Hungarian-Canadian physician (1944–)
Gabor Maté CM (born January 6, 1944) is a Hungarian-Canadian physician and author. He has a background in family practice and a special interest in childhood development, trauma and potential lifelong impacts on physical and mental health including autoimmune disease, cancer, attention deficit hyperactivity disorder (ADHD), addictions and a wide range of other conditions.
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The addict’s reliance on the drug to reawaken her dulled feelings is no adolescent caprice. The dullness is itself a consequence of an emotional malfunction not of her making: the internal shutdown of vulnerability.
From the latin word vulnerare, ‘to wound’, vulnerability is our susceptibility to be wounded. This fragility is part of our nature and cannot be escaped. The best the brain can do is to shut down conscious awareness of it when pain becomes so vast or unbearable that it threatens to overwhelm our capacity to function. The automatic repression of painful emotions is a helpless child’s prime defence mechanism and can enable the child to endure trauma that would otherwise be catastrophic. The unfortunate consequence is a wholesale dulling of emotional awareness. ‘Everybody knows there is no fineness or accuracy of suppression,’ wrote the American novelist Saul Bellow in The Adventures of Augie March; ‘if you hold down one thing you hold down the adjoining.’
Intuitively we all know that it’s better to feel than not to feel. Beyond their energizing subjective change, emotions have crucial survival value. They orient us, interpret the world for us and offer us vital information. They tell us what is dangerous and what is benign, what threatens our existence and what will nurture our growth. Imagine how disabled we would be if we could not see or hear or taste or sense heat or cold or physical pain. Emotional shutdown is similar. Our emotions are an indispensable part of our sensory apparatus and an essential part of who we are. They make life worthwhile, exciting, challenging, beautiful and meaningful.
When we flee our vulnerability, we lose our full capacity for feeling emotion. We may even become emotional amnesiacs, not remembering ever having felt truly elated or truly sad. A nagging void opens, and we experience it as alienation, as profound as ennui, as the sense of deficient emptiness…
As children become increasingly less connected to adults, they rely more and more on each other; the whole natural order of things change. In the natural order of all mammalian cultures, animals or humans, the young stay under the wings of adults until they themselves reach adulthood. Immature creatures were never meant to bring one another to maturity. They were never meant to look to one another for primary nurturing, modelling, cue giving or mentoring. They are not equipped to give one another a sense of direction or values. As a result of today`s shift to this peer orientation, we are seeing the increasing immaturity, alienation, violence and precocious sexualization of North American Youth. The disruption of family life, rapid economic and social changes to human culture and relationships, and the erosion of stable communities are at the core of this shift.
Nature’s ultimate goal is to foster the growth of the individual from absolute dependence to independence — or, more exactly, to the interdependence of mature adults living in community. Development is a process of moving from complete external regulation to self-regulation, as far as our genetic programming allows. Well-self-regulated people are the most capable of interacting fruitfully with others in a community and of nurturing children who will also grow into self-regulated adults. Anything that interferes with that natural agenda threatens the organism’s chances for long-term survival.
Almost from the beginning of life we see a tension between the complementary needs for security and for autonomy. Development requires a gradual and ageappropriate shift from security needs toward the drive for autonomy, from attachment to individuation. Neither is ever completely lost, and neither is meant to predominate at the expense of the other. With an increased capacity for self-regulation in adulthood comes also a heightened need for autonomy — for the freedom to make genuine choices. Whatever undermines autonomy will be experienced as a source of stress. Stress is magnified whenever the power to respond effectively to the social or physical environment is lacking or when the tested animal or human being feels helpless, without meaningful choices — in other words, when autonomy is undermined.
Autonomy, however, needs to be exercised in a way that does not disrupt the social relationships on which survival also depends, whether with emotional intimates or with important others — employers, fellow workers, social authority figures. The less the emotional capacity for self-regulation develops during infancy and childhood, the more the adult depends on relationships to maintain homeostasis. The greater the dependence, the greater the threat when those relationships are lost or become insecure. Thus, the vulnerability to subjective and physiological stress will be proportio
"A society that fails to value communality — our need to belong, to care for one another, and to feel caring energy flowing toward us — is a society facing away from the essence of what it means to be human. Pathology cannot but ensue. To say so is not a moral assertion but an objective assessment.
"When people start to lose a sense of meaning and get disconnected, that's where disease comes from, that's where breakdown in our health — mental, physical, social health — occurs," the psychiatrist and neuroscientist Bruce Perry told me. If a gene or virus were found that caused the same impacts on the population's well-being as disconnection does, news of it would bellow from front-page headlines. Because it transpires on so many levels and so pervasively, we almost take it for granted; it is the water we swim in.
