About the Author

Gabor Maté, MD

Born in Budapest, Gabor Maté immigrated to Canada at the age of twelve. He spent some time working as a teacher before returning to university to pursue his lifelong dream of becoming a doctor. He ran a popular family practice for many years, and spent twelve years working in Vancouver's downtown eastside, caring for patients suffering from mental illness, drug addiction, and HIV. In the 1990s, Dr. Maté was a regular medical columnist for the Vancouver Sun and the Globe and Mail. He is also the author of four works of non-fiction. His most recent book, In the Realm of Hungry Ghosts: Close Encounters With Addiction, won a Hubert Evans Award in 2010. In addition to being a physician and bestselling author, Dr. Maté is a highly sought after public speaker. He has three grown children and currently resides in Vancouver, BC, with his wife. Please visit drgabormate.com.

Books by this Author
Hold On to Your Kids

Hold On to Your Kids

Why Parents Need to Matter More Than Peers
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PART ONE: The Phenomenon of Peer Orientation
Chapter One: In Our Own Backyard

Something has changed. We can sense it, can feel it, just not find the words for it. Children are not quite the same as we remember being. They seem less likely to take their cues from adults, less inclined to please those in charge, less afraid of getting into trouble. Parenting, too, seems to have changed. Our parents were more confident, more certain of themselves and had more impact on us, for better -- or, sometimes, for worse. For many today, parenting does not feel natural. Through the ages adults have complained about children being less respectful of their elders and more difficult to manage than preceding generations, but could it be that this time it is for real?

Today’s parents love their children as much as parents ever have, but the love doesn’t always get through. We have just as much to teach them as parents ever did, but they seem less interested in following our direction. We can sense our children’s potential but do not feel empowered to guide them toward fulfilling it. Sometimes they live and act as if they have been seduced away from us by some siren song we do not hear. We fear, if only vaguely, that the world has become less safe for them and that we are powerless to protect them. The gap opening up between children and adults can seem unbridgeable at times.

We struggle to live up to our image of what parenting ought to be like. Not achieving the results we want, we plead with our children, we cajole, bribe, reward or punish. We hear ourselves address them in tones that seem harsh even to us and foreign to our true nature. We sense ourselves grow cold in moments of crisis, precisely when we would wish to summon our unconditional love. We feel hurt as parents, and rejected. We blame -- ourselves for failing at the parenting task, or our children for being recalcitrant, or television for distracting them, or the school system for not being strict enough. When our impotence becomes unbearable we reach for simplistic, authoritarian formulas consistent with the do-it-yourself/quick-fix ethos of our era.

The very importance of parenting to the development and maturation of young human beings has come under question. “Do Parents Matter?” was the title of a cover article in Newsweek magazine in 1998. “Parenting has been oversold,” argued a book1 that received international attention that year. “You have been led to believe that you have more of an influence on your child’s personality than you really do.”

The question of parental influence would not be of great moment if things were going well with our young. They are not -- and many of us feel that instinctively, even if we cannot explain exactly how and why. That our children do not seem to listen to us or to embrace our traditions and culture as their own would, perhaps, be acceptable in itself -- if we felt that they were truly self-sufficient, self-directed and grounded in themselves, if they had a positive sense of who they are and if they possessed a clear sense of direction and purpose in life. We see that for so many children and young adults those qualities are lacking. In homes, in schools, in community after community developing young human beings have lost their moorings. Many lack self-control and are increasingly prone to alienation, drug use, violence and a general aimlessness. They are less teachable and more difficult to manage than their counterparts of even a few decades ago. Many have lost their ability to adapt, to learn from negative experience and to mature. The crisis of the young has manifested itself ominously in the growing problem of bullying in the schools and, at its most extreme, in the murder of children by children, whether in British Columbia or New York, Quebec or Colorado.

