Conversations: Gabor Maté, MD
SYNOPSIS
Emily speaks with physician and author Dr. Gabor Maté about his latest book, The Myth of Normal, which explores the connections between our environment, psychological wounds, and medical disease.
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GUEST
Photo credit: Matej Stransky
A renowned speaker and bestselling author, Dr. Gabor Maté is highly sought after for his expertise on a range of topics including addiction, stress, and childhood development. Dr. Maté has written several bestselling books, including the award-winning In the Realm of Hungry Ghosts: Close Encounters with Addiction and has coauthored Hold On to Your Kids: Why Parents Need to Matter More Than Peers. His works have been published internationally in nearly thirty languages.
RESOURCES
Mentioned in this episode:
George L. Engel, The need for a new medical model: a challenge for biomedicine. Science. 1977.
Nadine Burke Harris, How childhood trauma affects health across a lifetime, TEDMED talk, 2014.
Gabor Maté, Scattered Minds
Darcia Narvaez, The Evolved Nest. www.evolvednest.org.
The Nocturnists, Shame in Medicine: The Lost Forest podcast series.
David Foster Wallace, This is Water. Commencement speech, Kenyon College, 2005.
Soma Weiss Student Research Day, Harvard Medical School.
Soma Weiss Papers, Harvard Medical Library.
CREDITS
Hosted by Emily Silverman
Produced by Emily Silverman, Jon Oliver, and Carly Besser
Edited and mixed by Jon Oliver
Original theme music by Yosef Munro, with additional music by Blue Dot Sessions
The Nocturnists is made possible by the California Medical Association, and people like you who have donated through our website and Patreon page
TRANSCRIPT
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The Nocturnists: Conversations
Emily in Conversation with Gabor Maté, MD
Episode Transcript
Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.
Emily Silverman
You're listening to The Nocturnists: Conversations. I'm Emily Silverman.
In medicine, we usually think of diseases as “abnormal.” ALS, MS, Crohn's disease, breast cancer. These are all pathologies that need to be fixed, cured, or at least managed over time. But today's guest, Dr. Gabor Maté, says these diseases are actually a normal and even expected response to the highly abnormal way that we live our lives.
Yes, we all come to the table with a different genetic endowment, but more than our genetics, Gabor argues, chronic disease is driven by the way we eat, work, interact with each other or don't, the way that we were raised and treated by our parents, and perhaps most profoundly, the way that we relate to ourselves.
Gabor elucidates this argument in his latest book, which he co-wrote with his son Daniel Maté. It's called The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture. You may have already heard of Gabor Maté. He's a tremendous figure in the medical world. A renowned speaker, bestselling author, highly sought-after person for his expertise on a range of topics, including childhood development, stress, and addiction.
He's written several bestselling books including the award-winning In the Realm of Hungry Ghosts: Close Encounters with Addiction, and has co-authored a book called Hold Onto Your Kids: Why Parents Need To Matter More Than Peers*, and his works have been published internationally in nearly 30 languages.
Reading Gabor Maté’s latest book really prompted me to think about the mind-body connection and the way that our souls and ourselves are intimately bound up with the neurohormonal immunological apparatus in the body. At the end of the book, Gabor offers a way to think about healing that I thought was really beautiful and actually offers a lot of hope for those of us dealing with chronic disease.
But before our chat, I asked Gabor to read an excerpt from his book, The Myth of Normal. Here is Gabor Maté.
Gabor Maté
"For better or worse, we humans have a genius for getting used to things, especially when the changes are incremental. The newfangled verb “to normalize” refers to the mechanism by which something previously aberrant becomes normal enough that it passes beneath our radar. On a societal level, then, “normal” often means “nothing to see here”: all systems are functioning as they should, no further inquiry is needed.
The truth as I see it is quite different.
The late David Foster Wallace, master wordsmith, author, and essayist, once opened a commencement speech with a droll parable that well illustrates the trouble with normality. The story concerns two fish crossing aquatic paths with an elder of their species, who greets them jovially:
“‘Morning, boys. “How’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over to the other and goes, ‘What the hell is water?’” The point Wallace wanted to leave his audience pondering was that “the most obvious, ubiquitous, important realities are often the ones hardest to see and talk about.”
He could have been articulating this book's thesis. Indeed, the lives, and the deaths, of individual human beings—their quality and in many cases their duration—are intimately bound up with the aspects of modern society that are “hardest to see and talk about”; phenomena that are, like water to fish, both too vast and too near to be appreciated.
In other words, those features of daily life that appear to us now as normal or the ones crying out the loudest for our scrutiny. That's my central contention. My core intention, accordingly, is to offer a new way of seeing and talking about these phenomena, bringing them back from the background to the foreground so we might more swiftly find their much needed remedies.
I will make the case that much of what passes for normal in our society is neither healthy nor natural, and that to meet modern society’s criteria for normality is, in many ways, to conform to requirements that are profoundly abnormal in regard to our Nature-given needs — which is to say, unhealthy and harmful on the physiological, mental, and even spiritual levels.
