Tuesday, January 1, 2013


Dr. Gabor Maté wrote the bestsellers Scattered: HowAttention Deficit Disorder Originates In the Realm of Hungry Ghosts: CloseEncounters with Addiction. The following article was adapted from an interview by Amy Goodman. Our society is suffering in a variety of ways - from widespread drug abuse to mass killings. Dr. Mate looks deeply to uncover the root of many of society's problems.

'Post-industrial' capitalism has destroyed the conditions for healthy childhood development. The hardcore drug addicts that I treat, are, without exception, people who have had extraordinarily difficult lives. The commonality is childhood abuse. These people all enter life under extremely adverse circumstances. Not only did they not get what they need for healthy development, they actually got negative circumstances of neglect. I don’t have a single female patient in the Downtown Eastside of Vancouver who wasn’t sexually abused, for example, as were many of the men--or abused, neglected and abandoned serially, over and over again. That’s what sets up the brain biology of addiction. In other words, the addiction is related both psychologically, in terms of emotional pain relief, and neurobiological development to early adversity.

AG: What does the title of your book mean, In the Realm of Hungry Ghosts?

GM: In the Buddhists’ psychology, there are a number of realms that human beings cycle through, all of us. One is the human realm, which is our ordinary selves. The hell realm is that of unbearable rage, fear, you know, these emotions that are difficult to handle. The animal realm is our instincts and our id and our passions.

Now, the hungry ghost realm, the creatures in it are depicted as people with large empty bellies, small mouths and scrawny thin necks. They can never get enough satisfaction. They can never fill their bellies. They’re always hungry, always empty, always seeking it from the outside. That speaks to a part of us that I have and everybody in our society has, where we want satisfaction from the outside, where we’re empty, where we want to be soothed by something in the short term, but we can never feel that or fulfill that insatiety from the outside. Addicts are in that realm all the time. Most of us are in that realm some of the time. My point really is, is that there’s no clear distinction between the identified addict and the rest of us. There’s a continuum in which we all may be found. They’re on it, because they’ve suffered a lot more than most of us.

AG: Can you talk about the biology of addiction?

GM: If you look at the brain circuits involved in addiction—and that’s true whether it’s a shopping addiction like mine or an addiction to opiates like the heroin addict—we’re looking for endorphins in our brains. Endorphins are the brain’s feel good, reward, pleasure and pain relief chemicals. They also happen to be the love chemicals that connect us to the universe and to one another.
Now, that circuitry in addicts doesn’t function very well, as the circuitry of incentive and motivation, which involves the chemical dopamine, also doesn’t function very well. Stimulant drugs like cocaine, crystal meth, nicotine and caffeine, all elevate dopamine levels in the brain, as do sexual acting out, extreme sports, workaholism and so on. The issue is, why do these circuits not work so well in some people, because the drugs in themselves are not surprisingly addictive. What I mean by that is that most people who try most drugs never become addicted to them. So, there has to be susceptibility there. The susceptible people are the ones with these impaired brain circuits, an impairment caused by early adversity, rather than by genetics.

AG: What do you mean, “early adversity”?

GM: Well, the human brain, unlike any other mammal, for the most part develops under the influence of the environment. And that’s because, from the evolutionary point of view, we developed these large heads, large fore-brains, and to walk on two legs we have a narrow pelvis. That means—large head, narrow pelvis—we have to be born prematurely. Otherwise, we would never get born. The head already is the biggest part of the body. Now, the horse can run on the first day of life. Human beings aren’t that developed for two years. That means much of our brain development, that in other animals occurs safely in the uterus, for us has to occur out there in the environment. And which circuits develop and which don’t depend very much on environmental input. When people are mistreated, stressed or abused, their brains don’t develop the way they ought to. It’s that simple. And unfortunately, my profession, the medical profession, puts all the emphasis on genetics rather than on the environment, which, of course, is a simple explanation. It also takes everybody off the hook.

AG: What do you mean, it takes people off the hook?

GM: Well, if people’s behaviors and dysfunctions are regulated, controlled and determined by genes, we don’t have to look at child welfare policies, we don’t have to look at the kind of support that we give to pregnant women, we don’t have to look at the kind of non-support that we give to families, so that, you know, most children in North America now have to be away from their parents from an early age on because of economic considerations. And especially in the States, because of the welfare laws, women are forced to go find low-paying jobs far away from home, often single women, and not see their kids for most of the day. Under those conditions, kids’ brains don’t develop the way they need to.

And so, if it’s all caused by genetics, we don’t have to look at those social policies; we don’t have to look at our politics that disadvantage certain minority groups, so cause them more stress, cause them more pain, in other words, more predisposition for addictions; we don’t have to look at economic inequalities. If it’s all genes, it’s all—we’re all innocent, and society doesn’t have to take a hard look at its own attitudes and policies.