Committed and responsible parents are frustrated. Our cues are not being taken, our directives are ineffective, and it appears our children would rather be elsewhere than at home. Despite our loving care kids seem highly stressed. Parents and other elders no longer appear to be the natural mooring point for the young, as used to be the case with human beings and is still the case with all other species living in their natural habitats. Senior generations, the parents and grandparents of the baby boomer group, look at us with incomprehension. “We didn’t need how-to manuals on parenting in our days, we just did it,” they say, with some mixture of truth and misunderstanding.

This state of affairs is ironic, given that more is known about child development than ever before. More courses and books are available on child rearing, and we can offer our children more things to do and explore. We probably live in a more child-centred universe than our predecessors did.

So what has changed? The problem, in a word, is context. Parenting is not something we can engage in with just any child, no matter how well intentioned, skilled or compassionate we may be. Parenting requires a context to be effective. A child must be receptive to our parenting for us to be successful in our nurturing, comforting, guiding and directing. Children do not automatically grant us the authority to parent them just because we are adults, or just because we love them or know what is good for them or have their best interests at heart. Those who parent other people’s children are often confronted by this fact, be they step-parents, adoptive parents, foster parents, grandparents, babysitters, nannies, daycare providers or teachers. Less obviously but of great importance is the fact that even with one’s own children the natural parenting authority can become lost if the context for it becomes eroded.

From the Hardcover edition.

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In the Realm of Hungry Ghosts

In the Realm of Hungry Ghosts

Close Encounters with Addiction
edition:Paperback
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The mandala, the Buddhist Wheel of Life, revolves through six realms. Each realm is populated by characters representing aspects of human ­existence–­our various ways of being. In the Beast Realm we are driven by basic survival instincts and appetites such as physical hunger and sexuality, what Freud called the id. The denizens of the Hell Realm are trapped in states of unbearable rage and anxiety. In the God Realm we transcend our troubles and our egos through sensual, aesthetic or religious experience, but only temporarily and in ignorance of spiritual truth. Even this enviable state is tinged with loss and ­suffering.

The inhabitants of the Hungry Ghost Realm are depicted as creatures with scrawny necks, small mouths, emaciated limbs and large, bloated, empty bellies. This is the domain of addiction, where we constantly seek something outside ourselves to curb an insatiable yearning for relief or fulfillment. The aching emptiness is perpetual because the substances, objects or pursuits we hope will soothe it are not what we really need. We don’t know what we need, and so long as we stay in the hungry ghost mode, we’ll never know. We haunt our lives without being fully ­present.

Some people dwell much of their lives in one realm or another. Many of us move back and forth between them, perhaps through all of them in the course of a single ­day.

My medical work with drug addicts in Vancouver’s Downtown Eastside has given me a unique opportunity to know human beings who spend almost all their time as hungry ghosts. It’s their attempt, I believe, to escape the Hell Realm of overwhelming fear, rage and despair. The painful longing in their hearts reflects something of the emptiness that may also be experienced by people with apparently happier lives. Those whom we dismiss as “junkies” are not creatures from a different world, only men and women mired at the extreme end of a continuum on which, here or there, all of us might well locate ourselves. I can personally attest to that. “You slink around your life with a hungry look,” someone close once said to me. Facing the harmful compulsions of my patients, I have had to encounter my ­own.

No society can understand itself without looking at its shadow side. I believe there is one addiction process, whether it is manifested in the lethal substance dependencies of my Downtown Eastside patients; the frantic ­self-­soothing of overeaters or shopaholics; the obsessions of gamblers, sexaholics and compulsive Internet users; or the socially acceptable and even admired behaviours of the workaholic. Drug addicts are often dismissed and discounted as unworthy of empathy and respect. In telling their stories my intent is twofold: to help their voices to be heard and to shed light on the origins and nature of their ­ill-­fated struggle to overcome suffering through substance abuse. They have much in common with the society that ostracizes them. If they seem to have chosen a path to nowhere, they still have much to teach the rest of us. In the dark mirror of their lives, we can trace outlines of our ­own.

