Did Ferdinand the Bull Have ADHD?

One of the most wonderful memories I have as a child is of my mother quietly snuggling up with me and reading Munro Leaf’s wonderful illustrated classic, Ferdinand the Bull.  The story is heartwarming, about a young bull in Spain who prefers to smell the roses rather than kick and jump and jockey with the other bulls.  Don’t even ask what happens when he is put in the bullfighter’s arena! The impression one gets from reading the book is that Ferdinand is a pacifist, and simply prefers to love than to fight.  And while this may be the intended interpretation of the book, as I was watching a 6 year-old child with attention deficit hyperactivity disorder (ADHD) play soccer the other day, it came to me that perhaps Ferdinand actually represents another group of easily-distracted folk who always seem to irk the circles around them by being stirred by delights that fancy them rather than focusing on what society needs and wants them to do —  people with ADHD.

This little girl in her green soccer uniform was so sweet, standing quietly at the edge of the soccer field, singing to herself.  At the beginning of the game she looked up into the sky and squinted her eyes, as if trying to visualize cotton candy animals in the clouds, clearly disinterested in the competition that was about to begin.  Her father yelled encouragingly, “FOCUS sweetie!  Keep your eye on the ball!” and when the whistle blew and the game started, he added, “RUN!!”  As if she was a racehorse released by an opened gate, the child jolted after the ball.  She ran hard to keep up with the other children, dedicated to getting at the ball, groping for it, clawing at it, but never actually reaching it.  After just a few minutes, one could see she tired of the game and slowed her pace to a stop.  The other kids were now on the other side of the field as this sweet child gazed into the distance, and appeared to be enjoying the freshly cut grass smell, breathing in deeply, calmly looking peaceful and free.  Her eyes then picked up on something a few yards away from her; she seemed mesmerized as she slowly walked towards something that enchanted her.  And then she stopped in the middle of the field, gently bent down and plucked a bright lone dandelion and brought it to her lips.  She smiled –- and was in heaven!   “RUN!” exploded someone from the bleachers, startling the child from her meditation, causing her to drop the fragile flower. She looked around hurriedly and scurried to where the other kids were, again trying to be part of the pack and perform.

ADHD can be a crippling disorder for many children and adults because it often interferes with one’s ability to fit into society’s structural expectations.  Yet, there is something very beautiful about the internal lives of people with ADHD, that is particularly apparent if you observe them closely:  When not interfered with and allowed to choose their own paths, they tend to have a keen ability to “smell the roses.”  This ability is enhanced by their tendency to be distracted by what the rest of us see as unimportant or irrelevant stimuli.  But is the smell of a rose irrelevant?

Should we be impervious to the simple joys of life, just because the game society is playing demands performance? Well – yes, and no.

I struggle with this question every time I treat someone with ADHD.  You see, if you really stop and watch people challenged with ADHD, they have a wonderful inner life that is much more spontaneous, creative and passionate than your average person.

The problem with ADHD is that people who suffer from it have trouble tempering their own inattentiveness in social or work situations: When not alone, and when forced to work in groups, the spontaneity of ADHD can been seen as impulsivity, creativity as uncooperative, passionate as irresponsible and flighty.  Often people with attentional disorders struggle with making transitions from task to task, a skill set expected more than ever in this fast-paced world we live in.  ADHD is a disorder of the frontal lobe of the brain that results in a tendency to be hyper-focused on tasks one is passionate about, and more easily distracted from mundane, often necessary tasks.  When pulled away from a task intensely focused on, patients with ADHD can become excessively frustrated and irritable.  ADHD is often characterized by a tendency to fidget, pick, or move, which I believe is an unconscious way in which patients self-stimulate in order to maintain focus on a topic that is particularly tough or complex.  This is often socially or academically unacceptable and leads to scolding and impatience from peers and supervisors.

People with ADHD, like most of us, also yearn to have friends and to succeed in life, but this requires them to live up to basic societal rules.

To succeed at work or in school, we all need to start and complete our homework before it is due, whether or not we like the subject.  To succeed interpersonally, while it definitely helps to be good looking and charming, the bottom line is that we all need to be responsive and responsible to those who we want to call our family and friends.

So, as usual, balance is key.  If I do decide to treat ADHD with medications or CBT, my goal is to manage the exaggerated fluctuations of attention that cause my patients to suffer occupationally or interpersonally; but I also strive to honor, and avoid disturbing, the beautiful contributions of ADHD – spontaneity, creativity, and a unique passion and tendency to smell the roses.

The ongoing public infatuation with the emotional sagas of celebrities like Charlie Sheen raises an important issue about how we as a culture perceive and respond to the public self-destruction of others.

Whether we approach their conduct as “entertainment,” “bad behavior” or “mental illness” speaks volumes about us as a society. If we view public emotional breakdowns as entertainment, then what separates us from the gladiator-gawking Coliseum audiences of ancient Rome? Alternatively, judging such behavior as “bad” or “spoiled” leaves little room for empathy and healing. However, one designation—that of mental illness—opens the door for empathy, support, treatment, healing and hope.

Many in the media suggest that Charlie Sheen’s erratic behavior might stem from drug and alcohol abuse or withdrawal, bipolar disorder or even a negative response to prescription medication. Because I have not examined or interviewed Mr. Sheen, I am unable to diagnose him specifically. However, what I can comment on is that rather than ogling at celebrities suffering from behavioral problems, we need to instead try to understand what they are going through.

