Does “bad” mothering cause ADHD and mental illness?

Debunking Erica Komisar’s Bad Science, Part 3

Welcome to Part 3 in this 4-part series dedicated to debunking Erica Komisar’s shitty science and false claims made during her interview on Diary of a CEO (now at 1.6 million views on YouTube). If you missed Part 1 (debunking the claim that only mothers can provide good care for children ages 0-3) you can catch up on that here, and Part 2 (debunking the claim that it’s not instinctual for fathers to nurture their children) here.

This entire series is free, because I want as many people as possible to have correct information on these important topics, in order to mitigate the shame and fear being spread by Komisar’s false claims. As always, if you appreciate these posts (and my work in general), please consider becoming a paid subscriber to support the time and effort I am putting into this research.

And now let’s dig into what I believe is the most harmful and false claim that Erica is spreading: “bad” mothering, by which she means simply not being physically present enough for your children, is what is causing the rapid rise in mental illnesses and behavioral disorders like ADHD.

Erica:

“We have a mental health crisis in America. 1 in 5 children will not leave childhood without breaking down, without developing a serious mental illness: anxiety, depression, ADHD…and it has everything to do with how we are raising our children.”

“Do you know what the fight or flight reaction is? Evolutionary response to predatory threat. Fight reaction is hitting or acting out. Flight is being absent-minded, not being present. The amygdala is the part of the brain that deals with fight or flight. That part of the brain is supposed to be offline in the first 3 years, that’s why mothers wear their babies for the first 3 years. To keep the amygdala quiet…by putting babies into daycare with strangers, and sleep training babies, we are turning on the amygdala. The amygdala gets too big too fast and then shrivels and ceases to be functional for a lifetime.”

“ADHD children are in hyper vigilant states of stress. It’s not a disorder; it’s a stress response.”

“The hippocampus, which is the off-switch for stress, is very small in children these days. So we have a large amygdala and a small hippocampus. That’s causing ADHD and behavioral problems. Instead of asking what’s causing this problem, we medicate and alleviate the symptoms.”

Steven Bartlett intervenes and says: “...In twin studies, they found that ADHD is about 70-80% heritable.”

Erica: “Let me tell you a different study that will help you understand that study, which is that we know that there is no genetic precursor to mental illness. There is no genetic precursor to ADHD, there is no genetic precursor to depression, and there is no genetic precursor to anxiety…meaning there is not a genetic connection. You don’t get it in your genes …Schizophrenia and bipolar disorder have a genetic connection, but the rest do not. No genetics.”

My thoughts:

Of all the claims that Erica Komisar makes, this is the most offensive and the most harmful. She says it repeatedly, on every podcast she gets invited on, even though she has been directly challenged on many occasions.

But before we get into the science of why Erica is wrong, let’s do a brief and infuriating tour of the history of all of the evidence-free, psychoanalyst quacks blaming mental disorders on moms, so that you can see how Komisar is just the latest iteration of this nonsense; one more Freudian psychoanalyst determined to milk mothers dry by convincing them that everything that goes wrong with their kids is their fault.

For whatever reason, people seem primed to believe this shit. Maybe because it’s more convenient to blame things on the individual failings of mothers rather than to examine the shortcomings of our society as a whole, or to admit that sometimes stuff just goes wrong in people’s brains and it’s no one’s fault. And of course, fathers never get blamed. They are just off doing their best to provide for their families!

Refrigerator moms and autism

Back in the 1950s, some punk named Bruno Bettelheim, a prominent psychoanalyst, began to advocate for the "refrigerator mother" theory of autism. He suggested that autism was caused by mothers who were emotionally cold and unresponsive to their children, thereby creating a "psychic wall" around them, leading to social and developmental difficulties.

Despite the fact that this dude had ZERO empirical evidence to support his claims, people latched onto it because people love to blame hard-working mothers for all of the ills of society. By the mid-20th century his theory had become widely accepted by the medical community and it was GREAT for the business of psychoanalysis. The poor mothers of these autistic children, racked with guilt, spent every spare penny on treatment to help fix their bad mothering and to help their children heal from the trauma they had allegedly inflicted on them.

Many of these mothers were ostracized and shunned, adding insult to injury. Instead of offering them help and support, society ratcheted up the pressure to be emotionally “perfect” - which impacted not just the mothers of these autistic children, but ALL mothers. If you weren’t perfect, you would cause your child irreparable psychological damage.

