Frequently Asked Questions
Click on any question to see Dr. Maté’s answer.
It’s the same principle as with any living thing, really: the right conditions need to be present in order for the innate potential of a grain of corn, or a baby bird, or a human infant, to grow and mature according to nature’s intended blueprint. Inherited factors may play a part, but the simple biological fact is that genes only express and realize their potential through interaction with the environment – and that’s where things can and do go so easily awry, especially in a stressed-out and increasingly fractured society like ours.
In North America, we tend to be too oriented around trying to fix problems without first seeking to understand them, where they come from, what they’re really about. That leads to superficial approaches that don’t get at the heart of whatever problem we’re trying to solve – for example, trying to change a child’s behaviour (with ‘time outs’, punishments, and so on) without understanding what that behaviour means about the child’s development, and what conditions, if we worked consciously to provide them, would foster natural development and improvement.
None of this is anyone’s ‘fault’ – it’s just how it seems to go for human beings. So it’s never appropriate to blame individual parents. People do their best, often under very difficult circumstances. But it is important to understand the simple scientific fact, which is not controversial, that children’s emotional and psychological surroundings shape their development in crucial ways – both in terms of brain development and personality development.Given what I’ve already said about the impact of stress on parents and their children, it’s clear that adding blame to the mix is worse than useless for parents: it’s completely counterproductive, since being blamed or blaming yourself is a surefire stressor (especially when you’re already doing your best, as the vast majority of parents are.)
What is useful is to understand what the conditions are that children need for their optimal development. And, as best we can, we need to strive to provide those conditions for our kids, whether on the individual parenting level or on the social policy level. If our kids are already grown, it’s possible to look honestly at the stresses they may have absorbed when they were younger without at the same time blaming ourselves for it. Compassion, for them and for ourselves, is the key.
In my view, diseases like cancer, rheumatoid arthritis, and multiple sclerosis – among others – are rooted in people’s lifelong emotional patterns. This contradicts the Western medical notion that diseases have a life of their own. Diseases are not autonomous or independent from a person’s life, and real healing requires examining and understanding what hidden stresses and emotional patterns may have contributed to the onset or spread of these diseases.
People can and should turn to Western doctors for treatment, especially to alleviate symptoms and make life more livable. But at the same time, no one should think that the answer ends there or that that’s all there is to it. The Western medical approach is valuable and has plenty to offer, but it’s also narrow. Most Western doctors, no matter how skilled or well-intentioned, haven’t got a clue about the stress-disease connection because they haven’t looked at the evidence. Medical schools don’t teach the latest findings in psycho-neuro-immunology, which is the field of research that looks at the fascinating connection – the unity, rather – between emotions, the nervous system, and the immune system. (And incidentally, this applies to all the subjects I write about: addiction, ADHD, parenting. People often go to pediatricians, for example, and ask them about how fix their kids’ behaviour problems – the problem being that pediatricians, for the most part, know nothing about that. They’re not trained in normal child development, they’re trained in diagnosing treating childhood diseases.)
Of course, in our society most of us have been brought up to believe in the doctor as an authority figure, and people often feel that they lack the knowledge, confidence, or faith in themselves to ‘challenge’ their doctor’s approach. Add that to the fact that many people with chronic diseases have a history of suppressing their own needs and a deep reluctance or fear of displeasing others – incidentally, which is one of the key stressful ‘emotional patterns’ that can predispose someone to disease in the first place – and you have a situation where advocating for one’s own care can be a real challenge for people. (If you do find that you’re afraid of displeasing your physician, you might want to look at that as a great example of your self-defeating – and self-stressing – ways of being in life and ask yourself, what’s that all about?)
The good news is, your doctor doesn’t need to support or believe or even know anything about the perspective I’m advocating. Why would he (or she)? It’s not part of his training or the language that he speaks. You wouldn’t go to a car mechanic for a back rub. So I wouldn’t worry so much about whether or not your doctor is ‘on board’. If so, great. But it’s far more important to do the work yourself to identify and understand, with compassion, your own tendency to take on more than you can handle, to take on other people’s emotional needs, to suppress your own needs, and so on. You can look at the ‘stories’ or interpretations that run your life, and the stressful impacts of those stories. You can recognize when your body is saying no, and consider what it is saying no to. You can be curious and compassionate with yourself.Your doctor can help you with what she can help you with; for the rest, look elsewhere. That includes looking within for your body’s own wisdom, and also looking to other resources outside the Western medical system, whether they be therapy, or spiritual or personal growth work, or alternative treatments that appreciate the mind-body unity. See my Resources page for some ideas of where to start.
At the same time, within Western medicine there is certainly some movement and some encouraging signs. There are Western-trained doctors and academics like UCLA’s Daniel Siegel and Northwestern University’s Bruce Perry (head of The Child Trauma Academy in Houston) who have done wonderful research, and of course practitioners like Andrew Weil and Deepak Chopra who have done much to publicize new approaches. There’s a growing emphasis on nutrition, on brain development, on the importance of the environment. There’s the work of Jon Kabat-Zinn on mindfulness in healing practices. So yes, there’s a lot more popular force these days behind these approaches that seek to open up medical practice and take it beyond the limited biological, technological paradigm.
