Gabor Maté - What promotes positive health?
In short, we can be summarized as a movement which advocates the application of the scientific method for social and environmental concern. Some background information, though I'm sure Dr. Maté needs no introduction: Dr. Maté ran a popular family practice in East Vancouver for two decades. For 7 years, he also served as medical coordinator of the palliative care unit at Vancouver hospital, caring for the terminally ill. More recently, he worked for 12 years in Vancouver's notorious Downtown Eastside with patients suffering from drug addiction, mental illness and HIV. He's authored four books; the last two have become national and international best sellers, translated into 9 languages. (Dr. Maté) 20. - 20 different languages. [Laughs] A recurring theme throughout his work is the development of the psyche, mental and physical health and looking at neurological and psychological mechanisms which he connects with the need for social change. Dr. Maté was gracious enough to lend us his expertise and was featured in the latest of the Zeitgeist film series: Zeitgeist: Moving Forward. He put forth progressive ideas about what factors come into play when looking at the development of the human psyche in relation to its social and physical environment. We are honored to collaborate with Dr. Gabor Maté in this joint presentation based on a fairly simple question: what promotes positive mental health and what would a society that supports and fosters healthy and stable individuals look like? Without further ado, please welcome Dr. Maté. [Applause] First of all, thank you for coming out to be part of this conversation; thanks to The Zeitgeist Movement for inviting me. I need to clarify that I'm not a member of the movement (you might call me a friend) nor was I gracious enough to put this bit in the movie. I did not know I was participating when I was interviewed. I didn't even know there was such a movie, I was simply interviewed by somebody who thought my ideas were interesting enough and next thing I know, I'm in the Zeitgeist movie, so grace had nothing to do with it. I was happy with the film, particularly the part that has interviews with myself and a number of other people. We all put forward a perspective which is what I'll be presenting today, which is that human beings can't be separated from their environment, and in order to understand the human being, you must understand the environment. The implication is also that if we're going to be different human beings or foster different human beings, we have to look at the environment. The medical practice that I was trained in, the University of British Columbia, has a very western ideology-infused medicine. Now, we think of medicine as a science, as a scientific practice, but it's as much ideological as it is anything else. What passes for science in our culture is a combination of scientific data but interpreted through an ideological lens, so we must never think of it as pure science. Unfortunately, it's not a conscious ideological lens, so that the practitioners are not aware that they have an ideology. They didn't choose that ideology, they simply grew up in it, they were trained in it, and they think that they're looking objectively at the world. But as the Buddha pointed out 2500 years ago: we create the world with our minds, so the kind of perspective that we have will shape what we see and that's absolutely true of science as well. What I'm interested in looking at is: before we create the world with our minds, how does the world create our minds? What kind of minds are we looking at the world with? That's the question that Western medicine doesn't ask very much. It makes two separations: it separates the mind from the body so that physical illnesses, or illnesses that are considered to be purely physical like rheumatoid arthritis, cancer, multiple sclerosis, any chronic health condition you care to name, is understood only in terms of the organs that it attacks, but not in terms of the relationship of the body to the person's psychological, spiritual and social life. That means if you go to a doctor with a flare up of rheumatoid arthritis, an inflammation of your joints, a disease in which the immune system actually attacks the body itself and therefore called 'auto-immune disease' (sort of like if the Canadian army attacked Canada, which under the current government is a total possibility in my opinion) that's what an auto-immune disease is: the immune system turns against yourself. We don't ask the question: why is the immune system in mutiny against the body? We simply give medications to suppress the symptoms. We deal with surface manifestations, but we don't look at causes because causes would imply a larger, more holistic look and fundamentally, as physicians, we throw up our hands and we say "We don't know what causes these things!" If you look at something like multiple sclerosis which is a degenerative disease of the nervous system, in the 1940s, the gender ratio of multiple sclerosis was a 1 to 1: for each man diagnosed, so was a woman. The gender ratio now is 3 or 4 women for every man and you cannot understand that on strictly physical grounds. If you think it's genetics, it won't cut it because genes don't change in a population over 70 years. If you think it's the diet or the climate, no, that hasn't changed more for one gender than the other either. So, there's something about gender in our society that certainly influences the onset and course of disease. In order to understand that, you'd have to look at something broader than just the body. So that mind/body separation doesn't work to explain either physical or mental illness. And by the way, my talk is not just about mental illness either, it's about