The first point to get there is that if people who become severe addicts, as shown by all the studies, were for the most part abused children, then we realize that the war on drugs is actually waged against people that were abused from the moment they were born, or from an early age on. In other words, we’re punishing people for having been abused. The second point is, is that the research clearly shows that the biggest driver of addictive relapse and addictive behavior is actually stress. In North America right now, because of the economic crisis, a lot of people are eating junk food, because junk foods release endorphins and dopamine in the brain. Stress drives addiction.
Now imagine a situation where we’re trying to figure out how to help addicts. Would we come up with a system that stresses them to the max? Who would design a system that ostracizes, marginalizes, impoverishes and ensures the disease of the addict, and hope, through that system, to rehabilitate large numbers? It can’t be done. In other words, the so-called “war on drugs,” which, as the new drug czar points out, is a war on people, actually entrenches addiction deeply. Furthermore, it institutionalizes people in facilities where there’s no care. We call it a “correctional” system, but it doesn’t correct anything. It’s a punitive system. So people suffer more, and come out more entrenched in their addiction than they were when they went in.

AG: You were born in Nazi-occupied Hungary?

GM: And one consequence is I have attention deficit disorder myself. Again, most people see it as a genetic problem. I don’t. It actually has to do with those factors of brain development, which in my case occurred as a Jewish infant under Nazi occupation in the ghetto of Budapest. The day after the Nazis marched into Budapest in March of 1944, my mother called the pediatrician and said, “Would you please come and see my son, because he’s crying all the time?” The pediatrician said, “Of course I’ll come. But I should tell you, all my Jewish babies are crying.”

Now infants don’t know anything about Nazis and genocide or war or Hitler. They’re picking up on the stresses of their parents. And, of course, my mother was an intensely stressed person, her husband being away in forced labor, her parents shortly thereafter being seized and killed in Auschwitz. Under those conditions, I don’t have the kind of conditions I need for the proper development of my brain circuits. How does an infant deal with that much stress? By tuning it out. That’s the only way the brain can deal with it. That "solution" becomes programmed into the brain. So, if you look at the three million kids in the States that are on stimulant medication and the half-a-million who are on anti-psychotics, what they’re really exhibiting is the effects of increasing stress in our society, on the parenting environment. Not bad parenting. Extremely stressed parenting, because of social and economic conditions. And that’s why we’re seeing such a preponderance.

AG: How do you think kids with ADD, with attention deficit disorder, should be treated?

GM: Recognize that it’s not a disease, it’s not genetic, but a problem of brain development. And knowing the good news, fortunately—and this is also true for addicts—that the human brain can develop new circuits even later on in life—neuroplasticity, the capacity of the brain to be molded by new experience later in life—then the question becomes not of how to regulate and control symptoms, but how do you promote development. That has to do with providing kids with the kind of environment and nurturing that they need so that those circuits can develop later on. That’s also what the addict needs. Instead of a punitive approach, we need to have a much more compassionate, caring approach that would allow these people to develop, because their development is stuck at a very early age. Naguib Mahfouz, the great Egyptian writer, said that "Nothing records the effects of a sad life so completely, so graphically as the human body”. I see that sad life in the faces and bodies of my patients.

AG: You have described the effects of parenting, bullying, the education system, and how a litany of stresses on the family environment is leading to what you call the "destruction of the American childhood."

GM: In the United States right now, there are three million children receiving stimulant medications for ADHD,  Attention Deficit Hyperactivity Disorder. There are about half-a-million kids in this country receiving heavy-duty anti-psychotic medications, medications such as are usually given to adult schizophrenics to regulate their hallucinations. But in this case, children are getting it to control their behavior. So what we have is a massive social experiment of the chemical control of children’s behavior, with no idea of the long-term consequences of these heavy-duty anti-psychotics on kids.
Canadian statistics just showed that within last five years, there’s been a 43 percent increase in the rate of dispensing of stimulant prescriptions for ADD or ADHD, and most of these are boys. We’re seeing is an unprecedented burgeoning of the diagnosis. Really, I’m talking more broadly about the destruction of American childhood, because ADD is just a template, or an example of what’s going on. In fact, according to a recent study published in the States, nearly half of American adolescents now meet some criteria or criteria for mental health disorders. We’re talking about a massive impact on our children of something in our culture that’s just not being recognized.

Specifically ADD is a compound of three categorical set of symptoms. One has to do with poor impulse control. These children have difficulty controlling their impulses. When their brain tells them to do something from the lower brain centers, there’s nothing up here in the cortex where the executive functions are, where the functions are that are supposed to tell us what to do and what not to do. Those circuits just don’t work. So there’s poor impulse control. They act out. They behave aggressively. They speak out of turn. They say the wrong thing. Adults with ADD shop compulsively or impulsively, behave in impulsive fashion. But again, the impulse control problem is general amongst kids these days. In other words, it’s not just the kids diagnosed with ADD, but a lot of kids. Furthermore, there’s a whole lot of new diagnoses now -- impulse control has become a general problem amongst children.

