The temperamental mind
Can you work, can you love, and do you strive with joy, at least most of the time? In the grown-up world, an affirmative pretty much sums up good mental health and, in the vernacular, peace of mind. With the help of modern biology, an expanding lexicon of illnesses has gained legitimacy as disturbers of mental peace: illnesses like mild depression, anxiety, and social phobia.
Just arriving from the pediatric domain is a new entry--adult attention deficit hyperactivity disorder. This illness, which makes it hard to pay attention, concentrate, plan ahead, organize, and remember everything you should, sparks failures in love, work, and happiness.
Whether this newly minted mental illness adds up to an unhinged emotional life for millions of American grown-ups is still not clear, but it is sure to provide fodder for ADHD pundits over the next few years. For ADHD, whether it's in the young or their parents and grandparents, seems ever wrapped in restless controversy. The tiff boils down to what some experts see as the medicalization and drug doping of behaviors that fall mostly within the bounds of normal temperamental variation. They chafe at labeling as pathological qualities that may be merely irritating. Indeed, some think these same traits may be linked to great imagination, inventiveness, high energy, humor, and resilience. Even more, labeling obnoxious behavior as a mental illness might offer a free pass, in lieu of the historical pull up your socks, suck it in, stop whining, and start listening approach.
Ancient wisdom. Those who counter this argument offer up biology. Mounds of information from studies in children and teens show altered brain scans, genetic predisposition, and trials and testimonials from both doctors and patients on the behavioral benefits of ADHD-quelling medication. More than half of young children who benefit from medication will still need it as teens and many of them into adulthood, encouraging the notion that ADHD echoes throughout life.
Almost any mom will tell you that her kids' behavioral and emotional inclinations track from the moment of birth. And medical thinking since ancient times supports her. In the second century, the Roman physician Galen, who doctored both emperors and gladiators, theorized that people had four different temperaments based on their mix of bodily humors. There were the socially outgoing sanguine, the calm and unemotional phlegmatic, the bad-tempered choleric, and the fearful and depressed melancholic. Not bad for 2,000 years ago. Temperament is the innate biologically determined disposition that shows up at birth. Though modified by experience, certain traits are lasting and make people more or less vulnerable to mental illness. In a modern-day equivalent of the "humors," innate traits of distractibility and hyperactivity are believed to involve the same dopamine neurotransmitter system that is central in ADHD.
Though adult ADHD is a real illness aching for more attention, we must move cautiously in defining its scope. After all, ADHD is undiluted in the young; adults can have other mental or physical illnesses and medications that confound its diagnosis. But even more so, the tugs on many adults in today's world, both at home and at work, can be punishing to the strongest of psyches. Smothered in multimedia ether, people find distraction in cellphones, fax machines, pagers, satellite channels, instant messages, and endless E-mails. Then there are fast foods, plastic money, ready but stressful travel, and just-in-time everything. On balance this might seem like a cosmic conspiracy to disrupt our peace of mind and give us all a raging case of adult ADHD.
The point is that destructive emotions cry out for control, regardless of temperament or environment. At the same time we must be mindful of the enduring reality and magic of human variability. Even in Galen's scheme, the nicest guys are the sanguine, but in battle it's the phlegmatic and choleric types that save the republic. And who knows, the multitasking and energetic ADHD brain may turn out to be the prized mind of tomorrow.
This story appears in the April 26, 2004 print edition of U.S. News & World Report.