If we could begin to see much illness itself not as a cruel twist of fate or some nefarious mystery but rather as an expected and therefore normal consequence of abnormal, unnatural circumstances, it would have revolutionary implications for how we approach everything health-related. The ailing bodies and minds among us would no longer be regarded as expressions of individual pathology but as living alarms directing our attention toward where our society has gone askew, and where our prevailing certainties and assumptions around health are, in fact, fictions. Seen clearly, they might also give us clues as to what it would take to reverse course and build a healthier world."
Emily Silverman
Gabor, thank you so much for that reading.
Gabor Maté
It's a pleasure to be able to speak my words, finally, in public. You know, this is my first opportunity to read from it.
Emily Silverman
I'm so honored. Thank you.
So, as I mentioned to you earlier, we are a podcast by healthcare for healthcare. And, you are a physician. We have a lot of doctors and nurses listening, and I always love to ask people about their path to medicine. So maybe just to start, could you tell us a bit how you ended up in the field of medicine?
Gabor Maté
Yes. So, I grew up in Hungary. My grandfather had been a physician in southern Slovakia. He died in Auschwitz. My aunt was a leading ophthalmologist in Hungary. She came back from Auschwitz weighing something like 80 pounds. And all my life, I had never any idea but that I would be a physician. That was my absolute goal. When I speculate on why, I can think of healing being an important theme in my life, given the terrible beginnings of my existence. However, I took a detour, because when I got to... I came to Canada when I was 13, and I did high school here. Decades later, I discovered that I qualify for the diagnosis of ADHD. But at the time, I didn't know. But that kept me from concentrating and focusing and working hard. Now, I love English and History, and those courses I could do by studying at the last minute. You can't do very well with calculus or organic chemistry, studying at the last minute.
So, basically, I defaulted into an English degree, and taught high school for three years. But by my second year, I knew this wasn't me. And, one day I just woke up, and {snap}, that's it; I'm going back to school. And then I had to do a year of make-up science courses, and then apply for medical school. It's the toughest work I've ever done. For some reason, I had to study calculus. And, to get into med school, you have to get high marks. I got 95%. Three weeks later, I couldn't have told you what calculus is about. So I had the smarts, but I didn't quite have the scientific mindset. But, I got in, got through; did well enough, and ended up in Family Practice. I practiced Family Medicine for seven years. I was also Medical Coordinator of the Palliative Care Unit at Vancouver Hospital, and the last twelve years of my medical work, I worked with a highly addicted population in Vancouver's Downtown Eastside.
Emily Silverman
How did you come to start writing books?
Gabor Maté
So, I've always been a writer, and I was a columnist for the student newspaper as an undergraduate. Even after I started medical practice, I began to write opinion columns for major Canadian newspapers. And, for six years, I wrote the medical column for the local newspaper, and also for the national newspaper The Globe and Mail. My ADD tendencies, however, kept me from ever fulfilling my ambition to write a book. I had a patient of mine, who was a very well known Canadian poet; his first name was Warren. And one day, I said to him, "Warren, I want to write, but I don't know what." And he said, "Gabor, you will write when you have something to teach the world." And that's exactly what happened. So in my mid 50s, when I'd stumbled into this diagnosis of ADHD,... and right away, I didn't buy into the existing dominant narrative as to what this is about. I never saw it as a genetic disease, or a disease at all – genetic or otherwise. I had a different take on it. I knew I wanted to share this with the world, and that became my first book.
Emily Silverman
You've written many books. So you mentioned the first book about ADD. You've also written books on stress and addiction. Tell us about your journey through these books, and how did that journey lead you to this book?
Gabor Maté
Well, let me begin with the ADD book. The Canadian title was Scattered Minds. I had this deep intuition that this condition is not a disease, and it's not genetic, despite the fact that, within a few months, two of my kids were diagnosed with it. But I knew something, which is that the tuning out, the absent-mindedness, which is the essence of ADD is not a disease. It's a coping mechanism.
And when I thought of my own infancy as a Jewish infant, spending my first year under the Nazi occupation with our mother, in terror for our lives. My father away in forced labor; her not knowing if he's dead or alive. My grandparents having been slaughtered in Auschwitz, and the anti-semitic laws and under the Nazis.... What kind of state would my mother have been in? And infants are exquisitely sensitive to the emotional states of their parents. They absorb them. Now, how do I deal with all that stress? I can't escape; I can't change the situation. Therefore, the nervous system in the brain goes to the default disconnection mode: tuning out. But when is this happening? This is happening when the brain is developing. And then I looked at the "epidemic" of ADHD, the rising numbers. That alone tells you that it can't be genetic, because genes don't change in a population over 10 or 20 or 30 years. So the medical "truism" that this is: A) a disease of the brain and B) is genetic, is nonsense.
What it actually is, is a response to increasing stress in our culture. And you don't need conditions of war and genocide to stress little infants, when their parents are stressed. So that became my first book.