There is a host of questions to be considered. Among ­them:

• What are the causes of ­addictions?
• What is the nature of the ­addiction-­prone ­personality?
• What happens physiologically in the brains of addicted ­people?
• How much choice does the addict really ­have?
• Why is the “War on Drugs” a failure and what might be a humane, ­evidence-­based approach to the treatment of severe drug ­addiction?
• What are some of the paths for redeeming addicted minds not dependent on powerful ­substances–­that is, how do we approach the healing of the many behaviour addictions fostered by our ­culture?

The narrative passages in this book are based on my experience as a medical doctor in Vancouver’s drug ghetto and on extensive interviews with my ­patients–­more than I could cite. Many of them volunteered in the generous hope that their life histories might be of assistance to others who struggle with addiction problems or that they could help enlighten society regarding the experience of addiction. I also present information, reflections and insights distilled from many other sources, including my own addictive patterns. And finally, I provide a synthesis of what we can learn from the research literature on addiction and the development of the human brain and ­personality.

Although the closing chapters offer thoughts and suggestions concerning the healing of the addicted mind, this book is not a prescription. I can say only what I have learned as a person and describe what I have seen and understood as a physician. Not every story has a happy ending, as the reader will find out, but the discoveries of science, the teachings of the heart and the revelations of the soul all assure us that no human being is ever beyond redemption. The possibility of renewal exists so long as life exists. How to support that possibility in others and in ourselves is the ultimate ­question.

I dedicate this work to all my fellow hungry ghosts, be they ­inner-­city street dwellers with HIV, inmates of prisons or their more fortunate counterparts with homes, families, jobs and successful careers. May we all find ­peace.

 

As I pass through the grated metal door into the sunshine, a setting from a Fellini film reveals itself. It is a scene both familiar and outlandish, dreamlike and ­authentic.

On the Hastings Street sidewalk Eva, in her thirties but still ­waif-­like, with dark hair and olive complexion, taps out a bizarre cocaine flamenco. Jutting her hips, torso and pelvis this way and that, bending now at the waist and thrusting one or both arms in the air, she shifts her feet about in a clumsy but concerted pirouette. All the while she tracks me with her large, black ­eyes.

In the Downtown Eastside this piece of ­crack-­driven improvisational ballet is known as “the Hastings shuffle,” and it’s a familiar sight. During my medical rounds in the neighbourhood one day, I saw a young woman perform it high above the Hastings traffic. She was balanced on the narrow edge of a neon sign two storeys up. A crowd had gathered to watch, the users among them more amused than horrified. The ballerina would turn about, her arms horizontal like a tightrope walker’s, or do deep knee ­bends–­an aerial Cossack dancer, one leg kicked in front. Before the top of the firemen’s ladder could reach her cruising altitude, the stoned acrobat had ducked back inside her ­window.

Eva weaves her way among her companions, who crowd around me. Sometimes she disappears behind ­Randall–­a ­wheelchair-­bound, ­heavy-­set, ­serious-­looking fellow, whose unorthodox thought patterns do not mask a profound intelligence. He recites an ode of autistic praise to his indispensable motorized chariot. “Isn’t it amazing, Doc, isn’t it, that Napoleon’s cannon was pulled by horses and oxen in the Russian mud and snow. And now I have this!” With an innocent smile and earnest expression, Randall pours out a recursive stream of facts, historical data, memories, interpretations, loose associations, imaginings, and paranoia that almost sound ­sane–­almost. “That’s the Napoleonic Code, Doc, which altered the transportational mediums of the lower rank and file, you know, in those days when such pleasant smorgasboredom was still well fathomed.” Poking her head above Randall’s left shoulder, Eva plays ­peek-­a-­boo.

