Keynote ACES to Assets 2019 – Dr. Gabor Maté – Trauma as disconnection from the self

[Music] [Applause] [Music] [Applause] [Music] albemarle say as many of you know is a retired physician through after 20 years in family practice and palliative care experience worked for over a decade in Vancouver's Downtown Eastside with patients challenged by drug addiction and mental illness he is as many of you know as well the best-selling author of not one not two not three but four best-selling books published in 25 languages and is an internationally renowned speaker duties expertise on addiction trauma childhood development and the relationship of stress and illness I'll give you more details about his website and Twitter details shortly but first of all let's hear from the man himself ladies and gentlemen it gives me great pleasure to welcome to Scotland dr. gamble Mattie thank you for welcoming me to your beautiful country and magnificently vibrant city it's an honor to be invited here and a pleasure to be sharing the stage with many others who who work to better understand and therefore to improve the conditions under which we all live you know I I didn't know about Jimmy Reed until yesterday and I learned about him when I watched Harry burns a TED talk where he quoted from the same speech that Suzanne cited this morning and he mentioned that the New York Times said this was the most important speech since Abraham Lincoln's Gettysburg Address and harry added that in saying so the New York Times is rather flattering Abraham Lincoln and then I read the speech and I understood why and of course Jimmy reads a citation of alienation being here a Labour leader was probably rooted in his understanding of Marx from that from the 19th century where mark talked about alienation and alienation is a good word as a theme for today because what does it actually mean well alien is the stranger so what happens in alienation has become strangers to something and the cost of the very nation what we get it what to become estranged from what to become strange to well following along Marxist works become alienated from ourselves and I'm going to be telling you that the essence of trauma is actually disconnection from the self so since we'll be talking about trauma today I might as well tell you what my understanding of trauma is now you don't have to take on this understanding but when I speak about it I want you to know what I mean by it so trauma well when James and Kim are on stage and Kim was relating that James had asked her what happened to you what happened to you that's a great question because in a Western diagnostic model in which I was trained we don't ask people what happened to you we ask basically what's wrong with you what's wrong with you and diagnostic categories assume that there's something wrong with the individual it's a very different question asking what happened to you because now you're no longer asking about some physiological or mental event inside the individual what you're putting the person in the context of their environment so that's very important but when it comes to my own standing of drama it's not actually what happened to you that's the important question to ask but that's not what trauma is so trauma is not the Aces as such trauma is not the physical or the sexual or the emotional abuse trauma is not the fact that your parents fought and divorced it's not that your parents was father was Jail although there was violence in the family that your parents were addicted but you and neglected that's not the trauma those are the events that induced the trauma but what is the trauma itself the traumas not what happens to you but what happens inside you as a result of what happens to you so trauma is something that happens within and the word trauma itself comes from the Greek word for wounding so traumas are wound now if you can imagine a wound on your flesh if you cut by a sharp object what happens is is that this pain so it's wrong way implies pain there's some loss of function perhaps and then there's scar forms and the scar is not the same as normal tissue the scar is hard so it doesn't feel so much thus trauma is that the scar is not flexible like ordinary connective tissue so there's also trauma we have pain we're more rigid in our responses to the environment and we don't feel as much that's what the trauma is what happens inside you so when you speak about alienation the first alienation is actually from ourselves and essentially the essential alienation in trauma is that disconnect from the South and I'll be expanding on my concept of trauma of the day goes on but just begin with that so that trauma basically is a disconnect from the self which is where recovery comes in and I might as well give it away right now the word recovery is interesting because what does it mean to recover to recover means to find something but if you find it it means it could never have been destroyed completely he could never have been obliterated we've just lost sight of it we lost contact with it and I'm not going to answer the question at this point but I'm asking you to consider what is it that recover what is it that we recover when we do recover and in considering this day on on trauma and adversity and resilience and recovery what is it that you want yourself to recover to find again what is it that you want your friends and your children and your clients and the people that you work with in whatever field you are never you're in whether it's just this or health or child care or education what is it that you want people not to lose or if they do lose it to recover again so that's first alienation is from ourselves the second alienation is from our work now I got a browsing the web this morning I found an article that just was published today in Canada or yesterday I should say the majority of Canadian men are so stressed out by work that they're sleep-deprived eating poorly skipping breaks and dragging themselves to the office even when sick without realizing the serious damage they are doing to their house and they found that 81 percent of Canadian men said their work was stressful while 60 percent said their work was impacting the quality of their sleep while Mark said that the second alienation is actually from our work we've grown estranged from our work the third alienation is from other people and I'll talk about that there's an outcome of trauma become estranged from others and the fourth is delineation from nature and if you want to look at what's happening to nature in our culture in a word today just look at the whole issue of climate change look at the movement here in Britain where people were demonstrating in the tens of thousands well that's an that shows you how alienated the societies from nature was sorely needed from it that we're actually destroying it oh these are major alien nations that I'm sure Jimmy Reed today would endorse us as being the ultimate challenges to humankind having said that