Chapter 1: What early experiences shaped Gabor Maté's understanding of trauma?
Dr Gabor Mate is a physician and author.
He was born in Budapest in 1944, just weeks before the Nazis occupied Hungary, and his family suffered terribly in the Holocaust. Gabor eventually fled with his parents and younger brother to Canada, where he later trained as a doctor, becoming a successful family physician. He then spent more than a decade working with people suffering drug addiction on the streets of downtown Vancouver.
But as Gabor reached midlife, he came to realise that the lines between illness and health, body and mind, patient and doctor, were not as clear-cut as he had assumed. And so he began the hard but life-saving work of attending to his own suffering, which in turn allowed him to become a very different kind of doctor. Gabor has written books on addiction, on ADHD and on stress.
His latest is a magnum opus, the international bestseller, The Myth of Normal, Trauma, Illness and Healing in a Toxic Culture. Hi, Gabor.
Thanks for the introduction. Nice to be here with you.
As I say, you entered the world at a very dark time, Budapest in 1944. What was happening to your family in your first year of life?
Hungary at that time was the only Eastern European country that had, up to that point, escaped the Holocaust. However, it was a very anti-Semitic country. My father was in forced labor with the Hungarian army, which was an ally of the Germans. In March of 1944, the Nazis actually occupied Hungary, and that's when began the extermination of Hungarian Jewry.
Within the space of three months, they killed over half a million people, including my grandparents in Auschwitz, and my mother and I came within a hairbreadth of being deported there ourselves.
But the whole first year of my life was spent under Nazi occupation with a very terrorized, reach-struck and struggling mother, who then, when I was 11 months of age, had to give me a two-complete stranger in Budapest, a Christian woman on the street, to save my life.
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Chapter 2: How does Gabor Maté define the relationship between trauma and addiction?
Was that part of my motivation? I think it was.
You spent many years as a family physician and also in palliative care and then worked for 12 years or so treating patients with serious drug addiction in Vancouver's downtown Eastside. Why did you leave your nice, cosy office to work on the streets? What prompted that?
Do you know what? When I graduated from medical school and finished my internship, my first job was in the downtown Eastside of Vancouver. which is North America's, indeed the Western world's, most concentrated area of drug use. So in a physical level of radius, we have thousands of people injecting, inhaling, ingesting drugs of all kinds. There's nothing like that in Australia.
There's nothing like it anywhere. In Europe or even in the U.S. And I felt completely at home there. At home? Yeah. I just resonated with the energies of these troubled, very sensitive, very troubled, very dysfunctional, but very human beings. And I worked there for six months and I always knew I was going to return. So when the time came, I did return. But it just called to me.
And of course, if I go back to the motivation of alleviating suffering, well, where is that most needed? Amongst these ostracized, punished, excluded, impoverished, very ill people. So it was a way to fulfill my mandate as a physician. But again, I just felt very much at home there. And I very much recognized myself in them.
The book you wrote about that experience is called In the Realm of the Hungry Ghosts. That's such an evocative title. What does that phrase, hungry ghosts, mean?
It's actually a Buddhist term. In the Buddhist cosmology, Tibetan Buddhist cosmology, people cycle through six realms. There's the ordinary human realm, ordinary selves. There's the animal realm, which is our drives and our appetites, our lusts. There is the hell realm, which is terror, fear. rage.
In the hungry ghost realm the creatures are depicted with small narrow necks and gullets, big empty bellies which they can never fill from the outside and that's the addictive realm because the addiction is all about trying to fill an emptiness or soothe something inside from getting something from the outside, but it can never be satisfied.
So whether you're addicted to sex, pornography, gambling, drugs, work, self-cutting, it never soothes that emptiness. It never soothes the pain. So that's the realm of hungry ghosts. So that's where the title of that book came from.
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Chapter 3: What insights does Gabor Maté provide on the mind-body connection?
So pleasure, craving, relief, that's the first criteria. Second criteria is These behaviors result in suffering and harm, and clearly people don't give it up despite the harm. So pleasure, craving, relief, harm in the long term, inability or refusal to give it up in the long term. I said any behavior. That could be drugs, legal, like nicotine or alcohol.
It could also be the illicit drugs, cocaine, crystal meth, the opiates, of course. But it could also be gambling, as I said before, pornography, sexual revolving, work, extreme sports, self-cutting, bulimia, shopping, eating. Anything. The criteria is, does it give you temporary pleasure or relief? Does it cause harm? Can you give it up? So let me ask you this.
I don't know you, Sarah, but according to that definition, have you ever had any kind of an addictive pattern in your life?
I could probably tick off a few.
Okay.
Easily.
I won't ask you what, but here's what I'll ask you. Choose any one of them and tell me what was wrong with it, but what did it give you? What did you like about it in the short term?
Comfort or relief?
Relief. Who needs relief?
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Chapter 4: How does childhood trauma influence adult mental health?
And when children are hurt, traumatized, like in Australia, there was a report a few years ago, tens of thousands of children have been abused in all kinds of institutions.
