Stolen Focus — Chapter no 10

10

Cause Eight: The Surge in Stress and

How It Is Triggering Vigilance

When I first admitted to myself I had an attention problem and fled to Provincetown, I had a simple story about what happened to my focus – the internet and cellphones broke it. I now knew that this was too simplistic – that the business model behind the tech was more important than the tech itself – but I was about to learn something even more important. These technologies arrived in our lives at a moment when we were unusually vulnerable to being hijacked by them – when our collective immune system was down, for reasons that are totally separate from the technology and its design.

At some level, many of us can sense some of the reasons for this.

In early 2020 I decided to team up with the Council for Evidence- Based Psychiatry, and together we commissioned YouGov – one of the world’s leading polling companies – to carry out (so far as I can tell) the first scientific opinion poll ever conducted into attention, in both the US and Britain. The poll identified people who felt their attention was getting worse, and then it asked them why they believed this was happening. It gave them ten options to choose from, and asked them to select any and all that they felt applied to them. The number-one reason people gave for their problems was

not their phones. It was stress, which was chosen by 48 percent.

The number-two reason was a change in life circumstances, like having a baby or getting older, also chosen by 48 percent. The number-three problem was difficult or disturbed sleep, which was named by 43 percent. Phones came fourth, chosen by 37 percent.

When I started to study the science of this in more detail, I learned that the hunches of ordinary people are not wrong. There are deeper forces than our phones and the web at work – and those forces led us, in turn, to develop a dysfunctional relationship with the web.

I began to understand the first dimension of this when I spent time with the woman who later became the Surgeon General of California, who has made a key breakthrough on these questions. Of all the people I met for this book, she is perhaps the one I most admire. At first, when you read her story, it might like seem the situation she is describing is so extreme that it doesn’t have much to do with your own life – but stick with me, because what she discovered can help us to understand a force that is fracturing the attention of many of us.

In the 1980s, in the suburbs of Palo Alto in California, a young Black girl named Nadine felt anxious as she made her way home from school. She loved her mother – her mom had taught her some ferocious moves on the tennis court, and she was always telling Nadine to get herself an education, because once you have it, nobody can take it away from you. But there were times when – through no fault of her own – her mother behaved very differently. ‘The problem was,’ Nadine wrote later, ‘that we never knew which mother we were going to get. Every day after school it was a guessing game – are we coming home to happy Mom or scary Mom?’

Two decades later, Dr Nadine Burke Harris looked at the two children sitting in front of her in her examination room and felt something in her body – an old, familiar ache. The kids were seven and eight years old, and a few hours before, their father had pulled them into his car, deliberately failed to put on their seatbelts, and driven off, until he found a wall. Then he aimed his car at it and drove forward as fast as he could. Nadine watched the kids and thought about how afraid they must have been. ‘I knew intuitively what that type of fear felt like,’ she told me when we sat together. ‘I could empathise on a physiological level, if that makes any sense. I know what happens in those moments.’ These children, it turned out, also had a parent with paranoid schizophrenia.

Nadine had coped with her mother’s mental illness by always being an A student, just as her mom, in her healthier moments, had taught her to. She got into Harvard, and then she studied public health and paediatrics. When it came to making a decision about what to do with everything she had learned, she realised she wanted to help children. While many of her classmates went on to provide medicine for rich people, Nadine went to Bayview, one of the last non-gentrified parts of San Francisco, which is a really poor, struggling neighbourhood with a lot of violence. Not long after she started there, Nadine was with some friends when she heard a cracking sound. She ran towards it, and found a seventeen-year-old boy who had been shot and was bleeding out. She learned that grandmothers in her new neighbourhood sometimes slept in their bathtubs because they were afraid of stray bullets hitting them in their sleep. She reflected later on what it’s like to live in the middle of random violence like this all the time. To live in Bayview, she realised, was to constantly soak up fear and stress.

One day, a fourteen-year-old boy who had been diagnosed with ADHD, who I’ll call Robert, was brought to see Nadine. (I have also changed some other details throughout this chapter, at Nadine’s request, to protect the medical confidentiality of her patients.) For a

while, Robert had been prescribed the stimulant drug Ritalin, but it didn’t seem to be making any difference for him. He said he didn’t like how it made him feel, and he wanted to stop, but his previous doctors had insisted that he carry on taking it at higher and higher doses.

