96 - (Part 1) Dr. Maté: Unacknowledged Trauma is Hurting Us But We Can Heal Our Wounds and Our Lives.mp3 - powered by Happy Scribe

Ruthless Compassion is a podcast about people who've turned their emotional shit into fertilizer for success. It's about seeing our darkest moments as opportunities for growth and transformation.

Gabor Maté is a retired physician who, after 20 years of family practice and palliative care experience, worked for over a decade in Vancouver's downtown East Side with patients challenged by drug addiction and mental illness. The best selling author of four books published in 25 languages, including the award-winning in the Realm of Hungry Ghosts, close Encounters with Addiction, Gabor is an internationally renowned speaker, highly sought after for his expertise on addiction, trauma, childhood development, and the relationship of stress and illness. For his groundbreaking medical work and writing, he has been awarded the Order of Canada, his country's highest civilian distinction, and the Civic Merit Award from his hometown, Vancouver.

Welcome Dr. Gabor Maté to the Ruthless Compassion Podcast.

Thank you. It's nice to be back.

It's wonderful to speak to you. I remember we met many years ago when I came to a talk you gave in Toronto. You were talking about the health implications of trauma. I think that was one of the big things that you were chatting about. It was in one of the colleges. Do you remember?

Of course not.

It was a long time ago. Yeah, but I remember being really impressed by your talk and going, oh, this is a person who's got some very interesting things to say. So it's been fun to follow your progress over the last. I don't know, 15 years or so.

Well, you know, with my ADHD, memory has never been my forte, and it's not getting any better. And also I've traveled so many places I just don't recall where I haven't or have spoken, so not to take it personally.

I don't take anything personally these days. That's one advantage of age. That's true for those who don't know who you are and what you do. Maybe you could start by just introducing yourself to the listeners and talk a little bit about who you are, what you do, your background and so forth.

Sure. So I'm a retired medical doctor. I worked 20 years in founding practice and palliative care. I delivered babies and looked up to dying people and everything else in between. And then for twelve years I worked in addiction medicine in Vancouver downtown East Side, which is North America, is indeed one of the world's most dense area of severe drug use. Based on my experiences and observations and research as a physician, based also on having to do my own personal growth. Having found myself in midlife, rather depressed and aimless and sometimes even despondent, I've learned that childhood trauma childhood adversity the patterning we receive early on in life has a huge impact on how we conduct ourselves later in life, on our relationships to others, to ourselves.

And, of course, in our health, mental and physical. And I've written four books about subjects related to child development, stress and health addictions. And so on. And I've just finished writing my next book, which will be published a year from now, which kind of pulls together everything I've ever learned or thought. And the title of that will be The Myth of Normal Trauma, illness and healing in a toxic culture. Just a little topic.

You know, nothing really big.

Yeah, no big as they say.

So the first thing I want to unpack with you because I think it's a very confusing word is the word trauma, because a lot of people have perceptions of what it means. They have their own ideas. But from your perception, what is trauma and how does it come about?

It's an important question, because on the one hand, the world is banded a lot rather loosely. On the other hand, it's not really understood and not used enough, where it really matters. So people often say, I went to the movie last night. I was really traumatized. No, you weren't. You just felt upset. You felt sad. You've had some emotional pain. That's not trauma. So we use the word rather loosely. On the other hand, where it really matters, which is in education, in the legal profession and certainly in the healthcare professions, it's not used nearly enough.

It's not really understood what it is and its implications. So how I use the word trauma. And again, it's one of these words like, God, do you believe in God? Well, what do you mean by God? And everybody's got a different idea, different concepts. So, it's a bit like that with trauma. So, I have to I can tell you what / how I use the word. And everybody listening have to decide for themselves if that makes sense to them. So trauma, actually, if you look at the word origin comes from a Greek word for wound or wounding.

So trauma is a wound. It's a psychic wound. It's an emotional wound. And if you look at wounds metaphorically or actually practically what happens to them. If a wound remains open or raw, every time you touch it, it really hurts. So trauma's got this characteristic that when somebody touches on your traumatic imprint, say, you don't believe you're very smart. And somebody calls you stupid. Now it really hurts. If you realize that you're plenty smart enough, it wouldn't matter if anybody calls you stupid. You just say, Well, what's wrong with those guys?

So trauma is a wound that hasn't healed. Somebody touches, inadvertently, even. And then it really hurts that's the one characteristic of a wound of unhealed wound is just extreme sensitivity. This is where people get triggered. We can talk about the meaning of the word triggered later on. The other aspect of trauma of a wound, of course, is you get scar tissue scab falling over it that protects the wound from hurting. But it also stops you from feeling because a scar tissue doesn't have any nerve endings in it.