Beside Randall stands Arlene, her hands on her hips and a reproachful look on her face, clad in skimpy jean shorts and ­blouse–­a sign, down here, of a mode of earning drug money and, more often than not, of having been sexually exploited early in life by male predators. Over the steady murmur of Randall’s oration comes her complaint: “You shouldn’t have reduced my pills.” Arlene’s arms bear dozens of horizontal scars, parallel, like railway ties. The older ones white, the more recent red, each mark a souvenir of a razor slash she has inflicted on herself. The pain of ­self-­laceration obliterates, if only momentarily, the pain of a larger hurt deep in the psyche. One of Arlene’s medications controls this compulsive ­self-­wounding, and she’s always afraid I’m reducing her dose. I never ­do.

Close to us, in the shadow of the Portland Hotel, two cops have Jenkins in handcuffs. Jenkins, a lanky Native man with black, scraggly hair falling to below his shoulders, is quiet and compliant as one of the officers empties his pockets. He arches his back against the wall, not a hint of protest on his face. “They should leave him alone,” Arlene opines loudly. “That guy doesn’t deal. They keep grabbing him and never find a thing.” At least in the broad daylight of Hastings Street, the cops go about their search with exemplary ­politeness–­not, according to my patients, a consistent police attitude. After a minute or two Jenkins is set free and lopes silently into the hotel with his long ­stride.

Meanwhile, within the span of a few minutes, the resident poet laureate of absurdity has reviewed European history from the Hundred Years’ War to Bosnia and has pronounced on religion from Moses to Mohammed. “Doc,” Randall goes on, “the First World War was supposed to end all wars. If that was true, how come we have the war on cancer or the war on drugs? The Germans had this gun Big Bertha that spoke to the Allies but not in a language the French or the Brits liked. Guns get a bad rap, a bad ­reputation–­a bad raputation, ­Doc–­but they move history forward, if we can speak of history moving forward or moving at all. Do you think history moves, Doc?”

Leaning on his crutches, paunchy, ­one-­legged, smiling ­Matthew–­bald, and irrepressibly ­jovial–­interrupts Randall’s discourse. “Poor Dr. Maté is trying to get home,” he says in his characteristic tone: at once sarcastic and sweetly genuine. Matthew grins at us as if the joke is on everyone but himself. The chain of rings piercing his left ear glimmers in the bronzed gold of the late afternoon ­sun.

Eva prances out from behind Randall’s back. I turn away. I’ve had enough street theatre and now I want to escape. The good doctor no longer wants to be ­good.

We congregate, these Fellini figures and ­I–­or I should say we, this cast of Fellini ­characters–­outside the Portland Hotel, where they live and I work. My clinic is on the first floor of this cement-and-glass building designed by Canadian architect Arthur Erickson, a spacious, modern, utilitarian structure. It’s an impressive facility that serves its residents well, replacing the formerly luxurious ­turn-­of-­the-­century establishment around the corner that was the first Portland Hotel. The old place, with its wooden balustrades, wide and winding staircases, musty landings and bay windows, had a character and history the new fortress lacks. Although I miss its Old World aura, the atmosphere of faded wealth and decay, the dark and blistered windowsills varnished with memories of elegance, I doubt the residents have any nostalgia for the cramped rooms, the corroded plumbing or the armies of cockroaches. In 1994 there was a fire on the roof of the old hotel. A local newspaper ran a story and a photograph featuring a female resident and her cat. The headline proclaimed, “Hero Cop Saves Fluffy.” Someone phoned the Portland to complain that animals should not be allowed to live in such ­conditions.

The nonprofit Portland Hotel Society, for whom I am the staff physician, turned the building into housing for the nonhousable. My patients are mostly addicts, although some, like Randall, have enough derangement of their brain chemicals to put them out of touch with reality even without the use of drugs. Many, like Arlene, suffer from both mental illness and addiction. The PHS administers several similar facilities within a radius of a few blocks: the Stanley, Washington, Regal and Sunrise hotels. I am the house doctor for them ­all.

The new Portland faces the Army and Navy department store across the street, where my parents, as new immigrants in the late 1950s, bought most of our clothing. Back then, the Army and Navy was a popular shopping destination for working ­people–­and for ­middle-­class kids looking for funky military coats or sailor jackets. On the sidewalks outside, university students seeking some slumming fun mixed with alcoholics, pickpockets, shoppers and Friday night Bible ­preachers.