But over time, as researched progressed, some brave scientists started voicing the unpopular opinion that hey, maybe this is just a neurodevelopmental disorder with a strong genetic component. Woops. Of course, it took a TON of research and empirical evidence to overturn the mom-blaming, and no apologies were forthcoming from the psychoanalytic community, even after the refrigerator mother theory had been thoroughly debunked.

Today the evidence overwhelmingly suggests that autism is a neurodevelopmental disorder, not a result of maternal neglect or emotional coldness, but the legacy that mothers are responsibility for most of their children’s psychiatric dysfunction lives on.

Schizophrenogenic mothering

The concept of the "schizophrenogenic mother" has a similar history; an even worse one, I would argue, because it is an even more horrible disease. Schizophrenia is a severe mental illness marked by symptoms such as delusions, hallucinations, disorganized thinking, and social withdrawal. Despite its association with genius-ness in pop culture, mainly thanks to John Nash and the film A Beautiful Mind, schizophrenia is a disease that I would wish on no one. (As a side note, I grew up down the street from John Nash and his son, both of whom were severely schizophrenic, and I do not know how his poor wife managed it).

The theory of "schizophrenogenic mothering” was developed in the 1950s by Rosine and Frieda Laing (two more wonderfully science-free psychotherapists) and later popularized by psychiatrist Ralph L. S. H. T. Doane. The Laings and others theorized that schizophrenia could be triggered by negative interactions between a child and their mother, especially during early childhood development. The basic idea was that these mothers were emotionally manipulative, intrusive, or inconsistent, leading to confusion and emotional disturbance in their children. According to this view, the child’s inability to understand or cope with the mother's behavior caused schizophrenia.

Once again, this was great for the psychoanalysis business. Shrinks bled these poor mothers dry trying to fix their crappy mothering and thereby heal their children (guess what: none of them were healed).

Eventually, a couple of smart moms with their heads screwed on straight said, “hey, how come I have four children and only one of them has schizophrenia. I mothered them all the same.”

That proved to be a tough one to answer.

By the late 1960s and early 1970s, however, critics started pointing out the fact, hey, there was literally no evidence whatsoever for this theory. Maybe we should take a step back? Research on the genetic and biological factors behind schizophrenia began to gain ground, challenging the view that parenting style was the primary cause of the disorder.

Here is my former mentor and all-star science writer, professor Robert Sapolsky, on the topic (he used to run a lab doing schizophrenia research at Stanford and has strong feelings on the topic):

“[Where does schizophrenia come from?] If it was 1950, the wisest psychiatrists on earth, the wisest neuroscientists, would have had an answer. They would say it’s YOU. You, the mother of that child, you caused your child schizophrenia through something that was called ‘schizophrenogenic mothering.’ It started off as a Freudian notion but it festered in all sorts of poisonous directions. The basic core of it was that a horrible mothering style could produce schizophrenia, and it was a mothering style that was built around a mother who unconsciously hated her child and wished that the child hadn’t been born. Oh my god! And thus you were teaching hundreds of thousands of mothers for decades that they caused their child schizophrenia. And, then in the mid-1950s along came biochemists who discovered the first drug out there that had antipsychotic effects. And, it worked not by going back in time and making your mother actually love you, it made you block dopamine receptors in your brain. And everyone sat there—in some cases the psychiatrists sat there for about 20-30 years—before finally admitting, ‘Oh my god, it wasn’t the mothering, it’s a crappy biochemical disorder. It’s brain chemistry, it’s not the wrong kind of incompetent mothering.'”

God, I love him.

In Sapolsky’s excellent book, Determined, he further outlines how “the psychoanalytic scumbags even developed a sneering, pejorative term for families (i.e., mothers) of schizophrenic patients who tried to dodge responsibility by believing that it was a brain disease: dissociative-organic types. Dissociative-organic types were typically lower-class, less educated people, for whom ‘It’s a biochemical disorder’ was akin to still believing in the evil eye, an easy, erroneous explanation for those not intelligent enough to understand Freud. “

I love that he refuses to take the high road here, despite his accolades. Let’s call a scumbag a scumbag. Credit where credit’s due!