Such empathy is possible if we have a better understanding about mental illness and substance abuse overall.

What role does substance abuse play in mental illness?

Binging on psychoactive drugs such as amphetamines, cocaine and alcohol can trigger erratic and self-destructive behavior. These types of drugs activate the release of dopamine in the mesolimbic reward pathway of the brain, which is perceived as pleasurable to the individual, biochemically reinforcing the desire to use the drugs again.

Furthermore, some people are more genetically prone to addictions than others, making abstinence very difficult, yet possible, to achieve. Substance abusers need to consciously fight the pleasure-reward pathway in order to combat the temptation of another “high.” Such a fight is almost impossible without insight and guidance from mental health providers, support groups or rehabilitation centers.

While awareness is possible, many substance abusers do not become “conscious” of their difficulties until they lose what is most important to them and hit what we know as “rock bottom.” Others, with the help of friends and family, are able to achieve insight more quickly and benefit dramatically from ongoing treatment.

What is mania?

Manic episodes are periods of time characterized by agitated irritability or euphoria, inflated self-esteem, delusions of power and control, a decreased need for sleep, racing thoughts, scattered thinking, pressured speech and impulsive behavior. They are often associated with a mood disorder called bipolar disorder, from which approximately 1 to 3 percent of the population suffers.

Bipolar disorder, formerly known as manic-depressive disorder, is characterized by destructive fluctuations of mood ranging from deep depression to severe mania, and requires consistent psychiatric treatment encompassing both medication and psychotherapeutic treatment and monitoring to control its symptoms.

Manias can also be triggered or exacerbated by medical conditions such as seizures, elevated thyroid hormone levels (hyperthyroidism), certain vitamin deficiencies, various infections that affect the brain, strokes, brain cancers, brain trauma and even multiple sclerosis.

Medications, such as certain antidepressants and steroids, as well as alcohol and illicit drugs like cocaine and methamphetamines, can also trigger manic-like symptoms in people who do not have bipolar disorder, or worsen manias in those who do.

The most dangerous aspect of mania is its associated impulsivity. Often, manic individuals behave so erratically that they lose their jobs and estrange their families, get into legal trouble, participate in dangerous sexual behaviors, become bankrupt or commit suicide.

Sixty percent of people with bipolar disorder abuse, or are dependent on, drugs or alcohol, often in misguided attempts to self-medicate. The risks of self-destruction and suicide are heightened further in patients with bipolar disorder especially if they are not under the care of a psychiatrist and if they have a dwindling support network.

Because mania is caused by biochemical changes in the brain, sufferers are unable to simply elicit the use of willpower alone to control their symptoms. Asking someone with mania to control themselves would be like asking a person with Type I Diabetes to stop letting their pancreas experience dysfunction.

Fortunately, mania can often be treated with medications, psychotherapy and alcohol and drug abstinence. All too often, however, individuals with manic symptoms, particularly because of their grandiosity and difficulties thinking rationally, have poor insight into their condition and therefore resent, resist and abandon treatment of their mania and substance abuse.

In this way, mania often gets in the way of its own treatment, as the erratic mind is unable to realize it needs help. If a patient suffering from mania does not have an ongoing relationship with a trusted psychiatrist and psychologist who monitors them closely and can “catch” and treat a manic episode before it peaks, it becomes very difficult to control until the patient “bottoms out.”  If one does have ongoing access to mental healthcare, there is a much better chance that they can get the treatment they need to return to a fully functional and fulfilling life.

From empathy to healing

The self-destruction and lack of insight often seen in substance abusers and/or people with bipolar disorder need to be understood as symptoms of their conditions and as tragic complications, not as spoiled rampages or a lack of willpower. With this understanding, our culture must move its focus away from gawking and stigmatizing, and focus more on compassion, education and the treatment of people with mental illness.

If you know someone who displays or has displayed symptoms of mania or substance abuse, there is hope for them to, one day, return to a fully functional life of stability, especially if they gain access and accept mental health treatment.  If possible, reach out to them if you can, and recommend that they get psychiatric help.  If their condition is an emergency or if you have concerns that they are dangerous to you, others or themselves, then it is prudent to call their family or emergency medical services.

Offering assistance is not easy and may even put you in an adversarial position, at least until that person is able to self-reflect and develop more insight. While initially, individuals in the throws of mania or under the influence of drugs or alcohol are very likely to reject your offers to assist, such attempts are not in vain: The more “messages” they receive directing them to professional help, the more likely they will ultimately accept help before it is too late.

With regards to Mr. Sheen, it is my sincere hope that those in his life recognize his condition and make efforts to assist him in receiving medical help. Nonetheless, a proactive start lies with the public, to whom Mr. Sheen has turned to in recent weeks, to send out a consistent message of concern to him.

With appropriate diagnosis and treatment, there is hope for Mr. Sheen to live a more fulfilling and functional personal life, as well as regain a career that so many fans have enjoyed and appreciated.

REFERENCES:

Bipolar Disorder: A Guide For Patients & Families

The Harvard Bipolar Clinic

The Matrix Institute on Addictions

Alcoholics Anonymous

Clearview Treatment Program

Sierra Tucson Treatment Program

McLean Hospital Programs for Bipolar Disorder and Substance Abuse Treatment