And the second one, then, When the Body Says No, that are also my experiences in Family Practice, and also in Palliative Care. We see people before they get sick, and we see people in the context of their families. And so, with that context, it just struck me that who got sick with chronic illness (and I'm talking about autoimmune disease: from scleroderma to lupus, to rheumatoid arthritis, to multiple sclerosis, colitis, Crohn's disease, chronic fatigue, fibromyalgia, chronic migraines, neurological conditions like ALS or Parkinson's – it wasn't accidental.
Now, what I have to tell you, nobody taught me this in medical school. But the point is, certain features of personality, which mostly had to do with emotional self-suppression, seem to be correlated with chronic medical illness of all kinds, from malignancy to autoimmune disease. Not to mention, certain childhood experiences and personality traits. Now, what I didn't realize is that there's been a vast literature about this, published for a long time. Literature that's utterly ignored in medical education.
Let me give you one example. There was a Hungarian-Jewish physician, like me, who taught at Harvard in the 1930s. His name was Soma Weiss. Weiss was so revered at Harvard that, to this day, Harvard has a research day in his honor. And he gave a lecture to a medical school class in 1939, I think, that in 1940 was published in the Journal of the American Medical Association. And Weiss said, (I'm paraphrasing, but very accurately), that emotional factors play just as much a role in the causation of illnesses as physiological ones, and they must be at least as important in the treatment of them.
Now, since Weiss published this, there's been decades of scientific research, showing the unity of mind and body – the inextricable oneness of the immune system at the emotional apparatus, the nervous system, the gut, psycho-neuroimmunology, in a nutshell. Tens of thousands of papers. Not a word of it is breathed about in medical education, as far as I can tell, to this day, in most medical schools. Anyway, I began to notice these patterns myself: That was my second book, When the Body Says No. And my contention was, when people don't know how to say no to the stresses in their lives, to the demands of the world, the body will say it in the form of illness. And I get emails from all over the world, people saying, "Oh my God, you described my life."
I can tell you about a rheumatologist at UCLA, who I interviewed for this new book. She read my book When the Body Says No, and began to see the same patterns and began to apply the lessons of it. She says, now she's so much more successful in treating her clients, and many of them are off medications. But she dare not talk about it with her colleagues, because she'd be laughed out of the profession. This is three years ago. So, that's When the Body Says No.
Do you want me to go on about my next book?
Emily Silverman I feel like we could do a whole interview about each book. And I guess the reason I asked the question is: this book, the new book, The Myth of Normal. It's taking on such a massive topic, and so I was curious about how you finally arrived at this. Where you're putting your attention on the water we swim in, as you read in the intro, focusing on the culture. How did you arrive there?
Gabor Maté
I didn’t know this, but in 1977, George Engel, an American physician and psychiatrist came up with this concept of biopsychosocial medicine. And he said that the problem of modern medicine is that we separate the mind from the body, and we separate the individual from the environment. But clearly, that's not possible. Not in real life. Not in science, either. So that, if the mind and body unity is accurate, then it's also clear that we are affected by other bodies and then our relationship with other people. And so, my friend and mentor, Dan Siegel, talks about interpersonal neurobiology. That our nervous system and brains are in contact with, and influenced by, and influence other brains and other nervous systems. Well, if that's true, I take that a step further. So, to give a simple example, we've known for decades that the more stressed parents are, the more likely a child is to develop asthma. It's also been shown that the more episodes of racism a Black American woman experiences, the greater her risk for asthma. Now, I'm going to ask you and your audience a skill-testing question: How do we treat asthma?
Emily Silverman
With stress.
Gabor Maté
With stress hormones. We give them adrenaline or cortisol or their analogs. Should it maybe not occur to us that, maybe stress, including social stress, has something to do with inflammation and the constriction of the bronchi and bronchioles?
In fact, if you go through medicine, what's the commonest medicine we use, across inflammation of the gut, the nervous system, the skin, the integument, the connective tissue, the joints? Steroid stress hormones. Is it not a reasonable question to ask ourselves: What impact does life have on our stress response mechanisms?
So, it's just clear that if the mind and body are inseparable, which they are, then our social relationships, are also part of the equation. Which, by necessity, means that so is the culture in general, because we're all creatures of the culture that we grew up in. Literally, creations of the culture that we live in, which acts upon our genetic endowment, of course. And, I tell you that in the last ten years or eleven years, I collected 25,000 different articles: medical journal reports, scientific papers, newspaper reports, and so on; filed them all. I had this idea of writing the book and at some point, I had a contract to do it about five years ago. And I said, I can't do it. It's too big for me. It's just, this is more than I can chew. And I gave it up and I gave the money back to the publisher. And that's partly because I was living such a stressed life. To encapsulate how stressed I was, my wife said to me (not that long ago), "My friend, you've written a book called When the Body Says No, now write one called When the Wife Says No, because I'm not living like this anymore.