By the 1980s, the idea of the schizophrenogenic mother had been largely discredited within the mainstream psychiatric and psychological communities. Schizophrenia was increasingly understood as a disorder with strong genetic and biological components, with environmental factors (such as stress) contributing to its onset, but not as a direct result of maternal behavior.

But just like refrigerator mothering, the idea of the schizophrenogenic mother had lasting effects on the way schizophrenia and family dynamics were viewed. The theory placed an undue burden of guilt and blame on mothers, leading to long-lasting emotional and social consequences, the effects of which, I would argue, we are still dealing with today.

Are you seeing a pattern here?

So what about Komisar and ADHD?

Erica Komisar is a Freudian psychoanalyst (it says so on her LinkedIn) who has not updated her ideas since the 1960s. But since it is now passé to blame autism and schizophrenia on mothers, she has moved on to ADHD. I have no doubt she is making BANK treating mothers for their crappy parenting (and making zero progress).

Research has consistently shown that ADHD is highly heritable and is largely influenced by genetic factors, perhaps even more so than autism and schizophrenia. As Steven Bartlett rightly points out in the interview (before he cows in the face of her pseudo-science), twin studies have repeatedly shown that the genetic influence in ADHD is 80% or more. In other words, family environmental factors have little to no effect (source).

Let me pause and emphasize here, for everyone reading, so that you don’t have the wool pulled over your eyes by manipulative, science-free psychoanalysts like Erica ever again: just because we have not yet found the genetic precursor for a disorder does not mean that it is not genetic. That’s like saying, “evolution isn’t real because we cannot yet explain how the flagella of certain bacteria evolved.”

No, people, the evidence is there and it’s overwhelming, even if we haven’t yet explained all of the nitty gritty details. Stop using absence of evidence as evidence. AHHHHHHHHH!!

Okay, deep breaths.

Anyway, as this paper explains, “Numerous meta-analysis studies have found significant relationships in the multiple genes for common genetic polymorphisms/variants [of ADHD]. Though multiple twin studies found that heritability estimates in ADHD could reach up to 90%, it is still challenging to identify ADHD risk genes, due to the complex and polygenic nature of ADHD pathophysiology.”

Let me put that in plain speak for you. Basically, we have overwhelming evidence from twin studies showing that ADHD is up to 90% genetic. In other words, if you take two identical twins, who have identical genes, and you put them into different families at birth, the odds that they will both develop ADHD (or not) regardless of the family environment, is overwhelmingly high. In all likelihood, some of these twin pairs had mothers that worked outside the home, and some of them did not. Yet they both ended up with ADHD, or they both ended up without it. BUT, the researchers say, we are having a hard time identifying the exact genes involved because it’s super complicated and there are probably a lot of different genes involved (that’s what they mean by “polygenic nature”). This, however, does not mean it is not genetic or heritable, or that we don’t have research proving that it is largely heritable.

In fact, many evolutionary biologists believe that ADHD is not a disorder at all: it’s simply a natural variant of human behavior that was probably adaptive in our evolutionary past, when being hyper curious and exploring new regions for food was a good idea, and it just doesn’t serve us very well in the modern context where we have to sit still and write articles about how bad Erica Komisar’s science is. I love this article on the hyper-curiosity theory of ADHD, which talks about the various ways in which ADHD characteristics may have been advantageous in our evolutionary past.

The truth is that ADHD is probably a whole conglomerate of different things that we lump into one bucket, some of which are more problematic than others. It’s kind of the Wild Wild West. There’s a lot we don’t understand. Which is why making absolutist claims about its origins and cause is a ridiculous thing to do at this point in time, especially when those claims fly in the face of the little evidence we DO have that is actually robust.

I will throw Erica this bone: childhood stress is also implicated in ADHD development. However, according to this paper (one of the most highly-cited papers I could find on the topic from a rigorous journal), “Despite a growing understanding that early adversity in childhood broadly affects risk for psychopathology, the contribution of stressful life events to the development of symptoms of attention-deficit/hyperactivity disorder (ADHD) is not clear…We found a small to moderate association between the of stressful life events and ADHD symptoms.”

So, there is a small to moderate association between early childhood adversity and ADHD, which is dwarfed by the enormous genetic component. What this probably means is that some people are more biologically predisposed to ADHD, and then stress makes it worse, and in some cases, truly pathological.

