Dr. Gabor Maté Part 1 of 3 Trauma & recovery across the lifespan: insight into addictions

[Music] as a medical doctor I'm sure your training was similar to mine in that Western medicine and for all its indubitable and miraculous attainments misses the mark in some very essential areas because what it does it separates some factors that cannot be separated in real life it separates mind from the body and it separates the individual from the environment so when it comes to understanding cancer for example it's always looking for the cause of cancer either in some external toxin like cigarette smoke or in some genetic problem individual but the fact the idea that cancer may have something to do with the person's emotional life and stresses throughout a lifetime and their psychological and social relationships with the environment doesn't enter into the thinking of mainstream medicine which is very ironic because the pioneering and great medical teacher Sir William Osler who is really still idolized in Canadian medical history one of the great medical teachers of all time in any language in 1892 when he wrote his textbook of medicine he said that rheumatoid arthritis for example is a nervous system disorder caused by worry and stress and older also said that if I want to know whether or not a man will survive tuberculosis I need to know not what's in his lungs but what's in his head now at the time he had no research whatsoever there was just no science to prove in the truth of what he was saying he was working purely on intuition and observation since his days over 120 years ago now his teachings have been fully validated by science but medical practice far from cashing out the science or even catching up with his pioneering insights completely ignores that was them and yet for example when it comes to HIV a whole number of studies have shown that survival is affected not only by the quality of the treatment which of course is important and nobody can deny the miraculous advances made in the treatment of that condition in the last decade or more but that still people's emotional stresses and their social connections have a lot to do with how well they do with the disease so that you can't separate the emotions and the psychology from the physiological that's the first point the second point is that you can't separate the individual from the environment now when it comes to understanding anything normally it comes to understanding cancer not when it comes to understanding room with arthritis not when it comes to understanding HIV not when it comes to understanding childhood developmental disorders like ADHD and all the various diseases that kids are being diagnosed with left right and center normally that comes to addiction no when it comes to anything there was an article in this February's Journal of pediatrics which is the leading pediatric journal in North America the article came from the center on a developing child from Harvard and they actually argued and it showed collated a lot of research that social and physical environments that threaten human development because of scarcity stress or instability can lead to short and physiologic and psychological adjustments that are necessary for immediate survival and adaptation but which may come at a significant long-term cost in terms of learning behavior health and longevity in other words the things that children do to survive stress in the early years not that they do them consciously but the adaptations that they are forced to to come to those same adaptations that help them survive the childhood actually make them sick later on and the case I'm gonna make for you today is that when it comes to addictions whether it comes to childhood disorders mental health issues or even physical illnesses like cancer rheumatoid arthritis and so on it's all based on childhood adaptation and that the common theme that the common source of all human illnesses after actually a disturbance in people's attachment relationships now attachment is the drive of a person to be close to another person so it's the drive for proximity the seeking of closeness for the purpose of being taken care of or for the purpose of taking care of somebody else now attachment is simply the most important human drive we are wired for attachment robotically instinctually programmed to attach for the very simple reason that is infants were the most hapless least mature and stay that way longer than any other creature in the universe so that we don't survive with that attachment nor as a species where we have survived but for our social relationships so quite contrary to the capitalist myth that people individualistic like autistic all competitive and aggressive we're just the opposite we're actually social creatures wired for love wired for closeness wired for attachment and Mendel's attachment dynamics are disturbed everything else follows now let me give you three examples of what I mean and and this perspective has been called the biopsychosocial perspective biopsychosocial means that the biology of human beings is inseparable from their psychological and social relationships so how do you explain certain things studies that show that if your parents are divorced your risk of a stroke doubles sixty years later a recent study men sexually abused have tripled the rate of heart attacks as adults not to mention multiple the rate of suicide girls whose fathers are distant emotionally are gonna menstruate earlier