Tracy Frisch’s interview with Gabor Maté [“What Ails Us,” August 2012] reminded me of my Psychology 101 class at Boston City Hospital in the late 1960s. There I learned that Freudian psychotherapists thought schizophrenia was caused by bad mothering. I never bought their reasoning. Maté’s theory seems to lay similar blame on the parents.

I certainly believe that environment can adversely affect a child’s development. I also believe that many illnesses have clear genetic links. Studies of identical twins have shown this over and over. I am a nurse, not a scientist, but developments in neurobiology and genetics have filled me with hope that those afflicted with mental illnesses will soon be offered a solution so that they can fit into society. I fear Maté’s thinking is a step backward, and that makes me sad.

Sharon McLaughlin
Kittery Point, Maine

Gabor Maté seems to believe that environments — specifically ones in which there is a paucity of appropriate parental attention and a lack of attachment — play the dominant role in causing attention-deficit hyperactivity disorder [ADHD]. While this is true in some cases, there are numerous examples of biologically induced ADHD in the literature. As a professor of psychology I have seen many such cases myself. This is not an either/or proposition.

I further take exception to Maté’s assertion that medications aren’t the answer to ADHD, though he allows that “for some they could be part of the answer.” Of course we should do all we can to improve the environment of a child with this disorder, but I’ll bet that if Maté had a more severe form of ADHD, he might well conclude that medications are, in fact, the answer.

Rich Wedemeyer
Edmond, Oklahoma

I am struck by how closely aligned Gabor Maté’s views on parenting are with the principles of Positive Discipline, a parenting approach created to develop respectful relationships between parents and their children. “Parenting is not about techniques. Parenting is about a relationship,” Maté says. Positive Discipline’s first principle is that all behavior serves a purpose and that every child — and adult, for that matter — seeks belonging and significance. When parents focus on connection before correction, they build the foundation for a positive long-term parent-child relationship. When children feel better, they do better.

Erin Barry
Santa Cruz, California

Gabor Maté responds:

Regarding the blaming of parents, I understand how my message may be perceived that way, but as I say in the interview, there is no one to blame. I can’t emphasize this too strongly. I never talk about “bad parents.” In my view parents do their best. The issue in child development is not the intentions, love, or good will of the parents but the quality of the parenting environment as determined by the parents’ own emotional patterns — ingrained in their childhood — and by the social-cultural-economic environment. These are the main influences on child development, including brain development. As Dr. Daniel J. Siegel succinctly says in his seminal book The Developing Mind, “Human connections create neuronal connections.”

It is well documented that the infant’s neurophysiology is significantly affected by the parents’ emotional states, from in utero onward. Stressed, depressed, or distracted parents are less able to attune to their young, no matter how loving their intentions. The problem I perceive in our society is not individual parental failure but a cultural loss of community, connection, and support for mothering and fathering tasks, along with increasing social and economic stresses on many parents. We see the result in the rising number of children with developmental problems.

Genes, while they have some influence, are not nearly as important as many physicians continue to believe. They may in some cases predispose, but in only a few do they predetermine. As we now know from research on epigenetics, genes are highly susceptible to external input and are, in fact, turned on or off by the environment. I have not the space here to refute the faulty logic that underlies the twin studies supporting genetic theory, but I do so in two of my books.

Finally, in regard to ADHD: Of course it is a biological condition. My point, again, is that the brain’s biology is shaped by the child’s emotional environment. I have no doubt, for example, that my own child’s ADHD is attributable to the stresses my wife experienced from being married to me, a workaholic doctor, and to her post-partum depression. (The latter has been shown to be a risk factor for ADHD.) I don’t blame either of us: I didn’t choose to be a driven individual any more than my wife chose to be depressed. But that is how it was.

I agree with Wedemeyer that medications can be helpful in treating ADHD. As I say in the interview, I have benefited from them myself and, as a physician, have prescribed them to adults and children. They are not the answer, however, because they treat symptoms without addressing the underlying environmental factors that maintain or exacerbate ADHD. In my book Scattered I explain the scientific and experiential reasons for my view that ADHD is not an inherited disease but rather a problem of development, both biological and psychological. The answer, therefore, has to be the maturation of emotional coping responses and the development of new prefrontal brain circuitry. We know from research on neuroplasticity that this is possible, given the right support and circumstances, but medications on their own do nothing to promote it.

A developmental view of ADHD, while intellectually and emotionally more challenging, is much more in line with current science than a heavily genetic perspective — and also much more optimistic. Though there is nothing we can do about what genes we inherit or pass on, there is a lot we can do to offer our children the right conditions for development and healing.

Of All the Mothers in the World,” by Heather King [August 2012], was a wonderful essay. One sentence really stuck with me: “If you’re single, you carry the added weight, the secret shame, of knowing that you are first in no one’s heart.” As a single woman of fifty-one (divorced for eleven years), I know what she means. I don’t normally go around feeling sorry for myself, but I’ve never read such a poignant description of being alone.

Jennie Renfrow Ibarguen
St. Petersburg, Florida

I enjoyed reading Heather King’s “Of All the Mothers in the World,” but I must disagree when she says that if you’re single, “you are first in no one’s heart.”

It’s no different for those who are in a relationship. We are almost never first in anyone’s heart. There are children, careers, elderly parents, chronic illnesses, and sometimes just plain selfish considerations that take the top spots. Most married people are doing well if they manage to be third or fourth in their spouse’s heart. I know that in twenty-five years I’ve never managed to place higher than third. Almost anyone who has been married for a few decades will say the same, if they’re honest.

Name Withheld

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Rita Braun
Whitefish, Montana

A tiny correction to Sara Catterall’s charming essay “Katydid” [July 2012]: water boatmen are true bugs (order Hemiptera, family Corixidae), not beetles. There are at least three common aquatic beetle families, but I shall refrain from any further entomological pedantry.

Paul E. Grayson
Silver Spring, Maryland

Aware of your magazine’s socialistic bent, I subscribed for several years, but eventually I found the pop-culture references, slang expressions, foul language, and confessions of various addictions — alcohol, nicotine, drugs, and sex — unacceptable.

Culture should elevate us. Americans had access to free Carnegie libraries for a hundred years. Up until the 1960s Europeans of lesser means strove to go to the opera, the theater, and classical concerts, if only once a year. America’s negative influence has changed the standards of many, but not mine.

Helga S. Teske
Olympia, Washington

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Astoria, Oregon