illness in general. Then the second separation that we make is, we separate the human being, the individual, from the environment. We think that if cancer shows up in somebody, or if mental illness shows up in somebody, it's strictly [due to] individual factors such as, for example, the genetics, so it has to do with the genes, the DNA that you or I inherited from our parents, or perhaps is a result of lifestyle choices we make: if you smoke, which of course increases your risk of lung cancer, then you get lung cancer, that's because of a choice you individually made. These are individual perspectives on disease, which again, causes us to miss a lot of things. Let me give you three examples of a different approach, which has been called 'a bio-psychosocial approach' which means to say that the biology of an individual is inseparable from its psychological and social environment. It's the only scientific understanding that makes any sense at all and it's the only way through which we can comprehend who gets sick and why. Of course, if you look at it in a broad scale, social factors such as gender, race and economic position are far more influential in population health than individual factors, and that's because we're bio-psychosocial creatures. Therefore, biology can't be separated from the psychological and social environment. For example, it's not even controversial, a number of studies have shown it, that children whose parents are stressed are much more likely to have asthma than children whose parents are not stressed. In polluted areas, where the air quality itself and the irritants in the air cause the triggering of more asthmatic flare ups in people, it's still the children of stressed parents who are most likely to have asthma. If you go to the ordinary, western-trained physician with either yourself or your child having asthma, you'll be given the appropriate treatment which will reverse the narrowing of the airways that happens in asthma; it will suppress the inflammation that happens in asthma. Now, the inhalers, the medications you get in whatever form to achieve those affects, it's interesting to consider what they are. Because the inhaler that opens up the narrowed airways of the asthmatic is actually a copy of adrenaline. In fact, if you rushed to a hospital with a severe asthmatic episode you'd be given an injection of adrenaline. The inhaler that suppresses the inflammation (which is the other aspect of asthma, the swelling, etc. that needs to be suppressed which further clutters the airways) that inhaler, or that infusion that you'd get the hospital's emergency ward, is actually cortisol. If you look at what cortisol and adrenaline are, anybody know what they are? They're stress hormones. They're treating asthmatics with stress hormones. As a matter of fact, cortisol is the commonest medication used in all of medicine. It's used in conditions of the skin, of the lungs, of the joints, of the intestines and of the nervous system. It's a stress hormone. If you were threatened right now, your adrenal gland would put out adrenaline and cortisol which would allow you to fight back or to escape, but in the long term, those same hormones damage your health. So, acute stress is just how you survive a threat; chronic stress debilitates your immune system: heart disease, thinning of the bones, ulcers in the intestines and depression are the side-effects. Now, we give these stress hormones to the asthmatic child, but we never ask the question: we're treating something with stress hormones, is it possible that the condition is connected to stress somehow? That question is never asked. Now, the lung functioning of the children of stressed parents, why is the lung functioning affected by the parents' emotional states? Because the child's biology is actually shaped or influenced by the parents' emotional/psychological states, because it bio-psychosocial. You can't separate the emotions from the body and you can't separate the individual from the environment. In another study in Australia, they looked at 500 women who'd had breast biopsies, lumps in their breasts, which needed to be biopsied for cancer to see if they're malignant. These biopsies were then done and before the results came back, the women underwent a psychological questionnaire, an interview. It turned out that if a woman has been emotionally isolated prior to the onset of that lump, that by itself had zero effect on that lump being cancerous. Similarly, if a woman had experienced a major stressful episode in her life, that by itself also had zero effect. So far so good. But if the woman had been emotionally isolated and stressed, the risk of that lump being cancerous was 9 times as great as the average. The researchers being left-brained, medically-trained, scientific-minded people, they had no way of understanding this. They were totally puzzled by this. They said "How does zero and zero add up to 9?" which is logical as a question, but it ignores the true nature of human beings. Because if you're stressed, then again these hormones are raging through your system. But if somebody comes along and says "Hey friend, I see that you're upset, how are you feeling?" puts a hand on your shoulder, what happens to you physiologically in a split second? You calm down, you take a deep breath. Your brain has more oxygen, you start thinking more clearly. The adrenaline levels and your blood pressure go down, your heart stops racing, the cortisol levels go down, so the immune system is no longer under siege. But if you're emotionally isolated and there's no one to relate to, then you'll be stewing on your own stress juices for months, suppressing the immune system, which of course means that that potential malignant transformation is not controlled. No wonder