you manage it, it can help you or hurt you."
His is a calm, moderate, reassuring voice on a subject that is fraught with confusion and controversy. There is dissent about whether or not ADD is truly a biological condition, concerns that it is overdiagnosed, and fears that Ritalin is replacing good parenting. A handful of states have even filed class-action lawsuits against Novartis, the maker of Ritalin, and the American Psychiatric Association for allegedly encouraging overdiagnosis of ADD and overprescription of the drug. Hallowell is well familiar with the doubts of ADD skeptics.
Much of Driven to Distraction was developed in conversation with his double first cousin, James Hallowell, who doubted that there really was such a thing as ADD.
"He thought this was just the biggest load of hooey he'd ever heard in his life," Hallowell says. "He thought it was ridiculous--these people just need to shape up and try harder. I developed a lot of my metaphors and analogies and explanations in conversations with him, trying to deal with his skeptical responses."
Although efforts to pin down the biological causes of ADD have met with mixed results, Hallowell points to a high concordance rate for ADD in twin adoption studies as strong evidence that it is a real, genetically based condition. And, yes, he admits it's true that ADD is diagnosed and Ritalin is prescribed more frequently in the United States than anywhere else in the world. Doctors need to be on guard against allowing the diagnosis from becoming a faddish quick fix.
But Hallowell speculates that the adventure and struggle of leaving the familiar behind and starting over in an unknown place would have appealed particularly to people with ADD, so there might have been an especially high number of people with ADD among those who settled this country or immigrated to it later. He also thinks ADD may have been underdiagnosed in other places, partly due to stigma. "They're finding higher incidences of ADD in Europe than they ever expected," he notes. "Over the course of time it'll even out."
He doesn't push drugs on those who don't want them, and recognizes that Ritalin and other drugs prescribed for ADD can be improperly used. But when used properly, in relatively low dosages, drugs are comparable to a pair of eyeglasses for your brain, he says. They just help you focus better.
"You should not think the treatment for ADD is to take Ritalin," he says. "That's part of the treatment, and sometimes an extremely helpful part of treatment. But you make a big mistake if you think all you have to do is take this pill and you've treated your ADD."
Not everyone who has ADD fits the stereotype of the hyperactive child--quiet, dreamy, scattered children can have it, too, as can adults. But not everyone who looks like they have ADD actually does. Hallowell says our culture promotes ADD-like behavior, a condition he calls pseudo-ADD.
"When ADD is overdiagnosed, or misdiagnosed, I think what you are seeing is a culturally induced syndrome of people who are overstimulated and disconnected," he says. "They're electronically hyper-connected but personally disconnected. They're multitasking; they're running a mile a minute; you can't get a moment of their attention. It feels as if they have this condition but they don't--it's just culturally induced."
The phenomenon of pseudo-ADD was one of the first things that drew Hallowell's attention to the subject of connectedness, the subject of his latest book, Connect. "As I traveled more and more, I came to see everywhere I went that there was just this growing amount of disconnection," he says. "Everybody's very electronically connected with their cell phones and e-mail and all that. But they don't have many human moments. And they don't have enough strong, longstanding loving connections."
It's not that he thinks there's anything wrong with the technology in itself. In fact, he is an avid e-mailer. But there's always stress and anxiety involved in interacting with others. It can be easier to disconnect, and technology gives us the means to do so. With e-mail and voice mail and Internet commerce, we never have to see each other face to face if we don't want to. It's not that we don't know we're supposed to value our connections. A hundred heartwarming Hollywood movies and a thousand inspirational best sellers have reminded us of the truth of this.
But we don't need anyone to tell us that relationships can be a real pain. Excepting the cruel reality of illness and physical disability, the main source of suffering in life is other people. "There's every reason in the world to avoid personal interaction," Hallowell admits. "Connection is so hard. We need each other but we drive each other crazy." But the catch is that we really do need each other.
Hallowell cites a long list of studies that seem to provide evidence that connection is good for our health, while disconnection is a health risk. The MacArthur Foundation Study of Aging in America, for example, showed that the top two predictors of well-being as people age are frequency of visits with friends and frequency of attending meetings of organizations.
The Alameda County Study, conducted over a nine-year period in the 1960s and 1970s, found that socially isolated people were three times more likely to die over the course of the study than those with stronger social ties. Even when other risk factors like smoking, obesity, poverty and health problems were present, people who had strong social ties lived significantly longer than those who did not. As Hallowell became more and more convinced of the importance of connection while seeing less and less of it, a sense of mission slowly began to grow in him.
He wanted to help people build connections. Still, he wasn't quite ready to say it out loud. And then, at the age of 49, he went back to Charleston for the first time in 37 years. The reason for the visit was purely professional. But as he wandered the city that held so many difficult memories, he found it almost impossible to comprehend the link between himself as a child and himself as an accomplished, happy adult.
When he found himself in front of the house he'd lived in with his mother and Uncle Noble, he walked up and knocked on the door. A retired Episcopal priest and his wife live there now. The couple was packing to leave on a trip to Italy the next day, but they invited Hallowell inside and allowed him to look around. He found, as is common when revisiting childhood sites, that everything was much smaller than he remembered and lacked the mythic resonance that his imagination had imbued it with.
Things were not what they had once seemed. The pain of the past lessened its grip around his heart, allowing him to reconnect with his childhood. He became more comfortable with, and less ashamed of, his past.
"When I went back to Charleston, which was the scene of the worst trauma of my life, and walked into the very house where those things happened, something changed," Hallowell explains. "Something just bubbled up from inside. It's like this gas exploding to the outside air. Now it's time for me to talk about love. The old stuff is over, it's done. This is what it's led to. This is the good place that it's led to."
And it has undoubtedly led to a good place. Hallowell has the writing career he dreamed of, the satisfaction of seeing positive change in the lives of his patients, and a happy family life with three children he clearly dotes on. Make no mistake--his family is not the second coming of the Cleavers. Once, when Hallowell was being interviewed by a reporter from the New York Times, his daughter rolled her eyes and commented wearily, "Connect, connect, connect," as if a more boring topic was inconceivable.
His son professes amazement that people pay dull old dad to come and speak. But a perfect family without conflict is not the point. Love is.
"My ambition is to open myself up to love as much as possible and to help others do the same," Hallowell says. "That's what I want to do with the rest of my life." It took him decades to work up the nerve to say that out loud, and he's still a little concerned about how his words will be perceived. "A lot of people will take potshots at that," he admits. "They'll say that's sentimental baloney. But it's not. It's heartfelt conviction, tested in life."
Heather Heilman is an editor in the Office of University Publications. This is her first article for Tulanian. This article originally appeared in the Winter 2000 issue of Tulanian.
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