Top critical review
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A useful book, but presents a very skewed perspective that isn't relevant to everyone
on 29 March 2012
I will start by saying that I feel that this book is a valuable addition to the literature & could be a huge help to many people struggling with a relationship affected by ADHD - almost every couple where one member has ADHD can find some useful information & advice, and for many couples it may be a godsend! However (and it is a huge however) I couldn't help that feel there were some very important biases and assumptions that meant some of it might be unhelpful or even damaging in certain cases, and at the very least not relevant in many cases.
First of all, the book was very much written from an American perspective. On a minor level this means some of the cultural references may not make sense, or may grate a little with a UK audience, but more significantly it meant that it was loaded with assumptions about what help is available to people who suspect they have ADHD. Although there are some enlightened medical & psychological practitioners in the UK, on the whole it can be extremely difficult to get ADHD taken seriously over here compared to the US, so actually getting any kind of treatment can be a huge challenge. The assumption inherent throughout this book is that if your partner doesn't have a diagnosis or isn't undergoing treatment it is probably due to them being in denial or procrastinating over getting the help they need, which colours the whole perspective of the book. In the UK, not having a diagnosis, or not being on medication, is often not the fault of the individual with ADHD, it is genuinely much harder to get help over here. So the focus on helping your partner get over their denial issues or stop procrastinating over getting treatment may not be relevant to many people in this country, and takes up an awful lot of the book which could be more usefully dedicated to ways you could help your partner regardless of whether they can get treatment or not. The assumption that getting medicated is easy meant that very little time was spent dealing with ways to help someone who isn't on medication. This isn't JUST a UK/US issue, as there can be many reasons for not using medication (from medical conditions like heart problems to personal aversion to being medicated), so I felt there could have been a bit more detail about this even if the author wasn't really thinking about the international perspective.
Secondly, I felt that, despite the author's apparent attempts to be balanced, the view of ADHD presented was of a very specific type of person with ADHD. There were certain things that kept getting emphasised which I don't feel are core parts of ADHD, and some could reflect unfairly on people that don't exhibit these characteristics. A prime example is the idea that most people with ADHD have problems with empathy. I do realise that an apparent difficulty with empathy is quite common in ADDers, but it isn't actually a universal feature (no reference is made to empathy in any diagnostic criteria), and anyway, empathy isn't quite as simple as this author seems to make out. For example, what looks like a difficulty empathising can be caused by many things, not necessarily any kind of deficit in the ability or desire to empathise. Hyperfocusing on things can look like like a lack of empathy, as your attention can become so caught up in something that you fail to notice other people & their needs. Being forgetful can look like lack of empathy, since "normal" people assume that if you care about someone you'll remember things that are important to them (birthdays, anniversaries, arrangements to meet up, promises made, following through on tasks they want you to do, etc). Thinking differently to others can look like lack of empathy, since a lot of our ability to imagine how others might feel about something relies on the fact that the way they think isn't too different from the way we think; if you try to imagine "how would I feel if I were in that situation?" it won't be much use if the way you would feel is radically different to the way someone else might feel, so to be good at empathising when your mind works differently to most people's requires a much higher level of empathetic skill than most people possess. Impulsiveness can look like a lack of empathy, since not taking the time to think through things you say & do can mean that you haven't had time to think about the other person's feelings. A difficulty with projecting into the future can look like a lack of empathy - it's one thing to respond to someone's current mental state, but predicting their future mental state can be challenging for someone who struggles to even predict their own future mental state! Counterintuitively, even an excess of empathy can look like a lack of empathy, since it is possible to become so overwhelmed by your emotional response to someone else's emotions that you are unable to behave in the way they expect (people with ADHD can often become "paralysed" under stress or other heightened emotional state - it is almost like the emotions "scramble" your rational brain). But the feeling I got from this book is that the author understood "difficulty empathising" to be something much more straightforward than all of this, that is, a basic deficit in empathetic ability which should be taken at face value.