what do we find when it comes to health in this world well I'm writing a new book it'll be an entitled the myth of normal illness and health and in insane culture that's actually the title and what is the what are the facts well the facts when it comes to a quick perusal of my research that I've done for this book I'm looking at worldwide in Scotland apparently the drug death rate is very high roughly two and a half times of that of UK as a whole and drug deaths are increasing throughout the Western world in the United States now every three weeks you have the equivalent over 911 in other words the number of people who died as a result of the terrorist attacks on on September the 11th was at 2001 that many died every three weeks from drug overdoses the United States in Scotland ever roughly a thousand I think overdose deaths over the last three years annually in Britain the numbers are going up now I think last year there were 4,000 drug overdose deaths in Britain as a whole or was that just in England I I'm not sure but think about it this way if only one person a day was killed by terrorists in the UK if every day terrorists killed one person a day imagine the public alarm imagine the outrage imagine a mobilization of resources imagine the sheer energy that we will put into stopping this assault on human lives well many more died of totally preventable causes every day for example drug overdoses and I'm only talking about the illegal drugs what about people who died of alcohol disease alcoholic related diseases which number gain is over a thousand a year in Scotland alone what about the monster drive smoking related causes what about the diet what about the people that die of the other illnesses that are associated with adverse childhood experiences such as for example autoimmune disease such as for example malignancy where's the outrage where's the mobilization of public resources where is the daily discussion in the newspapers where is the fevered debate on on the broadcast media barely even registers what is that all about what is this a better society that is far more devastating and and and deadly threats are so far in the background whereas we keep prattling on about the threat of terrorism as being the major challenge of our society what is the reason for that shift of focus from what's really going on to something that's a relatively it's a real but relatively minor disturbance the of children being diagnosed everywhere in the Western world with all manner of disorders so-called medical disorders and I say so-called because you'll be hearing for me that the so called childhood disorders the sofa childhood diseases are not diseases at all they're genuine problems but they're not the disease model doesn't account for them the number of kids being diagnosed with ADHD which by the way I was diagnosed in my 50s and I'll tell you about that later on the number of kids being medicated in Britain in the last ten years the number of prescriptions for antidepressants has doubled and I could go on and on with the statistics one-third of British adults are now pre-diabetic apparently childhood obesity one-third of British children are obese not which makes them prone for diabetes and other illnesses and I could go on and on along with the statistics but how are we to understand all this that's the question now you would think for example with a problem like addiction if if we actually stopped think for a minute if what we're doing is not working there could be two explanations for it let's just focus on addiction for a moment if what we're doing is not working there could be at least two possible reasons one possible reason is is that addiction is this intractable chronic incurable disease that there's just not a whole lot we can do about it it's a genetic condition it's rooted in our inheritance and damn it you just don't know how to fix it because it's so resistant to any human intervention that's one possibility the other possibility is could it be that maybe we don't understand and it could it be that maybe the way we were approaching it simply does not reflect reality and if that's the case why don't we take a look at what's actually we what's going on we need to have a new look at it it's entirely possible that it actually it's not interactable it doesn't need to be chronic that it does not need to be so hopeless in its outcomes that we managed to cure only a small percentage but that actually it's amenable to human approaches if only we knew what it was really all about so at least for today I'm just inviting you especially those that are professionally trained like I am to suspend the framework in which you usually think about these things and let's just see if it a different framework might throw more light on the situation now what is that framework that framework is not new either just as the alienation is not a new concept the framework that I'm gonna propose now is also not a new concept so let me give you a couple of facts there was a study two years ago in the United States that showed that the more episodes of racism a black American woman experiences the greater the risk for asthma so more racism she endures the more her risk for asthma we've also known for decades decades that the more stressed parents are the more risk their child has of having asthma so there's some relationship between stressed and asthma now it's very interesting if you have an asthmatic episode in which your lungs have trouble moving air in and out because the Airways have narrowed that gone to spasm and they furthermore they're inflamed further obstructing the flow of air if you go to a physician like myself you'll be given medications to suppress inflammation of to open up the airways the medications those are the medical medical 'train you know what they are they're copies of adrenalin and cortisol the cortisol scoop acid suppresses the inflammation and the adrenalin relaxes the Airways what our adrenaline and cortisol their stress hormones retreating asthma with stress hormones and we know that there's this relationship between stress and asthma now if you actually look at medical practice and those of you that are medical practitioners or the recipient of treatment will know this but in many conditions across the board we give the stress hormone cortisol for inflammation of the skin you go to a dermatologist you'll be given a cortisol cream inflammation of the intestines like Crohn's disease or colitis you'll be given steroids the stress hormone at some point inflammation of the lung the same thing inflammation of the nervous system as in multiple sclerosis the same thing we're given stress hormones across-the-board but in general as a as a profession we don't ask ourselves the following simple question gosh we give you stress hormones for everything could stress have something to do with the onset of these conditions it seems like an obvious question but we don't ask ourselves let me tell you another fact I just mentioned