Fraser Health Ethics Conference: Gabor Maté - Science and Compassion in Understanding Differences

it's a pleasure for me now to welcome Gabor maté a to the stage many of you will have known his work he's written on everything from addiction to mind and body wellness rather than going for the quick fix dr. Mattei usually invites us to think big and to think about the complexity of each and every one of our lives and making meaning from research case histories and offering our own experiences and insights and we're about to hear him speak to science and compassion in understanding our differences please welcome Gabor maté a so just to get to my own feelings as I was listening to Brooke I've certainly witnessed everything she described the lack of empathy the other blindness to the a person's actual experience the evident lack of compassion and I've seen this in emergency words in Vancouver I've seen it in psychiatric wards I've seen it throughout the hospitals I say evident lack of compassion because it's not true that there's a lack of compassion everybody's actually trying to do their best the nurses the physicians counselors who dealt with Jeremy I'm sure within the limitations of their own perspective were actually trying to do their best but that's still easily the frustration because of the key word here's the limitations of their perspective the problem is not lack of compassion or lack of a good will or a good intention the problem is that the system in which were trained in which we operate entirely lacks perspective about what's really going on if you get if you've got something like the current overdose epidemic we're in the United States every three weeks they have the equivalent of a 911 every three weeks and 911 happens in the u.s. in relationship the number of people dying and yet where's the public outcry where's the dedication of resources and public energy that the one Unitarian 9/11 provoked in the States and similarly in Canada the numbers of people are dying or increasing and the solutions have been evident for decades for decades we've talked about harm reduction for decades we talk about sous-vide injection sites and yet until very recently the Government of Canada fought the one injection site that existed and now governments are scrambling to open them because finally as a result of human sacrifices human sacrifices that were sacrifices not just to addiction but also to our social and systemic ignorance and willful ignorance about what needs to be done these people have had to lose their lives and Jeremy's loss of life wasn't simply due to heroin it was also due to a system that never got his experience where the experience of a councilor who actually was empathetic and and and wasn't judgmental had to be especially unique experience but it did not characterize the man's or the family's trajectory through the healthcare system well why is it that compassion and understanding have to be a unique experience why isn't it that that's just what the system delivers that we all delivered automatically and smoothly and as a matter of course it's not because we don't try our best it's not because we're not wanting to help but if we are wanting to help and if we're trying to do our best then what is lacking then clearly what is lacking is its perspective and so this is called a provocation and I tell you I'm personally provoked by having only half an art it because this is the kind of material that I would deliver over two days in depth and so all I can really do is provoke your your curiosity all I can little provoke your interest and perhaps provoke you to recognize that what you've understood to be the case might not be the case so that you'd be willing to look at it more deeply now what is the source of that disconnect well given that people that won't do their best and yet people are dying who don't have to die what is the source of the disconnect what is the source of the apparent lack of empathy the source of it I think resides in something that an author and a arsh with survivor Primo levy wrote in one of his amazing books on the genocide that he experienced he said our difficulty or inability to perceive the experiences of others is all the more pronounced the more distant those experiences are from ours and time space or quality we can be moved by the tragedy of mass starvation on a far continent after all we have all known physical hunger if only temporarily but it takes the greater effort of emotional imagination to empathize with the addict I'm saying this myself because we think that the experience of the addict is so far removed from ours well let me see if that's really true or not or whether there's just an actual fact of denial so let me give you a definition of an addiction addiction is a complex process but it's manifested in any behavior any behavior that a person finds temporary pleasure or relief in and therefore craves but cannot give up despite negative consequences so the essence of addiction is craving pleasure relief in the short term negative consequences in the long term and inability to give it up despite the negative consequences now notice that I said nothing about drugs these behaviors could have to do with drugs and silient li they do but they could also be sex gambling TV watching internet pornography eating shopping work video games gambling of course there's a casino just around the corner here and so let me ask you to consider now from that perspective from that definition how many of you would acknowledge that at one time or another in your life you had an addiction to anything I don't care what just raise your hands okay you got the vast majority here now let me ask you the next question I'm not gonna ask you what you were addicted to or when or for how long but I'm gonna ask you to consider what did you get from it what did it do for you temporarily that you wanted to create and if you were willing to say so again nobody's gonna ask you about what or when or how long but just what was the benefit the so-called benefit that you got from it for a moment okay so you hand is out at the back that you have to shout out because I have trouble hearing what go ahead pleasure okay thank you yeah numbing okay numbing thank you but take one more