Nadine asked Robert and his mother when his attention problems had first begun. It was when he was ten. She asked: what happened then? Well, they explained, that was when he was sent to live at his dad’s house. They talked about the divorce, and the boy’s life in general – and then Nadine asked gently: why was Robert sent to live with his dad? It took a while for them to tell the story, but in fits and starts, it tumbled out. Robert’s mother had a boyfriend, and one day when she came home, she found him in the shower, sexually abusing her son. She had been sexually abused all throughout her own childhood, and she had been groomed to be terrified of abusive men and to submit to their demands. In that moment, she felt powerless – so she did something she was deeply ashamed of.

Instead of calling the police, she sent her son away to live with his dad. Whenever Robert came back to visit, his abuser was still there, waiting.

Nadine thought a lot about this case, and she began to wonder if it might connect to a wider problem she was seeing. When she arrived at the medical centre in Bayview, she had noticed that the kids there were being diagnosed as having attention problems at a staggering rate – dramatically higher than in wealthier neighbourhoods – and that the first and usually only response was to drug them with very powerful stimulants like Ritalin or Adderall. Nadine is a believer in the power of medication to solve all sorts of problems – it’s why she went into medicine – but she started to wonder: what if we are misdiagnosing the problem a lot of these kids are facing?

Nadine knew that decades before, scientists had discovered something significant. When human beings are in a terrifying environment – like a war zone – we often flip into a different state.

She gave me an example, one I briefly referred to a little earlier.

Imagine that you are walking in the woods and you are confronted by a grizzly bear that looks like it’s angry and about to attack you. In that moment, your brain stops worrying about what you’re going to eat that night, or how you’re going to pay the rent. It becomes narrowly and entirely focused on one thing: danger. You track every movement of the bear, and your mind starts scanning for ways to get away from it. You become highly vigilant.

Now imagine that these bear attacks happen a lot. Imagine if three times a week, an angry bear suddenly appeared on your street and swiped one of your neighbours. If this happened, you would likely develop a state known as ‘hypervigilance’. You would start to look out for danger all the time – whether there’s a bear right in front of you or not. Nadine explained to me: ‘Hypervigilance is essentially when you’re looking out for the bear around every corner. Your attention is focused on cues for potential danger, as opposed to being focused on being present with what’s going on, or the lesson you’re supposed to be learning, or doing the work you were supposed to be doing. It’s not that [people in this state are] not paying attention. It’s that they’re paying attention to any cues or signs of threat or danger in their environment. That is where their focus is.’ She pictured Robert sitting in a classroom trying to learn math, but knowing that in a few days he will be seeing the man who sexually abused him and might do it again. How, Nadine wondered, could he bring the power of his mind to bear on sums in these circumstances?

It was primed instead to do one thing – to detect danger. This wasn’t a failing in his brain – it was a natural and necessary response to intolerable circumstances. She wanted to know how many of the kids she was treating, who were being told they had some inherent defect, might in fact be in a position like this. With the team at her clinic, she decided to scientifically investigate this question. She began to read the relevant scientific studies, and she learned that

there was a standard way to identify if a child has been traumatised, and by how much. It’s named the Adverse Childhood Experiences Study. It’s quite straightforward. It asks: Have you experienced any of these ten bad things in your childhood – factors like physical abuse, cruelty and neglect? Then it asks about any problems you might be having now – like obesity, addiction and depression.

Nadine decided her team was going to study all of the more than 1,000 children in their care in this way, to figure out how much childhood trauma they had experienced, and to see if that correlated with any of the other problems they might be having – including headaches, abdominal pains, and (crucially) attention problems.

With every child, they went through this detailed assessment.

Children who had experienced four or more types of trauma were 32.6 times more likely to have been diagnosed with attention or behaviour problems than children who had not experienced any trauma. Other scientists across the US have backed up the broad finding that kids are far more likely to have problems focusing if they experience trauma. For example, Dr Nicole Brown, in a separate body of research, found that childhood trauma tripled the development of ADHD symptoms. A large study by the British Office of National Statistics found that if there’s a financial crisis in the family, a child’s chances of being diagnosed with attention problems go up 50 percent. If there’s a serious illness in the family, it goes up 75 percent. If a parent has to make a court appearance, it goes up nearly 200 percent. This evidence base is small, but it is growing, and it seems to broadly back up what Nadine found in Bayview.