No longer. The crowds stopped coming many years ago. Now these streets and their back alleys serve as the centre of Canada’s drug capital. One block away stood the abandoned Woodward’s department store, its giant, lighted “W” sign on the roof a ­long-­time Vancouver landmark. For a while squatters and antipoverty activists occupied the building, but it has recently been demolished; the site is to be converted into a mix of chic apartments and social housing. The Winter Olympics are coming to Vancouver in 2010 and with it the likelihood of gentrification in this neighbourhood. The process has already begun. There’s a fear that the politicians, eager to impress the world, will try to displace the addict ­population.

Eva intertwines her arms, stretches them behind her back and leans forward to examine her shadow on the sidewalk. Matthew chuckles at her crackhead yoga routine. Randall rambles on. I glance out eagerly at the ­rush-­hour traffic flowing by. Finally, rescue arrives. My son Daniel drives up and opens the car door. “Sometimes I don’t believe my life,” I tell him, easing into the passenger’s seat. “Sometimes I don’t believe your life either,” he nods. “It can get pretty intense down here.” We pull away. In the rearview mirror the receding figure of Eva gesticulates, legs splayed, head tilted to the ­side.

The Portland and the other buildings of the Portland Hotel Society represent a pioneering social model. The purpose of the PHS is to provide a system of safety and caring to marginalized and stigmatized ­people–­the ones who are “the insulted and the injured,” to borrow from Dostoevsky. The PHS attempts to rescue such people from what a local poet has called the “streets of displacement and the buildings of exclusion.”

“People just need a space to be,” says Liz Evans, a former community nurse, whose ­upper-­tier social background might seem incongruous with her present role as a founder and director of the PHS. “They need a space where they can exist without being judged and hounded and harassed. These are people who are frequently viewed as liabilities, blamed for crime and social ills, and . . . seen as a waste of time and energy. They are regarded harshly even by people who make compassion their careers.”

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Scattered Minds

Scattered Minds

The Origins and Healing of Attention Deficit Disorder
edition:Paperback
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When the Body Says No
Excerpt

A Note to the Reader

People have always understood intuitively that mind and body are not separable. Modernity has brought with it an unfortunate dissociation, a split between what we know with our whole being and what our thinking mind accepts as truth. Of these two kinds of knowledge the latter, narrower, kind most often wins out, to our loss.

It is a pleasure and a privilege, therefore, to bring in front of the reader the findings of modern science that reaffirm the intuitions of age-old wisdom. That was my primary goal in writing this book. My other purpose was to hold up a mirror to our stress-driven society so that we may recognize how, in myriad unconscious ways, we help generate the illnesses that plague us.

This is not a book of prescriptions, but I do hope it will serve its readers as a catalyst for personal transformation. Prescriptions come from the outside, transformation occurs within. There are many books of simple prescriptions of one sort or another -- physical, emotional, spiritual -- that appear each year. It was not my intention to write yet one more. Prescriptions assume that something needs to be fixed; transformation brings forth the healing -- the coming to integrity, to wholeness -- of what is already there. While advice and prescriptions may be useful, even more valuable to us is insight into ourselves and the workings of our minds and bodies. Insight, when inspired by the quest for truth, can promote transformation. For those seeking a healing message here, that message begins on page one with the very first case study. As the great physiologist Walter Cannon suggested, there is a wisdom in our bodies. I hope When the Body Says No will help people align with the inner wisdom we all possess.

Some of the case examples in this book are derived from published biographies or autobiographies of well-known persons. The majority are taken from my clinical experience or from taped discussions with people who agreed to be interviewed and quoted regarding their medical and personal histories. For privacy reasons, names (and, in some instances, other circumstances) have been changed.

To avoid making this work prohibitively academic for the lay reader, notes have been used only sparingly. References are provided for each chapter at the end of the book.
Italics, unless otherwise noted, are mine.

