ADHD: What Maslow Overlooked

So here we see another non-pathological way to view at least one large aspect of ADHD, the need for risk taking or high stimulation.

Man finds nothing so intolerable as to be in a state of complete rest, without passions, without occupa­tion, without diversion, without effort. Then he feels his nullity, loneliness, inadequacy, dependence, helplessness, emptiness.
— Blaise Pascal (1623-62)

What Maslow Overlooked

As time went on after I developed the Hunter/Farmer hypothesis and published my first book on the topic, I dug deeper and deeper into the available literature about ADHD, talked with more and more of the re­searchers, and learned some truly interesting and often star­tling things in the process.

Abraham Maslow published his landmark book Motivation and Personality in 1954. In this book he articulated what he called the “hierarchy of human needs.”

Our most basic need, he said, is for biological stasis. We need water, food, appropriate nutrition, to excrete, and to maintain our body at a constant temperature.

The second level Maslow identified as the need for safety. Once these basic physical needs are met, then we go off in search of our third need, which he identified as the need for love and belonging. When that’s met, we start seeking self-esteem and status. Finally, when all these physical and emotional needs are satisfied, a person will turn to what some might call spiritual needs, and which Maslow called the need for self-actualization.

Maslow’s insight into this hierarchy or pyramid of needs had a revolutionary impact on the field of psychology, creating a whole new school of psychological thought called Humanis­tic Psychology, and was profoundly insightful. He shows us why a person who is starving will not care much about his social status. For example, in 1980 in northern Uganda I went into a famine area to help set up a feeding center and hospital for starving refugees. Not only did they not worry about their appearance, many didn’t even care if they were wearing clothes: they were starving.

Maslow points out some misconceptions many people have: for example, what we describe in western society as “hunger,” he calls “appetite.” Few of us have ever experienced life-threatening hunger, which is at the foundation of the pyramid of needs, or even when we say we are hungry, most of the time we simply crave a specific taste or flavor, or want that pleasant feeling of fullness in our stomach. This isn’t a stasis or survival need, but more likely a self-esteem or some other higher need.

Maslow said wherever a person is stuck on this pyramid, everything above that level becomes invisible.

For example, if somebody was to come up to you right now and put their hand over your mouth and nose, violating your need for homeostasis because you wouldn’t be able to breathe, you wouldn’t be worried about safety: “Am I going to fall off the chair as I knock this guy’s hand off my face?” You wouldn’t be worried about the low social needs: “What are the people in the room going to think of me if I knock his hand off?” You wouldn’t worry about the high social needs: “What’s he going to think?” You wouldn’t worry about self-actualization: “What’s God’s opinion about this?” It would just be, “Get a breath!”

Similarly consider a person stuck in “safety.” If you were out at night trying to cross a busy street and suddenly the traffic got really bad and you’re thinking it’s possible you might not even make it across this street, it’s all of a sudden real dangerous. At that moment you’re not wondering if your tie is straight or how your make-up looks. Your concern would only be about getting safety.

We’ve all known people, particularly children, who are so stuck in a low social need, who so desperately need the approval of their peers, that they’re willing to sacrifice the high social need. They will hurt a friend in order to get the approval of the peer group.

However, there is one question that was asked of Maslow when he first presented this theory that he never successfully answered. According to this model, if a person has homeostasis and has safety, then they won’t do things that violate that. People don’t go down the pyramid. A person would not endan­ger their own safety except to accomplish homeostasis.

The question that Maslow couldn’t answer was, “Why is it that people who have all their homeostatic needs met engage in risk-taking behaviors? Why do people drive too fast on the highway? Why do they drive around without a seat belt? Why do people go bungee jumping? Why do they jump out of air­planes? Why do they quit jobs to start entrepreneurial busi­nesses? Why do people take chances ?

The Need for Aliveness

The need Maslow overlooked exists between safety and homeo­stasis. It’s below the level of conscious thought. This overlooked basic human need may be so critical to an understanding of human nature that knowing it gives us a revelatory flash of insight into the nature of personality disorders, and specifi­cally ADD. This need is what I call The need to experience alive­ness: the need to feel that one is alive. Some people experience this need with great intensity, and some people experience it with only a moderate level of intensity.

Cogito, ergo sum, the philosopher Rene Descartes wrote in 1637, which means I think, therefore I am. Yet merely think­ing is not enough to create, in many people, the reality — the down-in-the-gut knowledge — that therefore I am.

To validate therefore I am, we must experience the fact of our aliveness. Ugo Betti wrote:

“At any given moment I open my eyes and exist. And before that, during all eternity, what was there? Nothing.”

