Dr. Gabor Maté was born in Budapest, Hungary in 1944. He emigrated to Canada with his family in 1957 and settled in Vancouver. For over twenty years, he ran a private family practice, and for seven years was the Medical Co-ordinator of the Palliative Care Unit at Vancouver Hospital. Currently he is the staff physician at the Portland Hotel, a residence and resource centre for the people of Vancouver’s Downtown Eastside, one of the poorest, most drug-ridden neighborhoods in North America. Gabor Maté is the author of three books: When the Body Says No: The Cost of Hidden Stress; Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder;and, most recently, In The Realm of Hungry Ghosts: Close Encounters With Addiction. The interview was conducted by James FitzGerald. Part 1/2
THE BELIEVER: How does your thinking differ from conventional ideas on addiction? 
GABOR MATÉ: Conventional thinking on addiction is based on two assumptions: first, that addictions are a matter of choice; an ethical lapse, a stupid decision that needs to be deterred by Draconian punishments. Secondly, there is the assumption that addiction is a brain disease – a genetically determined, inherited disease. This is the view which dominates medical thinking.
BLVR: If we believe solely in the “addiction gene” it absolves us of responsibility. 
GM: Yes, it takes society off the hook. It means we don’t have to look at social policies and conditions that facilitate addictions. People still believe that childhood conditions like ADHD are genetically determined. They can’t be; if they were, we wouldn’t see them arise in such great numbers. So the medical approach continues to defy scientific information and fundamental logic. The new science of psychoneuroimmunology shows the connection between the emotional systems and the hormonal and immune systems. Emotions actually do have an impact on physical health. It shows up in epigenetics, the science that shows that genes are not dominant but they are turned on and off by the environment. All this research is new but it’s not so fresh that people haven’t had an opportunity to absorb it. I believe the source of addiction is not to be found in the genes or in individual choice but within the addict’s particular history, within a particular multi-generational family within a particular culture.
BLVR: Why isn’t the latest addiction research being taught?
GM: There are few professions as profoundly conservative as medicine. When people invest their whole lives and careers in a certain point of view, they are not going to give it up just because new research comes along. If new ideas do break through, they will be taken up by young physicians. But the people who control the gates of the medical schools are not going to surrender their perspectives easily. If they did, they’d have to admit that for three decades they practiced medicine that was deficient. This applies not just to addictions but physical illness. The mind-body separation is innate in medical practice. Clinically, physicians treat bodies, not an individual with a life history. Physicians think that whatever occurs, whether addiction, mental illness or cancer, must be separated from a person’s actual life. I’m fighting the idea that people can be severed from their lives — not only the mind from the body, but individuals from their environment. The gates of the medical schools are being slowly forced ajar, but it’s going to be a long process.
BLVR: Why do we stigmatize drug addicts so severely?
GM: In my work, I try to confront the stigmatization of mental illness in general and addiction in particular. First, why are we so uncomfortable with mental illness? Because we’re all crazy to some degree. Some people are clinically depressed, but most of us are not free from feelings of intractable sadness or loss. People are afraid of their dark sides. In this society — rife with addictive behaviors that go way beyond drug addiction — we project our discomfort with ourselves onto the addict. It’s like scapegoating in the Bible, where the sins of the community are put on a sacrificial goat and we chase him into the desert. That’s what we do with drug addicts.
BLVR: Of all addicts, drug users seem to be regarded as the lowest of the low.
GM: Exactly. There’s a continuum of addictions. You can be addicted to profit and kill the earth as a result, and that’s OK; but if you fill your own body with drugs, that’s not OK. As most of us aren’t drug addicts, but have other addictions, we can safely stigmatize the drug addict. He or she represents the ugly part of us we don’t want to acknowledge and deal with.
BLVR: Nancy Reagan’s mantra “Just Say No” is still a popular admonition to addicts. You prefer to say: “Give them something to say yes to.” What do you mean?
GM: Whether an addiction is behavioral or substance-related, it always serves a purpose in a person’s life. Addiction is always about soothing pain, dealing with stress, gaining a sense of meaning and connection, or a temporary relief from unbearable mind states. These are all things we want in our lives. But the addict doesn’t not how to get them except through addictive behavior. When we say, “Just Say No” we are saying say no to pain relief, meaning, vitality, dealing with the stress. The American physician Vincent Felitti puts it well: “Dismissing addictions as ‘bad habits’ or ‘self-destructive behavior’ comfortably hides their functionality in the life of the addict.” So the question is: what function is the addiction serving? I’m not saying it’s a good thing — the addiction creates more suffering and pain than it can possibly soothe — but for the addict, drugs represent the only way they know how to relieve distress. We should ask not why the addiction but why the pain? If we are going to ask the addict to give it up, let’s give him some other way of coping with pain, emotional loss, spiritual emptiness, isolation. Let’s give them safer environments where they can find qualities and resources within themselves, or help them learn how to ask for them from the environment. It’s only in relationships with compassionate others they can start to develop a healthy relationship with themselves. 