then, do women who are emotionally isolated and stressed are more likely to have breast cancer, significantly so. This also tells us that cancer is not the disease of an individual. It's a disease of an individual which manifests a lifelong set of relationships with the psychological and social environment. For all the hundreds of billions of dollars that they raise for cancer research, it's never going to amount to anything. At least, they'll have certain breakthroughs and they'll show these spectacular advances in the treatments of specific cancers, but overall our ability to understand cancer or to treat it has not really moved forward one iota in the last 40-50 years. Someone very astutely said "Trying to find the answer to cancer by studying the individual cell is like trying to understand the traffic jam by studying the internal combustion engine." In other words, to understand the cancer of the individual, you have to look at the much larger picture. That's just something we militantly refuse to do in Western medicine. Now, there are ideological reasons for that. Finally, at the end of life, amongst elderly couples when one of the is hospitalized, not surprisingly, the other one is much more likely to fall sick, according to studies. Why? Because the immune system of the one is actually modulated by the psychological relationship with the other, so that our attachment relationships have a huge formative influence on our physical and mental health. This means that if we're going to understand health, we can't do it by reference to the individual. Given these obvious scientific facts, and they're really so obvious that a 5-year-old could come up with them, why is it that we're so blind to it in this culture? That has to do with ideology, because the ideology of any particular culture does not evolve accidentally. It actually reflects the dominant interests of the groups that control or most benefit from that society. Now, the dominant ideology in this society, given that we live in a society that worships competition, that worships individual profit, that actually worships and considers to be its heroes those people like Donald Trump who are managing to exploit many others in order to amass wealth and power. In a society like that, we have to look at people as individuals rather than social creatures. Because if we admitted, acknowledged and fully got the implications of the reality that human beings are social creatures with social and psychological needs, we wouldn't be treating people the way we are. In order to treat people the way they are being treated we have to commodify the individual. So the individual himself or herself needs to become a commodity, which means that our value is simply based on what we produce or what we acquire, but not actually who we are. It's not based on just our very existence as human beings. There's this very popular book called 'Tuesdays with Morrie'. Are any of you familiar with it? Quite a few of you are. This is a man who develops a degenerative neurological illness called ALS (Amyotrophic lateral sclerosis) in which the nervous system literally dries up and hardens. In the end you're rigid, immobile, paralyzed; you can't even breathe. You're completely withered mentally, it's like drowning in air, because you can't breathe at the end. This guy Morrie is a teacher who develops ALS, a true story and his student Mitch who writes the book begins to visit him. They start talking and Morrie is a bright guy, he has insights, and particularly, he's exploring his own death. They go through this conversation every week and finally the conservations become the subject of a book called 'Tuesdays with Morrie'. Here's this guy, Morrie, who decides to transmit his wisdom to the world. He says to Mitch "The reason I want to teach people about the dying process and pass on my wisdom is because I want to prove that dying people aren't useless." I want you to consider the assumption behind that. The assumption is that dying people may be useless because they're not contributing. A way that you attain value is to contribute, so who you are as a human being, in your very existence, is insufficient to give you value. You have to be producing something. That thinking is actually, in a very specific way (and I'm not going through the details of it) is what I think causes ALS. People are desperately trying to make themselves useful totally ignoring who they are. It's the foundation of most chronic illnesses in our society because of the mind/body entity. But, the very ideology that dying people are useless, or that anybody is useless, is a reflection of the capitalist idea that people are only useful when they produce. In the 1840s, a young Karl Marx talked about alienation. He said that human beings are alienated from themselves, from their true nature, from their essence, from their work because their work no longer reflects who they are; it reflects their use value. They are alienated from other people because, of course in a society that says it's all about individual competition and it's dog against dog, what we call social darwinism, you can't help but being alienated from other human beings and finally, we're alienated from nature. Just to what degree we're alienated from nature is tragically and painfully obvious to us in the 21st century. We're so alienated, that we're actually destroying it. It's in this kind of a context that we have to understand health. When you look at factors like social status, even if you have a heart attack, if you live in a higher economically, status area, your chances of surviving a heart attack are actually better. It's not even because the services are better, but simply because as a higher economic status person, you have more going for you, protecting you