multiple sclerosis which is there represents really a degeneration of the nervous system without going into the details inflammation and loss of the protective sheath or on the nerves so we become numb and paralyzed you might not be able to see and so on let me tell you a statistical fact at least in North America and I'm pretty sure the British statistics would be parallel to this in the 1930s 40s the gender ratio of multiple sclerosis was about one to one you know what is so for every man diagnosed the woman would be more or less you know what the ratio now is three and a half women to every man now what does that tell us it tells us it can't be genetic because gene is going change in a population over a few decades it can't be the food or the climate because that doesn't change more for one gender than the other there's gotta be something going on that's environmental it's clear now what that is I'm not gonna say just yet but I'm gonna give you the framework in Western medicine we tend to treat organs now let me ask you following question - or show of hands if in the last five years you've had reason to go to any kind of a specialist a consultant otolaryngologist the throat specialist or a Respironics the lung specialist or cardiologist or a neurologist or dermatologist gastroenterologist any kind of a knowledge astrays your hand okay thank you now put your hand up again if in the close to that visit you asked about your other experiences what do you have in a began if - about stressed in your life now we see a couple of hands will you hand up if they asked you about how you felt about yourself as a person about your relationship with your spouse here I'm telling you those questions I hope at least to indicate to you by the way who completely relevant to whatever cause took you to the physician in the first place so in Western medicine we tend to separate things and now I'm not a militant critic of my own profession it's a beautiful profession with astonishing achievements to its credit I don't have to tell you that but I'm not looking at what doesn't work I'm looking at today it will be what we miss I think so we tend to separate the mind from the body we tend to separate we tend not to believe that what happens to people emotionally has a role to play in their physiology and therefore they understand health number one and we tend to separate people from their environment so we see people two discreet individuals and actually not even as whole persons but more as a collection of organs each with their own particular set of diseases well in 1977 there was an American physician an internal medicine specialist who also developed some expertise in psychiatry and his name is dr. George Engle and George Engle called for what he called a biopsychosocial approach and he said that the mark the the modern practice of medicine he said is separates the mind from the body and we looking at molecules and we look at organs and look at cells and look it's organ systems well we don't look at the whole person and we don't look at the whole person in the context of the environment so he called for what he called a biopsychosocial model which is very simple biopsychosocial simply means that our biology is inseparable from our emotions and since our emotions are very much modulated by our social relationships therefore you can't separate biology from emotions and from our relationships relationship is the word that Susanne emphasized this morning so the biopsychosocial model actually looks at the individual in the context of their emotional lives and their social lives and their particular relationships so that's the biopsychosocial model which is to say that life is inseparable but life is a unit but life isn't one and that's not a new idea either 2500 years ago the Buddha said that he says contemplate what he called the interconnected core rising of phenomena which means that which means that everything that arises every phenomena that arises is related to everything else he says think about a leaf or a raindrop he said a leaf contains the Sun because of course we sought the sunlight there's no photosynthesis there's no chlorophyll there's no life the leaf contains the sky because the irrigation of water and the earth of course the minerals so in that leaf you don't understand that leaf see it's interesting like I know this intellectually but when I go out for a walk outside I still only see a leaf my mind is not grasping that that leaf contains everything and yet that's the nature of life the nature of life but everything does contain everything else and this was said really well by him by the American author Susan Griffin said that the story of one life cannot be told separate from the story of other lives who are we the question is not simple what we call the self is part of a larger matrix of relationship and society so this idea of the separated individualized self is the myth had we were born to a different family in a different time to a different world we would not be the same all the lives that surround us are in us this was not perspective now that I want to look at first addiction and then more broadly mental health and physical health in general so let's look at addictions now for 12 years I've worked in Vancouver's Downtown Eastside Vancouver being Canada's westernmost large city on the Pacific coast and it contains an area called the Downtown Eastside which is North America's most concentrated area of drug use so that within a few square block radius we have more people in jesting inhaling and injecting illegal substances than anywhere else in North America and anybody who's visited on Sunnyside is shocked by the suffering and the drug use the people injecting in the streets on the back alleys the poverty so I looked there for 12 years and in my book in the realm of hunger ghosts close encounters with addiction I describe a scene where there's a memorial service for a patient of mine who died of an overdose and I said as I said in other talks of mine if the success of a physician is to be measured by the longevity of his patients then truly speaking I was a failure because my patients died often they died of overdoses of course they died of sometimes suicide violence of all kinds of illnesses related related to addiction hepatitis HIV and so on infections of all kinds and so in this scene in the second chapter of the book I described a memorial service for a 36 year old woman with her name is Shannon she died of an overdose I look at the small cluster of human beings gathered at the funeral of a comrade who met her death in her mid-thirties how powerful the eviction I think that not all the physical disease and pain and psychological torment can shake loose its lethal hold on their souls nothing sways them from their habit not not illness not the sacrifice of love and relationship not the loss of all the earthly Goods not the crushing of the ignaty their dignity not the fear of dying the drive is that relentless