than girls whose fathers are close to them women followed over a 10-year period who are in the United States 17 other women married women those who that weren't happily married but didn't express their emotions in that 10-year period were four times as likely to die as those women who were also unhappy married but they expressed their emotions so the difference wasn't unhappiness or happiness the difference was did you express who you were that you express your feelings or do you suppress them how do you explain such facts how do you explain that in Canada in the 1940s the gender ratio of multiple sclerosis was pretty much one-to-one maybe slightly more women than men you know where it is now seven years later it's three or four women to every man no you can't explain that genetically because genes don't change in a population over 70 years you can't explain it by diet or climate but that hasn't changed more for one gender than the other something has happened and that's something I maintain has to do with psychological and social relationships now let me give you clear examples of this throughout the life cycle it's been known now for a while that children whose parents are stressed or more likely to have asthma some polluted areas where there is of course more irritants in the air kids are more likely to have asthma but even in those areas it's the kids of parents more stressed or most likely asthma know if the child is taken to the average physician Wester trained physician he'll be given or she'll be given a treatment for asthma in a form of inhalers no anybody here ever been to use for asthma by the way yeah okay what did you get what did they give you do you know exactly so you got a bronchodilator because your bronchi were narrowed so you got something to dilate your bronchi to open them up and you got a steroid because in asthma there's inflammation of the airways so that is cluttering and swelling and and further obstruction of the airflow hence we'll give you something to suppress inflammation which is a steroid now since this is a health care oriented audience some of you might know it's okay if you don't but what are these inhalers copies of anybody know what are they based on well the bronchodilator is a copy or an analogue of adrenaline and the steroid is a copy or analog oh of cortisol now Shirley many of you know what cortisol and NL are what are they there's stress hormones exactly in other words we're tweeting as one with stress hormones but in fact if you had a southern not somatic episode status asthmaticus where your lungs really shut down you'd be rushed to hospital you'll be given an injection of adrenaline and an infusion of cortisol well we never ask ourselves gee we're treating with the stress hormone could stress has something to do with it as a matter of fact when you think about it and and will back me up on this that the Communist medicine used all across medical practice whether it comes to inflammation of the skin the joints the intestines the nervous system certain cancers what is it that's cortisol we treat almost everything with stress hormone but we never have psoriasis you know we never ask ourselves the stress has something to do with it it has something happened to the stress regulation apparatus or that individual that we have to give them extra stress hormones in order to keep them in a healthful balance now why the children of stressed parents because the emotional states of the parents affect the physiology of the child and when the parents are stressed the kids are stressed and the stress mechanism get overwhelmed now we have to give them a to stress hormones to keep their Airways open so it's biopsychosocial you can't separate the biology from the psychological and social environment similarly in a study in Australia they looked at 500 women who had breast biopsies for suspicious lumps that had to be checked for potential malignancy and before the results came back these women underwent psychological into you when the results were collated it turned out that if a woman had a major stressful episode prior to the answer that lump that by itself did not increase the risk of the cancer zero effect similarly if a woman was emotionally isolated that by itself also did not increase the risk of the cancer zero in fact so far so good but if a woman was emotionally isolated and stressed the risk of that lump in cancers was 9 times as great as the average now the researchers being medical scientists had no way no way to explain this because to the left brain how does zero-one-zero add up to 9 how does zero and zero multiply tonight how can anybody here suggest the explanation very straightforward physiologically and yeah okay give me hazard a guess supposed to close the connection here well okay think about it when you're stressed it's not just if it's not a psychological event again this is what's so ironic because just as Osler was a great canadian medical teacher the work on stress was actually done here in canada the research on stress the research that showed for all the world what the physiological effects of stress are was done at the University of Montreal by the canadian-born so yeah hungarian-born physician like I am his name was Hansel yeh and he's the one that did the seminal work on stress he nearly won a Nobel Prize for it in fat he's the one that coined the word stress stress is a Canadian word did you know he's the one that coined it in a way that we use it today I mean