It also is not flexible. So the trauma makes you more rigid. It stops you from feeling your genuine emotions. And there's no growth in a scar tissue. It doesn't grow like normal tissue does, it's not flexible. So trauma's got all these characteristics, on one hand, high degree of sensitivity, pain coming up all the time. And on the other hand, numb feelings, inability to grow, restriction of your consciousness and your awareness and your emotional life. The second point is, trauma is not what happened to you. It's what happens inside you as a result of what happened to you.

So the wound happens inside you. So the trauma is not. This may sound strange to people, but trauma is not that you were hit as a child or that you were yelled at or that you abused in one from another. That's not the trauma. That's the traumatic event. The trauma is what happens to you inside as a result of what happened to you. And so what are the impacts? The impact is that you have a lifelong emotional pain. Discomfort. Trauma means that you disconnect from yourself.

Why do you disconnect from yourself to protect yourself from the pain? So people get disconnected from their true self from the gut feelings. You might develop a worldview that's either too rosy to compensate for the negative experiences or a worldview that's negative because that's the world you grew up in. So, for example, if you believed as a very famous person, did that the world is a hitsorrible place where its dog eat dog or even your friends. And it's not your enemies. Your friends want you home, they want your dog, they want your wife, they want your wealth.

Then what you're going to do is you want to be as big as possible, aggarandize yourself, be as aggressive as possible, be as selfish as possible, be as suspicious as possible. In other words, you'll be President of the United States because I just quoted Donald Trump from his autobiography. And we know what a traumatic childhood he had. So the worldview that you develop in childhood will then govern the rest of your life until you work out your trauma. So trauma disconnects you from yourself from other people gives you this wound that hasn't healed.

It makes you disconnect. It gives you a worldview that's distorted. And, of course, when it's severe enough, it even interferes with how your brain develops. And I believe that trauma underlies most chronic physical illness, autoimmune disease and malignancy. I didn't say causes it. I said underlies it, there are multiple causes, but this is a major one that medical practice ignores. Despite all the research evidence, I believe trauma underlies everything we call mental illness, addictions, depression, anxiety, ADHD, psychosis, bipolar illness, et cetera, et cetera. In other words, trauma is the big hidden piece that the healing professions don't pay enough attention to. Nor do the schools when they have all these troubled kids.

They don't see that these kids are acting at their trauma. They try and control their behaviors. And, of course, in a legal profession, we end up jailing people who are severely traumatized. Which is why in Canada, Indigenous people make up 5% of our population. They make up 30% of our J population. To this country's eternal shame, we are hurting the most traumatized people. Therefore, trauma awareness is something I'm very passionate about.

That's a very excellent answer. I think to a question I think you said not enough people ask. So, I appreciate that. So you said that people don't talk about trauma, aren't aware of trauma, resist being aware of trauma. What's going on? Why are so many people in those kind of helping or curatorial positions so adverse to acknowledging the existence of trauma? Why is it so taboo?

Well, it's really not for lack of evidence. I mean, the evidence just keeps accumulating. We've had thousands of studies. One came in just this week. I think it was from the Journal of the American Medical Association about how the more adversity you experience as a child, the more disease you're going to have as an adult. Half a million people a year, they say they die because of the inner states every year, prematurely. I think the figure is much larger than that if they understood trauma in a broader sense.

But even it was only half a million preventable deaths a year. You'd think that the medical profession would pay huge attention when it's published in their own journals, but they don't. So the question is, why not? Well, when I say they don't, I'm not talking about every physician. I'm talking by a large about the profession, about the medical schools, about the medical institutions. One, it's not simply a medical problem. Western culture in general separates the mind from the body and separates people into, like, little silos.

So there's the body here. There's a mind here. Then there's the spirit. There Indigenous cultures and traditional cultures like Chinese Chi medicine or Indiana Radic medicine. Traditional medicine cultures in North America or elsewhere, they never made that separation. For them, everything was always one. They didn't have the technical expertise and the scientific brilliance that we have, which is nothing to be sneezed at. But they also had a much broader, more accurate view of human beings. So, the Western world separates those things. The separation has been going on for hundreds of years in that medicine just reflects the general culture.

Number one. Number two, the people that go into medicine are very often very stressed people, very driven people like I was. And I'll tell you a couple of interesting studies about medical students. One is that, do you know why their level of empathy is the highest? Its when they first begin their training and it gets lower from there. Why? Because they're so stressed and so badly treated, very often. This is changing a bit. But I'm talking traditionally, until very recently, there's a structure called telomeres. Do you know what telomeres?

