Addiction is a Response to Childhood Suffering: In Depth with Gabor Maté

By John Lavitt 01/06/16

The Fix Q&A with Dr. Gabor Maté on addiction, the holocaust, the "disease-prone personality" and the pathology of positive thinking.

12 Questions About Alcoholism, Addiction & Recovery With Dr. Gabor Maté
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A Hungarian-born Canadian physician, Dr. Gabor Maté specializes in the study and treatment of addiction and trauma. He is well known for his firmly held belief in the connection between mind and body health. Dr. Maté’s bestselling books include the award-winning In the Realm of Hungry Ghosts: Close Encounters with Addiction. Rather than offering quick-fix solutions to complex issues, Dr. Maté weaves together scientific research, case histories and his own insights to present a broad perspective.

For over a decade, Dr. Maté worked in Vancouver’s Downtown Eastside with patients challenged by drug addiction, mental illness and HIV, including a stint at North America’s only supervised injection site. Beyond his work with addicts, he has over 20 years of family practice and palliative care experience. Dr. Maté regularly speaks to health professionals and lay audiences across North America. He has received the Hubert Evans Prize for Literary Non-Fiction and the 2012 Martin Luther King, Jr. Humanitarian Award from Mothers Against Teen Violence.

You have said that you believe that, “many doctors seem to have forgotten what was once a commonplace assumption, that emotions are deeply implicated in both the development of illness, addictions and disorders, and in their healing.” When I got sober at Beit T’Shuvah, the Jewish rehab in Los Angeles, Rabbi Mark Borovitz often told us to forget our feelings and focus on our actions. A common saying in 12-step groups is that you have to act yourself into right thinking. Can you also act yourself into right emotion? 

Can you act yourself into the right emotion? Let me put it this way, John; the question does not interest me. What interests me is for people to really know where they are coming from and where their actions come from. People can act the right way, but that doesn’t mean they are being the right way. You can’t force emotions; you really have to know what they are. For me, the important question is, what are the actual emotions underneath the action that are driving my behavior and where do those emotions come from? For me, it’s not a question of acting into the right emotion. It’s a question of understanding what are the source emotions from which we are acting. That is the really important question.

I completely appreciate the 12 steps, and I talk about them in my book where I have an appendix on them. I think where they fail or where they miss something is when they focus on action while tending not to look at the underlying emotions and the experiences that underlie those emotions. You can go to 12-step groups for a long time and never find out how traumatized you were. That’s where the missing piece is and has been for a long time.

The patients that I worked with—I’m talking about hardcore, street level drug users, people injecting cocaine and heroin and so on—not a single one of them ever came to me and said, “Doc, I was traumatized, and I’m using that as an excuse to do drugs.” They didn’t know they were traumatized. No doctor had ever pointed it out to them. They thought they were just fuck-ups. They thought they were just bad people. They thought they were just addicts. They didn’t realize that they were using the addiction to soothe a deep pain that was rooted in trauma. In all cases of addiction that I have seen, there’s deep pain that comes out of trauma. The addiction is the person’s unconscious attempt to escape from the pain. 

That’s not just my personal opinion. It’s also what large-scale studies show. In large population studies, you find that extreme trauma, whether in a population like the Native Indian population in your country or the Aboriginal population in Australia or the Native population in my country with the loss of land and the violence and the forced abduction of their children who were brought up for a hundred years in residential schools away from their families where they were sexually abused, generation after generation, there’s a huge statistical and causative link between that trauma and the addiction. That’s not a theory. It’s just reality. 

And not it’s not only that. We also know that the brain itself, the human brain itself, is shaped by the environment. The brain is not purely genetically programmed. Brain development occurs in reaction to the environment. The necessary conditions for healthy brain development are healthy relationships with responsive parents. When the parenting environment becomes distorted or hostile and abusive, you’re actually distorting people’s brain development. This means they are going to be more likely to want to use substances to feel better in their brain in order to achieve a different state of the brain. 

Whether we are talking about the emotional pain and the shame that’s at the heart of addiction or whether we are looking at the brain physiology of addiction, which is very much influenced by childhood experiences, we are looking at the impact of trauma.