She believed she had uncovered a key truth about focus: to pay attention in normal ways, you need to feel safe. You need to be able to switch off the parts of your mind that are scanning the horizon for bears or lions or their modern equivalents, and let yourself sink down into one secure topic. In Adelaide, in Australia, I met with a child psychiatrist named Dr Jon Jureidini who has specialised in this question, and he told me that narrowing your focus is ‘a really good

strategy in a safe environment, because it means you can learn things and flourish and develop. But if you are in a dangerous environment, selective attention [where you focus on just one thing] is a really dumb strategy. What you need instead is to evenly spread vigilance around your environment, looking for cues for danger.’ After she learned this, Nadine realised that with Robert, the response by his previous doctors had been a serious error. She told me: ‘Guess what? Ritalin does not treat sexual assault.’ For these kids, ‘The medications are treating the surface symptoms and not the root cause … If a child is having horrific behaviour, most of the time, it’s the child’s really great way of alerting the system that something is not right.’ She came to believe that when children can’t pay attention, that’s often a signal that they are under terrible stress.

Jon, the doctor in Adelaide who specialised in this subject, told me: ‘If you’re medicating a child in that situation, you’re colluding with them remaining in a violent or unacceptable situation.’ One study compared children who had been sexually abused with a group of children the same age who hadn’t been abused, and found that the sexual-abuse survivors had double the usual rate of diagnosable ADHD. (This is not the only cause of ADHD – I’ll come to the others later.) The approach that was taken to Robert can lead to horrendous outcomes. In Norway, I went to interview the politician Inga Marte Thorkildsen, who started to investigate these questions – and wrote a book about it – after she was shaken by the case of one of her constituents. He was an eight-year-old boy whose teachers identified him as showing all the signs of hypervigilance. He wouldn’t sit still; he was running around all the time; he refused to do what he was told. So he was diagnosed with ADHD, and given stimulants. Not long afterwards he was found dead, with a seventeen-centimetre gap in his skull. He had been murdered by his father, who, it emerged, had been violently abusing him all along. When I sat with her in Oslo, Inge told me: ‘Nobody did anything because they just

said, wow, he has problems with attention, blah blah. They didn’t even talk to him during [the period when he was being given] medication.’ Nadine began to ask, If that is the wrong approach, what’s the right way to respond? How could she help Robert, and all the other kids in her care like him? She told me that she starts by explaining to parents: ‘I believe this [inability to focus] is being caused by your [child’s] body making too many stress hormones. So here’s how we fix them. We have to create an environment. We have to limit the amount of scary or stressful things that your [child] is experiencing and witnessing. And we have to layer on lots of buffering, lots of caregiving, lots of nurturing. In order for you to be able to do that, you, Mom, have to recognise and address your own history of what’s gone on in your life.’ There’s no point saying this if you can’t then offer them practical ways to do it. So she worked really hard to get funding from Bay Area philanthropists so that she could turn this proposal into a reality.

In a case like Robert’s, Nadine explained, there are lots of steps that have to be taken. They had to help the mother get therapy, so she could understand why she felt powerless to challenge his abuser.

They had to connect the family with legal help so they could get a restraining order on the abuser, so he was out of Robert’s life for ever. They had to prescribe yoga for both the abused child and mother, so they could reconnect with their bodies. They had to help them to improve their sleep and their nutrition.

Nadine told me that you have to ‘scale the tools that you offer to be the same scale as the problems folks are having’. These deeper solutions are, she stressed, really hard work – but she has seen them transform children. ‘I think it’s easy for people to hear that when you’ve experienced childhood trauma, you’re broken or damaged,’ but in reality, ‘we have an ability to change.’ She sees it all the time in her practice: ‘The number of kids who have gone from failing to honour roll when they have the right diagnosis and the right

support is nuts.’ That’s why, for her, this is ‘joyful work’, because ‘it shows us the profound potential for change. That’s what I see in my clinical practice. This is eminently treatable. It’s nuts how treatable it is. And there’s so much low-hanging fruit.’ She believes that if we work hard enough to inform people, ‘We’re going to get there: we’re going to get to the place where we’ve transformed the landscape of how society and medicine – all of us – respond to this issue.’