ever the word existed but he's the one that adopted it to that particular adapted it to that particular usage so when you're stressed it's not just that you're upset or perturbed psychologically it's that your body homeostasis your body's internal biochemical balance shifts what happens is that in will in response to emotional messages from the brain for example if I were to scare you right now by threatening you with a weapon then those emotional triggers would we would send messages to a master gland in the brain called the hypothalamus which would then affect another gland called the pituitary which would then send messages to the rest of the body including there be messages sent to the adrenal gland on top of your kidney and then the adrenal gland would release these two hormones adrenaline and cortisol and the job of ativan and cortisol are to help you fight or to escape a flight or fight response so they give you more energy they elevate your sugar levels heart rate tense your muscles prepare you to defend yourself in a short term but in the long term those same hormones if the stress is chronic damage your body adrenaline will give you high blood pressure by the way it's very interesting in medical terms we talk about what they call essential hypertension when it comes to high blood pressure so that you know there's some identifiable causes for blood pressure such as kidney disease or other conditions rare conditions but most people with high blood pressure we say we don't know what causes it that's only because we're not listening to ourselves as I just said in medical terms we call high blood pressure hypertension think about it too much tension too much tension in people's lives too much adrenaline that's what causes high blood pressure most of the time and I know for myself you know that I I'm prone fly but they should talk about they're sure when I got very stressed my brother shows up I don't think medications I just I take my how but for sure when it happens as a sign that I'm too stressed and that how you got to deal with the stress and and my Butler shoes usually you know in a low range but you know if I permit myself if I ignore my own advice and permit myself to get over stress it goes into very high levels so over a period of time the cortisol also causes ulcerations in the intestines well this is a very interesting because the one disease that used to be understood to be a stress-related disease by me even by Western medicine were ulcers and then lo and behold in the 1990s or late 1980s we discover that there's a bacteria implicated in ulcers called Helicobacter pylori pylori and if you give antibiotics you can cure the ulcer a higher doctors say so much for the stress up stress hypothesis it's all the bacteria I guess what at age 40 40 percent of the population has the bacteria in their stomachs at age 50 50 percent to at age 60 60 percent to but the 60% of people have ulcers if the bacteria caused the austria why doesn't 60 percent of ulcers because it's the stress that makes them vulnerable for that bacterial damage you don't separate the one from the other you don't separate the one from the other so cortisol also thins your bones women for example who are depressed who got higher levels of cortisol are much more likely to foster a process and yet when he asked to reverse the society does its public educational work they never talk about stress they talk about exercise quitting smoking they talk about calcium vitamin D sunshine good stuff but they don't talk about stress it's the thing that we ignore all the time and yet I think it's the most important factor in health the in the long term excessive cortisol can also suppress your immune system let me know this so now go back to the Australian study then how do we understand this finding of isolation and stress nine times as great as average of cancer risk if one of you are stressed right now something happened you lost a job economic loss perhaps you lost a relationship and you're really upset again your stress hormones will be higher and if you all known with that if you're emotionally isolated you'd be basically obsessing and thinking and suffering over that stress for a long time and that means for a long time your body would be under siege from your own stress hormones but what if you weren't emotionally isolated what if a friend came along and said and by the way when I say this think about the work that you're doing thinking about the importance of the work that you do on the physiological level what if a friend came or somebody who cared came along came along and said well I see that you're having a hard time you want to talk about it what would happen immediately to your body to your physiology well the first thing that happens you take a deep breath yeah and air would oxygen would go to your brain you started thinking more clearly and your blood pressure will go down and your adrenaline levels would abate and your cortisol levels would fall and your body would come back to a normal physiological state then you'd be protected from the immune suppressant effects of the cortisol no wonder then that the women are isolated and stressed or nine times as likely to have cancer which also tells us that cancer is not an individual disease cancer reflects a lifetime relationship with the environment and I can give you a whole talk about that not just a physical environment so it's easy enough to say that smoking causes cancer except we all know