from death. In the British civil service there are the famous Whitehall Studies, where they looked at heart attack risk, or heart disease risk, in the civil service. The higher up you were in the civil service, the less the risk of heart attack. It's not just an economic factor because even on two different tiers, at the top and second tier where the income differences weren't all that great, the heart disease differences were significant simply because people at the top had less heart attacks. Position in the civil service was more of a predictor of heart disease risk than cholesterol and high blood pressure levels which are all the things you get paid attention to when you go to the doctor's office. So, social status is a significant determinant of health; gender obviously is. If you look at the statistics I gave you about multiple sclerosis, what's different? Why has the ratio changed? If you understand that multiple sclerosis is in fact a response to stress, which of course it is, although most physicians wouldn't see it that way (I talk about that in my book 'When the Body Says No'). If you look at women's situations, what has happened? Women in our society have always carried the burden of being the emotional supports for their men and for their families, so that hasn't changed; they're still doing that. They're the emotional absorbers of their environments which, by the way, would help to explain why married men live longer than unmarried men, but married women don't live longer than unmarried women. What has changed, is that since the Second World War, women have had to take on an economic role, and they're doing so in the context of their support. Because we used to live in clans, and tribes, and communities and extended families and neighborhoods and much more sense of social cohesion and contact, so that the depression of the 1930s, while it was economically, so far at least, more devastating than the current recession is, there was also more social cohesion. People supported each other much more, communally. So you have more stress and less support, naturally, if disease is stress related, which I'm convinced it is, you're going to get more disease. There's no other explanation for it. It's not simply an individual issue, it's also very much a gender issue in our society. Not that women are unique to that kind of stress, but they're the main recipients of it. Finally, of course, race: black American males have a significant increase in prostate cancer death risk over whites. Their biological relatives in Africa do not, so it's not a genetic issue. I think it has to do with racism, stress and being an African American in the United States. Needless to say that in Canada, we have the First Nations population, which 100 years ago had no diabetes, and 150 years ago, no rheumatoid arthritis, and now they have the world's highest rates of those diseases in some areas. Now, that's not a genetic issue. That's not an individual issue. It's a question of looking at what happened socially, economically and culturally, and the abuse that they've undergone in this society, and continue to. Therefore, you can't explain disease, again, in isolation from a psychosocial environment. Beyond that, there's the evidence now, it's not even controversial, but most physicians and educators have never even heard about it which is an extraordinary statement. Actually, it's an extraordinary reflection of how ideological the medical practice is and how ideological everything is. We now have all this science that is beyond the shadow of any doubt whatsoever that shows that the human brain actually develops in interaction with the environment. The kind of brains we have reflects what is happening in the environment. And yet, if you look at the situation of children these days, you've gained a burgeoning diagnosis of ADHD, autism, oppositional defiant disorder, conduct disorder, Tourette's, Asperger's, reactive attachment disorder, all these diagnoses, and more and more kids are being medicated. Sometimes they're being medicated with drugs that do them all kinds of harm, so much so that the British Columbia Children's Hospital recently assessed to establish a clinic just to treat kids for the side-effects of the anti-psychotic medications they're getting. They're getting these anti-psychotic medications not to control psychosis which they don't have, but to control their behavior. Because we don't understand that the child's behavior reflects his relationship to the environment, we just try and treat the kid's symptoms. The environment gets very stressed, kids' brains don't develop the way they should, they have poor impulse control and all kinds of emotional pain and confusion that they're acting out on their behaviors. And instead of changing the environment, or at least addressing the environment, we medicate the kid. In other words, we try and suppress the symptom, the surface manifestation of something that's completely psychosocial. The result is that kids are developing metabolic syndrome, diabetes and risk for heart disease, etc. as a result of these medications which have never been studied in kids. Nobody's ever studied the long term effects, but we're handing them out. Tens of thousands of kids in this country, hundreds of thousands in the States, and all because we don't get the relationship between the environment and the individual child. This is what we're seeing. Now, if you then turn to the question of: what promotes positive health? If you look at the literature on stress (and I'm saying that stress is the common factor whether it comes to physical or mental illness) if you actually look at the literature on childhood adversity, the more adverse circumstances that are present in a child's life in the early years, exponentially, the greater the risk of addictions the greater the risk of mental illness, of psychosis, of rheumatoid arthritis, of cancer, of obesity of all kinds of behavioral problems. Why? Because the early environment changes the brain, and as Antonio Damasio, who is a leading neurologist, writes: "To understand in a satisfactory manner the brain that fabricates human mind and human behavior, it is necessary to take into account its social and cultural context." The very circuitry of the brain depends on the emotional and social environment for its development. When that is stressed, the child's brain doesn't develop the way it should, and that's why you see so many kids now being diagnosed. It's not an individual problem, but again, we don't get that as a society. Instead of looking at the larger picture