To go back to the original quote about doctors, if we actually understood that all behaviors are for the most part coping mechanisms for emotions that we are not able to deal with, then the focus could shift not just to changing behaviors, but actually understanding the emotions that underlie them. That’s what I think is missing from medical practice. Whether it's addictions or whatever it is, we are not seeing what’s driving it and what’s underneath it. That’s why I said the question did not interest me. I’m trying to turn your questions around on its head or I’m trying to put it back on its feet. Let’s put it that way.

In an article about the death of Robin Williams, you wrote, “While there may be genetic predispositions toward depression and addiction, a predisposition is not the same as a predetermination.” If a family knows that their child has a predisposition toward either addiction or depression, or both given the commonality of co-occurring disorders, what can they do to help ensure their child lives a healthy, happy and productive life?

Let me turn that question around again. Let’s say you didn’t know your child had a genetic predisposition toward depression, and then what should you do? It’s not that people have a genetic predisposition towards depression; it’s that they are more sensitive so they are more affected by what happens. The more affected you are, the more depressed you are going to get. Depression is a response to what happens. 

Let’s say you don’t know anything about your child’s predispositions. What kind of childhood do you want to give your child? To answer that question, does it matter what you know? Don’t you want to give them a childhood in which they are loved, in which they are respected, regardless? You want to give them a childhood where they are accepted for who they are, where they are celebrated for who they are, where they can explore the world under guidance but with freedom, where they can be themselves and be happy being themselves. There is no difference in how you should want to parent one child as opposed to another child.

This is how we want to parent children, and it doesn’t matter what predispositions a child has, if they get these conditions of love and respect in their childhood, they’ll never be addicted, they’ll never get depressed and they’ll never be anxious—not in terms of the medical diagnosis of those conditions.

Any person might experience anxiety at some time or sadness. I’m not talking about that, but in terms of the so-called illnesses, they will never happen. It doesn’t matter what we know about our children’s predispositions. The question is, what kind of childhood do human beings require to be healthy, self-realized creatures? Look at all of the characteristics that I listed. 

The question is, why the disease focus? Your question is very disease-focused. How do I prevent a disease? That’s not the right question. That’s already coming out of fear. You don’t want to parent out of fear. The right question is what does a human being need, any human being.

Explaining the disease-prone personality, you said, “No personality causes disease. So there's no cancer personality. However, there are some common traits that, if they are present in exaggerated degrees, will make you more predisposed to the disease. They don't cause it, but make you more likely to get it because they increase the amount of physiological stress you've got inside you...Stress is the thing that leads to disease or leads to conditions for it, but certain personalities are more prone to this stress.”

Such a concept is somewhat alien to mainstream medicine. Do you believe it can be proven? Is the idea of the disease-prone personality a philosophical supposition or a medical reality?

This is not really controversial at all because it’s a medical reality. It’s only controversial because most doctors don’t know about it. If you look at studies of patients with malignant melanomas, for example, there is no absolute cancer personality, and you explained this idea very well. But there is no one type of personality that means you are going to get this disease. That’s not going to happen. You can’t say that there’s a disease personality. But there are definitely disease prone personalities; certain personality traits that make a person much more likely to have a disease than people who don’t have that type of personality. There’s no question about that. 

It’s important to note that this tendency was discovered in relationship to malignant melanoma. People who developed malignant melanomas often tended to be people who didn’t express emotion in a healthy way and who suppressed or repressed their anger. Those are risk factors for illness. We know that. The repression of anger suppresses the immune system as opposed to healthy expressions of anger. It’s not a question of philosophy. 

I was a physician for 33 years, and I didn’t begin with any of these assumptions. Nobody had told me about this. I just kept noticing, particularly when I worked in palliative care for seven years. We looked after terminally ill people, people who were dying of cancer, and I kept noticing and kept noticing and kept noticing that these people with auto-immune disease or with cancer typically had very tough childhoods where they survived by repressing their emotions, and that suppression of emotion was tied to their development of disease. 

But I wasn’t the first one to notice this connection. It turns out that many doctors had remarked on this before. It had been noticed in ancient times, in Roman times. We are talking about doctors who go beyond just the body and are willing to look at the whole personality. They can’t help but notice that certain emotional patterns, certain personality traits make it more likely that you are going to get that disease. It’s an observation, and whenever it’s been studied, it’s been shown to be the case. There have been many studies, and I outline many of those studies in my book, When the Body Says No, Exploring the Stress-Disease Connection. I am talking about clinical observations backed up by studies. 

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Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.