If you look at the situation of the Aboriginal population of Australia who have been massacred, oppressed, deprived and marginalized for hundreds of years, naturally the rate of addiction is high amongst them, as it is in Canada. And then we punish them for the pain that we've caused them.
And human beings, as has been said by a great American physician, George Engel, are biopsychosocial beings, which means to say that our biology is inseparable from our emotions, our psychology, and from our social relationships. And that means that the more children suffer...
the more likely they are then to become addicted, but not only just to be addicted, but also develop pathology of all kinds. And again, that's been studied, documented, the pathways have been delineated, and this information is almost completely ignored in medical training.
You said that right from the start, working with people grappling with addiction, you felt a kind of kinship or felt at home, I think you said. What was it? about those people that registered with you?
Because I'm the same as they are. I have my own addictive behaviors, my own depressions, my own pain, my own ways of coping with pain, just to tune out my own difficulties. I was just more fortunate than they had been so that I could channel marriages in different directions. But even when I was working with this highly addicted population, I was still pursuing my own addictions.
It didn't have to do with substances. In my case, it was shopping for classical music. And people say, how can you compare yourself? I'm not comparing myself. The differences between me and my patients with HIV and hepatitis C... and living barely outside the law are obvious. But it's the similarities that are striking in that I was compelled to do this.
I would drop thousands of dollars a day sometimes. I would lie to my wife. I would ignore my kids. So for the sake of my addiction and also for the sake of my work addiction, which if you go back to my infancy, what message did the world give me when I was an infant? That I didn't matter, that I wasn't important. Maybe I'm not even wanted.
And of course, when my mother gives me to a stranger to save my life, that message that I'm not wanted is reinforced. Well, if you're not wanted, as I've often said, here's what you do. You go to medical school. Now they're going to want you all the time. And every day you get to prove how important you are. So that becomes an addiction in itself, which means now I'm ignoring my own family.
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Chapter 5: What role does attunement play in emotional and physical health?
And I'm also very compassionate. At least that part of me shows up. Let me put it that way. But I was working too hard. which means I was depleted. I was in my workaholic state, which means I was depleted, and when I'm depleted, I'm not very nice to be around, including and especially for my wife.
And so my wife said to me, literally she said, Buddy, you've written a book called When the Body Says No, and you better write one called When the Wife Says No. And my good fortune has been to be married to somebody who doesn't put up with my stuff, who challenges me. Do you want to be with me? You have to grow up.
And so it's been a, now that works both ways, but there's something that happens, and I talk about this in the myth of normal, and autoimmune disease, for example, happens mostly to women. 80% of people with rheumatoid arthritis or lupus or chronic fatigue or fibromyalgia, inflammatory disease of the bowel, you know, and so on, are women. And why is that? It's genetics. No, it isn't.
For example, in autoimmune disease, multiple sclerosis, in Denmark, in women it doubled in 20 years, not in men. In the 1930s, the gender ratio of MS was one to one. Now it's three and a half women to every man, which proves that it's not genetic.
By the way, there was an Australian study in 1967 that systemic lupus, which is an autoimmune disease that really attacks the whole body, but the immune system turns against the organism. The more childhood neglect and adversity people experienced, the greater the risk for multiple sclerosis.
If you look at who gets autoimmune disease, not just according to my own observations, but a lot of research, is people who tend to suppress their healthy anger, who tend to be nice, who tend to look at the emotional needs of others more than their own. Now, which gender in this culture is programmed to be that way? Not by genetics, but by culture. So the reason, it's not women's fault.
It's not even men's fault. It's not a question of fault. It's the way we are cultured to function. Now, in my marriage, my wife had to increasingly learn to say no to that role of essentially being my emotional mother. When men take on that role, they take on a lot of stress. And that's why there's more autoimmune disease amongst women.
And, of course, the male personality, I'm speaking of myself... doesn't take kindly to being called to responsibility. I want to be mothered. A part of me wants to be mothered, you know, and part of me also resists being mothered or resents it. But women do take on that role of, well, there was a New York Times article during COVID times
based on research that women tended to take on the stresses of their husbands during COVID and they felt guilty if the husband was stressed. So the article was called Society's Shock Absorbers, which then became a title of a chapter in my book. What am I saying again? It's all one. Our social roles and our emotions tell on our physiology.
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Chapter 6: How can families foster emotional well-being in children?
What's the role of the immune system?
I guess it's to keep out foreign bodies, dangerous elements.
And?
Invite in what's healthful.
Exactly. In other words, it's the same. The role of the immune system is the same as that of the emotional system. Now, I've said they're the same system. Scientifically, they're the same system. The immune system is talking to the brain. The brain is talking to the immune system. The white cells in your circulation, the immune cells can manufacture every hormone that the brain can manufacture.
They're talking to each other. It's the same system. When you suppress your emotions, guess what? You're also suppressing your immune system. And that's the tension, what I call the tension between authenticity and attachment. Our need to belong is attachment, which is absolutely indispensable, because as infants, young children, we don't survive without attachment relationships.