So, in the middle of all that stress, how could I have created this work? And it was in San Francisco, oddly enough, that I was sitting there four years ago, this February, having come from holiday, having some space in my head, I was sitting in a hotel restaurant, having breakfast with my wife, Rae. And this Myth of Normal just popped into my head. And I revisioned the book. Within two months, I had a major New York agent, who had taken me on as a client. I never had that before. And within eight months, I had a book contract. And it took two and a half years of really hard work during which, believe me,... My blood pressure is usually 110 over 65. My blood pressure was in 170 over 110 some days. I have panicked so much; I put so much stress on myself writing this book. I was so desperate, I actually talked to a therapist. And she really helped me to dis-identify from the book. That I'm doing the book, but I'm not the book, and how the book goes is not how I need to go. And my son, Daniel, who helped me write the book, was a wonderful support as well. I could not have done it without him. Two and a half years of writing, the book is 500 pages long, to read, plus 70 pages of endnotes and scientific references and index. Our first draft was double this length; there's so much I wanted to say. And I didn't know what not to say. So it took another year to trim it down, and to rewrite it, and I'm very happy with it now, but it was a long, arduous process. And here it is.
Emily Silverman
So I love this story of you sitting in the restaurant, in San Francisco, of all places, and the title comes to you: The Myth of Normal. So, what do you mean by the myth of normal? What myth?
Gabor Maté
So, in medicine, we use the word "normal" very legitimately. There's a normal range, outside the limits of which your physiology just can't sustain itself: body temperature or blood pH, our bodies can't sustain life. So that's a legitimate use of the word "normal." But in our society, we've come to confound that sense of normal with what the norm is in this culture. We think that what is normal is also healthy and natural, or at least inevitable. And that's the myth of normal, that the way we're living right now... It's like, if you wanted to study zebras, where would you study them? In a zoo, or out there on the savanna? And studying human beings, in this society, is like studying animals in a zoo, who don't know that they're in a zoo. They're like the fish in the water. Number one. Number two, the other implication is that what we call "abnormality", like mental illness, or what we call mental illness, or much of physical ailments, are actually a normal response to abnormal circumstances. So the myth is that these people or these conditions are abnormal. They're not. The ADD tuning-out is not abnormal. It's a normal response to the stress that many children are under these days. So, those are the two senses which I employed to use the myth of normal.
Emily Silverman
And this analogy of the zoo... So, studying humans today is like studying them in a zoo, but they don't know that they're in a zoo. And, in the book, you have chapters for different aspects of things. So, you have a chapter about politics and economics and unfettered capitalism, and what that does to us. You have stuff about climate; you have stuff about all sorts of aspects of society. I can see why your initial impulse was to return your book advance and say, no, no, this is too big. So I guess the question is: Can you lay out, as simply as possible to our audience, like, what is the zoo? Is it modernity? Can it be encapsulated in a single word or diagnosed in a way that gets at some route or is it more just a conglomeration of these economic and political and social and cultural forces?
Gabor Maté
I do think it can be expressed fairly simply. How we evolved as human beings was over millions of years. And, even our own species, which has trod the earth for about 150 to 200,000 years, for most of our existence, we lived out there in nature in small band hunter-gatherer groups. Which is what the wonderful psychologist, Darcia Narvaez from Notre Dame, calls "the evolved nest." And the evolved nest involved a relationship to nature, and a relationship to each other, where children grew up in the context of multiple adult relationships.
If you study Aboriginal groups here in North America or elsewhere, they held their children; they didn't put them down to let them cry it out. In fact, a Cree woman told me in Canada that, in our nation, she said, children weren't even allowed to touch the ground for two years, because we just held them all the time, you know. So, this is the evolved nest. It involved a context of safe, supportive, secure attachments.
Now, human beings are incredibly adaptive, we can adapt to all kinds of different environments. But that doesn't mean we'll do our best at all these different environments. There are basic human needs, that if you meet them, you're going to get a certain line of development. But if you don't meet them, you're going to get distorted lines of development. The change happened with the onset of civilization 10,000 years ago, 12,000 years ago, but it's been accelerating and accelerating and accelerating throughout history. And globalized capitalism represents the highest departure from the evolved nest, in every way, which is atomization, aggressive competition, setting people against each other, making people economically insecure, setting racial groups against each other. All these things go against our essential needs as human beings. And this includes how we gestate children, how we birth children, how we raise them, how we educate them. And then on the stresses that society imposes on people... this is in the richest societies in the world: how insecure and lost people are. This is so far away from the evolved nest, that you couldn't get any further.
Emily Silverman
Why did this happen? We're animals. Other animals don't go off and build cities out of concrete and glass. They don't open businesses; they don't create legal systems. And they don't write Shakespeare; they don't develop the concept of human rights. There are so many things about civilization that are horrible, but also so many things that can be beautiful. We have evolved to develop this, like, cerebral cortex that can think, and that can abstract itself and create these things. So why did that happen? Why didn't we just use our cerebral cortex to stay in hunter-gatherer tribes and carry our children for two years, and just keep things how they were?