that smoking does not cause cancer only if smoking caused cancer then everybody who smoked would have cancer but most people who smoked don't have cancer which doesn't mean that smoking doesn't contribute cancer of course it does it's a major risk factor 95% of people with lung cancer are smokers but it's not by itself the cause when you actually look at the lives of people who get cancer they also the people are suppressed their emotions and the more separate the more they suppress their emotions the less smoke they need to trigger the cancer so we have to stay away from this idea that single factors cause disease so cancer doesn't just reflect and by the way why do people suppress their emotions well they have to go back to their attachment relationships early in life because no two day old baby ever suppress their emotions or nor have you ever met one so the suppression of emotion is an adaptive response remember that that article from pediatrics it's an adaptive response to an environment that can't handle your emotions as a child then you should learn to suppress it as a way of adapting as a way of surviving but then that same adaptation becomes a cause of pathology later on think of depression you think was nothing adaptive about depression yester is what is depression what is the word Veda what does the word depression mean it means to push something down right you depress the pedal where we push down when we depress our emotions well I was gonna say what do we push down when we have depression we pushed on our emotions is their survival in pushing down our emotions there sure is if parents can't handle them then in order to maintain our attachment relationship with the parent we suppress their emotions because we sense that they're too stressed and they can't handle it and then we become depressed so that's an adaptation that later on becomes a source of pathology just as emotional self suppression potentiates cancer but that that that emotional stuff suppression begins as begins as an adaptation so as somebody very astutely said in a New York Times series on cancer couple years ago that you can no more understand but trying to understand cancer by studying the individual cell is like to understand a traffic jam by studying the internal combustion engine okay you can't do it you have to do it you have to study the inhalation shape of that individual to the environment and that's why for all I hate to tell you but all the March for cancer and all the research never gonna get anywhere they're gonna come up with billions of dollars with the research and they're going to come up with treatment modalities that extend life by a few months and in a few cases will cure some cancers but for the most part they'll never find the cause of it because they're looking in the wrong place they're looking inside the cell that's not where the cancer originates because the other thing that we know now is that cells don't exist autonomously genes don't act autonomously genes actually turned on and off by the environment the whole study of epigenetics is that is how genes are actually activated or inactivated by the environment so a study out of McGill University just within the last couple of years looked at the brains of suicide victims and they knew who had been abused as a child in who hadn't and in the brains of people who had been abused as kids there was there were particular genetic changes that was caused by the abuse and every at University of British Columbia within the last year they showed that when they looked at the genetic functioning of teenagers a whole number of genes have been affected in the teenager by stresses that the mother had in the choice first couple years of life and a bunch of other genes were affected by stresses on the father when he was a little bit older in other words when the primary relationship is just with the mother and it's the mother stresses that affects the genetic functioning of the child who later becomes a teenager whose genes are still affected by what happened to the mother in the first three years of life and then later on stresses on the father so that genes don't buy themselves explained very much unless really recognize that genes are actually turned on and off by the environment and that's what I mean again but there's a biopsychosocial understanding of human beings that is so foreign to the practice of medicine so that's the second example these women in Australia the third example of what's been called a biopsychosocial approach is if you look at a study in the New England Journal of Medicine three four years ago elderly people who've been together for a long time an elderly couple when one was hospitalized what he supposed happens to the other one they're much more likely to die the physiology they're very immune system of the one is significantly influenced by the emotional relationship with the other but all of a sudden that emotional relationship is lost death has a greater risk of occurring and many of you have seen examples I'm sure that in couples who've been together for a long time one of them dies the other one still comes very quickly afterwards this is not universal because it depends on the attachment relationship and how individuated that person is if they relied totally on the relationship for their sense of self the more susceptible they are and that reliance on a relationship was an adaptation early in childhood when you look at people's behaviors when it comes