of what conditions do kids actually need for health, we're just trying to deal with the symptoms. We mostly do that according to the lines dictated by medical economics, which is to say by the needs and profits of the pharmaceutical companies. Because there's lot's of money to be made on developing new drugs, there's no money to be made on researching stress on the family and how to alleviate it. That's not going to be profitable to anybody. It's not even that there's a conspiracy, not that they don't conspire, they do. When there's research that undermines their profits, they'll suppress it. They'll magnify or over emphasize research that will support their profits. It's not that they're above being conspiratorial, but fundamentally it doesn't take a conspiracy, it just takes the profit system. Then you've got a perfect melding of individualistic ideology and the profit motive, hence you're getting to medicate millions of kids. The number of prescriptions for stimulant medications for ADHD in this country, which I have myself, has gone up 43% in the last 5 years and nobody's looking at how to deal with the child's environment that actually shapes that brain that then manifests itself in poor attention skills, poor impulse control and hyperactivity. If you look at the literature on stress, the dominant stress factors affecting people are: uncertainty and lack of information (I want you to think about the position of the average citizen in this culture) uncertainty and lack of information for the most people don't have information, because information sources as we all know, are controlled by very few people. I grew up in communist Hungary under a very rigid and brutal dictatorship where the information flow was controlled,
but the difference was: everybody knew it. There's a story that might be apocryphal or might be true and I wish I remembered where I read it. It's [a story] of some Russian journalists coming to England in the '50s or early '60s and they say "You have all this conformity and people buying into the official ideology! In our country, we have to have jails and we have to pull people's fingernails to achieve that kind of unanimity. How do you do it over here?" How they do it is through their control of the media and through the repetition of untruth as truth, and people buy into it. The propaganda system and the mind control system is far more effective here than it is those brutal dictatorships where anyone with a mind can see through it. But there are lots of intelligent people here who are totally caught up in it, who actually think they're free. But how can you be free, when you don't have information, or when the information that you're working with is the opposite of reality? There's no freedom in that. For all the Internet, and the reality that people can access any sorts of information they want these days, that has not increased the freedom quotient in our society significantly because ideological people are blinded. Even though it's available to them, there's no danger of most people ever finding out the truth about climate change. Not at least sufficiently to get them alarmed about it enough to do something about it politically. We have people in charge who are in total denial, and we keep electing them. It's like if somebody was legally blind, and you took away their white cane and you make them the guides in traffic. This is what we're doing with our politicians, we elect the most blind people and say "Lead us on!" How can you talk about freedom? What person who is actually free would make such a choice? Uncertainty and lack of information characterizes the average citizen and the social discourse and the social conversation. Secondly: loss of control. You take rats, you yoke them in pairs and you actually tie them up together. You attach electrodes to their tails (this is an experiment that's been done) and through that electrode, they can get an electric shock. Both rats in each pair receive the same degree of shock for the same duration, but one of them has a paw free. That paw allows them to turn a lever which would turn off the shock. Both rats receive the same shock for the same duration, but one of them has a paw free that they can shut off the lever with. When you look at their stress hormone levels afterwards, they receive the same shock for the same duration but the rat that had a paw free so it could have control, its stress hormone levels are lower. So it's not the duration or degree of shock that created the stress, it's the loss of control, and similar experiments have been done with human beings. In stress, there's a loss of control and if you look at our society, who's got control here? How many people are actually in charge of their lives, given the manipulation that takes place, and given that the most important decisions are made by people far away who are not in any way subject to any kind of democratic control, because they do it through their ownership of the means