To understand how Maslow could have overlooked a fun­damental human need which drives the behaviors of as much as 30% of our population, it’s important to first understand how a particular part of our brain is wired. This part of the brain, and the way it works, can cause this need to come into being, or, to remain unexpressed.

Thalamic Gain

The part of the brain which most likely drives this process is called the thalamus.

All of our senses, except smell, flow into the thalamus, which is a small structure near the base of the brain. When we hear, see, feel, or taste something, that information from the sensory organs and nerves is first passed along to the thala­mus, before being relayed to the rest of the brain.

What our eyes see, for example, moves along as electro­chemical impulses through the optic nerves (through the op­tic chiasma) to a part of the thalamus dedicated to vision. From there, the signals project to the part of our brain that actually sees, the primary visual cortex located in the occipital region of the cerebral cortex. The same process occurs with sound, touch, and taste.

The thalamus acts in much the same way as a faucet does on a sink. Sensory inputs pass through it on the way to their final destination (much like water must pass through a faucet to reach the sink). The faucet of the thalamus controls how much of that information reaches its ultimate destination — and how quickly and at what level of strength.

Another model, suggested by Dr. Dale Hammerschmidt of the University of Minnesota’s Medical School, is of the thalamus as a graphic equalizer on a stereo system. This is probably a more accurate way of looking at it, as the thalamus doesn’t always ap­ply the same amplification or attenuation to each sense. Some people are more sensitive to sight, others to hearing, others to touch, and some to taste, or any combination of these four. These anomalies are sometimes the result of thalamic variations. How­ever, I’ll use the faucet metaphor here both because of its simplic­ity and because not everyone is familiar with a graphic equalizer.

Another important brain structure connected with the thalamus is the reticular formation (often called the Reticular Activating System or RAS).

The RAS is a large group of nerve cells which originate deep within the brain. Long nerve cells that look like fibers grow up from this area through the thalamus, and then extend on out into and throughout various parts of the cortex (our thinking brain). It’s as if the thalamus had a little curled-up porcupine underneath it, with disproportionately long quills which stick up into virtually every important part of the conscious brain.

Largely on orders from the thalamus, the RAS tells the conscious brain how alert it should be. The RAS is responsible for the startle reflex, and is one of the primary control sys­tems for our general level of arousal or awakeness.

The thalamus and the RAS are the ever-vigilant doorkeep­ers of our senses, and, as part of our most ancient brain struc­tures, they have as a primary responsibility to provide informa­tion to the brain for that most ancient of instincts — the fight- or-flight response. They are responsible for our safety and sur­vival (at the most primal level of Maslow’s hierarchy).

Let us say that the thalamus gets an unusual input from the eyes or ears — say a loud noise or the sight of something flying at us. Instead of just normally passing it along to the cortex so we could think about it, the thalamus will do two things:

♦  First, it turns up the volume level for that particular sight or sound, so our conscious brain will notice it more vividly. Those vivid memories are known in the literature as “flashbulb memories.” (People who’ve been in car accidents often relate how clearly they remember seeing the oncoming car, for example. This is the result, in part, of the thalamus having opened up the faucet, thus pro­ducing a more memorable impression on the brain.)

♦  Second, the thalamus will activate the RAS, saying, “Hey, wake up the rest of the brain! Something impor­tant and maybe dangerous is happening out there! ” The very long and super-efficient nerves of the RAS trans­mit a whoops!/startle impulse to the brain, that adds a huge dose of impact to our sight, sound, feeling, or taste.

The RAS and thalamus are so powerfully involved in main­taining and modulating our level of awareness or awakeness, that if either are accidentally damaged during surgery or in an accident the person will slip into a permanent coma. Simi­larly, when someone sustains a concussion which knocks them unconscious, it’s usually because the RAS has been jarred hard enough to shut itself down as a defense strategy.

So, in combination, our thalamus and our RAS control how much of the world around us we sense — how fast and with what volume the input flows through the faucet of the thala­mus, and how awake or aware we are as we process that input.

People with a wide-open thalamic faucet are awash in sen­sory input. Those with a closed thalamic faucet sense the world as if through cotton.

Closed and Open Faucets

One of the more interesting recent medical discoveries is the fact that each one of us has a slightly different “normal” set­ting for how open or closed the faucet of our thalamus is, and thus how hair-triggered our RAS may be at activating the rest of the brain.

The Volume Control of the Thalamus

Those born with their thalamic/sensory volume control set above the midpoint line only have to open their eyes to know they’re alive. Those born with the gain control below the line must periodically remind themselves they’re fully alive by interacting with their environment in stimulating ways, so as to increase their sensory inputs enough to push through the low thalamic gain and reach into the realms above the line.