Dr. Gabor Maté was born in Budapest, Hungary in 1944. He emigrated to Canada with his family in 1957 and settled in Vancouver. For over twenty years, he ran a private family practice, and for seven years was the Medical Co-ordinator of the Palliative Care Unit at Vancouver Hospital. Currently he is the staff physician at the Portland Hotel, a residence and resource centre for the people of Vancouver’s Downtown Eastside, one of the poorest, most drug-ridden neighborhoods in North America. Gabor Maté is the author of three books: When the Body Says No: The Cost of Hidden Stress; Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder;and, most recently, In The Realm of Hungry Ghosts: Close Encounters With Addiction. The interview was conducted by James FitzGerald. Part 1/2

THE BELIEVER: How does your thinking differ from conventional ideas on addiction? 

GABOR MATÉ: Conventional thinking on addiction is based on two assumptions: first, that addictions are a matter of choice; an ethical lapse, a stupid decision that needs to be deterred by Draconian punishments. Secondly, there is the assumption that addiction is a brain disease – a genetically determined, inherited disease. This is the view which dominates medical thinking.

BLVR: If we believe solely in the “addiction gene” it absolves us of responsibility. 

GM: Yes, it takes society off the hook. It means we don’t have to look at social policies and conditions that facilitate addictions. People still believe that childhood conditions like ADHD are genetically determined. They can’t be; if they were, we wouldn’t see them arise in such great numbers. So the medical approach continues to defy scientific information and fundamental logic. The new science of psychoneuroimmunology shows the connection between the emotional systems and the hormonal and immune systems. Emotions actually do have an impact on physical health. It shows up in epigenetics, the science that shows that genes are not dominant but they are turned on and off by the environment. All this research is new but it’s not so fresh that people haven’t had an opportunity to absorb it. I believe the source of addiction is not to be found in the genes or in individual choice but within the addict’s particular history, within a particular multi-generational family within a particular culture.

BLVR: Why isn’t the latest addiction research being taught?

GM: There are few professions as profoundly conservative as medicine. When people invest their whole lives and careers in a certain point of view, they are not going to give it up just because new research comes along. If new ideas do break through, they will be taken up by young physicians. But the people who control the gates of the medical schools are not going to surrender their perspectives easily. If they did, they’d have to admit that for three decades they practiced medicine that was deficient. This applies not just to addictions but physical illness. The mind-body separation is innate in medical practice. Clinically, physicians treat bodies, not an individual with a life history. Physicians think that whatever occurs, whether addiction, mental illness or cancer, must be separated from a person’s actual life. I’m fighting the idea that people can be severed from their lives — not only the mind from the body, but individuals from their environment. The gates of the medical schools are being slowly forced ajar, but it’s going to be a long process.

BLVR: Why do we stigmatize drug addicts so severely?

GM: In my work, I try to confront the stigmatization of mental illness in general and addiction in particular. First, why are we so uncomfortable with mental illness? Because we’re all crazy to some degree. Some people are clinically depressed, but most of us are not free from feelings of intractable sadness or loss. People are afraid of their dark sides. In this society — rife with addictive behaviors that go way beyond drug addiction — we project our discomfort with ourselves onto the addict. It’s like scapegoating in the Bible, where the sins of the community are put on a sacrificial goat and we chase him into the desert. That’s what we do with drug addicts.

BLVR: Of all addicts, drug users seem to be regarded as the lowest of the low.

GM: Exactly. There’s a continuum of addictions. You can be addicted to profit and kill the earth as a result, and that’s OK; but if you fill your own body with drugs, that’s not OK. As most of us aren’t drug addicts, but have other addictions, we can safely stigmatize the drug addict. He or she represents the ugly part of us we don’t want to acknowledge and deal with.

BLVR: Nancy Reagan’s mantra “Just Say No” is still a popular admonition to addicts. You prefer to say: “Give them something to say yes to.” What do you mean?

GM: Whether an addiction is behavioral or substance-related, it always serves a purpose in a person’s life. Addiction is always about soothing pain, dealing with stress, gaining a sense of meaning and connection, or a temporary relief from unbearable mind states. These are all things we want in our lives. But the addict doesn’t not how to get them except through addictive behavior. When we say, “Just Say No” we are saying say no to pain relief, meaning, vitality, dealing with the stress. The American physician Vincent Felitti puts it well: “Dismissing addictions as ‘bad habits’ or ‘self-destructive behavior’ comfortably hides their functionality in the life of the addict.” So the question is: what function is the addiction serving? I’m not saying it’s a good thing — the addiction creates more suffering and pain than it can possibly soothe — but for the addict, drugs represent the only way they know how to relieve distress. We should ask not why the addiction but why the pain? If we are going to ask the addict to give it up, let’s give him some other way of coping with pain, emotional loss, spiritual emptiness, isolation. Let’s give them safer environments where they can find qualities and resources within themselves, or help them learn how to ask for them from the environment. It’s only in relationships with compassionate others they can start to develop a healthy relationship with themselves.