Zeki ama Saplantılı (Smart but Stuck)

The original title is Smart but Stuck: Emotions in Teens and Adults with ADHD. It was published by Jossey-Bass in March 2014, about three hundred pages.

Thomas E. Brown is a clinical psychologist who earned his doctorate at Yale. For many years he served as a clinical faculty member at Yale School of Medicine and as associate director of the Yale Clinic for Attention and Related Disorders. In 2017 he moved to California and founded his own clinic. He is known for his model of ADHD based on executive functions and the rating scales based on this model. His clinic specializes in the assessment and treatment of people with ADHD who have a high level of intelligence.

There is a Turkish edition: Zeki ama Saplantılı: Dikkat Eksikliği/Hiperaktivite Bozukluğu (DEHB) Olan Genç ve Yetişkinler, ODTÜ Geliştirme Vakfı Yayıncılık, 2015, translated by Deniz İlalan. I saw the publication details at D&R and Kitapyurdu.

What happened to the word "stuck"

I have an objection to the Turkish title and I will say it first.

The English "stuck" means to be caught somewhere, unable to get out. This is the whole concern of the book: smart, capable people getting stuck at a certain point at school, at work or in relationships, unable to move forward.

"Saplantılı," on the other hand, carries another association in Turkish. Obsession, fixation, being overly attached to something. This word can lead a reader who already confuses ADHD with obsessive-compulsive disorder even further in the wrong direction.

What the book really describes is almost the opposite of fixation: not being able to commit to an important task, not being able to start it, not being able to keep it going. If you are going to read the Turkish edition, I suggest reading the title as "takılıp kalmış," that is, stuck.

To be fair, let me add this too: the Turkish blurb stresses that these people can focus excessively on some of their interests. It is possible that the translator or the publisher meant to point to this excessive focus with the word "saplantı." Even so, the situation at the center of the book is getting stuck.

One theory chapter, eleven names, one way-out chapter

The structure of the book is very clear.

An introduction and the first chapter set up Brown's theoretical framework on the relationship between ADHD and the emotional brain.

From the second chapter to the twelfth, each chapter carries a person's name: Eric, Karen, Martin, Sarah, Mike, Lisa, Steve, Sue, Matt, Lois, James. The publisher's description speaks of fifteen true stories; in some chapters the stories of more than one person may be interwoven. They are stories from Brown's clinical experience, ranging from teenagers to working adults.

The thirteenth chapter is devoted to how to get out of where you are stuck. At the end there is also a section of discussion questions.

So the center of gravity of the book is the cases. One chapter of theory, one chapter of solution, and eleven people in between.

Emotion, the engine of attention

Brown's basic thesis in this book is this: in ADHD the attention problem cannot be thought of apart from emotion and motivation.

The paradox we all know is the starting point of this thesis. Someone with ADHD can focus for hours on something that interests them, but cannot look for even five minutes at something they know is important. The environment reads this as unwillingness or laziness.

According to Brown, the issue is not willpower. The brain's management system, that is, executive functions, decides largely through emotional importance which task to give attention to. If a task arouses interest, excitement or anxiety in the moment, the system works. If it does not, the system struggles to move into action even when the importance is known.

In explaining this the book describes the relationship of emotions with the brain, how certain emotions can capture attention, and how in some people shame or fear of failure locks the starting of a task.

This is where I stopped most while reading. As someone who heard the sentence "you could do it if you wanted to" for years, I found a language explaining why it is not true. I had also opened the subject in the article on ADHD, dopamine and motivation.

Six clusters

Brown's model groups executive functions into six clusters. This book does not give a detailed account of the theory, but the cases are read through these clusters:

• Activation: Organizing work, prioritizing, getting started.
• Focus: Gathering attention, sustaining it, shifting it to another task when needed.
• Effort: Regulating alertness, sustaining effort, processing speed.
• Emotion: Regulating frustration and other emotions.
• Memory: Using working memory, recalling information when needed.
• Action: Monitoring and regulating your own behavior.

That emotion has a place in this list as a separate cluster is important. The DSM-5 does not count difficulty with emotional regulation among the diagnostic criteria of ADHD. But since the review published by Shaw and colleagues in 2014, it has been increasingly accepted that emotional dysregulation is common in ADHD and seriously affects functioning. This emphasis of Brown's points early to where the field has arrived today.

If you are curious about the theoretical side of the model in more detail, Brown's A New Understanding of ADHD in Children and Adults, published a year earlier, explains it far more systematically. Smart but Stuck is like the human face of that model.

Why it felt so familiar

The case chapters are the real strength of the book for me.