I welcome comments at my e-mail address: gmate@telus.net.

1
The Bermuda Triangle
Mary was a native woman in her early forties, slight of stature, gentle and deferential in manner. She had been my patient for eight years, along with her husband and three children. There was a shyness in her smile, a touch of self-deprecation. She laughed easily. When her ever-youthful face brightened, it was impossible not to respond in kind. My heart still warms -- and constricts with sorrow -- when I think of Mary.

Mary and I had never talked much until the illness that was to take her life gave its first signals. The beginning seemed innocent enough: a sewing-needle puncture wound on a fingertip failed over several months to heal. The problem was traced to Raynaud’s phenomenon, in which the small arteries supplying the fingers are narrowed, depriving the tissues of oxygen. Gangrene can set in, and unfortunately this was the case for Mary. Despite several hospitalizations and surgical procedures, she was within a year begging for an amputation to rid her of the throbbing ache in her finger. By the time she got her wish the disease was rampant, and powerful narcotics were inadequate in the face of her constant pain.

Raynaud’s can occur independently or in the wake of other disorders. Smokers are at greater risk, and Mary had been a heavy smoker since her teenage years. I hoped that if she quit, normal blood flow might return to her fingers. After many relapses she finally succeeded. Unfortunately, the Raynaud’s proved to be the harbinger of something far worse: Mary was diagnosed with scleroderma, one of the autoimmune diseases, which include rheumatoid arthritis, ulcerative colitis, systemic lupus erythematosus (SLE) and many other conditions that are not always recognized to be autoimmune in origin, such as diabetes, multiple sclerosis and possibly even Alzheimer’s disease. Common to them all is an attack by one’s own immune system against the body, causing damage to joints, connective tissue or to almost any organ, whether it be the eyes, the nerves, the skin, the intestines, the liver or the brain. In scleroderma (from the Greek word meaning “hardened skin” ), the immune system’s suicidal assault results in a stiffening of the skin, esophagus, heart and tissues in the lungs and elsewhere.

What creates this civil war inside the body?

Medical textbooks take an exclusively biological view. In a few isolated cases, toxins are mentioned as causative factors, but for the most part a genetic predisposition is assumed to be largely responsible. Medical practice reflects this narrowly physical mindset. Neither the specialists nor I as her family doctor had ever thought to consider what in Mary’s particular experiences might also have contributed to her illness. None of us expressed curiosity about her psychological state before the onset of the disease, or how this influenced its course and final outcome. We simply treated each of her physical symptoms as they presented themselves: medications for inflammation and pain, operations to remove gangrenous tissue and to improve blood supply, physiotherapy to restore mobility.

One day, almost on a whim, in response to a whisper of intuition that she needed to be heard, I invited Mary to make an hour-long appointment so that she would have the opportunity to tell me something about herself and her life. When she began to talk, it was a revelation. Beneath her meek and diffident manner was a vast store of repressed emotion. Mary had been abused as a child, abandoned and shuttled from one foster home to another. She recalled huddling in the attic at the age of seven, cradling her younger sisters in her arms, while her drunken foster parents fought and yelled below. “I was so scared all the time,” she said, “but as a seven-year-old I had to protect my sisters. And no one protected me.” She had never revealed these traumas before, not even to her husband of twenty years. She had learned not to express her feelings about anything to anyone, including herself. To be self-expressive, vulnerable and questioning in her childhood would have put her at risk. Her security lay in considering other people’s feelings, never her own. She was trapped in the role forced on her as a child, unaware that she herself had the right to be taken care of, to be listened to, to be thought worthy of attention.

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Hidden Lives

Hidden Lives

True Stories from People Who Live with Mental Illness
edition:eBook
also available: Paperback Paperback
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A Room in the City

A Room in the City

Photographs of Gabor Gasztonyi
by (photographer) Gabor Gasztonyi
introduction by Gabor Maté, MD & Harold Rhenisch
edition:Hardcover
tagged : essays
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