Okay, so telomeres are the DNA structures at the end of our chromosomes, they act like the glue at the end of our shoelace. That's the commonest metaphor that I hear. It keeps the strands from unraveling. So telomeres keep our chromosomes from unraveling. And when we're born, there are certain length as we age, they get shorter. So if we have 10,000 units of telomeres of birth by old age, we have about 4000. So as they unravel, so do we basically now not only aging shortens telomeres, but so does stress.

So, for example, the mothers of chronically ill children tend to have shorter telomeres. The shorter telomeres(?), the more likely there's going to be inflammation in your body, the more likely immune system is going to be depleted. They looked at the telomeres of medical students, compared them to telomeres of other people their age. In a year, the medical telomere shortened much more than those of their age related cohorts, which has to do with the stress of medical training. So these are people who have to utterly ignore their own traumas and stresses in order to succeed.

How would they pay attention to the traumas and stresses of their patients, especially in health care systems that don't give us a whole lot of time to spend time with each individual. And furthermore, to talk to somebody about trauma, well, that's a bit complex. If you come to me with depression, I can just go with the biology and say, okay, here's the medication. It will improve your serotonin levels. Here's some prosaz for you. Incidentally, I've taken it and it helped me. So I'm not against medications.

But, if you actually look at the meaning of the word depression, just think about it. What does it mean to depress something? Push it down, push it down. What gets pushed down in depression? All your pain, all the emotions, anger, pain, and so on. Why would somebody do that? Because they have no other way of dealing with it. This is a coping mechanism in childhood. Now, if you really want to help somebody with depression, you talk to them about where they learned and how they learned and how they keep themselves pushed down, not saying you wouldn't give them medication.

Maybe you would. Maybe you wouldn't. But you would also engage in that longer conversation. But that takes some skills, some training. And certainly it takes time. For us to give you a pill, it takes me three minutes. Is your medication now? You can take it for a few years, or maybe for the rest of your life. And there you are. And there's one more reason, who funds research. It's people with money who got money. The pharmaceutical companies, which means that a lot of the research that doctors read is actually funded by the pharmaceutical companies.

These companies aren't going to fund research on modalities that are not profitable. There's no profit to be made for them and talking to people about trauma. But there should be profit to be made by coming up with yet another antidepressants. So those are the reasons.

What about in other settings? I understand completely what you're saying about the medical profession. I also think I would add that people are afraid of talking about trauma because they're afraid of touching onto their own trauma. And if they talk about your trauma, they have to think about their trauma. But what about people like in prison systems or in shelters or in schools like you say in religious institutions? Why is trauma so taboo in those settings? Is there a similar reason?

Well, I think actually the reason you just gave, which I usually include, but neglected to this time is actually the one. Once you recognize trauma, you can't help but recognize it in yourself, and that's going to be painful. And a lot of the people in power are often very driven, very compulsive people who actually want power to compensate for their own inner lack of worth, which they don't even want to acknowledge. So for them to acknowledge trauma is to actually re-undermine their own position. And then what happens, of course, is when you don't acknowledge it, you end up imposing it other people.

So, then this happens in churches, religious institutions, in spiritual movements, certainly in politics, everywhere. Furthermore, if you look at something like the legal profession, well, they don't know this, but the whole bread and butter, at least in the criminal justice system, is based on dealing with traumatized people and punishing them. The police forces is the same thing. So, there's a kind of an investment in not looking at trauma in education. Education just takes part in the general social lack of awareness of trauma. But if the average teacher understood that the kid with ADHD who is acting out or is having a poor impulse regulation with a kid who's being oppositional or the kid who's got learning difficulty is actually manifesting trauma.

I think they'd be happier if they knew it. But there's nothing in education that prepares them for. The average teacher does not get a single lecture on trauma even though so many of the children they are going to deal with are traumatized children

I completely agree. And getting back to this thing about people having a hard time facing their own trauma. I'm sure you've seen this where people get angry at those who express their trauma because it's threatening to them. Right.

So, when we talk about punishing people with trauma, it makes me feel like it's very easy for somebody who has their own unacknowledged trauma to become punitive to someone who is expressing their trauma more overtly because the person who's trying to hide their trauma is threatened both by having to perhaps face their trauma and possibly be exposed as someone who has their own secret shameful trauma.