to the the spread of the HIV epidemic I remember reading a book quite some years ago now I think it was called when the ban stood still by Randy still it fills was it a journalist from the states we himself died of age later later on and in the book he describes the it traces the rise of the HIV epidemic and of course it was abetted in large measure by the incredible promiscuity of homosexual males on the west coast and elsewhere I mean it was incredible people would have sex across a hole in the wall with some total stranger but that promiscuity is not a moral failure nor is it a bad choice that people make it's actually an adaptation which is the same is true in heterosexual promiscuity there's nothing about almost sexuality that itself causes causes promiscuity because basically truly I think we're monogamous by nature the promiscuity is a desperation to be loved a desperation to be found desirable a desperation to be wanted where does that come from in every case it comes from your relationship with parents when you didn't have that sense of being wanted and loved and welcomed and accepted and being desirable and very often these guys would have very bad where they should with their fathers then of course you will engage in behaviors that'll prove to you that you're desirable and lovable and and and want it so it's an adaptation it's an adaptation that then becomes a source of pathology later on so it's with that perspective then that I think we can understand almost all and I know that sounds like a heck of a mouthful but almost all human disease and psychological dysfunction if you understand number one the importance of attachment and number two the desperate adaptations that people will have to make if their attachment needs are not met early in life now I and and and that is that is true of addictions as well which I'll come to in a moment now I first became interested in a childhood development when I was in family practice but most specifically when I myself was diagnosed with ADHD attention deficit hyperactive disorder at age 54 and what happened was that I was working in palliative care at the time I was the coordinator of the palliative care unit at Vancouver Hospital looking at the terminally ill and a social worker on the unit aged 38 at that time came to me all excited one day and said hey I gotta have coffee with you I said okay as if coffee and so we did and she told me she just been diagnosed with ADHD and she told me all symptoms hyperactivity difficulty focusing poor impulse control tuning out absent-mindedness and of course you know within three minutes into the conversation I fully understood why it was with me that she wanted to have coffee because I I completely recognized myself and everything she said now if we look at what's happening with kids these days in North America an increasing number of kids are being diagnosed with ADHD the number of stimulant prescriptions in Canada has gone up 43 percent in the last five years when I wrote my book on ADHD 12 years ago it had gone up I think five fold in the previous 15 years so keeps going up and up and up and up and up in the United States 10% of children are not said to meet the diagnostic criteria for ADHD in the States there are three million kids at least we're getting stimulant medications half a million children who are getting antipsychotic medications tens of thousands of kids in this country are probably are getting added psychotic making medications as well and psychotics like risperdal incircle such as gift we give to a doll schizophrenics to control their psychosis we're not giving it to kids to control their so causes why are we giving it to them to control what to control their behaviors well be good well be but now is a massive experiment in the chemical control children's brains we have no idea because the research has not been done of what are the long-term effects of antipsychotics and shoulders brains we have no idea what I do know is that in Children's Hospital in Vancouver they've had to establish a clinic just to deal with the side effects of the antipsychotics which include a b c t skin problems cognitive problems behavior problems and so on but we don't know what the long-term effects are because these are off-label uses the number of children being diagnosed with autism is burgeoned it's 30 for the last 40 years or i always forget about it's 30 fold in the last 40 or 34 or 40 for the last 30 was something incredible the number of kids being diagnosed with anxiety bipolar illness depression conduct disorders oppositional defiant disorder going up and up and up and up and if you ask most physicians what's causing the problem the official explanations for ADHD for example it's a genetic disease which is inherent nonsense because genes don't change in a population that quickly now you could argue that it's not that the disease is going up because that we're better recognizing it well that's true doesn't seem to be the case we're just seeing many more kids who are troubled and anybody who's been in education for 30 years or psychology will tell you that so i became interested in that when i was diagnosed myself and i just read you something from my books scattered minds how did i respond the very first day I heard about ADHD because I really I knew nothing about it now one of the traits of one of the hallmarks of ADHD is poor impulse control impulse control means that there needs to be a part of the brain that puts a damper