We are steeped in the normalized myth that we are, each of us, mere individuals striving to attain private goals. The more we define ourselves that way, the more estranged we become from vital aspects of who we are and what we need to be healthy. Among psychologists there is a wide-ranging consensus about what our core needs consist of. These have been variously listed as:
- belonging, relatedness, or connectedness;
- autonomy: a sense of control in one's life;
- mastery or competence;
- genuine self-esteem, not dependent on achievement, attainment, acquisition, or valuation by others;
- trust: a sense of having the personal and social resources needed to sustain one through life;
- purpose, meaning, transcendence: knowing oneself as part of something larger than isolated, self-centered concerns, whether that something is overtly spiritual or simply universal/humanistic, or, given our evolutionary origins, Nature. "The statement that the physical and mental life of man, and nature, are interdependent means simply that nature is interdependent with itself, for man is a part of nature." So wrote a twent
In order to heal, it is essential to gather the strength to think negatively. Negative thinking is not a doleful, pessimistic view that masquerades as “realism.” Rather, it is a willingness to consider what is not working. What is not in balance? What have I ignored? What is my body saying no to? Without these questions, the stresses responsible for our lack of balance will remain hidden.
I was diagnosed with ADHD in my mid fifties and I was given Ritalin and Dexedrine. These are stimulant medications. They elevate the level of a chemical called dopamine in the brain. And dopamine is the motivation chemical, so when you are more motivated you pay attention. Your mind won't be all over the place. So we elevate dopamine levels with stimulant drugs like Ritalin, Aderall, Dexedrine and so on.
But what else elevates Dopamine levels? Well, all other stimulants do. What other stimulants? Cocaine, crystal meth, caffeine, nicotine, which is to say that a significant minority of people that use stimulants, illicit stimulants, you know what they are actually doing? They're self-medicating their ADHD or their depression or their anxiety. So on one level (and we have to go deeper that that), but on one level addictions are about self-medications.
If you look at alcoholics in one study, 40% of male adult alcoholics met the diagnostic criteria for ADHD? Why? Because alcohol soothes the hyperactive brain. Cannabis does the same thing. And in studies of stimulant addicts, about 30% had ADHD prior to their drug use. What else do people self-medicate? Someone mentioned depression. So, if you have been treated for depression, as I have been, and you were given a SSRI medication, these medications elevate the level of another brain chemical called serotonin, which is implicated in mood regulation. What else elevates serotonin levels temporarily in the brain? Cocaine does. People use cocaine to self-medicate depression. People use alcohol, cannabis and opiates to self-medicate anxiety.
Incidentally people also use gambling or shopping to self-medicate because these activities also elevate dopamine levels in the brain. There is no difference between one addiction and the other. They're just different targets, but the brain systems that are involved and the target chemicals are the same, no matter what the addiction. So people self-medicate anxiety, depression. People se
In the rare moments I permitted any stillness, I noted a small fluttering at the pit of my belly, a barely perceptible disturbance. The faint whisper of a word would sound in my head: writing. At first I could not say whether it was heartburn or inspiration. The more I listened, the louder the message became: I needed to write, to express myself through written language not only so that others might hear me but so that I could hear myself. The gods, we are taught, created humankind in their own image. Everyone has an urge to create. Its expression may flow through many channels: through writing, art, or music or through the inventiveness of work or in any number of ways unique to all of us, whether it be cooking, gardening, or the art of social discourse. The point is to honor the urge. To do so is healing for ourselves and for others; not to do so deadens our bodies and our spirits. When I did not write, I suffocated in silence.
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The family therapist David Freeman once concluded a public lecture on intimacy and relationships by saying that if there was any one thing he hoped his audience would remember from his talk, it was the awareness that one does not know his or her spouse, his or her children. We may believe we have a perfect idea of why they act as they do, when in reality our beliefs reflect no more than our own anxieties.
The very essence of the opiate high was expressed by a twenty-seven-year-old sex-trade worker. She had HIV and has since died. “The first time I did heroin,” she said to me, “it felt like a warm, soft hug.” In that phrase she told her life story and summed up the psychological and chemical cravings of all substance-dependent addicts.
It is worth recalling here that the injudicious use of rewards and praise can be pressure tactics no less than verbal or physical coercion. As we have seen, there are three dangers with motivating by means of reward and praise. First, they feed the anxiety that not the person but the desired achievement is what is valued by the parent. They directly reinforce the insecurity of the ADD child. Second, since children can sense the parents’ will pushing them, even if under benign disguises such as gifts or warm words, counterwill will be strengthened. Third, praise and reward will themselves become the goal, at the expense of the child’s interest in the actual process of what he is doing. Children thus motivated will sooner or later learn to get by with the least amount of effort necessary to earn the praise or the reward. Short cuts and cheating often follow.
Since having a strong core self relies on acceptance of feelings, being out of touch with the emotional side puts a person out of touch with herself. What then remains to be esteemed? Only a false self, a concoction of what we would like to imagine ourselves to be and what we have divined others want us to be. Sooner or later, people come to realize that this false self — wanting what they think they should want, feeling what they think they should feel — does not work for them. When they look inside themselves, they discover a frightening emptiness, a vacuum, an absence of a true self or of intrinsic motivation.