A lot. Because I worked in the addiction field, and there's so much ostracization. And punishment and demeaning and judgment that's projected towards addicted people. Why? I think it's because of the reason you suggest is that addiction is something that affects so many of us on one level or another, we just don't want to look at ourselves. So now we can feel superior to these ones who are living in the streets and who are using needles. Those of us that are addicted just to food or to work or to pornography or shopping, shopping, say, or to power. Any of those.

We can feel superior to these abject drug addicts. We're not different. We're just not as hurt as they are. And maybe we're socially more advantaged. But it certainly allows us to feel superior. And it gives us a reason not to look at ourselves.

It's really sad. Like you said, the people who are the most vulnerable are the ones who are being ostracized and punished the most. And it's so backward.

Absolutely.

So I remember that you were talking in your wonderful movie, The Wisdom of Trauma, about all these different aspects of trauma. And I was wondering, why do you think that some people who have trauma are more self-destructive, whereas other people with trauma tend to be more destructive toward others? I've seen both in my psychotherapy practice over the last 20 years. What do you think is going on there?

Partly it's a gender issue. In general, I think you'll probably agree with me or will you? That men tend to act out more and women tend to act in more? In other words, this is not true in every case but we are talking in general women tend to internalize their trauma more. By the way, do you know why women have 80% of autoimmune disease? It's because they internalize their trauma. Why do they have more depression and anxiety? Because they internalize their trauma, whereas men, they tend to act it out.

Now, some men who act out their trauma, they're rewarded for it, as we've already said, with power and position and privilege. How many dysfunctional bosses are there out there who really terrorize their employees? But they make a lot of bucks. So this culture, in that sense, rewards the acting out of certain traumas. And it culturally ingrains in women the need to act in their trauma and even to absorb the traumas of their men. And that's why I believe women have more autoimmune diseases much more. I mean, it's not even comparable.

Let me give you an interesting study that was done here in Canada. Generally, it's known that people in their 40s, 50s who have bypass surgery, coronary bypass surgery for blocked arteries. Men tend to do better than women. Now, one of the reasons is they did this study when a man is coronary bypass surgery, usually there'll be a woman afterwards who'll look after them. When a woman is coronary bypass surgery, she goes back to taking care of everybody else. That's not a genetic gender thing. It's an inculturated gender manifestation of patriarchy.

So partly it's cultural, is what I'm saying. You're saying the patriarchy is making women sick. Chronic caretakers have suppressed immune system, shorter telomeres, more inflammation in their bodies. We know this from all kinds of studies.

I've certainly seen that in my practice.

And this culture expects women to be the caregivers. Let me tell you an interesting study that was done in Sweden from my new book I looked at it. I don't know how many thousands of studies, now this one really jumped out at me. If a woman has pre partum depression, depressed during the pregnancy, that increases the chance of a late miscarriage. If the husband has depression while the woman is pregnant, that increases the chance of an even earlier miscarriage. Now, how would we explain that? Why does the man's depression have more of a negative effect than the woman's depression?

Because the woman absorbed the stresses of the man. And this is what women are expected to do in this culture. So this is a cultural thing. I haven't answered your question fully. You asked why do some people, I said partly it's a cultural gender thing that's a major part of it. Others just have to do with the kind of families they grew up in and the kind of rules that were made to take on in their families of origin. If you're one of these children that had to take on the caregiving role to your parents emotionally, then you'll be acting in your trauma more than you're acting it out.

Right. And I guess some kids get to be labeled the bad kid. They get to carry that in their adult life.

Absolutely. Although it's very often the good kids that I worry about more because they're the ones who are internalizing everything, and they're the ones who are going to show up with malignancy or autoimmune disease or very often severe depression and so on.

Well, speaking of kids, I've been thinking a lot about children these days because everyone's talking so much about how the pandemic has affected children. But even before the pandemic, I was getting all these requests from universities and colleges around where I live to go and be a psychotherapist for the youth because they were in a crisis in the colleges. This is pre pandemic. So I'm just wondering what your take on this crisis in our young people is coming from these days. Is it trauma in your mind?

Well, trauma and stress. One thing we can throw out right away is any idea that we're dealing with genetic conditions. There's nothing genetic about anxiety or depression and stuff we can talk about. Why not? But there just isn't no genes have ever been found for any of these conditions, although the belief is very widespread that these are genetic problems. If something is getting worse in the population over a short period of time, we know that it can't be genetically because genes don't change your ten and 20 years or 30 years or 40 years, 50 years.