hard to understand the death grip of drug addiction what gives penny injecting after the spinal abscess is that I've nearly made her paraplegic why can Beverly give up shooting cocaine despite the HIV the recurring abscess is a fetid vein on her body and the joint infections that repeatedly put her in hospital what could have drawn Sharon or Shannon back to the Downtown Eastside after a suicidal habit after six months get away well what's the answer to that question of what is this death grip the dominant answer in Western culture I should say internationally is that it's a choice that people are making going to some kind of a failure of will moral weakness a desire for pleasure now if people are making choices that are harmful to themselves and I'll continue to be a social how do we deal with it well we deal with by trying to prevent them making their choice by telling them how drug bad or bad drugs are so we tell skuki is not these drugs is bad for you and we call that prevention and let me tell you it's totally useless all we then punish people for engaging in that behavior now how do we punish people and hayburn's talks to others in his TED talk or we punish the kids in our society as a in a two year-old I don't know what the practice here in Britain is but I'm pretty sure it's the same in North America most parents are taught that when the two-year-old misbehaves what you do if they will not be brought to order is to give them a timeout which is to say you can't be in my company you can't be with me because your behavior doesn't please me so we give them a timeout and the mini from adults and they still do stuff that is not your liking we also give them a timeout and that's called prison we say to them you can't be with us and as Harry points out in his talk when a kid is acting out in school let's say a bully you see we exclude you you can't be with us so basically we withdraw from them something that's essential for human life which is human contact and that's what we do and we do this because we believe that as a matter of choice so the it's hard to keep up with the American cabinet these days is like a revolving door one dysfunctional person replaces another but the most recently resigned that Attorney General or the chief Lum for some doctors in the u.s. made the following statement the longest lines that addiction is the choice he said we need to say as Nancy Reagan said just say no now if you don't know this Nancy Reagan who was the wife of of Ronald Reagan who was the soul brother of Margaret Thatcher and when you become the when you become the the first lady they call it the wife of the president you have a cause you just have to have a cause so they all choose a car so here was drug prevention they're an idea of drug use prevention was to put up billboards on the highway saying just say no just say no and so now the Attorney General two years ago made the speech where he said we need to say as Nancy Reagan said just say no don't do it and our nation is to say clearly once again that using drugs is bad it'll destroy your life in the 80s and 90s we saw campaign stressing prevention we can do this again educating people and telling them the terrible truth about drugs and addiction will result in better choices choices by more people now just as successful that just say no campaign was in preventing drug use is illustrated by the fact that every three weeks in America as many people died of overdoses as did in 911 you know once I was invited to the Senate of Canada Canada's got a Senate like America it's not as powerful as the American Senate but they do debate and discuss issues and I was invited to address them a subcommittee of the Senate on a new drug law proposal which would have made things more harsh for users and of course the law was passed but these senators who asked me all these questions and I was telling them all the science that I understood about addiction which I'll tell you about in a little while but of course I wish I could say that it went in one ear and out the other never went in one ear they just kept repeating the same questions over and over again as if I had said nothing and I finally said to them in a somewhat exasperated State but look senators you expect me to practice evidence-based medicine how about you practice evidence-based part of politics because because we because the evidence about the the punishment model when it comes to drug addiction is in it's not controversial it's completely useless and worse than useless it's harmful and then he said we can reduce the use of drugs save lives and turn back the surge in crime that inevitably follows in the wake of increased drug use that's not - either it is not true that a surging crime follows increased drug use what is true is that surgeon kind follows increased drug use in the context where drug use is criminalized it is not the drug use that leads to crime I mean yes if you drink alcohol which is perfectly legal by the way you might become more violent because you'll be disinhibited and it's also true that crystal meth and the stimulants can make you violent or very aggressive that's also true but most of the crime is not drug fueled our crime when it comes to addiction most of the crime is around trying to desperately to obtain the drugs that are illegal and when in a North America there was prohibition in the 1920s and 30s so you couldn't legally buy alcohol the the surge in crime not because people were drinking more but because the the alcohol was illegal so there's no evidence behind those statements I'm not gonna spend more time on the choice model it's just utter nonsense you've never met I've never met anybody who ever woke up one morning and said my ambition is to become a drug addict or my ambition is to become an alcoholic that's just not how it works though the second model which is worth considering because there is a lot of truth to it without being true is the medical model and in the medical model addiction is a disease it's the American Society of addiction medicine defines addiction is a primary brain disorder so it's a disease that arises in the brain and it affects circuits of reward and incentive and impulse regulation and decision-making and because you got this brain disease you got this disturbed brain physiology now you've got this brain disease how does the brain disease arise it arises mostly because of genetics about 60 40 to 70 percent generically determined and then you meet a drug and now you have this genetic predispose the drug and not you're hooked now the disease model is certainly more forward-looking in the choice model because at least you're not blaming somebody at least theoretically you're not blaming somebody you can't blame somebody for inheriting the wrong genes and if somebody's got a chronic disease just as you would deal with malignancy or rheumatoid arthritis or chronic depression you don't blame people for relapsing and you don't punish them for relapsing and you also