Abstract
This brave and important book has been reviewed by writers far more important than I in some of the most distinguished newspapers and journals in the world. They, as well as the book, are worth reading. As this is an academic journal, however, my purpose is to discuss the book from the perspective of a physician and psychiatrist who evaluates and treats ADHD/ADD (Attention Deficit Disorder). I refer to the book as “brave” because Andrew Solomon demonstrates great courage in exploring regions of humanity where few would choose to go.
Far From the Tree is a unique exploration of disability and “differentness.” In an exhaustive exploration, Solomon interviews more than three hundred families about their experiences dealing with 10 different categories of disability, ranging from conventional notions of disability, such as deafness and Down’s Syndrome, to the more unusual and provocative, such as children of rape, musical prodigies, and families of criminal children. One can easily envision each category as a book unto itself, yet Solomon crams all this exhaustive research into one grand essay on his notions of identity and what binds families together.
While never specifically addressing the disability of ADHD, so many of the attributes and effects of differentness Solomon raises about these conditions absolutely apply to ADHD as well.
Solomon wades deep into the territory of what most would consider heartbreak. What is it like for parents to discover that their children are born with achondroplastic dwarfism or Down’s Syndrome at birth, or the dawning realization that your developing child is autistic, or that your nearly grown child is transgender or even criminal? These experiences cut to the core of how we think about ourselves. Solomon explores the emerging identities derived from different disabilities. For example, there is a powerful culture and identity among the deaf. People with dwarfism congregate in Little People of America conventions, and people with gender identity issues flock to supportive organizations, such as Parents, Family and Friends of Lesbians and Gays (PFLAG). Children and Adults With Attention Deficit Disorder (CHADD) serves a very similar purpose when the unique condition is ADHD.
These organizations help to sustain what Solomon refers to as “horizontal identity,” as contrasted with the “vertical identity” of one’s family. In our Lake Woebegone culture, which so values conformity among our children, it is every parent’s wish to have to have “above average” children. But what Solomon discovers is a transformative love which many of these families experience in their journeys. What was at first frightening or shameful can become exceptional. “Life is enriched by difficulty; love is made more acute when it requires exertion,” Solomon muses, and this is perhaps his essential message.
Reading story after story of these families’ struggles is moving and humanizing. His families demonstrate the surprising ways in which their attachment to their disabled children deepens their understanding of themselves. His message is a powerful alternative to the culture of the disease-based model of our current medical establishment. “Diversity is not a disease; the anomalous is not pathological,” Solomon argues. We physicians are trained to differentiate the normal from the abnormal, to define and treat pathology. But who is to say what constitutes “normal”?
These stories abound with clumsy and insensitive ways in which physicians communicate with families with severe disabilities. “I regret to inform you that you have given birth to a circus dwarf,” is what one family remembers being told in the delivery room. Solomon reminds us that sometimes the most powerful thing we can do as physicians is to acknowledge the struggle our patients endure and strive to maintain respect for their dignity. We are trained in a culture of fixing things, and when we fail, we are at a loss. We often respond to our inadequacies as healers with avoidance and dismissal.
Children with ADHD have horizontal identities as well. I remember a 12-year-old boy who was having terrible problems performing in a highly academic school in which his parents enrolled him. There was significant amounts of homework, which was excruciating for him. He did excel, however, in sports and action-oriented activities. He had a sixth sense on the soccer field, and refused to take stimulant medications during games or practices, feeling that they dulled his ability to sense where the action would occur. Similarly, he was a skilled Boy Scout who greatly enjoyed orienteering. This boy felt that his ADD cognition was a gift on the playing field and in other activities which he valued, but a curse in the classroom and in the activities that his parents valued. In our final session, acknowledging his talents, I told him that if I ever got lost in the forest, I would want him to help me find my way out.
Managed care, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), and now DSM-V, as well as the influence of the pharmaceutical industry have all created a tsunami of forces which funnel us into the role of efficient technicians to diagnose and fix problems. To fill this void, we have broadened and made increasingly vague conditions like ADHD and Bipolar Disorder for which we prescribe and dispense. If you have any doubts about this, witness the phenomenal rise of these diagnoses in children and young adults in the past decade. In the chapter which investigates the challenges of families with child musical prodigies, the conductor Leon Botstein comments, “If Beethoven were sent to nursery school today, they would medicate him, and he would become a postal clerk.”
In the hands of many other writers, Far From the Tree might be a grand, overly ambitious project, glossing over the differences of highly disparate conditions in an attempt to create artificial cohesion. Comparing child musical prodigies with Down’s Syndrome children seems strained, and his general choice of topics, given the wide array of conditions in the disability world, strikes me as arbitrary. By overreaching, he risks diminishing the power of his argument.
The chapter on crime is perhaps the weakest in the book. Unlike the other conditions discussed, most would agree that juvenile crime is mostly the outcome of complex family and social dynamics. Dylan Klebold’s parents, who speak movingly about their shock and horror in discovering that their son, Dylan, carried out the massacre at Columbine High School, are surely the exception in the universe of families of criminals and sociopaths. To imply that sociopathy is merely another form of “neurodiversity” simply does not hold water. However, these criticisms feel trivial in the face of the honesty and courage of his writing. In the end, his stories argue for a simple call for tolerance for all of humanity, regardless how foreign or ugly it may seem at first glance.
He very openly shares his own battles with growing up gay in the 1970s and his lifelong struggle for acceptance from his parents. This is no mere intellectual exercise for him, as he shares with the reader the challenges he confronted in creating a family with his partner while exorcising ghosts from his own childhood. The book is quite long, but never boring, a testament to Solomon’s facility with language and storytelling. I felt somehow changed by reading this book, proof of the deeply humanizing power of these stories. For anyone working intimately with children and families within the broad and diverse spectrum of what we call ADHD/ADD, Far From the Tree is a thought-provoking and uplifting experience.