on your urges to do things now the impulses don't arise from the gray matter they don't come from the cortex to thinking for it impulses arise from or the lower emotional centers you see something you want it for example or you're cursed to you and you want to do it right away and by the way who's like that who who has no impulse control normally very young kids because they because the impulse regulation circuits and they're being haven't have been developed yet so there needs to be circuitry to control the impulses so the job of the cortex the gray matter is not so much to initiate impulse as to inhibit impulses so in ADHD there's lack of impulse control what's another large group of adults who lack impulse control addicts when you do brain scans on drug addicts the Commons main finding is that the part of the brain that regulates impulses doesn't work which by the way is right here behind the right eye it's called the right orbital frontal cortex which is astonishing because thousands of years when people want to indicate that somebody's a little bit funny you know they go back they go in hungry we went like this in North America you go out you go like this how people know there's the right order of fun cortex but right but somehow it's the point exactly the right spot for people that lack impulse control so what we've got right now is an epidemic of impulse regulation problems amongst their kids the opposition ality their conduct disorders the Asperger's that arrests ADHD autism these all have impose regulations as one of its salient deficits so to come back to my own story with an impatience and lack of judgment characteristic of a needy I'd already begun to self-medicate even before the formal diagnosis a sense of urgency typifies attention deficit disorder a desperation of immediately whatever it is that one may desire at the moment be an object and activity or a relationship and there was something else here too well expressed by a woman who some months later came for help it would be nice to get a break for myself at least for a little while she said a sentiment I fully understood one longs to escape the fatiguing ever churning ever spinning mind I took ritalin and higher than recommended initial dose on the very day heard about attention deficit disorder on the principle that if a little bit of linen is good then more wetland would be even better and don't try this at home kids but I could do it as a physician I could do this because I went to one a palliative care colleagues and I said hey Bev I think I've a DD can give me some ritalin oh sure how much do you want secrets of the medical profession within minutes I thought you four can present experience myself as full of insight and love my wife thought I was acting weird you look stoned was your immediate comment well they're ritalin really did help me focus and within a couple days that made me very depressed that was a side effect on me that may not be a side effect on you but that sort affected me I I did see a psychiatrist that was for me diagnosed I was given dexedrine which helped me focus I was writing a medical colloquial mail the time so the decks didn't help me stay up at night and be a much more efficient workaholic and then used to be and but but right away the idea that this is some our genetic condition made no sense to me and the reason that the the Jeanette even though a couple of my kids have been diagnosed and the reason it made no sense to me that this is a genetic condition was very simple the hallmark of a DD is a tuning out the absent-mindedness but tuning out is not a disease genetic or otherwise what is tuning out what is it it's a protection it's a coping mechanism a coping mechanism against what against overwhelming stress so if I were to stress one of you right now in this environment you'd have a number of healthy options one healthy option would be to assert yourself in to fight back and say hey stop it the other healthy option we just to walk out and I didn't come here for this and just walk out and given that there is I don't know a couple of our people here in the room with you if you couldn't walk out or fight back you could always ask for help but if no help is available if you couldn't leave or assert yourself then you might tune out in order to protect yourself from the distress of the stress so the tuning out is an automatic brain mechanism soldiers do it when they wounded they'll to not to pain so they keep running away from the enemy until help arrives and then it can collapse so tuning art is a nature granted coping mechanism dynamic in the brain that allows circuits to be switched on and off and so then a real question in my mind becomes why do more and more kids these days find themselves to hang out what's causing that no the part that I didn't know the part of that I didn't know because nobody taught me medical school and I doubt very much whether you were taught this in medical school either and I doubt very much that they still teach it non medical schools is how the human brain actually develops and I'll come to human brain development you know in a few moments but let me speak to know about addictions and trauma [Music]

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Views: 165,854

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Keywords: HIV, mental health, trauma, addictions, health care, Casey House, Dr. Gabor Mate

Id: SGgwMe6y4hU

Length: 38min 27sec (2307 seconds)

Published: Mon Mar 19 2018