anybody yeah comfort all right let's just look at those three things pleasure is something we all want in fact it's necessary for life it's necessary for life the real question is given God's green earth and everything in it why did you lack pleasure in your life numbing when do people have to be numbed so we go to the dentist this is when you're gonna have pain so it's a response to pain and comfort again is something that's a totally normal normal human aspiration the problem is that you were in so much discomfort that you don't know what to do with it and so that we see that the addiction is not a choice that you made nor is it a disease that you're inherited it was an attempt to solve problem the problem of pain so he had to be numbed the problem of lack of pleasure of alienation of boredom the problem of discomfort and if we understand if we want to understand why you lacked comfort why you lacked pleasure why at pain we have to look at your life and these factors always goes back to childhood trauma in every single case this is what we don't learn we don't learn that human experience is shaped or human functioning is shaped by human experience in the world and so that the average nursing student does not hear the root trauma in four years of education the actual the average medical student nevermind that they don't get a single lecture in trauma that they don't get a single course in it they don't even hear the word trauma in four years of medical education so that when Jeremy shows up at the at the counselor's office or the physician's office or the or the nursing station nobody realizes that - looking at a traumatized human being they think they're just looking at an addict who's behaving in certain ways willfully and out of choice no I just got an email this morning as I was sitting here at the table it's in the brook dark yet another study talking about pain that shows that people with adverse childhood experiences are much more likely to have chronic pain as adults and I could go into the physiology of that it's very straightforward but nobody teaches you that so all you see is a drug seeker you don't see a traumatized person whose physiology is responding to painful childhood experiences and so what I'm saying is that the difficulty that we have is that we have trouble understanding people with different formative experiences than ours and precisely because if I look at something like addiction as you could see from the show of hands here it really is a matter of a spectrum and we have just about all of us on a spectrum but precisely because we're all on a spectrum and we think we could deal with this in our own life we say well why couldn't they deal with erol every full of judgment why couldn't they deal with it if you've never been profoundly depressed you don't have an idea or it's like to be depressed you have no idea what it's like to have life be utterly drab and meaningless and and and and and threatening to the point that you might even want to leave life the pointer to kill yourself because it is on a spectrum and we've all felt down sometimes we've all felt units sometimes what we snapped out of it and we have no idea what it's like to be deeply into it we're a choice no longer exists and so we have great difficulty understanding people whose brains give them a different experience of life and I'll say something about the human brain in a moment there's also something else that comes into it there's a new word I learned recently called intersectionality how many of you've heard the word that's great I did a few of you have I haven't done to three weeks ago to tell you the truth but it is what it means we're all human beings we all share that we all share our our species being as you as homo sapiens but then we start to have different experiences now most of us in this room as I look around most of us not all of us but most of us are Caucasians in background so that intersects we have that in common it's difficult for Caucasians living in this society to recognize not not being a Caucasian in if society gives you a completely different life experience so if you're an Aboriginal native and the natives of course make up a disproportionate section of the care receiving population especially may the comes to mental illness and addiction or when it comes to the criminal justice system I mean native Canadians make of aboriginal Canadians make up for 5% of the population but 25% or 30% of the jail population the same with addiction we have no idea what their experience is like we think they're living in a sane world because we live in the world they think they live in is we think they live in the same world but let me tell you they don't live in the same world they do not live in the same world there's a black American psychologist called Kenneth Hardy who talks about what he calls socio-cultural trauma and he talks about the experience of a black man walking down a street in the States is not the same as that of a white man walking down the city in the states though the white man doesn't see that he assumes that his experience is the universal experience so what does that black guy so upset about but he doesn't have the experience of not knowing when he might be beaten up by the police and what that's does to his sense of self and so we have trouble imagining the experience of others of a different race we have trouble imagining the experience of somebody with a differently functioning brain now let me tell you something about the brain we think the human brain is the same for everybody no it isn't I'm gonna quote you from an article appeared in the journal Pediatrics which is the official Journal of the American Academy of Pediatrics the articles from Harvard at the University Center for developing child and what is so frustrating is I traveled on North America in the world talking about these matters this evidence that I'm gonna quote you has been published in major medical journals the average physician never here is it it's absolutely amazing how there's a screen analogical screen that excludes reality from our perceptions we keep talking about evidence-based practice but we're not looking at some of the most important evidence well let me ask you a question I just be honest