If a lot more kids are being diagnosed with anxiety or depression or ADHD. It can't be the genes, can it people? Because genes don't change in 100 years or 500 years. Never mind, ten years or 20 years, there's going to be something in the environment. So what's going on in the environment? So there are two ways that you can hurt people. You can do it to overt trauma, by really wounding them by doing bad things. Or you can do it by denying their needs and I talk about this in my new book. What are the needs of young human beings and how is this culture meeting their needs? Now, if you look at what are the needs of human beings, you actually have to look at how human beings evolved. How did we evolve? In small band hunter-gatherer groups where we lived for millions and hundreds of thousands of years, including our own species? We've been around 150,000 years, 200,000 years, something in that range virtually even for just in the life of our own species, until about the last 10% of our existence. So if human beings, homo sapiens has existed for an hour, except for the last six minutes, we lived in hunter-gather groups where children were with their parents all the time, looked after by multiple adult caregivers.

They were not put down when they were crying, they were held all the time. They were not hit. They were not separated from their parents for most of the day and with the whole community looked after them. That's how we evolved when you take any species, when you take it out of its environmental niche and put it into a different, less favorable environment, it can survive but it's not going to do as well. This culture separate children from their parents very early. In the United States, 25% of women have to go back to work within six weeks of giving birth or two months of giving birth.

You know what that is? That is a major trauma to the child. The child needs to be with that mom for years. I'm talking about ideally, now, if we had decent substitute institutions and modalities, that would be fine but we don't. Children have a need not to be put down. We teach our parents to let the kids cry out, to go back to sleep. It's a terrible insult. When I say insult injury to the child and to the child's brain development. Try telling a mother cat to ignore the baby's crying or a mother bear and then you find out what anger really is all about. So in our society, we're giving parents all kinds of wrong advice. We're telling parents, if the kid is angry, separate from them, give them a time out. Don't accept the child's feelings. What does the child learn? It learns that in order to connect with the parents, I have to suppress my anger, push it down, depress it. Do we wonder why so many more kids have depression these days. In the absence of healthy adult relationships, children will gravitate to any relationship to whoever's around who's around for kids most of the time these days? Other kids.

So kids form relationship with other kids that are way too important. I'm not saying they shouldn't have friends, but the friends shouldn't be as important as they are because they should be with healthy adults. But when those healthy adults are gone from the child, most of the day, the kid connects to other kids. Now you have immature creatures who cannot possibly provide that unconditional living acceptance that human development requires so this society betrays the child in a major way, not even to mention how we get them to addicted to devices by the time they are two years old. Deliberately designed devices consciously constructed to cause addiction. I'm not being paranoid. I'm looking at research literature. We get them addicted to foods that are bad for them, deliberately concocted foods that are consciously created to addict kids. I'm not being paranoid. I'm looking at the research literature, and the more kids are not having their emotional needs met, the more they're going to turn to their devices. So we live in a society that could also be designed to deny the child's needs.

Well, of course, you can have a lot more anxiety. Of course, you can have a lot more ADHD. Of course, you're going to have a lot of depression. What else do we expect? It's a lot to take in. And I haven't even talked about the prenatal stress on women and what that does to babies. And I haven't even talked about birth practices that interfere with healthy mother and child bonding. Oh, boy, in my new book, which I'm not trying to advertise too much because it won't be up for another year. But that time your readers will have forgotten about it.

But the point is that I write about this stuff because there's so much research now and also because it's so obvious but not paying attention.

It's a funny world that we're living in where the things that are the most important are the things that are ignored and the things that are so bad for us, like all the consumerism and addiction are the things that are glorified.

Well, there is a good reason for that. Somebody profits from it. There's a big bucks in getting people addicted to junk food or to devices. There's no bucks and getting people to have healthy relationships.

And of course, the big bucks is also the addiction, right? So whoever is pursuing the big bucks is addicted to that instead of something meaningful for themselves from their own trauma, probably.

Well, that's certainly true. It's just that some people some traumas or some trauma implants are rewarded by this society. And if you're a power seeker or a profit seeker and you don't care at what cost, then you're going to sell junk food to people that kills millions of people worldwide every year, which is what happens. It's just objectively true. You're going to make drugs that are going to cause overdoses, and you're going to tell doctors that these are not addictive so you can make a profit. As we saw in the case of Purdue Pharma and Sacred Family, you're going to make devices that have documented diminished children's mental health.

You're going to pollute the environment. You're going to do all that if you addicted to profit.

Yeah.

That was part one of my interview with the remarkable Dr. Gabor Maté, I'm Dr. Marcia Sirota. And this is the Ruthless Compassion Podcast. Please stay tuned for part two of this interview coming soon.