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The four-story brick building, an annex of Massachusetts General Hospital's psychiatry department, is where I see patients as part of my research and teaching responsibilities at Harvard Medical School. They span the age and occupation spectrum—elementary-school children, grandparents, lawyers, salesmen, housewives and house-husbands—but they have one thing in common: they are coming to see me and my colleagues with familiar complaints and concerns. "I know I could be doing better" is a common one; as is, "I can't go on like this."
While the complaints may vary slightly, the symptoms they describe are the same—and consistent with the condition we treat. You've probably heard of it: attention deficit/hyperactivity disorder (ADHD).
One of those patients, we'll call her Jill, is late for her appointment.
As I sit catching up on e-mails, the door bursts open and in she flies, out of breath from climbing the two flights of stairs to my second-floor office. She is flustered and clearly upset.
"Sorry I'm late!" Jill says, as she plops down on the chair facing my desk. "You wouldn't believe my day."
"Try me," I say. "Take a deep breath and tell me what's going on."
Jill is in her late thirties and a highly educated research scientist, one of the many "knowledge workers" who labor in Cambridge, home of Harvard and Massachusetts Institute of Technology. She takes a moment and launches into her story, which begins a few weeks earlier when she temporarily moved into a friend's apartment while her own house was being renovated.
"Last night, when I came in," she says, "I put my keys down somewhere, and this morning, I had not a clue where they could be."
I nod. I have a feeling I know where this is going.
"I looked everywhere—the usual places, which of course are not the usual places, as it's not my place. My friend, she really is a good friend, but I am wondering if she has more trouble than I do. You think I am disorganized, you should see her place…"
I know this is the right time to jump in and direct our conversation back to the issue at hand or—like this morning—Jill could continue running in verbal circles and not getting anywhere. "Okay, so, you were looking for your keys …?" Jill smiles. "Oh, right, yes, I was flipping out. I spent thirty minutes trying to find my car keys."
Jill then stops, shaking her head.
"Well, did you find them?" I ask.
She nods ruefully. "Eventually."
"Where were they?"
"Right on my friend's kitchen table! And, of course, I'd walked back and forth through the kitchen ten times while I was looking for them. All that time they were right there …right there in front of me. Unbelievable!"
"Sounds very frustrating…but pretty believable, as those keys have eluded you before." Jill smiles ruefully, and I press on. "Then what happened?"
"My day was in shambles from that point on." Jill went on to relate how the half hour she'd spent looking for the keys set off a domino effect of tardiness and inefficiency—problems galore. She arrived at work late for a meeting and opened the door to the conference room just in time to interrupt an important point that one of her company's head honchos was making. Embarrassed and angry at herself, she returned from the meeting and finally got in front of her computer to find a barrage of e-mail reminders that further annoyed and overwhelmed her. She sent out a flurry of responses, including a snippy reply to the wrong person, who was not happy to get it (neither was the correct recipient, when she eventually cleared up the mistake). Dealing with her e-mail gaffe kept her from attending to a project due by noon. Her deadline blown, she skipped lunch, scrambling to get her work done, and what she did hand in—two hours late—was subpar and received with something less than an enthusiastic response by her supervisor.
In other words, it was a crummy day for Jill. It wasn't the first time such a day had begun with something misplaced or by an episode of forgetfulness, but the snowball effect of losing her keys still surprised and upset her.
"This happens all the time," Jill says, teary-eyed, angry and ashamed. "At this rate, I could lose my job …just because I can't keep track of stupid things like keys."
I'm sorry to hear that Jill is upset, but her story is not unusual. Jill has ADHD—and she is certainly not alone. It's estimated that about 4 percent of adults and 5—7 percent of children in this country meet the medical criteria for ADHD. It's equally safe to estimate that at some point in their lives almost everyone has felt as if they have ADHD, too. The symptoms of ADHD include forgetfulness, impulsiveness, losing items, making careless errors, being easily distracted and lacking focus. Who hasn't exhibited one of these symptoms in the last few days …or even hours? Who hasn't lost their car keys? Who hasn't been distracted in the car (once the keys are located), on the job or at home—by a text, a tweet, an e-mail, a cell phone ring? Who hasn't been late for a meeting or missed a deadline or made a mistake because they were disorganized that day, lost focus that morning or were distracted that minute? That doesn't necessarily mean you have ADHD, but it does suggest you might be part of the distracted masses that now make up such a large part of our society. If so, you've come to the right place because we're going to show you how to get back on track.
Whether or not you have ADHD—and chances are, you probably don't—the purpose of this book is to inform, inspire and organize your brain. Whether forgetfulness is a "symptom" of a disorder for a person like Jill or an "issue" for someone else who doesn't have the same degree of severity, this book will approach it in a straightforward way—and with equally straightforward and effective solutions.