In an agricultural (Farmer) society, above-the-line thalamic gain would be valued and useful, as those people wouldn’t leave the farm in search of stimulation. In a hunter/gatherer society, the below-the-line setting would be valuable, as it would drive hunters to the stimulation of the hunt.

Bobby’s adrenal system and RAS fill him with stimulation ... until the novelty wears off.

Bobby’s baseline gain is low, so in class he doesn’t feel “alive.” To get aliveness, he pulls on Sally’s pony-tail, she screams, stimulating his RAS to turn up his thalamic volume control over the threshold of aliveness.

Bobby’s neurology returns to his “normal” but the classroom is still too boring to give him a sense of aliveness, so after a few minutes he throws a spitball at Billy. Boom!

People with a wide-open thalamic faucet experience sight, sound, touch, and taste as being strong and vivid: they’re flooded with sensory input. The result is that they often want to back away from the world. Their sensory experience is some­times painfully bright. Boisterous conversation or loud music overloads their brains, and they’re uncomfortable with strong touch or other intense physical sensation.

These people are sometimes referred to as introverts, although in the context of Carl Jung’s original meaning for the term this is a misnomer. Nonetheless, people with a very active thalamus and RAS tend to be quiet, withdrawn, and to dislike wild disruptions in their lives. Their primary life strategy is often avoidance of excess sensation, pain, emotion, or disruption.

So much input is flowing through the thalamus and RAS into the cortex that they necessarily step back from life and look for a little peace and quiet.

On the other end of the spectrum are those people whose thalamus and RAS are not as open: less sensory information flows through, or flows through with a lower intensity. People with a more-closed thalamic faucet experience the world as “too quiet.” Since the faucet is closed a bit tighter, less con­tinuous sensory stimulation comes through, and it takes a much more dramatic event to punch through and activate their reticular startle response.

These people see, hear, taste, and feel (in terms of sensation, not emotion) less vividly. Rather than trying to push themselves away from the world, they throw themselves into it, often with an intensity that is bewildering to the open-faucet thalamus folks.

Since it takes a stronger sensory input to make it through the faucet of their thalamus and RAS and into their thinking/ experiencing brain (the cortex), these people are not over­whelmed by bright lights, strong colors, loud sounds, intense physical sensations, or strong tastes. If anything, they enjoy these things, because such sensations bring them, if only for a few moments, into a more close and intimate contact with a world they may normally feel is a bit distant.

We’ve all known people who fit into the two extreme ends of this spectrum: they’re stereotypes or cliches in our society and in popular literature.

Closed-faucet folks who crave stimulation, live for the party, love to perform in front of people, are into skydiving or roller coasters, and consume hot peppers with an enthusiasm that baffles their friends.

Open-faucet folks, inundated by sensory input, just want to be left alone, don’t generally speak up, appreciate subtle things such as fine art and classical music, and often are quick to dismiss the closed-faucet folks as boors or egomaniacs.

Then, of course, there are those people who fall in the middle between these two extremes. The world is vivid to them, but not painful. They have enough sensory input to satisfy them, so they don’t go out of their way to create more for them­selves, yet they’re not so overpowered by it that they feel the need to withdraw. These people are the ones who some would consider “normal.”

Final Basic Human Need

But what, you may ask, does this have to do with basic human needs and things like ADHD?

Maslow gave us a remarkable look into human behavior when he outlined his hierarchy of needs. Maslow pointed out that:

“The human being is a wanting animal and rarely reaches a state of complete satisfaction except for a short time.”

Freud, Adler, Skinner, Jung, and other psychologists have pointed out that many of those behaviors we define as neu­rotic are really misdirected attempts to satisfy basic needs, or are the result of unfulfilled basic needs.

We see that in different people, different thresholds of sen­sation are necessary in order to experience gratification of this basic human need to feel alive.

Nobel-prize-winning poet, playwright, author and philoso­pher Rabindranath Tagore, for example, had a life devoted to quiet meditation and contemplation. He enjoyed sitting quietly and pondering the nature of things, living within his mind (so to speak), presumably because his need for sensory input was adequately satisfied. The faucet of his thalamus and RAS was probably wide open, and life came in at him full-force. The writ­ings he left us say things such as, “That I exist is a perpetual surprise which is life.” Similar descriptions of the naturalness of aliveness, the fulfillment of that “need to experience alive­ness” simply from being alive, can be found in the writings of many others, from Thomas Merton to George Santayana.

These people had their “need to feel alive” satisfied from birth. Their thalamus and RAS were open wide enough to ex­perience the world constantly, in full Technicolor. Like a per­son after a perpetual Thanksgiving dinner, they felt full all their lives.