Nadine believes she can only do this work because of the scared child she was in the suburbs of Palo Alto all those years before. She told me: ‘There’s a Buddhist saying – be grateful for your suffering, because it allows you to empathise with the suffering of others.’ Not long before I saw her last, Nadine had just been appointed Surgeon General of California, the most senior medical position in the state. But as prestigious and powerful as that is, she told me she is more proud of something else. She had recently met with Robert and his mother. She saw how – as a result of the extensive help they have been given – they were slowly changing. He was no longer drugged for attention problems, nor was he showing difficulty focusing. They were developing empathy for each other. They were healing at a deep level, in a way that drugging the child could never have achieved. Robert’s mother was able to see how her own sexual abuse had left her unable to protect her own child, and she was able, for the first time in her life, to see herself differently – and to have compassion for herself. This in turn meant she could start to have compassion for her son. They are both, Nadine said, ‘recognising how the story can unfold differently’ from now on.

Nadine could see that the severe trauma that Robert experienced had been devastating, but she also came to believe that ordinary life

in Bayview – with all the stress that entails – corrodes attention. Her patients who weren’t being abused as kids were still worried a lot of the time about being evicted, or going hungry, or being shot. They were under constant low-level pressure.

When she explained this to me, I wanted to understand – do other forms of stress affect attention? How about ones that are vastly less harrowing than sexual abuse? I found that the scientific evidence on this is a little bit complicated. The evidence in labs shows if you are put under mild-to-moderate stress, you will perform better on some tasks that require attention in the short term. We’ve all had that experience: before I go on stage to give a speech, I feel a surge of pressure, but it makes me wake up, pull myself together, and perform at my best.

But what if that stress is protracted? In those circumstances, even mild levels of stress ‘can significantly alter attentional processes’, as one scientific team found in a typical study. The science is so clear on this that a recent summary explained: ‘It is now obvious that stress can cause structural changes in the brain with long-term effects.’ I started to ask – why would this be? One reason is that stress often triggers other problems that we know undermine attention. For example, Professor Charles Nunn, a leading evolutionary anthropologist, investigated the rise of insomnia, and found that we struggle to sleep when we experience ‘stress and hyper-vigilance’. If you don’t feel safe, then you’ll be unable to wind down, because your body is saying to you – you’re in danger; stay alert. So the inability to sleep, he explained, isn’t a malfunction – it’s ‘an adaptive trait, under circumstances of perceived threat’. To really deal with insomnia, Charles concluded we ‘need to alleviate the sources of the anxiety and stress to effectively treat insomnia.’ They have to get to grips with the causes.

What might those deeper causes be? Here’s one. Six out of every ten US citizens have less than $500 in savings for if a crisis comes

along, and many other countries in the Western world are moving in the same direction. As a result of big structural changes in the economy, the middle class is collapsing. I wanted to understand: what happens to your ability to think clearly when you become more financially stressed? I learned that this has been studied carefully by Sendhil Mullainathan, professor of computational science at the University of Chicago. He was part of a team that studied sugarcane harvesters in India. They tested their thinking skills before the harvest (when they were broke), and after the harvest (when they had a fair bit of money). It turned out that when they had the financial security that came at the end of the harvest, they were on average thirteen IQ points smarter – an extraordinary gap. Why would that be? Anyone reading this who’s ever been financially stressed knows part of the answer instinctively. When you are worried about how to survive financially, everything – from a broken washing machine to a child’s lost shoe – becomes a threat to your ability to get through the week. You become more vigilant, just like Nadine’s patients.

As I studied this big cause of stress, I kept thinking about something Nadine said to me: you have to ‘scale the tools that you offer to be the same scale as the problems folks are having’. I wondered: what would this mean if we applied it to our financial stress? It turns out there is a place that answered that very question.

In Finland in 2017, a coalition government, consisting of both centrist and right-wing parties, decided to try an experiment. Every now and then, politicians and citizens across the world have suggested that we should give everyone a small guaranteed basic income every month. The government would say to you: we’re giving you a small amount of money to cover the basics (food, housing, heat), but no more. You don’t have to do anything for it – we just want you to be secure and have the basic minimum necessary to survive. This idea has been mooted by everyone from Republican President Richard Nixon to the Democratic presidential candidate Andrew Yang.