Gabor Maté
It's also evolution. I'm not putting down progress of civilization. I'm not suggesting that we destroy cities. I'm not engaged in such juvenile fantasies. And we have evolved. We have developed intellectual capacities or creative capacities. It's amazing what human beings have achieved, just as you suggest. In science, in medicine and art, and in self-understanding even.
Now if you ask me, "Well, how did that happen?" I think that's a big mystery. I mean, I'd be presumptuous to explain to you human development. But, what happened was, that as we began to use the intellect, we also unconsciously gave the intellect primacy over our emotional lives. Now, when you look at phylogeny or ontogeny, both the emotional systems developed before the intellectual ones. And they're never meant to be overwritten by the intellect. They're meant to help use the intellect for the benefit of the organism. And I'm not the first one to say so, but the intellect has been used now against the organism itself.
Now, when you combine that with the rise of different classes and with different levels of power, and influence, and wealth... Now you have people who can use the intellect, and all the technology that's available, for their own for purposes, even to the detriment of the majority.
Emily Silverman
Most doctors could probably get on board with the idea that stress causes illness. And I think most doctors would even agree that certain diseases can be, quote, "psychosomatic." Although this is often distinguished from, quote, “real” or “organic” illness, it's almost like in its separate category. But in your book, you're arguing for something deeper, which is that almost all illness... I mean, not all, but, you know, ...not like infectious diseases and things like that. But everything from diseases like ALS (as you mentioned), multiple sclerosis, Crohn's disease, autoimmune diseases (especially in women), certain instances of cancer. That even those types of diseases that we traditionally, as doctors, view as, quote, “real” that they stem from our emotional life.
Gabor Maté
What I'm saying is what insightful physicians have been saying forever. James Paget (of Paget's disease), in the 1900s, talked about the relationship of depressive emotions and breast cancer; he says it's undeniable. And we have studies now to show that if at the time of diagnosis, a woman is depressed, her chances of survival are less. But he said this about 150 years ago.
In the 19th century. So, William Osler, one of the founding physicians at Johns Hopkins, and the Canadian Medical icon. He talked about rheumatoid arthritis as stress-driven. Jean-Martin Charcot, the great neurologist, "the father of modern neurology", who first described multiple sclerosis, said this is a disease driven by stress. George Engel, who in 1977 talked about biopsychosocial medicine. Rudolph Virchow, the German physician, "the father of modern pathology," he said that politics is just medicine on a broader scale. He said this after investigating the typhus epidemic in northern Germany and Silesia, now part of Poland. So, these insights have been with us forever. The difference is, we now have the science to prove it. So when you talk about psychosomatic, I say all diseases are psychosomatic in the truest sense of the word. Not in the sense of imagined, "It's all in your head" kind of dismissal, but in a sense that the psyche and the soma (the body) are inseparable. So when something happens in one area, given the unity of it all, it's going to have an impact.
Now, let's just look at healthy anger for a moment. What is the role of healthy anger? Why do all mammals have anger circuits in their brain? We share that with other animals, by the way, because it's boundary protection. It basically says "You're in my space. Get out." It's a boundary defense. Now if we ask ourselves, what is the role of the emotional system in general? I don't think I'm being controversial when I say that the role of emotions is to keep out what is not healthy and welcome and to allow in what's nurturing.
Let me ask you a trick question, then. What's the role of the immune system?
Emily Silverman
It's the same. To keep out what's dangerous and keep in what's safe.
Gabor Maté
Exactly. Now, given that physiologically this is one system, as psychoneuroimmunology, or you want to give it its fancy name, psychoneuroimmuno endocrinology, has amply and elegantly demonstrated, when you're repressing the one, you're affecting the other. And the repression of anger has been shown to depress the activity of natural killer cells. For example, how do you explain epidemiological studies that show that men who are sexually abused in childhood have triple the rate of myocardial infarctions regardless of whether they smoke or drink. Because trauma causes inflammation, which you can measure in the body.
As I travel around the world, audiences of hundreds, and I’ll say: "Well, how many of you have been to a neurologist, rheumatologist, cardiologist, gastroenterologist, immunologist, dermatologist – any kind of an "ologist" – in the last five years?" A lot of people have put their hands up. And, I'll say: "Keep your hand up if they asked you about childhood trauma. Keep your hand up if they asked you about how you feel about yourself as a human being, whether you like yourself or not. Keep your hand up if they asked you about your primary relationships. Keep your hand up if they asked you about how you feel about your work, and what the work environment is like." As I say in this book, the number of hands that stay up could be counted on the fingers of one hand.
So, you might be vaguely or theoretically aware of the relationship of stress and illness. In practice, we utterly ignore it to the detriment of our clients. Because as I also show in this book, and as other people have documented, paying attention to those questions can actually lead to significant remission of illnesses.