offer them treatment because you get that they're suffering that is also their illness and and you want to alleviate that suffering so the medical model is formal humane and forward-looking but is it adequate is it cover the science does it take into account the human experience behind addiction I say it does not for one thing it doesn't explain the non drug addictions is there video gambling Jean is a really a online video game Jean number one number two let me give you a definition of addiction that I think is controversial and I'm gonna ask you a question so I'm going to define addiction as any behavior at least it's a complex process physiological psychological yes but that manifests in any behavior that a person finds temporary pleasure or relief in and therefore craves but suffers negative consequences as a result of and he's unable or unwilling to give it up despite those negative consequences so I said so there are hallmarks of addiction are craving pleasure relief in a short term negative outcomes in the long term refusal or inability to give it up despite those negative consequences now notice that my definition said nothing about drugs obviously it does include drugs substances of all kinds could also be gambling as James was saying this morning sex video games work extreme sports relationships shopping eating chemical go on and on and on so any behavior that so according to that definition craving relief pleasure in the short term negative constant was a long-term difficulty giving it up how many of you would acknowledge that at some time another in your life you've had some kind of an addictive pattern just to put your hand up yeah well put your hand up if you didn't put your hand because we want we want to know how you did it what I'm saying is that addictions are rife throughout the society it touches almost everybody and if we understand with its video about I'm gonna ask you a very simple question and I'm gonna ask just some of you in the front row so I can actually hear you to raise your hand if you're willing to and tell me I'm gonna ask you not what you were addicted to not for how long or when just whatever it was whenever it was what did you like about it what did it do for you so if you wanted to tell me in the first year was just a second here you're shouting at me vision okay yes to dissociate to escape now let's look at that for a moment when does the person have to escape when does a person have to escape it's when they're suffering okay thank you anybody else sorry in pain so the escape from pain is everything so pain relief is that we its name yeah those pain relief so escape from suffering discomfort pain relief what else yes escape from loneliness so that it gives you a sense of social contact so social relationships number three take one more maybe yes see comfort comfort okay now your desire for comfort implies discomfort okay so let's just look at these escape from suffering pain relief social relationships comfort are all these not genuine human needs are all these not genuine normal human desires anything wrong with them in other words the addiction wasn't your problem the addiction was your attempt to solve a problem and the question is why were you Payne and how's that but you can have the resources internally to deal with that pain or how is it that you're in a position where you didn't know how to ask people to help you with your pain posited that you had to escape from suffering I mean suffering happens in human life that's just suffering as a fact of life it doesn't mean you have to become addicted we've been way addicted when we don't know how to deal with the suffering and there's a reason why we don't know what I'll do without suffering so that's the problem why are you so lonely there's 7 billion human beings on this earth why are we so isolated and incapable of finding human contact that you had to seek solace in an addiction and what make it so uncomfortable if I want to ask those questions I have to look at not at your brain physiology not at the supposed choices that you made but at your actual life at your actual life so on one level in other words I have to ask like James asked Kim what happened to you that's the first question now let's look into addiction in a bit more deeper fashion but on the first level and the broader level on the basic level it's simply an attempt to solve a problem and if you want to understand why the addiction you have to look at well what's the problem here and how did that problem arise in that person's life what happened to you that's the first one second point is I was diagnosed myself in my in my 50s about 20 odd years ago now with attention deficit hyperactivity disorder and typically of you know one of the traits of a DD or attention deficit disorder with or without hyperactivity is poor impulse regulation in other words you you want to do something and and it's even though it's not a good idea you're still not doing it because you can't control your impulses so a very simple explanation or example of impose regulation would be if I was hungry right I had enough breakfast perhaps and you're sitting in the front row head oh he's the fruit in your hand and my impulse would we've grabbed that fruit and bite into it that's the impulse just arising from sheer hunger nothing wrong with the impulse but there'll be something wrong if I acted it out because it's your fruit not mine and I'm giving a talk right now I'm not suppose I'm not getting paid to eat fruit so that's okay because it's a part of my brain right here that says okay Gobbo you may be hungry but that's not appropriate to grab that fruit right now that's the impulse per Galatian now people kiss with a DD don't have impose regulation adults with addiction don't have impulse regulation and I'll talk about that later and there's another large group of human beings who completely lack impulse regulation absolutely like it the more we call those people did you say petitions yeah we won't go there even larger than that recall the me young children infants have absolutely no impulse regulation what does that tell us it tells us that impulse regulation has to develop ah it has to develop know if plant in your backyard was not developing what questions would you ask yourself your ask yourself what conditions are lacking that promote the healthy development of that plant nutrition minerals irrigation sunlight you wouldn't necessarily make that plant wrong for not developing you would simply say what are the conditions that are needed here is it possible that when we look at the poor impose regulation of the addict and the poor impose regulation of the ATD child not as diseases but as failures of development and as soon as you ask why didn't something develop properly what are you actually asking you asking what happened to you what would the conditions under which you brain developed how come not the impulse regulation that should have developed didn't that's a developmental question