Gabor Maté: I began to notice that the people who got chronically ill had trouble saying ‘no’

For many people, the Hungarian-Canadian physician and author Dr Gabor Maté is one of the most influential thinkers of the 21st century. I’ve met many social workers, youth workers, addiction counsellors, aid workers and activists who reference Maté’s work on trauma and illness.

In his most recent book, The Myth of Normal: Illness, Health and Healing in a Toxic Culture, Maté (co-writing with his son Daniel) argues that our dysfunctional societies make us ill. To people who work on the front line with vulnerable people, the idea that poverty, inequality and prejudice can lead to trauma and poor physical and mental health seems evidently true. The medical establishment is a bit slower to come on board, Maté tells me, over Zoom. “Historically, social workers, nurses ... grasp my message much more easily than doctors do.”

On Thursday he is speaking at an event in the RDS called Exploring the Myth of Normal in a Toxic Culture organised by Jacqueline Kyne (the proceeds go to charity). A core thesis of Maté’s work is that society’s injustices and built-in-stressors have a significant impact on the body and mind, and ultimately people’s mental and physical health. He cites studies that show higher rates of all sorts of illness in those who have experienced childhood trauma, racism, poverty and misogyny.

“[Individuals] are manifestations of a whole social structure and culture and multigenerational history. In the book, I quote Bessel van der Kolk, who says that we’re taught to think of ourselves as individuals, but we barely exist as individuals at all. So the solutions can’t be just individual.”

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Gabor Maté: I began to notice that the people who got chronically ill had trouble saying ‘no’

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Maté is very careful about continuously referencing existing science and he is also adamant about his insights being used alongside established medical treatments and not in place of them. “My [criticism] of my profession is not that it’s too scientific, but that it’s not scientific enough,” he says. “It excludes science that doesn’t jibe with its ideological framework. Physicians are not trained in this broader perspective.”

To what does he attribute the resistance to that perspective? “The dominant institutions of any society are going to reflect the governing values of that society,” he says. “The governing values of capitalism, especially global capitalism, are individualistic, greedy, competitive, aggressive. The legal profession and the medical profession and the pedagogic professions are going to reflect all that.”

He thinks that the very way in which doctors are trained can blind them to the psychosocial components of poor health. “Who goes into medicine? It’s very often people [who] are very driven and who are willing to put up with a lot of stress in order to get through their training, which means they have to ignore their own humanity very often.”

There’s no post-traumatic stress disorder here, because the trauma is never post. That’s the situation of the Palestinians under occupation

Maté’s early work was as a GP. “As a family physician you do have an advantage, in that you get to know people before they get sick,” he says. “The specialist only sees you after you’ve been diagnosed. They don’t know anything about your life and they’re not trained to ask anything [about it]. They don’t know your family situation, your multigenerational history, what you were like before you got ill. But as a doctor, as a family physician, I get to see all that. And I also worked in palliative care and talked to people who were dying who had a lot of questions about their lives ... I’d say that the palliative care movement is rather exceptional within the medical field. [They] generally have a more holistic and more humanistic view of illness and death than most doctors.”

Maté is very honest about his own issues and shortcomings, and says that keeping them in mind helps him empathise with others. “When I’m talking to a hardcore drug addict, I’ve never been a substance user of any kind, but I can certainly recognise my own addictive tendencies,” he says. “And I’ve had to struggle with my own difficulty saying ‘no’ – workaholism, addictive patterns, depressions – so, what I see out there is also what I recognise internally.”

He was born in Nazi-controlled Budapest, Hungary in January 1944 where, for a time, his Jewish mother left him with another woman for his safety. His own trauma, he says, came from that separation as well as “the death of my grandparents [in Auschwitz], my mother’s grief ... the daily threat bombings of Budapest, the threat to life for being Jews under the Nazis, the hunger.”

He maintains that such wounds inflicted in early childhood reverberate through people’s lives and through the generations. He is very sensitive to injustice. He has spoken repeatedly about the suffering of Palestinian children. “There’s a new film in which I feature a little bit called Where the Olive Trees Weep. It’s about the West Bank where I was years ago. I say this in the film, it’s not original to me, that there’s no post-traumatic stress disorder here, because the trauma is never post. That’s the situation of the Palestinians under occupation.”

As a younger man he was a Zionist but he went on to reject the ideology. Was that difficult as a Jewish person? “Fifty years ago, it was, but that was a long time ago. It was tough at the time, because it meant breaking with friends and giving up a nice dream... But at this point? No. I just feel grief and rage. That’s all.”

He talks a little about the psychological mindset of colonisation. “How did the British talk about the Irish?” he asks. “To colonise somebody, you have to dehumanise them. And you have to dehumanise yourself in the process. I don’t want to lecture you on Irish history, but any time people are recruited to serve a colonial project, they’re going to have to dehumanise people.”