None of this has anything to do with mothers staying home or going to work. When we talk about “stress” and “early childhood adversity” in the scientific literature, it does not mean that mom did not read you enough story books. It means you were abused, one of your parents was incarcerated, your father beat your mother to within an inch of her life, you were born into extreme poverty, etc. Let’s keep things in perspective, people.

What about depression?

Depression also has a genetic component, although it is less strong than for ADHD. Major depressive disorder (MDD) is estimated to have a 30-50% heritability range (source). Like ADHD, it is highly polygenic, meaning there are a lot of different genes involved and we have not yet identified all of them. But once again, that doesn’t mean it’s not genetic. It just means we don’t know for sure which genes are involved yet. In the case of MDD, we have identified over 100 genetic risk loci (source), so claiming that genes are not involved is totally ridiculous and unscientific. Like everything, genetics are moderated by the environment. So just because you have the genes associated with depressive risk does not mean you are destined to get it. There still has to be an environmental trigger. But genes are most certainly involved in predisposing you to greater or lesser risk.

That said, once again, people with a history of childhood adversity are more likely to experience major depression. Emotional abuse and neglect are particularly impactful, and the effects of adversity can be long-lasting, influencing mental health well into adulthood (source).

Again, the risk factors we are talking about here are serious: emotional abuse and neglect, physical and sexual abuse, household dysfunction and family violence, bullying, and poverty. No one is saying that because your mother chose to work and left you with a kind and caring nanny you are now destined to have a crippling case of MDD.

Finally, what about anxiety?

Like depression, twin studies indicate that the heritability for anxiety disorders is between 30% and 60% (source). Once again, it’s a highly polygenic trait, which means it’s complicated to trace its genetic origins, but we are pretty sure there’s a genetic component (source).

And yes, once again, early childhood adversity is also linked with increased rates of anxiety. Sexual and emotional abuse are especially associated with high levels of anxiety (source).

Are you seeing a pattern here?

Concluding thoughts

I got a little feistier than I usually do in this series because the claims are so blatantly false and so obviously harmful. I don’t know why we keep platforming people whose information is so wrong and then letting it go unchecked. Even when Steven Bartlett had the data in front of his eyes about the heritability of ADHD, he was easily intimidated by Komisar’s sneaky avoidance of the question and allowed her to retreat into complex, fancy-sounding proximate explanations of the epigenetic factors at play, which passed for a solid rebuttal. Worse, he then told the audience that he had “run everything through AI” while she was speaking and everything checked out! So that’s a final nail in the coffin then!

But wait, Steven, she didn’t answer the fucking question!

There is basically no component of human behavior that involves “no genes.” As they say, genes load the gun and the environment pulls the trigger. In the case of ADHD, the gun is very loaded. In the case of anxiety and depression, it’s closer to 50-50. But it’s also worth noting that even when the genetic contribution is only 50%, the other 50% is the environment, and that includes a lot of things besides the mother. Erica Komisar says that when a child is young, you, the mother, are the environment, but this is simply not true and was never true at any point in human history. No mother raises her child in a bubble. Fathers matter. Friends and relatives matter. Socioeconomic status matters. Diet matters. Random things that no one ever thought would matter, like using a black plastic spatula to cook dinner, apparently matter. Some day we might discover that the toxins they put in pink socks cause people to become depressed and that would be classified as an “environmental” factor - but it has nothing to do with mothering (unless you want to blame moms for buying pink socks, instead of blaming the pink-chemical industry, which would be my preference).

So please, stop blaming everything on moms!!! We are doing are fucking best. And we’re not getting much help.

Now, I know a lot of people out there are CONVINCED that daycare is the culprit behind all of this, and once again, that is an empirical question that we have a lot of research on. I am going to say right now that the research on this is super complicated and making blanket statements one way or another is stupid. But I am invested in getting to the truth (even if, in some cases, it’s painful). People always tell me: but someone has to advocate for the children, even if it makes moms feel guilty! Fine, but not if the science behind it is bad. I have no issue making moms feel guilty if the data is good and it serves a higher purpose (i.e. improving the mental health of children and teens), although I think communicating that message with as much empathy as possible (instead of rage-bating moms by calling them narcissists) is a preferable approach.

I am going to give the daycare topic the time and research it deserves. This will be the subject of my next (likely very long) newsletter. If you don’t hear from me for a bit, it’s because I am busy researching! Stay tuned.