Mike's chapter, for example, is the story of a young man whom his father always called smart but lazy, who ended up on academic probation at school, who could start things only at the last minute. His trying a friend's medication and his father's worries about medication are part of this story too. In this chapter I read familiar tones of my own adolescence.

In the other chapters there are people stuck in similar ways at school, at work and in relationships. In each case Brown explains where this person got stuck, the pattern of executive function and emotion underneath it, and what worked in the course of treatment.

This way of telling differs from the case narratives of Hallowell and Ratey. In theirs the case leads the reader to a moment of recognition. In Brown the case makes a mechanism visible. As a reader I experienced both, but from Brown I was left with a concept.

One more thing caught my attention while reading the cases: none of them is resolved at once. Every story has understanding, trying, falling back and trying again. Most ADHD books promise the reader a turning point. Brown's cases, on the other hand, show that change is slow and uneven. This was the telling that felt closest to the truth in my own life, and it helped me blame myself less at the next relapse.

The years when intelligence is a shield

The word "smart" in the book's title says something too.

Intelligence can cover the difficulties of someone with ADHD for a long time. In middle school studying the last night is enough, in high school it keeps being enough, and in university or the first job it suddenly stops being enough. In the eyes of those around them, this person is someone not using their potential. In their own eyes too.

This pattern meets you again and again in Brown's cases. As an adult diagnosed late, reading this pattern was like seeing my own story from the outside. From this book I learned that the answer to the question I asked myself for years, "if I'm this smart, why," should not be sought in intelligence.

Not being able to start, seen from inside

Of the six clusters I found myself most in activation.

To someone looking from the outside, not starting looks like a decision. From the inside it is like a wall. You know what the task is, you know why it matters, you even know what the first step is. But that step is not taken, and as the hours pass a layer of shame builds up around the task.

Brown's cases describe this wall very well. They show that shame makes starting even harder, that each postponement feeds the next. Reading this cycle not as a character flaw but as a lock between emotion and the management system changed a great deal for me.

The book does not give a magic method for opening this lock. But it shows what the lock is, and I think that is the first step.

Where I got stuck

The sample. All of the cases are people who are smart and who were able to reach a specialist clinic. Considering that Brown's clinic focuses on high levels of intelligence this is understandable, but it leaves out a large part of people with ADHD. If you are curious about the relationship between intelligence and ADHD, there is the article does ADHD affect intelligence.

The way-out chapter is short. After eleven case chapters comes a single solution chapter. If you are looking for a practical guide, this proportion will not satisfy you.

The distance between theory and case. The cases are impressive but they are not evidence. In other publications Brown grounds his theory in research; in this book he tries to persuade the reader mostly through cases. You cannot always tell which generalization rests on research and which on clinical observation.

Women. The book does not look separately at the distinct presentation of ADHD in women. The effect of hormones, masking, and the causes of late diagnosis specific to women are not on this book's agenda.

On the treatment side

In the cases Brown looks at medication, psychotherapy and environmental adjustments together.

The balanced side of the book is that it shows that a single intervention is not enough, and that especially the shame and avoidance habits accumulated over years need to be addressed separately. The medication decision is of course made with a physician.

A surprisingly good book for a reading group

The discussion questions at the end make it very easy to read this book in an ADHD support group or a reading group.

The case chapters are also independent of one another. It is possible to read and discuss one chapter a week.

These questions work for someone reading alone too. After reading a case, answering the questions in a notebook through your own life brings the book from a narrative closer to a workbook. In this way you can make up for part of what the book's short way-out chapter leaves lacking.

Brown in Turkish

Brown has one more book in Turkish: Dikkat Eksikliği Bozukluğu, published by ODTÜ Geliştirme Vakfı Yayıncılık, translated by Esra Çetintaş Sönmez. I could not see the original title in the Kitapyurdu listing. It seems to be out of print.

For someone who wants to read Brown in Turkish, Zeki ama Saplantılı is both easier to find and a warmer introduction.

For whom

For an adult who was told they were smart and heard the question "why can't you do it" for years. Especially someone diagnosed late who got to a certain point academically or professionally and was blocked there.

I also recommend it to the parent of a teenager with ADHD, to understand that their child is not lazy.

For someone who wants to build a practical system, this book is not enough. Strong for shame and understanding, limited for organizing daily life.

How to read it: first the first chapter, because the framework that makes the cases meaningful is there. Then choose among the cases the ones you find close to yourself. Last, the thirteenth chapter. You do not have to read all of it; after two or three cases you begin to see the pattern.

If you want to open the subject of emotional regulation, it would be good to read it together with the article emotion regulation in ADHD.