Emily Silverman
You mentioned early childhood trauma, and you gave examples like, you know, horrific examples, like sexual abuse and things of that nature. You speak of your own personal story with the Holocaust, also horrific. But you also say in the book that it doesn't have to be "capital T" trauma, that there's also this "small t" trauma. And that sometimes, when you ask people about their childhood, they'll say, "Oh, I had a happy childhood." Or they'll say, "Oh, I actually don't remember that much about my childhood." But that there are things hidden in there, in this "small t" trauma that can also lead to disease. So maybe tell us a little bit about the "small t" trauma, and what that might look like, and how that affects us.
Gabor Maté
So, you have to then understand what I mean when I use the word "trauma." And I go back to its Greek word origin; it means a wound. So trauma is a psychological wound. But the essence of trauma is what I alluded to before, which is the disconnection from self. You never met a one-day-old baby that disconnected from themselves. You never met a one-day-old baby that represses their emotions. She's lying there, wet and hungry and lonely. And she's saying to herself, "Oh gosh, I'm wet, hungry, and lonely. But Mom and Dad have been working so hard, I better not bother them. So, I'm going to just be quiet." I mean, have you met a one-day-old baby that'll do that? Nobody ever. So that repression that happens is a response to life experience.
Now, people can be wounded or hurt in two ways. One is by bad things happening to them. Or, as we see all over the world, abuse of children, which happens far more frequently than doctors tend to know. Because if you don't ask those questions.... But I know that in California, Nadine Burke Harris, your Surgeon General, is now introducing the questionnaire about adverse childhood experiences into the evaluation of children in public health clinics. I think I got that right. So, there's a growing awareness.
So, you can hurt people by bad things happening to them. But you can also hurt little kids, not by doing bad things to them, but by not meeting their needs. Now human children have evolution-determined certain, what I call, "irreducible needs". Irreducible needs being, if you don't meet them, there's going to be suffering. Well, we have an irreducible need for water. If you don't... You don't have to hurt somebody; just deprive them of water. See what will happen to them. Well, people have also... Being that we're emotional creatures, with a sophisticated limbic system, our emotional needs are also important for our development. And in this society, those irreducible emotional needs of children...(which I could outline if you like, but I'll just mention them now)... They're often not met, not because parents don't love their kids, not because they don't do their best. But because of the stresses of this culture. And, the very, I would say, anti-child parenting advice a lot of parents get from so-called parenting experts, which undermine the attachment relationship, and try to emphasize behavioral control, which is toxic to the child. These are from loving, well-meaning parents. Then there's a lot of us, like myself and my wife, who... our kids weren't abused, but they were raised by two parents who were carrying their traumas that they hadn't evolved through yet by the time they became young parents. We passed our traumas onto the kids unwittingly, for all the love that we had.
So children can be hurt in many ways. And that's what I mean by the "small t" trauma. And, now, one of the effects of "small t" trauma is the child gets the sense that they're just not acceptable with all their emotions.
Well, let me give you an example of "small t" trauma, okay? Let me tell you a story. A four-year-old girl runs into the house because she's being bullied by neighborhood children. Four-year-old little girl, and she runs to her mummy seeking protection and support, and her mother says, "There's no room for cowards in this house. Now, you get out and deal with those kids." How would you perceive that: as a physician, as a mother, as a human being? How would you perceive that interaction?
Emily Silverman
As incredibly stressful. It would make me feel alone and like I have to fend for myself.
Gabor Maté
Yeah. That was Hillary Clinton, who told that story at the Democratic Convention, as an example of resilience-building mothering. In fact, it was the relation of a child being traumatized in front of millions of people, and nobody even batted an eyelash. That's how normalized "small t" trauma has become in our culture.
Emily Silverman
I've been thinking about these ideas, which intuitively I agree with, and wondering to myself, "Why does Western medicine, and why do doctors, ignore this? And ignore the evidence? And so on and so forth. And I was thinking about myself, and I was thinking about, like, if I, let's say in 10 years, I get diagnosed with breast cancer, God forbid, I would wonder to myself... and you talk about this a bit in your book, but for the audience, like, if I would blame myself? If I would say, "Oh, clearly I had all this trauma, and I just didn't work through it in time. And it's my failure to address all my wounds. And now I have breast cancer." If we're talking about things like breast cancer, and MS and diseases like this as stemming from trauma that's not been dealt with, do you ever worry about how that narrative might show up for people when they get sick? And then, in thinking to themselves, like, "Oh, I should have been able to get under this in time. And now that I'm sick, like, it's just another failure." Like, do you ever worry about that? Or how do you think about that, because I can see that being a barrier to people really taking up this worldview.
Gabor Maté
It's an essential issue that you're raising. And it's very important that if we are to talk about these things, we have to do it very sensitively. Now, in each of my books, I spend pages explaining why blame is unscientific, inappropriate, and cruel. You can't on the one hand, scientifically point out the importance of the early environment, and not talk about parents. You have recognize the context in which parents are parenting their kids. So there's no question of blaming individual parents here.