here how many of you have heard about the adverse childhood experiences studies ok the adverse childhood services studies they're just the most important studies ever done from the point of view of your work the most important studies ever done and maybe 15 20 percent of you have heard about them now that is not your personal failure I'm talking about how the system excludes evidence that doesn't match its biases the other childhood experiences please look them up tonight you can find them on this it's been published in major medical journals it's not like that it's not like they're isolated somewhere in some weird journals you can find in a major medical journals major psychological journals the CBC has had a whole series on it on the under program ideas and most people have never heard about them that's miraculous how come we've never heard about them what is it that excludes this it excludes what excludes this kind of information is that they don't meet the suppositions of the system now the adverse childhood experience studies the AC studies they looked at 18,000 adults in California more than half of them had been to University the majority Caucasians and a disaster expense was physical sexual or emotional abuse apparent dying a parent being addicted apparently mentally ill violence in the family my parent being jailed neglect or a divorce and for each of these adverse childhood experiences the risk of addiction went up exponentially they multiplied each other by the time of male child had said six of these his risk of being addicted as a substance using injection using adult was forty six hundred percent greater than that of a male child with no such experiences the risk of addiction goes up the risk of mental illness goes up depression of ADHD of anxiety of antisocial behavior of relationship problems of sexually transmitted disease of autoimmune disease and of cancer and most of us have never heard of them and these studies have been repeated in Alberta in Finland in other countries always exactly with the same results now to go back to the brain and listen III understand that especially when I'm short of time I tend to speak rather urgently with a fair bit of heat and my tone I hope you don't feel assaulted I'm simply very keen to get as much information and as and to provoke is deeper shift of perspectives that possibly can in a very short period of time anyway here's what this Harvard article says about the brain did you know this let me tell you these two paragraphs I'm gonna read you now they're not controversial they are simply the summary of decades of brain research and they're not taught in the medical school or the nursing schools the average health care practitioner never hears this stuff not because it's not true but because it threatens the reigning paradigm too much so how's the brain constructed the architecture of the brain is constructed to an ongoing process that begins before birth continues into adulthood and establishes either a sturdy or a fragile foundation for all the health learning and behavior that follow and go through that paragraph again the architecture the brain is constructed to an ongoing process that begins before birth what does that mean that means that the kind of experiences that the pregnant woman has during gestation will already affect the brain of the infant which means that the infant who is just stated in a womb where the mother is stressed abused poor discriminated against is are gonna have a brain disability because of the impact of the stress hormones on the developing brain of the child and so consider that when you're looking at a human being and you think they're just like you not necessarily not necessarily and the difference might have begun already when they're in the womb and you know I could decide you 300 different studies showing the evidence for that so this process begins before birth continues into adulthood and establishes either sturdy or a fragile foundation for all the health learning and B fear that behavior that follow they didn't say some of the health learning and behavior that follow they said all the health learning and being here that thought behavior that fall which means when you're looking at a human's behavior and you're judging it consider what kind of experiences form the brain that that drives that behavior what kind of experiences look at the a stays that most of us have never heard about and then they say the interaction of genes and experiences literally shapes the circuit of the developing brain that means that the kind of if you look at addiction and which circuits involved in addiction or depression or anxiety or ADHD or aggression or anything else you have certain specific well identified brain circuits which I don't have the time to delineate for you right now but the circles of impulse regulation for example that stops you from acting out in a certain way that they have to develop if you look at addicts the Communist brain scan finding is the abnormality in the part of the brain that regulates impulses so they can help themselves from acting out their urges but what shapes those circuits is early experience because which brain chemicals will be present in what quantities and which circuits will connect and which will not depends on the early experiences beginning in utero and to go on so the interactions of genes and experience is not changed by themselves but the interactions of genes and experiences literally shapes to circuitry developing brain and is critically influenced by the mutual responsiveness of adult-child relationships particularly in the early childhood years which means that the key factor in shaping the proper development of the brain is the quality of the responsiveness of the adult world to the needs of the infant that's what shapes the physiology of the brain so when you have somebody who's not able to have pleasure who's in so much discomfort that they don't know what to do with it who's in so much pain that they have they have to numb themselves or they lack impulse control so they act out you're not looking at a bad person you're looking at a person who's early experiences shape their Bane in certain ways that's what you're looking at and any judgment or lack of empathy