and then a second question then is given that it didn't develop in the first place when it should've what conditions do you need right now to help you develop those capacities so what if we looked at human this derivative the promotion of resilience comes in what if we looked at these human problems not as inherited diseases or diseases at all but as problems of development then the questions would be asking ourselves what conditions do we have to provide to promote a healthy development not how do we fix this condition hardest suppress the symptoms but how do we provide the healthy conditions so I was diagnosed with a DD in my 50s and as I described in my book on ADHD scattered Minds on the very day I first heard about a DD and I didn't know anything about it I was the typical physician you nothing about it but I friend of mine told me that she had just been diagnosed with it and I recognized myself in her in her description and the very day I I took a ritalin and a higher than recommended dose now how could I do this I could do this because I'm a doctor you see so I hear you're not supposed to do this but I did I went to one my colleagues I was working in palliative care at the time I went to one our colleagues and said hey Bev I think I got a DD can you give me some ritalin and she said sure how much do you want and so under the principle that if a little bit of riddling is good that more villain is even better I took a higher than recommended dose than a very first day I heard about a TD and I went home my wife were blessed that he has just left the audience she'll be back later i I took the ruling I felt present and grounded instead of this hyperactive jumping on that my mind always does I was just there and I was full of insight and love and rain my wife said to me you look stoned so I did go see a psychiatrist I was properly diagnosed and the ritalin didn't work for me but I was given dexedrine which is a stimulant and that helped me it I became a much more efficient workaholic and wrote my first books with it if he did help but what stimulants do like ritalin and and and and dexedrine and adderall and all these anti ATD drugs that kids are getting in large quantities these days is they elevate the level of a chemical on the brain called dopamine and open is an essential brain product which I'll tell you about shortly and it promotes incentive and therefore attention and [Music] there are other substances that elevate dopamine all the stimulants do nicotine does caffeine does crystal meth does cocaine does Sunnyside it would not be unusual for me to have a client coming in and say you know doc I don't get it but ah most people they do crystal meth and they they go haywire at me I calm down and I clean my room they were handing me the diagnosis on the platter their substance use was a self medication for a DD and it's been shown in studies that about 30 percent of stimulant users actually meet the criteria three drug use of attention there's a disorder so right now I'm talking about so if you're doing six cups a day of coffee you might as well just diagnose yourself know what I'm talking about knowledge is is addictions on the second level which is that of self medication so people self medicate EDD and by the way a DD is a major risk factor for addiction it's a major respecter of prediction people self medicate anxiety of course with tranquilizers with marijuana with opiates people self medicate social phobia or social anxiety with alcohol people self medicate bipolar illness salient they with alcohol because alcohol Vincent van Gogh the great Dutch painter he was an alcoholic he had bipolar illness and the alcohol brought up his lows and soothe his highs so that's a common self medication for people with bipolar disorder and salient Lee people self medicate what people self make it depression you know when you're given fluoxetine or paroxetine or other antidepressants they're useful which is doubled as I said in Britain in the last ten years that elevates the level of chemical in the brain called serotonin cocaine elevates it temporarily as well so people self medicate depression with cocaine and salient Lee people self medicate post-traumatic stress disorder with opiates so in North America at least and I don't know what the situation in Britain is but I suspect it's rather the same that these soldiers who come back from our various adventures in the Far East with post-traumatic stress disorder their self-medicate a lot with opiates that become opiate addicts so in the second level addiction is self medication in many cases now let's dive a bit deeper into it now into the brain why is it that the opiate works they actually so opiates have been used in human medicine now for at least 3,000 years that's the earliest written record of it in China opiates of course the most powerful pain relievers that we have but the opiates don't only soothe physical pain they also soothe emotional pain as a matter of fact the part of the brain that experiences the suffering of physical pain also experiences the suffering of emotional pain you can see the some brain scans when you subjects and you subject people to emotionally hurtful experiences while they're undergoing a brain scan such as excluding them from a game the same part of the brain lights up as would light up as if you stuck them with a knife so pain is pain and so the opiates soothe that pain as a matter of fact if you look at the drugs it's rather interesting cocaine itself is a pain reliever it's a it's a local anesthetic it numbs nerve endings alcohol has analgesic properties towards marijuana and I maintain that all the all the practices of addiction whether they involve substances or not are actually attempted as escapes from emotional pain from discomfort from suffering of some kind enhance and this is my mantra if you remember this line please do the first question is not why the addiction but why the pain and if you understand why people's pain exists in them so powerfully you have to look at their lives and by God you have to look at their childhoods now why is it that the opiates even work in the human brain but this is really crucial to understanding addiction the the opiates work in a human brain because they resemble chemicals that we have ourselves in our brains and therefore our brains have receptor sites for them sites where they exert their effect so we have an internal opiate system in our internal opiates are called endorphins and orphan means endogenous or internal morphine like substance so we have rent or morphine like substances why for instant addiction look at what the endowment endogenous morphine like substances do for us what do the endorphins do what are their roles in the bunam body many from the god to the mucous membranes to the immune system nature uses the same chemical for many different purposes but in the brain and when it comes to addiction what did they do well first of all pain relief so the so-called placebo effect