As far as the individual blaming themselves? I mean, if I came to you, with my ADD, and if you understood that this is a coping mechanism that I adopted as an 11-month-old, would you ever blame me for tuning out? There's no room for blame here. There's just understanding, is the point. So, when people adopt these dynamics unconsciously early in life, why would I blame them? I was in my late 40s, before I even realized that I'd ever been traumatized.
Emily Silverman
So is the idea that a book like this might help people realize these things sooner in life so that they can get ahead of them?
Gabor Maté
Let me come back to your hypothetical example of you developing breast cancer, okay? Now, we often dismissed that as a genetic disease. But in fact, as you probably aware, out of 100 women with carcinoma of the breast only seven have the genes. And, by the way, out of 100 women with the genes, not all of them will develop breast cancer. Although they have a much higher risk, no question. If I was your physician, and you came to me with breast cancer, what would you rather hear? You've got this mysterious condition that we don't know why the heck you got it. You live a healthy life. You've exercised; you had the right diet. But here we are with breast cancer, too bad.
Or would you rather hear, there may be factors that you're not aware of, that have to do with your childhood experience, and certain way you relate to yourself. That if you reverse them, they could have a positive effect on your illness, which is documentedly the case in multiple sclerosis and rheumatoid arthritis, and in cancer. Which would you rather hear? Which is the more compassionate, but also more scientific, and more hopeful message? And, I'm telling you, I have had so many people with breast cancer just thank me for the work.
So there's a chapter in the book called "Diseases' Teacher", that I don't recommend that way of learning. But when disease shows up, when people undertake not just a medical treatment, which as a physician, I can only support and marvel at. But at the same time, looked at this other side of the coin, we had actually given them a better chance. And I don't know if you know this ... Well you did, because you read the book. But there are even documented cases of ALS that reverse themselves. Now, they don't know why. But I think I know why. And there's some indication that the more anger they get in touch with, the better their prognosis becomes. Now, would you rather hear that or not hear it? And there's no blame involved there; no blame whatsoever.
By the way, just so that we can humble ourselves a little bit as physicians and health care givers, Stephen Hawking, the physicist, was diagnosed with ALS at age 20, and given two years to live. And he died as the world's greatest living physicist, or one of the ones, 55 years later. Maybe there's some things we don't know. And what's interesting is: these patients when they get better, that doctors never ask, "What did you do?" The most they will say is, "Whatever you’re doing? Just keep doing it." But they never ask, "What is it that you did do?"
I don't know if you relate to this, but... first of all, who goes into medicine in the first place? Speaking of myself, a very driven individual who really wants to be important. Why did I want to be important? I’m compensating for something. Now, if you want to be important, for God sakes, go to medical school. If you want to be wanted, go to medical school. You'll be wanted all the time. Number one.
Number two, what is that we put up with to get to medical school? For a lot of people, medical school is a traumatizing experience. Sleep deprivation, emotional deprivation, healthy food deprivation; subjected to authority and leaders in a highly-stressed environment when you're being shamed, not infrequently. No wonder that the cellular clocks of our bodies, the telomeres, they fray faster in medical students than in other people their age. And then, nothing in our education prepares us to even know about these things. How would we recognize all this stuff?
Emily Silverman
It's funny that you mentioned shame, because we're actually on the verge of releasing an entire series on "Shame in Medicine". So I'm hoping that that will help bring some of this into the light. But, as we approach the end of the interview, I want to make sure that we talk about healing. You mentioned some of these examples of cases of spontaneous remission. And you know, these are extreme examples. Fascinating examples, but definitely extreme. You offer a definition for healing, and you talk about healing as returning to wholeness. And you say, "Any movement toward wholeness begins with the acknowledgement of our own suffering and of the suffering of the world. This doesn't mean getting caught in a never-ending vortex of pain, melancholy and especially victimhood. As mentioned earlier, a new and rigid identity founded on trauma, or for that matter, healing, can be its own kind of trap. True healing simply means opening ourselves to the truth of our lives, past and present, as plainly and objectively as we can. We acknowledge where we were wounded. And as we are able, perform an honest audit of the impacts of those injuries as they have touched both our own lives, and those of others around us." Tell us more about this idea of healing as returning to wholeness, because that is not a definition I learned in medical school. And I think it's really beautiful.
Gabor Maté
Well, first of all, let me just quickly, parenthetically, say that what we call spontaneous healing, there's nothing spontaneous about it. That we call it spontaneous, is simply our lack of awareness of the dynamics of healing. And when I talk to Jeff Rediger of Harvard, we both agree that the biggest change in the person's relationship to themselves, which is to say they return to themselves. Now, when you say "healing", the definition about wholeness, did you know that the word "healing" originates in an Anglo-Saxon phrase for wholeness? That's the word origin. And I'm Hungarian, and literally, the word to be healthy is to be whole. Literally, the same words for both concepts. So language has always carried the imprints of ancient wisdom that we've become alienated from. So, if trauma is the disconnection from self, which is the essential traumatic dynamic, then the healing is the return to ourselves, which is to be in touch with our bodies, our emotions, and our needs. And as my friend, Lissa Rankin, points out, it's not the same as cure. You can get cured without healing, and sometimes you get healing without cure, and sometimes you get both. But the healing is that return to the self.