of production or capital. We don't elect our capitalists. There's no elections. "Hey, I'd like to exploit you, vote for me!" That doesn't happen. At the very best, we elect our representatives, who are the politicians. But in a society like that, there's no genuine control, so most people feel totally helpless. That creates stress for people. That creates stress for people. Uncertainty, lack of information, loss of control and finally loss of human contact because as I indicated in the beginning, for health, you need a social and human connection. That mitigates stress, that mitigates everything. Now, as we isolate people more, as machines take over more and more, as we talk less to human beings... Just think about your experience, when you make a phone call and the machine says "Thank you for your phone call. Due to an unexpected number of calls, [please hold...]" and then you wait for half an hour, and the frustration that you have of not being able to talk to a human being. We're talking less and less to human beings, more and more talking to and through machines. There's less and less community, people no longer live where they work, they no longer shop where they live. We don't relate to people that we know on a daily basis; it's largely strangers that we interact with in large chain stores, etc., so there's less human contact. People are more suspicious. All that leads to stress, which leads to illness. In terms of creating a positive health, and by the way, interesting about mental versus physical health, the Buddha who was a great psychologist, said 2500 years ago: "You might meet a person who can maintain perfect physical health for a few years, or even for a hundred years, but you're rarely meet anybody who can stay mentally healthy for any length of time." Because for mental health, you need all kinds of conditions that most people don't have. Therefore, the recent Canadian report about mental health, about how between 6 and 7 million Canadians are affected by mental health issues, that's probably an underestimate, but that's one quarter, or one in every five, and 50% of North American adults have some chronic physical illness. We're the wealthiest society in history and also one of the sickest, and overmedicated of course. In terms of creating positive health what you need is community, contact, local control, involvement, engagement, information (the right information). In other words, you need consciousness, you need freedom, you need community. It's healthy therefore, those that are involved in any level of social engagement, that they no longer be passive. As long as they do that consciously rather than in a driven fashion (because if you do it unconsciously, you're not helping very much) social engagement is healthy, because it connects you to others and it gives you meaning, so long as you're conscious. It's entirely possible to be an unconscious social activist; that's another conversation. As long as you're a conscious social activist, that's a healthy thing to do, and also of course, you're creating community. In our lives, we need to seek contact and communication with other people and we need to be as informed as possible. Sometimes, people say to me "When I get too much information, I get disillusioned." My response is "Would you rather be illusioned or disillusioned?" These are the factors that we have to seek, and not only do we have to seek [them], we have to create [them] in our lives. Of course, behind all that is a much larger social question: is this society conducive to human health? The answer is: no it isn't. Although you can't change society by the flicking of a thumb or the waving of a magic wand, certainly, being engaged with the question of what kind of society we'd like to see and how do we best work towards whatever vision we may have, that's a question that's very important for human beings to engage with. Otherwise, we're passive victims of circumstance. In terms of a social vision and how to obtain it, that's going to be... A particular view of that will be Matt's subject and I'll turn the mike over to him now. [Applause] As he comes up, let me just read you one quote from from the catholic monk Thomas Merton who in an autobiography, 'The Seven Storey Mountain' [made a] very eloquent statement. He was writing in the 1940s, he's a fantastic writer. He says: "It is true that the materialistic society, the so-called culture that has evolved under the tender mercies of capitalism, has produced what seems to be the ultimate limit of worldliness. And nowhere, except perhaps in the analogous society of pagan Rome, has there ever been such a flowering of cheap, petty and disgusting lusts and vanities as in the world of capitalism, where there is no evil that is not fostered and encouraged for the sake of making money. We live in a society whose whole policy is to excite every nerve in the human body and keep it at the highest pitch of artificial tension, to strain every human desire to the limit and to create as many new desires and synthetic passions as possible" (synthetic passions, not genuine, human ones) "in order to cater to them with the products of our factories and printing presses and movie studios and all the rest." Karl Marx could not have put it better. [Applause]
The Zeitgeist Vancouver chapter presents Dr. Gabor Maté giving a presentation entitled 'What Promotes Positive Health? (2012-06-03). Note: This 'working location' is currently open for translation into all languages. Once acknowledged, all completed and proofread 'official' translations can be found at the Repository location here: http://dotsub.com/view/19a3bcc5-57e4-4357-a2c2-8a82d5332013. To join/help with these efforts: http://tinyurl.com/LTcontacts
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