We also have a need to be ourselves. So here's a little trick that I do again with my audience. Let me ask you this question, Sarah. Have you ever had the experience of having a strong gut feeling about something, ignoring it, and being sorry afterwards?
Yes, of course I have.
All right. Of course you have, and so have I, and so have just about every listener. But you just told me about your childhood. Because as an infant, you never repressed anything. We were totally connected to your body and your gut feelings. Authenticity, that connection to ourselves, is actually a huge need.
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Chapter 7: What are the implications of Gabor Maté's views on medication for ADHD?
Now I look after my own needs. In other words, she's learned from her illness. One more time, I don't romanticize illness nor recommend it, but when people are able to learn its lessons, they can actually heal very often. Conditions that doctors told them can't be healed.
Are there people, though, who hear that as another kind of judgment, that they're responsible for their illness and it's something bad they've done? You know, it piles on that.
Well, people say that, but only if they misunderstand what I'm saying, because I don't blame anybody, because nobody did it deliberately. Again, I'm talking about childhood programming. Now, how can I blame somebody if their father was an alcoholic? And in that home where their father's an alcoholic, their mother was stressed.
So the child survives by not rocking the boat, by walking on eggshells, by suppressing their own emotions, by, in fact, looking after the emotions of the parents, and they're programmed that way. And the problem with these childhood adaptations is once they get ingrained, then they persist until we deal with them. Now, do I blame somebody for having grown up in an alcoholic home?
Do I blame somebody for having been abused, perhaps? Having been abused and the natural response to abuse is to ask for help, but there's no help, or to fight, but you can't fight when you're four years old, or to escape, which you can't do when you're six years old. Do I blame somebody for being in those conditions? I don't even blame the parents.
Because they're just doing what was done to them. So in my world, there's no blame. If anybody perceives it, they're projecting their own guilt onto me. I'm not blaming them. I'm saying is, you're not guilty for causing your illness, but you can take responsibility for healing it once you understand it.
Another area that you've written on a lot, Gabor, and spoken about in terms of your own experience is ADHD. Yeah. How do you understand the relationship between ADHD and attachment?
Okay, so attachment means the sense of belonging to others. Human beings are creatures of attachment. I mean, the human infant is par excellence the creature of attachment. They don't survive for one day without people looking after them. But our attachment needs are not only physical, not only for nurturing and shelter, clothing, they're also emotional. We're wired that way.
And actually, children whose attachment needs in the emotional sense are not met, they really suffer. So we have this deep need to attach emotionally. Now, if you look at my situation... As an infant, my mother was stressed, grief-struck. She could barely ensure survival. She could not have had the calmness, the presence to attune with me.
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Chapter 8: How does Gabor Maté suggest we approach healing from trauma?
So that dissociation and tuning out is simply a defense. But when am I doing this? When my brain is developing. Attunement is essential for healthy brain development. So that the tuning out then, when there's no attunement, there's tuning out. And then... That gets programmed into my brain. And then later I'm told in my mid-50s, you've got this genetic disease. No, I don't.
I have a coping mechanism that got wired into my brain that's not creating problems. Because that's the issue with these early coping mechanisms is that later on in life they can become sources of problems. Now, does it take a Second World War? to make a mother stressed? No, it doesn't. In this society, a lot of mothers, a lot of parents are stressed. Not their fault. I'm not blaming parents.
They do their best. But people carry their own traumas into our marriage, just like my wife and I did, which means we act out our traumas. when our kids are small before we even realize they're reacting our trauma. So that means we're passing on their traumas onto them, just like I did. People can be stressed because of economic, social circumstances. People can be stressed because
The social support, the clan, the tribe, the extended family is no longer there to support them, which incidentally is how we were meant to develop. That's how we lived for hundreds of thousands of years until recently. So for all these reasons, we live in a very stressed and fractured society. Parents are stressed.
And if kids are genetically sensitive, and that's what's genetic here is sensitivity. If they're sensitive, the more sensitive the child, the more they suffer. And the more they suffer, the more they need to tune out.
So what's an appropriate response then if the wound, as you were describing it, is one of attachment rather than a genetic misfire?
I wouldn't say so much as attachment as attunement. Attunement. Okay. The parents love their kids, you know, but inside that attachment, they're not attuned because of their own stuff that I just talked about. So here's the good news. When I wrote Scattered Minds, my book on ADHD, which is my first book written 26 years ago now, I took medication from my ADHD.
It was a much shorter book, a simpler book. When I wrote my most recent book, The Myth of Normal, which is much more complex, larger, Much more research, thinking, writing had to go into it. I took no medication. In fact, when I even tried to, I thought it might help. All it did is cause me side effects. In other words, my brain has changed because I've looked after it.
Now, what I'm talking about is neuroplasticity, the capacity of the brain to develop new circuits in response to new experiences. So if we see... ADHD in particular, mental health issues in general, not as these written in stone genetic conditions, but as problems of disturbed development, then by providing new conditions, we can promote healthier development.
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