Now in practice, when we heal there’s very often demonstrable benefits to our physiological states. I know people with multiple sclerosis, who once they understand how they unconsciously stressed themselves, and they stop doing it, the diseases stopped progressing or even remits, and they're off their medications. I have a woman in the book who talks about these beautiful conversations I have with my rheumatoid arthritis. She's off all her medications. Typically traumatized person, self-repressed until the disease woke her up. So, that's what I mean by healing. And no. Those examples I give are extreme. And I... by no means, do I pretend that I think everybody can do it, or that would work for everybody. I, myself, don't know if I can engage in that kind of deep self-transformation that these people have manifested. It just shows you what's possible; that's all.
But I know lots of people, whether with mental health conditions, as I outline in the book, or addictions, or what we call physical illnesses, and so on, who have had significant impact on their health, by engaging in this journey of healing and on which I spend more chapters, by the way, than I do in outlining the problem. Which surprised me. Because I thought when I was writing the book, yeah, I can diagnose and I can describe the problem. But what am I going to say about healing? In fact, it was all there inside me. I just had to ask myself, "What do I already know? What have I already learned from all the people I've worked with? What have I learned about my own healing? What have I seen in the world?" And these eight chapters on healing just generated themselves.
Emily Silverman
You talk about the four A's: authenticity, agency, anger, acceptance. And then there's two bonus A's, which focus not so much on the level of the individual or the relationship, but society. So you talk about activism and advocacy. How did you arrive at these A's?
Gabor Maté These four A’s represent kind of a distillation. So agency, meaning, who's in charge of my life; whose life is this? Now we're programmed in a society to live in other people's minds, or image: what they think of us, what we look like to them. Number one. And, you know, to please other people, and so on.
Anger, healthy anger: we already talked about. Its role as a natural boundary defense. That is distinct from rage, which is sort of inchoate, triggered, volcanic eruptions, which also threaten health. In the aftermath of a rage episode, your risk for stroke or a heart attack doubles for the next two hours. Documentedly. I'm talking about healthy anger, which I explain more in detail in the book.
Acceptance, which means just a non-sugar-coated acceptance of how things are right now. Acceptance doesn't mean toleration. Acceptance doesn't mean that I have to like that it is how it is. Acceptance means that I see how it is. And I'm going to accept how I am here at the moment. And I'm going to be curious about it. And talking of shame, you mentioned the fourth As... what was the fourth one?
Emily Silverman
Authenticity.
Gabor Maté
Oh, yeah. Oh, yeah. Who could forget authenticity? So, authenticity is this connection with ourselves, of knowing who we are, knowing which of our emotions belong in the present moment, and which is triggered from the past. Of not rejecting any emotion that arises for us. Not necessarily acting it out either, but not rejecting and not repressing it. Not making ourselves wrong for it. And, of saying no, when a "no" needs to be said. Or for that matter, saying a "yes", when a "yes" needs to be said, because so many people suffer not only because they don't know how to say no, but also because they have deep urges and desires and passions, that in the stress-society they don't say yes to. So authenticity comes down to the knowing when to say yes, and when to say no. And that shows up in our work, in our creativity, in our personal lives. And by the way, how old is your child?
Emily Silverman
She's just over eight months.
Gabor Maté
Terrific.
Gabor Maté
What word do you think she'll start using around one and a half?
Emily Silverman
Mommy.
Gabor Maté
Yeah, she'll say, Mommy, Daddy, but there's another word that you hear all the time. It's going to be "no". Time to put your shoes on. No. Why does nature do that? Why doesn't the kids say "Yes, I'd love to put my...". Because we have to be able to develop our own will. And we have to know to say no, before a "yes" doesn't mean anything. Now, in this deranged culture, we call that the terrible twos. There's nothing terrible about it. We make it terrible, because we think that it means that we're failing as parents. But the child's "no" is the little wall behind which she develops her own little will. So, authenticity means that authentic yes and no.
Emily Silverman
So Gabor, if you could give a message to the healthcare workers in the audience, what would it be?
Gabor Maté
It would be that all of us have entered this field with a mix of unconscious and conscious motives. But surely, the calling in it is the potential for our work to provide healing to a very troubled and aching and suffering world. And in order to do that clearly and efficiently and compassionately and in a way that fulfills us, we have to be aware of everything that goes into creating health or ill health. And our education has not prepared us for it, which makes the work much more frustrating, and much more disillusioning than it needs to be. So that there's a possibility of us working more true to ourselves, even in the face of a system that often doesn't get it.
Emily Silverman
I have been speaking to the wonderful Gabor Maté about his book The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture. Gabor, thank you so much for being here today.
Gabor Maté
Wow, what a pleasure this conversation has been. Thank you very much.