Does he think the need to dehumanise also has roots in trauma? “I quote one study in The Myth of Normal where they looked at young American men who had very harsh views on foreign wars and [were very] anti-abortion and pro-death penalty,” he says. “After therapy, they softened up. A lot of those harsh views are very much related to trauma. People are defending against their own vulnerability. When you open up your vulnerability and you’re not defending any more, you’re a lot more empathetic to other people.”

I tell him that given the political ramifications of his ideas, I was surprised that he didn’t outline a more political prescription for change in the Myth of Normal. He’s not sure people want his “plan”, he says. “But you’re right. In the last chapter, I hold back. I don’t lay out my vision of a society that I think would be equitable and workable.”

The other thing [people say] is that I’m putting too much emphasis on the emotional side of things. I don’t think so. And if I do, it’s because nobody else pays attention to it

He felt, he says, that an explicit political position might alienate some of those who needed the book’s message of healing. He has been disillusioned by several political ideologies over the years, from autocratic Hungarian communism to Zionism to global capitalism. If he has a political worldview, he says, it aligns with what he calls “communalism ... people co-operating and not pulling their own individual interests above that of group. That’s a direction where solutions are to be found. But it’s not for me to lay out ... I don’t know how to tell people to move towards that.”

One of the more controversial arguments in The Myth of Normal is that self-sacrificing people who can’t express their needs are more likely to succumb to chronic illness. “I began to notice that the people who got chronically ill had trouble saying ‘no’,” he says. “At 1½ years of age, every kid starts saying ‘No’. That’s nature’s way of giving them some space to be themselves. So, something had to have happened to you or to anybody else who’s got trouble saying ‘no’. That’s what I talk about in The Myth of Normal, the tension between attachment, which is the need to belong, and authenticity, which is the need to be ourselves. And if we get the message that if we are ourselves with our ‘Nos’ and our anger and our self-assertion, that we’re then not going to have attachment, guess what’s going to have to go out the window? It’s going to be authenticity.”

He is wary of people taking the wrong lessons from his work. He frequently stresses the importance of established mainstream medicine when people are ill and he repeatedly says that people are not to blame for their illness.

“It is true to say that the way you lived your life and the emotional dynamics that you manifested, and the degree to which you suppressed your true self in order to belong, that that harmed your health. But are you to blame? Which morning did you decide that ‘I’m going to ignore my own needs to serve those of others?’ ... These are defensive mechanisms that the organism adopts automatically, not consciously ... It’s not deliberate. Why would anybody be blamed? But can they take responsibility? Yes, they can. They can say, ‘Yeah, the way I’ve lived hasn’t been good for me. I can take responsibility for changing it if I get enough support and enough insight.’”

Some of his critics acknowledge a general connection between trauma and illness but resist the direct line he draws between repressed emotions or trauma and a variety of specific conditions (such as MS or ADHD). He, unsurprisingly, disagrees. He contends that scientific studies back him up. “Some people argue I’m too anecdotal, that I tell too many stories and stories don’t prove anything. [But] I use story to illustrate points. I cite the science, for those who want that kind of proof. The other thing [people say] is that I’m putting too much emphasis on the emotional side of things. I don’t think so. And if I do, it’s because nobody else pays attention to it.”

Others have issues with his support for the therapeutic use of the South American psychedelic drug, ayahuasca. He took the drug for the first time 15 years ago. “I’d written a book on addiction called In the Realm of Hungry Ghosts and after that was published, people kept asking me what I knew about psychedelics and ayahuasca specifically, in the healing of addiction,” he says. “Somebody said, ‘You know, you don’t have to go to the Amazon, you can do it here in Vancouver.’ So I did. And I got it. I got what they were talking about.

“I could see the self-awareness that the plant can open up in people and the way it removes that membrane between [the conscious and] the unconscious so that you can actually experience all the pain and terror that you were running away from all your life. So it was kind of a revelatory experience for me and I started working with it.”

He tells a story about how the Peruvian shamans at one ayahuasca retreat took him aside and told him that he wasn’t helping people at the retreat and was, in fact, stressing them out. “I was working on this crazy long speaking trip to the UK and I flew from London to Peru and I’d not taken care of myself and all my trauma imprints were just active and they picked up on it like that. They were not impressed with who I was. They didn’t know who I was. They just saw this human being in need of help who should not be helping others in that place.

“Twenty-four people had come from four continents to work with ‘the great Maté’ and they said, ‘There is no great Maté, there is just this kid who needs help.’” He laughs. “I was grateful. My ego hated it. But at the same time, I knew they were right.”

Exploring the Myth of Normal in a Toxic Culture featuring Gabor Maté is on Thursday June 20th in the RDS. Detail at rds.ie

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