Finland decided to stop talking and actually try it. They selected 2,000 of their citizens at random, aged between twenty-five and fifty- eight, and told them: for the next two years, every month, we’re going to give you 560 euros (which is about $650 US, or £500), no strings attached. The government set up alongside it a rigorous scientific programme to see what happened next, and once the project was over, the results were published. I interviewed two of the lead scientists who worked on it: Olavi Kangas, who is a professor in the Department of Social Research at the University of Turku, and Dr Signe Jauhilinen, and they talked me through their findings.

Olavi told me that when it came to attention and focus, ‘the differences were very significant’ – once people received a basic income, their ability to focus improved significantly. Signe said they couldn’t figure out the exact reason why, but they found that ‘problems with money are really not good for concentration … If you have to worry about your financial situation … it takes a lot of the capacity of your brain. If you don’t have to worry, then it improves your capacity to think about other things.’ What the guaranteed basic income seems to have done – even though it was quite small – is give the recipients a sense they were standing on stable ground at last. How many people in the world feel that at the moment? Anything that reduces stress improves our ability to pay deep attention. Finland showed that a universal basic income – enough to give a baseline of security, but not so much that it disincentivises work – improves people’s focus by dealing with one of the causes of our hypervigilance.

This made me think again about our problems with our phones and with the web. The internet arrived for most of us in the late 1990s, into a society where the middle class was starting to crumble, and where financial insecurity was rising, and we were sleeping an hour less than people did in 1945. A more stressed society will be less able to resist distractions. It would always have been hard to resist the sophisticated human-hacking of surveillance capitalism,

but it appeared we were already getting weaker, and we were easier to hack than we would have been otherwise. I was about to investigate other causes that also made us increasingly vulnerable.

I want to be honest here about something that complicates the argument I am putting forward in this book. There’s one way in which what Nadine had to teach me – and the wider science of stress that I learned later – is a challenge to the broader thrust of what I’m writing here.

As you saw in the introduction, I believe it is reasonable to argue that our attention problems are getting worse, even though we don’t have any long-term studies tracking changes in people’s ability to focus over time. I came to this conclusion because we can prove that there are several factors that damage focus and attention, and those factors are rising.

But there’s one counterargument to that. You might ask: what if there are counterveiling trends, happening at the same time, which make our attention better? Nadine has shown that experiencing violence damages your ability to focus. But over the past century, there has been a big fall in violence in the Western world. I know this runs contrary to what we read in the news, but it’s true – Professor Stephen Pinker, in his book The Better Angels of Our Nature, lays out the evidence for this very clearly. This seems counterintuitive, in part because we are constantly fed images of violent and threat on television and the web, but it is a fact that you are far less likely to be violently attacked or murdered than your ancestors. Not very long ago, the whole world – in terms of violence and fear – looked more like Bayview, or worse.

The threat of being beaten up or killed is surely the largest source of stress any person can face. Since that has fallen, we would

expect this trend to have improved attention and focus. I want to be candid about this fact.

Do I think this sole – but highly significant – trend improving our focus outweighs all the other factors dragging it down? Does it outweigh the effects of a huge increase in switching, a decline in sleep, the effects of vast machinery of surveillance capitalism, the rise in financial insecurity? I think – on balance – it doesn’t. But this isn’t something we can put into a computer and crunch the numbers on – it’s too hard to quantify and compare each of these effects. So reasonable people could disagree with me. It is possible that Nadine’s evidence suggests our attention, as a society, should be improving.

But I then learned about another attention-wrecking force in our culture – one that has been rising throughout my lifetime.

As a culture, in the Western world, we work longer with each decade that passes. Ed Deci, a professor of psychology who I interviewed at the University of Rochester in upstate New York, has shown that an extra month per year has been tacked on to what, in 1969, was considered a full-time job. As the twenty-first century began, the Canadian health service decided to study how people in their country spent their time at work. They studied over 30,000 people in over one hundred workplaces – public and private, large and small – and they ended up producing some of the most detailed research anywhere on how we work. They explained that as work hours swell and swell, people get more distracted and less productive, and concluded: ‘These workloads are not sustainable.’ I only understood the full implications of this for our attention when I went to two places that had experimented with ways to radically reduce the amount of stress people experience at work. They are 10,000 miles apart, and their experiments are quite different – but I

believe they have big implications for how we could reverse the damage that is being done to our attention today.