when you give hundred people an inner tablet which they think of contains the painkiller and 25% 25% of them will get pain relief as if you gave them a morphine tablet they're not imagining the effect the very belief that they're getting help will trigger endorphin relief in them and his own endorphins are providing the pain relief so pain relief physical and emotional is the first job of the endorphins their second job is to make possible the experience of pleasure and reward of elation of joy so when he's highly elated by highly charged states we have a lot of endorphin activity in their brains that's the second thing they do now think about those things how important is that pain relief is essential for human life you couldn't live without it pleasure reward joy are essential in human life as the philosopher John was it Hobbes said life is short nasty and brutish or maybe he said short nasty and British I'm not sure but but but but it is tough life as we all know we have to have some pleasure some joy in it that's their second function and their third function is the most important one of all they make possible a little thing without which life is not possible and that little thing is called love and by love here I don't mean the gooey romantic sentiment although that's not nothing wrong with that I'm talking about actually the attachment the pole that drives two bodies together now this is I have to dwell on this for a moment gravity is an attachment force gravity pulls me towards the earth it also pulls the earth towards me which ensures that I'm grounded and I'm not gonna fall away into the stratosphere gravitational forces an attachment force in human life attachment is that instinctive volatility the dremen dynamic that we share with birds and other mammals that both two bodies together for the purpose of being taken care of or for the purpose of taking care of the other does an attachment Drive Dan was talking about his son and his adventures with the his intestines this morning and the comedian Jerry Seinfeld the American community a Seinfeld became apparent you know 20 years ago 18 years ago and he said you know it's tough being a parent he says you know it's strangest as your nurse you're in a room with a human being and he looks like you and it's smiling at you and his pooping his pants at the same time your tuile you know so parents have to pull up with a lot of to coin a phrase what is it that keeps them going is that attachment drive to wanna take care of the child the endorphins help to make that possible not by themselves but they but they're essential to it so in a particular experiment they took mice in a laboratory genetically they knocked out there and orphan receptors so they had no endorphin activity these are the mice and separation from the mothers did not cry for help what would that mean in the wild it would mean their death that's so important there or endorphins are and it wasn't just like somebody said that their addiction served to get them or their loneliness in the Downtown Eastside I would ask people what does the heroin do for you and the kind of answers I would get would be the first time I did heroin it felt like a warm soft hog or a doc I don't know how to tell you this this is a six-foot-two guy with tattoos and muscles and earring and the whole bald head and the whole thing I said what is there in blue for you he said doc I don't know how to tell you this but it's like you're three years old and you're shivering with a fever and your mother put you on his leather lap and a rapture in a warm blanket and getting some warm chicken soup that's what the heroin feels like no take that away from people put a sign on the wall saying just say no and see how far you gonna get punished them for having for some reason come to the conclusion that without that chemical they will not experience those states so that's the opiates I mentioned the stimulants elevating dopamine level let me tell you about another Mouse experiment this little mice in a laboratory you put food in my front of him he is hungry he hasn't been said he will not budge to eat the food he in fact was started up why because genetically they now thought there is dopamine receptors and dopamine is the incentive and motivation chemical dopamine flows remyxx pouring a novel object a novel environment you know the Dan was talking about his three-year-old picks up every a core and it looks at every leaf and look at that flora daddy high dopamine state of seeking and exploring it's essential for human life dopamine flows when were seeking food when we're seeking a sexual partner and by the way let me pause here and talk to you about the process addictions that the addictions that don't involve drugs like gambling like sex addiction like shopping addiction what are those about I've had a shopping addiction problem I saw if I talked about in the book and and I tell you what when I was involved in my shopping addiction there was no ad D I was totally present I was focused highly motivated I remembered everything I remember to this day almost everything I bought and when and where this is for CDs that was my particular focus of addiction because I had a high dopamine state it's not that people addicted to shopping it's not it's not what they're buying that they're addicted to because what they buy never satisfy them and as soon as they finished buying one thing they have to buy something else same at the gambler same at the sex addict if sex addiction was simply about sex the solution be straightforward and I'm not I don't mean to be in any way jolly about a very serious condition but if sex was the issue in sex addiction the solution we defined another sex addict and now you'd be okay for the rest of your life but that's not what it's about it's about the seeking is about that high dopamine state of elation and and focus an incentive and vitality and being alive and the question is why don't you feel alive already what happened to you so that's dopamine I mentioned two other circuits in in addiction and then I will finish for now I mentioned already impulse regulation it was actually I think a Scottish physician who said that the problem addiction is not lack of free will but lack of a free won't because what happens is that if you look at brain scans on drug addicts or any kind of addicts actually the the impulse regulation circuits in the brain are functioning well as I already mentioned and later on I'll talk to you about why not so input and then stress regulation my if you had if you look at your own addictive history when you were okay for a while you you you were not using or engaging in the behavior for a while and then your relapsed most of the time the reason you've relapsed is because there's something stressful happen to you which means that you didn't order regulate your stresses the stress regulation mechanism in your brain had not developed properly now why didn't it develop properly well you know what I'm gonna