that you have doesn't come from your own it comes from two sources I suggest to you it comes from first of all your lack of awareness of what that person is really experiencing because they're experiencing what you haven't at least you haven't fully looked at it in yourself and your and they're experiencing something that your education did nothing to prepare you for because you've been taught about behavior and behavior control and you can talk about symptom control and even thought about pathology but you've not been taught to understand the development of the human being in relationship to the environment and what is being manifested in their behaviors and there's something else here too which i think is more difficult to convey but here's what I know working having worked in the Downtown Eastside for 12 years it's not like what I'm telling you here was always available to me I mean I knew it intellectually but that doesn't mean that my heart clean closed down it didn't mean that I couldn't be sure good judgment didn't mean that I I couldn't act in in ways that were hurtful to my clients I certainly could and I did sometimes the part that we have difficult appreciating is is how we create the other person I know that on days when I was tense and judgmental which usually had to do with factors in my own life that I wasn't dealing with I had different clients my clients were different and I'd then I'd say why is everybody so ordinary today what's wrong with them today not realizing that they were responding to me and I'm telling you you can change the other person like that simply by how you show up but for you to show up and to understand their own pain to understand their pain and their experience you have to do the kind of exercise that you were guided through by the chaplain before I spoke you have to look at your own pain you have to look at your own experience and you have to develop compassion for yourself so very often the compassion that we lack for other people is really a function of the compassion that we lack for ourselves we just haven't worked it through yet and let me tell you about some bad news here if you're working in the mental health field you can tell yourself that I'm doing this because I want to help people because it's a mission I have to support and suffering humanity and all that will be true all that will be true but also true if my own experience is any guide whatsoever is that you're also in this because on some level what do you want to recognize it or not you resonate with the people that you're working with in other words you fed you own trauma and the question is whether you've recognized it already have not recognized it and if you haven't recognized it you won't be fixing it in them and you'll be very impatient when they don't get fixed that easily and if you have worked it through in yourself you'll have all kinds of compassion all kinds of patient patients are all kinds of understanding and then when you show up differently I promise you they will show differently let me say a final word to you about trauma which is a word that we use but what do we mean by it everybody thinks that timing is bad things happening to you that's not what traumas dramas not what happens to you trauma is what happens inside you as a result or what happened to you and trauma can show up in overt ways like those adverse childhood experiences and again I urge you to go to the Internet tonight and download the ACCE questionnaire and fill it out on yourself and when you see a client fill it out on every single client you see it's gonna like that in five minutes change your perspective on them like that but trauma isn't only those bad things that happen to people trauma is anything that constricts you that limits you that makes your response is more stereotypical and less flexible because you see what happens if a trauma is that it shapes not only the personality it also shapes the brain and we have this part of a brain called the mid frontal cortex the NF C whose job it is to regulate the body to have impact insight and empathy and attuned communication with other people and to regulate impulses and to give us what is called a response flexibility response flexibility means that means something happens you have a range of responses that you can consciously choose you're not just reacting the very often when we when we're dealing with challenging people we're not actually the response flexible which is reacting and that reactivity in our part is actually means there's a limitation of our own mid final cortex because of our own traumatic experiences so we want to develop here in ourselves and in our clients is a response flexibility which means when person a does something person B isn't just driven by their emotional reactions now the nurses that Brooke described at that orthopedic ward I've seen it there's no response flexibility there it's all reactive it's all reactive in their part because they're afraid they're puzzled that bewildered they don't know what to do there's fear behind that rigid response but we don't understand this is what I'm gonna leave you with is the power imbalance between ourselves and our clients you see if I lost it was one of my clients if they lost it with me I'd have all kinds of recourse I could call the cops on them I could take away their methadone privileges I could do anything I wanted to if I lost it with them which sometimes they did but see okay I'm going to the college to complain about you but good luck good luck being an injection using Downtown Eastside homeless junkie complaining about a doctor to the College of Physicians and each of us has this power that our clients do not know we don't think of ourselves as powerful we don't think of ourselves as wielding that kind of authority but in relationship to their experience we do which means that it's all the more important that we take responsibility for that power that we deal with our own staff and we do our very best to transcend this limitation of not understanding the other person's experience thank you you

Channel: Fraser Health

Views: 31,883

Keywords: fraser health, ethics, science, compassion, health

Id: sBtklSnf2wE

Length: 32min 23sec (1943 seconds)

Published: Wed Aug 01 2018