Those with a thalamic faucet that’s more closed, how­ever, need to periodically leap up through the baseline set by their thalamus to gasp in a full breath of aliveness. Their lives are characterized by a constant search for stimulation, and many are tortured by this basic need to feel alive on a daily basis.

The philosopher Pascal wrote in 1670, “There is a plea­sure in being in a ship beaten about by a storm, when we are sure that it will not founder.” Would Tagore have said the same? Probably not. Pascal would have probably enjoyed The Scream Machine roller coaster at the famous Six Flags Over Georgia amusement park; Tagore would have probably dismissed it as crude and overly stimulating.

So we have here now a final Perhaps it’s a Life Wish:        To wake up, even if just for an instant a day, and viscerally know that they  are alive.

Freud first came close to nailing down this “basic human need in 1933 when he wrote about the Id: “We can come nearer to the Id with images, and call it a chaos, a cauldron of seething excitement... These instincts fill it with energy, but it has no organization and no unified will, only an impulsion to obtain satisfaction for the instinctual needs, in accordance with the pleasure principle.”

This is not to say that the basic human need to experience “aliveness” is the same as what Freud called the Id, but I do believe that Freud was close to touching this need when he embarked on an exploration of those driving and motivating forces which lie below our normal levels of waking conscious­ness. After all, consider how few people are sufficiently self-aware to say, for example, “I like to drive fast because it makes me feel more alive.”

Yet how else to explain this sort of behavior, unless we leap to the conclusion (as Freud and others sometimes have) that such behavior must demonstrate an unconscious death wish? The idea of an unconscious death wish is interesting and, no doubt, occasionally true, but it doesn’t explain the liking of spicy foods, loud music, vivid colors, wild sex, and other types of sensation-seeking behavior that are often associated with the types of people who also drive like maniacs. They can’t all be trying to kill themselves!

So if these folks aren’t trying to kill themselves with all this sensation-seeking, what is their goal?

Perhaps it’s a Life Wish: To wake up, even if just for an instant a day, and viscerally know that they are alive.

A New Understanding

Characterizing this previously undefined human need as the basis of these behaviors then gives us a whole new key to un­derstand both healthy high-stimulation activities as well as de­structive and self-destructive stimulation-seeking behaviors. In both cases, the person seeks the experience of aliveness. In the former, they’ve found appropriate ways to get it (skydiving, public speaking, sales, politics, substitute teaching, being an emergency room physician). In the latter case they’ve stumbled into — often by life circumstances which shut out the appropri­ate routes — destructive ways to experience stimulation (mug­ging people, taking drugs, having frequent sex with a wide vari­ety of people, starting fights, gambling).

How does this help us better understand ADHD and other variations from the norm?

If this model is accurate, this tells us first that ADHD, or this disruptive behavior as it were, is not about cognition. It is not a failure of the thinking mechanism.

Number two, it’s not a failure of morality.

Number three, this is not the failure of the inhibitory mechanism or executive function.

It’s a starvation for aliveness.

In placing the “need to experience aliveness” on Maslow’s scale of human needs, we see a variety of ways in which people can fulfill this need. Maslow points out that people are rarely stuck in just one of the levels of the hierarchy, but operate instead at different levels simultaneously. We tend to have one primary place where we’re dealing with life’s issues at any given moment in time. For a closed-faucet person, that place will always be colored by a need to feel aliveness, because this need is so primal.

It may be that we’re mostly struggling for aliveness.

When we know whether a person is closed- or open-faucet, we can predict how they’ll express or act out their other needs. Closed-faucet people struggling with the need for love will be distracted by the opposite sex, make impulsive decisions about relationships, and take risky chances in those relationships. Those people struggling with the need for self-actualization, on the other hand, will leap from group to group, guru to guru, in the quest for new experience and insight. Of course, you could apply this logic to any level of need and behavior.

Open-faucet people, on the other hand, will be more cau­tious in their seeking and less likely to connect with high-stim situations, people, or relationships.

When I shared this concept of a new basic human need that Maslow may have overlooked with psychotherapist George Lynn, he observed:

“Your emphasis on this additional human need to feel alive in Maslow’s Hierarchy makes a lot of sense. This explains the rage that my ADHD clients’ parents tell me their kids experience in school. Rage may be a response to hav­ing a basic need suffocated or starved.” (Italics added.)

This is so common-sensible as to be intuitive, particularly for those people with a closed-faucet thalamus/RAS who have experienced this in their own lives. These kids and adults are different from the norm, and their core self will instinctively resist being squashed into society’s proverbial round hole.

So here we see another non-pathological way to view at least one large aspect of ADHD, the need for risk taking or high stimulation. I’ll talk about others in future articles.