go into this next and go just a couple of minutes over time and then then I'll pause because I want to just finish this piece I'll tell you quickly why those things don't develop because the human brain develops under the impact of the environment we know this this isn't this is I was gonna say it's not brain science but it is brain science this is state of the art brain science not controversial we've known this for decades at least two decades now it's no longer debated and it's not taught in the medical schools if somebody told me that what I'm about to tell you is taught in the local medical schools I'd be so delighted to be proven wrong but in North America I'm telling you I have yet to find a medical school where they teach this stuff even though it's been published a major major medical journals so I'm going to quote from an article that appeared in the journal Pediatrics which is the Official Journal of the American Academy of Pediatrics and the articles from the Harvard Center in the developing child you couldn't find a more prestigious university a more prestigious institution in this article period in 2012 and here's what they said about brain development summing up decades of consensus on brain research the architecture of the brain is constructed through an ongoing process that begins before birth continues into adulthood and establishes either of sturdy or a fragile foundation for all the health learning and behavior that follow let me go through that again so the point is that the human brain develops under the impact of admire of the environment and the right conditions have to be there and just as if you were gardener looking at that little plant in your backyard the development of the human creature depends even more on the environments even more fragile it's even more sensitive to what happens and so which circus developed the endorphins circuits the dopamine circuit self-regulation stress regulation emotional balance inside all of functions of the mid frontal cortex it depends on the environment just as if you take a child with perfectly good eyes at birth and you put him in a dark room for five years and he doesn't see light he'll be blind thereafter for the rest of his life because the circuits of vision require light waves these emotional circuits and software those circuits also need the right environment and that's because the the human brain has to develop on the outside of the room mostly compared to a horse which can run on the first day of life we can't do that for a year and a half two years so so much depends on the environment so they say the architecture the brain is constructed through an ongoing process that begins before birth what does that mean it means that the prevention of addiction needs to begin at the first prenatal visit at least because already what happens to pregnant women has a huge impact on a child's brain development we know this from animal studies and multiple human studies so women who were stressed or abused during pregnancy take their kids brains don't develop too much cortisol too much stress hormone is present and that impedes brain development of essential circuits this is true before birth and after birth as well which also explains why adopted kids are so much higher risk doubled the risk of suicide multiple the risk of ADHD multiple the risk of depression and so on why because by definition they came from a stretched uterus any woman that has to give up a baby for adoption is by definition stressed a single mom a teenage mom a poor mom and addicted mom and abuse mom those kids are getting stress hormones throughout the pregnancy and then they have this tremendous loss of the separation from the birth mother of all which I'll talk to you later but that should tell us something about the care system as well of what we're playing with here when you separate kids from their parents and what we have to keep in mind so this process begins before birth continues into adulthood which brings us to education those of you I used to be a high school teacher by the way I decided that was too stressful so I went to medical school instead and I taught high school for three years the schools think they're in the business of giving people's skills and facts no they're not that's not their proper business their proper business is the promotion of healthy brain development because the healthy brain will be curious and acquisitive of knowledge spontaneously and the other unhealthy brain you can't knock knowledge into it or if you do it's gone as soon as the exams are over and I'll talk to you more about education later and discipline and all this stuff but what I'm saying is that those who are in education consider that throughout adolescence beginning in preschool or nursery school what we're really dealing with here is the development of human brains that's our most influential important task and I wonder how many lectures does the average teacher student or educational student pedagogics student in Scotland actually hear about brain development and the necessary condition for good morning it probably probably again I'd be delighted to be proven wrong probably zero and then they say this continues into adulthood and establishes either a sturdy or a fragile foundation for all the health learning and behavior that followed they didn't say some of the health learning and behavior they say all the health their learning and behavior that follow is established in that process from when kids are not behaving where at all so not behaving what are we looking at the products of development and then the second paragraph the interactions of genes and experiences literally literally shapes the circuitry of the developing brain those genes interacting with experiences and it's critically influenced by and here they're going to tell you the most important qualities of the parenting environment and it's quitting's influenced by the mutual responsiveness of adult-child relationships particularly in early childhood years in other words the most important input into the healthy physiological development of all the brain circuits have been talking about of all the brain circuits that go wrong in mental illness in general addictions specifically in ADHD and so on is the quality of parent-child relationships the responsiveness the relationship again their relationship and what's essential for healthy brain development for our children is the presence of non-stressed non-depressed emotionally available consistently available are tuned parenting caregivers that's the essential condition for healthy brain development and we'll stop here for 10 minutes and continue with Darren and I thank you [Applause] [Applause] you you

Channel: ACE-Aware Scotland

Views: 290,916

Rating: 4.8849287 out of 5

Keywords: Gabor Mate, Gabor Maté, trauma, Suzanne zeedyk, connected baby, addiction, ACEs, TIGERS, drug addiction, therapy

Id: tef5_HK5Zlc

Length: 73min 7sec (4387 seconds)

Published: Sun Jul 07 2019