An interview with Dr. Gabor Maté on addiction, the ‘disease-prone personality’ and the pathology of positive thinking.
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?
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 no 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.
Predisposition to Addiction
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’s say you don’t know anything about your child’s predispositions. What kind of childhood do you want to give your child? 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.
Disease Prone Personalities
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.
Emotional isolation is a major risk factor for disease, addiction, illness, death and everything else.
As long as we are in denial of trauma, we’re never going to understand addiction. The aha moment that needs to occur is not that we recognize how bad addictions are, but that addictions are about an escape from trauma, and this society traumatizes people. Life in this society means that a lot of people are going to become traumatized. That’s the aha moment that hasn’t happened yet.
I believe people are actually looking for the truth. In terms of the mainstream media, that hasn’t happened. The aha moment where the connection between addiction and trauma is recognized is what is needed. It doesn’t have to happen in relation to me and my work—I’d love it if it was—but just in general, it needs to happen. We just keep talking about this bad problem of addiction, but we don’t want to look at what it’s really all about.
The Dangers of Positivity
You have written about The Power of Negative Thinking, and the dangers of embracing an absolute positivity. You pointed out in a recent interview that, “Not having negative thoughts is not allowing reality to intrude on your perception of the world. You never see how things are. You have to always maintain a sunny, falsely rosy view of the world so that you can’t see what doesn’t work. Lots of studies show that people who are sunny and positive die quicker of their disease. If you’re a woman with breast cancer and you’re a positive thinker, you’re guaranteed to die much quicker.”
How have you come to such a conclusion that goes against the mainstream emphasis on the power of positive thinking? What is the relationship between the power of negative thinking and cathartic experience? Is opening the door to negativity an honest perception of the reality of the world, a healthy way to purge the trauma from your own mind and soul?
When I talk about negative thinking, you must understand that I’m being tongue-in-cheek. I don’t want people to think negatively, but I put that idea out there as a way of counteracting this relentless cheerful positivity that’s often given as the answer to the world’s problems. To my mind, we don’t need positive thinking or negative thinking; we need thinking. Thinking means you don’t load your point of view with either negative or positive vibes. Rather, you are simply willing to look at what is. The positive thinkers are in full denial of reality.
Barbara Ehrenreich wrote a book called Bright-Sided: How Positive Thinking Is Undermining America. I am very much with her. When I talk about negative thinking, I’m talking about the willingness to look at reality however it is. It is not a question of whether it’s positive or negative, but rather a question of looking honestly at it.
In palliative care, in which I worked for seven years looking after terminally ill people, I had so many people say to me, “Doc, I don’t know what I’m doing here. I’ve never had a negative thought in my whole life.” And I thought to myself, that’s why you’re here. You were in denial of reality. You suffered so much as a child that the only way to survive was to suppress your awareness of pain and suppress your awareness of your own suffering. You coped in ways that ended up making you more stressed because you took on too much because you were not willing to look at what it was costing you.
That’s why I argue that relentless positive thinking is actually pathological. That doesn’t mean I want people to think negatively. I just want people to think, which to me means a willingness to face reality exactly the way it is.
Awareness of the Way Things Are
With such an array of social and biological factors affecting us, many of which we have no control over, how can we ever find the right formula for long-term health and happiness? What would you recommend to your patients?
What I recommend is consciousness. People have to be aware of where their behaviors come from, and what stressors they’ve taken on, what stressors they continue to take on, which of those stressors are avoidable, which of those stressors are not avoidable and they just have to adjust to them, but they have to do so consciously. In a society that stresses people so much, there are no individual answers. There is no individual solution.
Until people manage to change society so that society takes a different approach, suffering is going to happen. On a certain level, there is no individual solution, but in terms of what advice I’d give to individual patients, you have to live with the way it is, even as you wish it was otherwise. You can work to make it different, but so long as we are living in the world we are living in, you have to deal with the way the world is.
What people need is a lot of awareness, a lot of consciousness, so they can identify stressors and eliminate them when they are capable of doing so and find ways of living with them when they can’t. Emotional isolation is a major risk factor for disease, addiction, illness, death and everything else. They have to create conditions in their personal lives that, as much as possible, counteract the stressors that are caused by the society that they live in, and they need to be conscious and aware in order to do this.