The second criterion for ADD is physical hyperactivity. So the part of the brain, again, that’s supposed to regulate physical activity and keep you still just, again, doesn’t work. Finally, the third criterion is poor attention skills—tuning out; not paying attention; mind being somewhere else; absent-mindedness; not being able to focus; beginning to work on something, five minutes later the mind going somewhere else. There is a kind of a mental restlessness and the lack of being still, the lack of being focused, the lack of being present. These are the three major criteria of ADD.
...The conditions in which children develop have been so corrupted and troubled over the last several decades that the template for normal brain development is no longer present for many, many kids. Dr. Bessel Van der Kolk, professor of psychiatry at the University of Boston, says that the neglect or abuse of children is the number one public health concern in the United States. A recent study coming out of Notre Dame by a psychologist there has shown that the conditions for child development that hunter-gatherer societies provided for their children, which are the optimal conditions for development, are no longer present for our kids. She states that the way we raise our children today in this country is increasingly depriving them of the practices that lead to well-being in a moral sense. So what’s really going on here now is that the developmental conditions for healthy childhood psychological and brain development are less and less available, so that the issue of ADD is only a small part of the general issue that children are no longer having the support for the way they need to develop.

The essential condition for the physiological development of these brain circuits that regulate human behavior, that give us empathy, that give us a social sense, that give us a connection with other people, that give us a connection with ourselves, that allows us to mature—the essential condition for those circuits, for their physiological development, is the presence of emotionally available, consistently available, non-stressed, attuned parenting caregivers. Now, what do you have in a country where the average maternity leave is six weeks? These kids don’t have emotional caregivers available to them. What do you have in a country where poor women, nearly 50% of them, suffer from postpartum depression? When a woman has postpartum depression, she can’t be attuned to the child.

What we have to understand here is that human beings are not discrete, individual entities, contrary to the free enterprise myth that people are competitive, individualistic, private entities. What people actually are are social creatures, very much dependent on one another and very much programmed to cooperate with one another when the circumstances are right. When that’s not available, if the support is not available for women, that’s when they get depressed. When the fathers are stressed, they’re not supporting the women in that really important, crucial bonding role in the beginning. In fact, they get stressed and depressed themselves. The child’s brain development depends on the presence of non-stressed, emotionally available parents. In this country, that’s less and less available.

AG: How do the standard drugs affect the development of the brain?

GM: In ADD, there’s an essential brain chemical, which is necessary for incentive and motivation, that seems to be lacking: dopamine. Dopamine is simply an essential life chemical. Without it, there’s no life. Mice in a laboratory who have no dopamine will starve themselves to death, because they have no incentive to eat. Even though they’re hungry, and even though their life is in danger, they will not eat, because there’s no motivation or incentive. So, one way to look at ADD is a massive problem of motivation, because the dopamine is lacking in the brain. Now, the stimulant medications elevate dopamine levels, and these kids are now more motivated. They can focus and pay attention.
However, the assumption underneath giving these kids medications is that what we’re dealing with here is a genetic disorder, and the only way to deal with it is pharmacologically. Yet if you actually look at how the dopamine levels in a brain develop, if you look at infant monkeys and you measure their dopamine levels, and they’re normal when they’re with their mothers, and when you separate them from mothers, the dopamine levels go down within two or three days. In In other words, what we’re doing is we’re correcting a massive social problem that has to do with disconnection in a society and the loss of nurturing, non-stressed parenting, and we’re replacing that chemically. Now, the drugs—the stimulant drugs do seem to work, and a lot of kids are helped by it. The problem is not so much whether they should be used or not; the problem is that 80 percent of the time a kid is prescribed a medication, that’s all that happens. Nobody talks about family environment. The school makes no attempt to change the school environment. Nobody connects with these kids emotionally. In other words, it’s seen simply as a medical or a behavioral problem, but not as a problem of development.

AG: What does acting out mean?

GM: That's a great question. You see, when we hear the phrase "acting out," we usually mean that a kid is behaving badly, that a child is being obstreperous, oppositional, violent, bullying, rude. The phrase "acting out" means you’re portraying behavior that which you haven’t got the words to say in language. In a game of charades, you have to act out, because you’re not allowed to speak. If you landed in a country where nobody spoke your language and you were hungry, you would have to literally demonstrate your anger—sorry, your hunger, through behavior, pointing to your mouth or to your empty belly, because you don’t have the words.

A lot of children are acting out, but it’s not bad behavior. It’s a representation of emotional losses and emotional lacks in their lives. And whether it’s, bullying or a whole set of other behaviors, what we’re dealing with here is childhood stunted emotional development. And rather than trying to control these behaviors through punishments, or even just exclusively through medications, we need to help these kids develop. 


Soch said...

Thank you for the informative post.

Mae said...

You're most welcome! And thank you for stopping by and for commenting...I went to your site and it looks like you're doing great work, may you continue to be an instrument of peace! Namaste!