What was first labeled the "Distraction Epidemic" by Slate magazine in 2005 has now reached epic proportions, right up there with the obesity epidemic and is of no less import than that or other public health crises that have befallen modern society. In a 2009 New York magazine story on the attention crisis, David Meyer of the University of Michigan described it as nothing less than "a cognitive plague that has the potential to wipe out an entire generation of focused and productive thought" and has drawn comparisons to the insidious damage of nicotine addiction.
"People aren't aware of what's happening to their mental processes," says Meyer, "in the same way that people years ago couldn't look into their lungs and see the residual deposits." The difference here is that unlike the "mad men" of the 1950s and 1960s who went around merrily sucking up packs of unfiltered Camels, seemingly oblivious to the harmful effects, most of us today know that we are having problems staying focused, paying attention and maintaining some sense of order in our lives.
Unlike smoking (which you either do or don't do), it's not just the people afflicted by the most serious and definable form of distraction and disorganization—ADHD—who are affected by this epidemic. Ask friends, family members and colleagues how they're doing, and chances are, the responses will usually include words like "frazzled," "stressed,"
"overwhelmed" and "trying to keep my head above water." In casual conversation, you often hear people talking about "brain freezes," "blanking out" on something or suffering "senior moments" (often, when they really aren't very senior). All of them …all of us …are affected to some degree by the epidemic.
To get back to my patient Jill in the four-story brick building in Cambridge, Massachusetts, I knew that the woman with the lost keys and the lousy day was not one of the millions complaining to each other about how crazed their lives have become. She has a clinical disorder; most do not. But, as I listened to Jill's story, I also knew the potential power of a rather simple solution that could help her and many others.
A couple of weeks earlier, during one of our regular sessions, Jill and I had somehow gotten on to the topic of the Apollo lunar landing. We talked about the coverage of the fortieth anniversary of that historic moment, the spectacle of the great Saturn rocket that hurled the astronauts into space, how exciting it still was to see the old black-and-white images of Aldrin and Armstrong on the moon and hear their voices crackling over the television from Tranquility Base and about whether we'd ever go back.
The memory of that conversation about the space program and her interest in it gave me the language needed to help frame the solution for Jill.
"So, I have a thought about how to start your day tomorrow," I say. "As we've been talking about, we are working on bringing order into your life, changing old patterns that don't work with new ones that do."
"Right, that sounds good," she says attentively. "What's your idea?"
"You need a launch pad for your keys."
Her eyebrows raise quizzically.
"A launch pad," I repeat. "A place where you always put your keys and maybe your ID and glasses, too. That way, you'll know that's the place they're always going to be …and every morning, that's where you'll launch your day."
Slowly, as if an unseen hand was drawing it methodically, a smile etches itself across her face.
"A launch pad," Jill says, starry-eyed "Yes, a launch pad. What do I have to use? A box …a hook …a basket …a tray?"
I smile back. "It's your launch pad. You can use whatever you like. You just need to make sure you know where it is and keep it in the same place …so that the moment you enter your friend's house, you'll leave your keys there and then every morning that's where they'll be. On the launch pad, ready to lift off."
This seemed to really resonate with Jill. First of all, it was an actionoriented solution, something she could do right away and without great difficulty. But more importantly, and Jill appreciated this, the launch pad served as an image, a reminder of how one's day can begin, not in confusion and distraction but with precision and predictability.
The next week, Jill arrived for her appointment on time. And she entered the room not in a huff but with a smile.
"Go ahead," she says, "ask me about my forgetfulness this week. I'm ready to answer."
"Okay," I respond. "So tell me, did you forget any items, appointments, things like that this past week?"
"Nope," she said triumphantly, "and here's why." She reached into her pocketbook and pulled out a small, uncovered trinket box, one, she explained, that she hadn't used in years. "My launch pad," she says, proudly. "I have a spot for it right by the kitchen door." Moreover, Jill went on to tell me, she had not neglected the area around the launch pad. In fact, you could say that a major redevelopment project had been undertaken in the area: the table cleared and the space near the door rearranged so that her launch pad had its own …well, space. That wasn't all, she reported. She built a launch pad at her office, too—but this one was project oriented for critical tasks to distribute to others. This, too, was accompanied by a cleaning and rearranging of her workspace.
That week, you might say, all systems were go for Jill. Is this an ADHD "cure"? No, but it's a small success to build upon. And she has. You could see the impact on her organization and on her self-esteem; she began to regain confidence, as she could now trust herself that her mornings would be a little less frantic and a little more consistent. I'm happy to add that since she "launched" her launch pad, she has not missed a morning meeting again because of time spent looking for her keys.
My experience with Jill illustrates a few important points about organization. First, individual moments of forgetfulness and disorganization can have major consequences.