Tuesday, October 30, 2012

The Sun - Gabor Maté Challenges The Way We Think About Chronic Illness, Drug Addiction, And Attention-Deficit Disorder

This article from the always wonderful The Sun Magazine features an interview of physician Gabor Maté by Tracy Frisch. This is only a part of the interview, the rest is available in the print edition only, but even this is more than you might find in any other magazine. The Sun is the only ad-free magazine that I am aware of, so let's support them by subscribing if you are able and interested.

Among Maté's books are In the Realm of Hungry Ghosts: Close Encounters with Addiction (2010), Scattered: How Attention Deficit Disorder Originates And What You Can Do About It (2000, his first book), and When the Body Says No: Exploring the Stress-Disease Connection (2011, now in paperback).

One of the many things I like about his approach to illness is that he understands biology is not the only possible cause of disease, and in fact it may not even be relevant in some cases (especially, as shown in his own work, attention deficit disorder [ADD] and addiction). 

Here is the beginning of the article:

What Ails Us

Gabor Maté Challenges The Way We Think About Chronic Illness, Drug Addiction, And Attention-Deficit Disorder

by Tracy Frisch

~ TRACY FRISCH lives in Argyle, New York. For almost a decade she ran a sustainable-agriculture organization called the Regional Farm & Food Project. Currently she is a homesteader, community educator, and journalist.

Physician Gabor Maté was born in Nazi-occupied Hungary in 1944 to Jewish parents who were primarily concerned with simple survival. His father was interned in a forced-labor battalion, his aunt disappeared, and his maternal grandparents died in Auschwitz. 

In 1957 Maté and his mother and father immigrated to Canada, and he went on to get a medical degree from the University of British Columbia in Vancouver. He started a private family practice in East Vancouver that lasted for twenty-seven years. While treating patients, he observed that those who had experienced trauma, stress, and anxiety at a young age tended to repress their emotions and also to have more health problems. He also served as medical coordinator of the palliative-care unit at Vancouver General Hospital for seven years. In the late 1990s he took a job working with hiv-positive drug addicts at several innovative urban rehab programs, including one where addicts are given needles and allowed to inject heroin on-site — the only such supervised-injection program in North America. 

With both the chronically ill and addicts, Maté again saw the roots of their problems in “adverse childhood experiences,” such as abuse, neglect, poverty, or parental stress. At a time when medical science was increasingly looking to our dna for the source of many illnesses, Maté was becoming convinced that experiences in our early years play an even greater role in brain development and behavior. The emotional patterns we learn as small children, he says, live on in the cells of our minds and come back to us as adults. 

In his fifties Maté diagnosed himself with attention-deficit disorder [add] — a result, he says, of his early childhood in wartime Hungary. Those difficult formative experiences also led him to become a workaholic and a shopaholic, he believes. He credits mindfulness meditation and therapy with helping him cope.

In his first book, Scattered, Maté makes the case that add is not a genetically inherited disorder but rather is caused by the environment in which one is raised. He proposes the same for addiction in his book In the Realm of Hungry Ghosts. His other titles are When the Body Says No: Exploring the Stress-Disease Connection and, with Dr. Gordon Neufeld, Hold On to Your Kids: Why Parents Need to Matter More Than Peers. Protecting and strengthening the parent-child bond is crucial, Maté says, and he identifies the lack of support for struggling families in the U.S. and Canada as the root cause of many social and healthcare crises. 

For many years Maté wrote a weekly medical column for The Globe and Mail, Canada’s most widely read newspaper. Recently he gave up practicing medicine to focus on his appearances at seminars and conferences, where he discusses disease, addiction, and human development within a social context. Attributing our maladies to heredity is simplistic and disempowering, he says, a distraction from the problems of economic inequality, bad schools, and a declining sense of community.
I met with Maté over dinner in Albany, New York, following one of his intense all-day presentations, at which he’d developed a powerful rapport with an audience of two hundred. It was his fourth program of the week.

Frisch: Medical science has tried to offer genetic explanations for everything from alcoholism to obesity to breast cancer to depression. Why do you think genes can’t account for all our differences?

Maté: The genetic explanation is comfortable because it means that we don’t have to look at people’s lives or the society in which those lives are led for the source of our problems. If addiction is genetic, we don’t have to worry that it’s connected to child abuse, for example.

But studies actually show that, though certain genes might predispose you to addiction, if you grow up in a nurturing environment, those genes are inactive. Most genetic studies completely ignore the science of epigenetics, which is how the environment actually turns certain genes on or off.

Frisch: What led you to become interested in the connection between illness and environmental pressures?

Maté: As a family physician I began to notice that who got sick and who didn’t wasn’t completely random, that people who got sick more often tended to have more stressful lives. And I began to think that the stress had a lot to do with their illnesses.