One thing I kept thinking about the type of ADDer being described by the book was that they seemed to be very definitely male! The author did make reference to women with ADHD, and I think she was attempting to be balanced in her assumptions about whether the person with ADHD was male or female, but she couldn't help but be influenced by her own experiences as the wife of a man with ADHD, and by the fact that diagnosis of ADHD is more common in males & therefore a lot of the literature is written with males in mind. Whilst I realise that many people find the idea of gender differences controversial, there is a great deal of evidence of some gender differences in the way that ADHD is expressed in males & females, as well as some more general gender differences in behaviour common in people regardless of whether they have ADHD. The empathy thing is probably a good example of this - although I would never say that men are useless at being empathetic & women are all great at it, I think it is safe to say that there are some broad gender differences in empathy (or at least in the way that empathy is expressed) that can't be ignored. Whether by nature or nurture, females, on the whole, seem to devote more effort to other people's emotional wellbeing than men, and when you throw ADHD into the mix this can create quite dramatic differences in the problems it causes. Based on the descriptions in this book and elsewhere, it seems a common complaint that many men with ADHD can come across as uncaring or even bordering on sociopathic/psychopathic (that is a term I have read in multiple descriptions by women of their ADHD partners or ex-partners, especially in describing how they explained their behaviour before ADHD was suspected), while women will often find themselves totally overwhelmed by their responsibility for everyone else's wellbeing which can lead to intense feelings of guilt & depression. The empathy thing was only one small aspect of what made me feel that the prototypical ADDer envsiaged by the author was male; other examples would be things like the specific areas of concern that were dwelt on in the book - not much was said about the impact of ADHD on household management for example (despite years of so-called "equality" this still usually ends up being the woman's area of responsibility, and women with ADHD often experience huge difficulties living up to society's expectations that women should be good at keeping a clean, tidy, organised home, with meals prepared on time & everyone's needs taken care of). And while the book talked a lot about how the ADDer can be totally oblivious to the problems their behaviour causes, a more common issue in women seems to be an overwhelming, all-consuming sense of guilt and failure, due to, if anything, an overabundance of awareness of exactly how their behaviour is perceived by others!! As I say, I realise talking about gender differences is controversial, and I would be the first to say that some women & men defy all attempts to classify behaviour by gender, but there do seem to be certain broad differences between the "average" man and the "average" woman that are undeniable, to say nothing of the impact of social expectations of male & female behaviour. And this book certainly seemed to be discussing the behaviour of the "average" male with ADHD & failing to go into enough detail on many issues more common in women, with the resulting effect that much of it did not feel applicable in my own situation. If taken at face value by a reader this perspective could lead them to jump to incorrect & even damaging conclusions about their partner's behaviour. Interestingly, my husband & I both felt that many of the things discussed in the book applied much more to my non-ADHD husband than to me (to the extent that he even started to wonder if he had ADHD! However, as I pointed out, the things he was identifying with were more the "male" behaviours that are made worse by ADHD rather than the specific ADHD problems themselves).
Thirdly, I didn't like the way that the author placed most of the blame on the ADHD (and thus the burden of responsibility for behaviour change on the ADDer), and actively discouraged the non-ADHD partner from believing their own behaviour may play a role in relationship difficulties. Now, I can see why she did this; it is easy for people in a relationship with an ADDer, especially where the ADHD has been unrecognised for a long time, to start to blame themselves for the problems, and I have no doubt that many people with ADHD, particularly those who are in denial about their problems, unfairly blame their partners and fail to recognise how their own behaviour affects their partner's behaviour. And as the author describes, couples who seek help from therapists who don't know much about ADHD may find that the therapist unfairly attributes blame to the non-ADHD partner. I can absolutely understand why the author was keen to counteract all of this. But I think in doing so, the pendulum swung too far in the other direction. Problems in a relationship are rarely entirely about only one person's behaviour, but the way the book talks about it might encourage many non-ADHD partners to entirely shift all blame to the ADDer, even where this is not justified. People with ADHD have often spent their whole life feeling like an utter failure, like everything is their fault, and they deserve the blame for all of their problems; the attitude the author encourages in partners might in many cases only make this feeling worse. It seems quite plausible to me that people with ADHD will often end up with particular kinds of partner; some may seek out (& be able to hang on to!) a partner who is incredibly well balanced & "together", but in many cases I suspect people often end up with someone who is as much of a mess as they are! In my experience, people who are a little bit "different" often find it easier to become close to other people who are "different", since "normal" people can be rather intimidating, or seem weird or boring, or the "normal" people can be put off by their odd behaviour. This means it seems rather likely that the partner of the person with ADHD may have their own mental health issues or at least some difficulties in how they relate to other people or fit into society, which can't be ignored as a significant factor in realtionship problems. So to suggest that the behaviour of the partner without ADHD bears none of the responsibility for the problems in the relationship seems unrealistic and grossly unfair to the person with ADHD, when there is a very high chance that they bring a whole host of their own "issues" to the table. There is a very real danger that this book could encourage the development of some of the very same problems in the non-ADDer as the author ascribes to the ADDer, such as denial of their own problems & lack of empathy for the other person's perspective.
Fourth, I felt that the author often lacked real insight into what is going on in the head of an ADDer in many situations; she made a valiant effort, and has clearly done a great deal of research, but over and over again I couldn't help but think she had misinterpreted certain aspects of ADHD behaviour or had brought her own prejudices & assumptions to the table. To be fair, for a non-ADDer with no psychological training it is probably rather difficult to truly understand the mind of a person with ADHD, so I can't really blame her for this flaw, but as an ADDer reading the book I couldn't help but get annoyed by some of the assumptions inherent in her explanations. It's a shame her husband isn't a writer himself, as I think this book would have benefited from the balancing effect of the ADHD partner's perspective.
Overall, despite all of these serious flaws in the book, I would still recommend it as a useful book to read if you want some insight into the relationship problems that can be caused by ADHD, as long as you bear in mind that the book is written from a very specific perspective that may not all be applicable to all readers. Of course, part of the reason I would recommend it is because there is a serious lack of similar literature; if another book comes along which presents a more balanced perspective I would suggest you read that, but for the time being this seems to be the main contender in this subject area. For couples whose problems fit well with the patterns described in this book (i.e. a female non-ADDer in a relationship with a male ADDer who has difficulty with empathy & self awareness, and is somewhat in denial about the extent or nature of their difficulties) I would highly recommend it, but for those of us who present with a slightly different set of problems this book should be read with the knowledge that it may not all be applicable. In most cases it might be a good idea to seek out a book with a counterbalancing perspective to read in conjunction with this one, such as one of the books dealing with ADHD in women, or a book written by a person with ADHD to get more of an "insiders" point of view.