I am not the first to arrive at that thought, which has been amply validated by research over the decades. Stress is a significant factor in the onset of diabetes, high blood pressure, heart disease, and cancer. But that research is generally not part of medical education. Doctors are trained to understand disease as a random event usually caused by external agents — bacteria, viruses — or genetics. We’re not taught to look at patients’ formative experiences or multigenerational stress patterns. Yet both my own observations and the research literature clearly indicate that you can’t separate people’s bodies from their environments.

Consider all the stresses of life in a society where people feel little sense of control and lots of uncertainty all the time; where people are expected to behave contrary to their true nature; where relationships are often troubled; where parents are not available for their kids because they’re too busy. Under such conditions, you’re more likely to get sick. Nearly 50 percent of American adults have a chronic illness.

On top of that, the U.S. has an inequitable healthcare system that provides good care to some but minimal care to others, and the debilitating expense of healthcare stresses patients further.

Frisch: We all experience stress, but we don’t all get sick. What makes some people more prone to illness than others?

Maté: People who have a chronic illness of any kind — cancer, multiple sclerosis, rheumatoid arthritis, fibromyalgia, inflammatory bowel disease, chronic neurological and skin disorders — often fit certain personality profiles. For example, they tend to pay a lot more attention to the needs of others than to their own. They get caught up in their job or their role as a caregiver rather than looking after themselves. They also tend to suppress the so-called negative emotions, such as sadness and anger. They try not to acknowledge these emotions even to themselves. And, finally, they tend to think they are responsible for how other people feel and to be terrified of disappointing others who are important to them.

So an overwhelming sense of responsibility and self-suppression is what tends to characterize the chronically ill.

Frisch: Have there been studies that support this?

Maté: Yes. In some studies of women who are having breast biopsies, psychologists could predict with relative certainty who would be diagnosed with cancer based purely on personality profiles. They were right as much as 90 percent of the time. The so-called cancer personality has been studied particularly in relationship to multiple melanoma, a type of skin cancer. Of course the personality doesn’t cause the disease, but it does increase your risk of getting it.

Frisch: Are there different personalities for people who have cancer and people who have, say, heart disease?

Maté: Well, there are two kinds of people who are prone to heart disease. One type is the rageful Type A workaholic. After a fit of rage, your chance of having a heart attack or stroke doubles for the next two hours, because your blood pressure is up, your adrenaline is up, clotting factors are increased, and your blood vessels have narrowed. In the long term you’ll suffer high blood pressure, constriction of the arteries, and so on.

The other type of person who gets heart disease is the emotional suppressor. They express no anger at all, not even healthy anger. They tend to get diseases of the heart muscle. Instead of the coronary arteries being damaged by high blood pressure, the cardiac muscle is weakened.

Frisch: Why shouldn’t we make an effort to stay calm? Doesn’t anger hurt relationships?

Maté: To say that we shouldn’t have anger is like saying that we shouldn’t have rain: we may not like getting wet, but without it there’s no irrigation. Healthy anger is a necessary response to a boundary invasion. It’s our way of saying: You’re in my space. Get out. You see this behavior in animals, too. It’s not a question of should or shouldn’t; it’s a part of our makeup. The role of emotion is to keep out that which is dangerous or unhealthy and allow in that which is helpful and healing. So we have anger and revulsion, and we have love and attraction.

Now, rage is always unhealthy. Rage is anger that is disproportionate to the situation. It usually arises from past experiences, not present boundary issues, and it keeps going on and on. It’s not discharged once you’ve protected your boundaries. It’s the result of frustration that’s built up for many years, like a pressure cooker that explodes.

Anger that is repressed can also turn inward. People who repress their anger can actually suppress their immune system, making it turn against itself. When that happens, you’re going to get autoimmune disease. Anger and the immune system have the same purpose: to protect boundaries. The immune system does its job of attacking foreign particles, and anger does its job of keeping out human invasions.

When you suppress your response to a boundary invasion, you’re going to become stressed. If I started rifling through your purse, for instance, and you didn’t object but instead repressed your anger, you’d feel very stressed, because you’d be worried I’d take your money. It takes tremendous energy to suppress emotions. The act itself is stress producing. Self-suppression is not innate. It’s a learned coping style. When you’re a child and your parents can’t handle your feelings, you learn to suppress them to maintain your relationship with your parents. But what was a coping response in the child becomes a source of illness in the adult.

Frisch: Does positive thinking protect people from illness?

Maté: A genuinely positive attitude that’s based on real experience and authentic power does protect people. If you realistically see the world as a place where you can get your needs met most of the time, you’ll be healthier.

The compulsive positive thinker is in trouble, however, because he or she is in denial of reality. Some people are not comfortable with their own pain, so they cover it up with positive thoughts in a desperate attempt to avoid what’s there.
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