The enthusiastic response to my books and to the work of others working in these areas gives me a real sense that something else is, in fact, possible. When I present to audiences of academics or professionals (e.g. psychiatrists) they tend to be very positive about what I’m saying – it’s just that they’d never heard or seen the evidence before. It’s new to them. It’s not what tends to get talked about at conferences; it’s also not part of the journalistic literature. The media prefers simple genetic explanations (no matter that such explanations are generally shown to be bogus) than a more nuanced understanding of how the environment shapes brain development. That says more about the institutional inertia of the system, of the profession, and in our culture at large, than about people’s individual interest level or openness.The public is definitely very hungry for a different, broader perspective. People know intuitively that what they’re getting from Western medicine does not speak to the totality of their experience. Hopefully, a critical mass is building that will cause the dam to burst even more and have this material permeate how we train health professionals in this society.
For example, the rate of prostate cancer among Black males in the U.S. is the highest in the world, whereas their genetic relatives in Africa have nothing close to that cancer rate. So we’re clearly not talking about a genetic problem, we’re talking about the effects of stress; and that stress is imposed by historical and social and economic factors, and it gets handed down through the generations – not genetically, mind you, but nonetheless biologically. That’s just one example of how history and societal conditions interact with individual human biology to create a widespread health crisis, and there are many other such examples.
Furthermore, what keeps people stressed in their lives has a lot to do with what they’ve internalized. People who aren’t liberated from disempowering beliefs about themselves and the world are by definition stressed people, because those negative beliefs are inherently stressful and counter to good health and wholeness. In that sense, liberation (or wellness) is actually about distinguishing and letting go of outmoded ideas and structures in the mind – which is, of course, the first step in any kind of political liberation. ‘Free your mind and the rest will follow’, as the saying goes. Or, as Marianne Williamson wrote, ‘The revolution that will save the world is ultimately a personal one.’
I think it works both ways, paradoxically enough: we need to work for a healthier society if we want to improve individual health, and at the same time how are we to create a healthier society unless we take on ourselves, our own development, our own physical and spiritual and mental health as individuals? People who get involved in trying to change the world don’t always recognize this, and that’s a pitfall that makes them less effective. Particularly in progessive/left politics, you find a lot of oppositional energy, a kind of automatic resistance to authority, which comes from unresolved anger about childhood pain. And then of course you have hard right-wingers, who invariably are in denial of their childhood pain, their deep anger and fear and shame, which is why they can come across as cold or unfeeling.
Whatever your political commitments, it comes down to this: any automatic or unconscious emotional reactivity is bound to be a detriment to effective communication. Even when you’re speaking the objective truth, people who aren’t already on your ‘side’ don’t hear your words or the facts you’re presenting – they only hear the shrillness or stridency in your tone. So if you want to be effective as an activist for positive change, that’s another good reason to get your own ‘stuff’ sorted out.
2) Addiction / IN THE REALM OF HUNGRY GHOSTS
So many of us, whether or not we were acutely traumatized or faced extreme adversity as kids, have these sorts of lingering challenges to contend with. We can and should be grateful things weren’t worse, but we shouldn’t discount or minimize the pain we carry from childhood even if it didn’t result from severe neglect or abuse.
I do, however, place my addiction on the same continuum as theirs, and that’s important because I firmly believe – and the scientific research supports this – that there’s really only one addiction process. Addictions are separated from each other only by degrees of severity, which are obviously tied to socioeconomic factors and personal history. And any addiction has the capacity to fester and grow into a dynamic that can wreak havoc in someone’s life, to their self-esteem, their relationships, and so on. The fact that some addictions are frowned upon and criminalized in our society (e.g. hard drugs), while others are more or less tolerated (e.g. alcoholism, tobacco smoking), and still others are encouraged or rewarded (e.g. workaholism, the quest for power or wealth) – that’s a rather arbitrary set of standards that has more to do with our culture’s self-delusions than with the truth of addiction per se.
So while the differences between me and my patients are obvious, I’ve chosen to focus on the similarities – the obsessive preoccupation, the negative impacts, the relapses, the rationalizing, the feeling of nagging emptiness at the core of the addict’s experience of life – in order to make this point about the addiction process, to which none of us can claim to be immune.
To take a non-substance example, someone who’s passionate about social activism might work tirelessly for a cause, while her colleague may have a workaholic relationship with the same activity. It all depends on the energy with which one pursues the activity, and what happens when the activity comes to an end. There may be a letdown after a big event, but does the person feel a sense of basic worth in the absence of the adrenaline and the long hours? Does she find comfort in the other parts of her life? Or is she left irritable, restless, and less at ease with the people in her life?
The activity or feeling to which one is addicted may be in itself considered postive or laudable, but the energy of addiction always turns a “good” thing into a harmful one. In the end it’s not about the object of addiction, but about the relationship one has to it.
If spiritual belief discomfits you, then don’t believe; instead, open yourself to the possibility that you could experience yourself and your life in a different, healthier way – that however difficult it’s been so far, “it ain’t necessarily so,” as the song goes. But it’s also very helpful and healing if you can come to understand that you are not alone, that there is something greater within and without to connect with than your usual everyday mind, whether you see that as nature, or compassionate humanity, or a “higher power”.
It’s also worth remembering that even spiritual work can become addictive, particularly if one becomes attached to the religious practices or institutions it’s housed in, or the belief systems associated with them. Anything that the ego can latch onto and say “Aha, now I’ve found the answer!” is likely to feed addictive tendencies, even if the expressed purpose is to move away from those tendencies. Remember the ancient spiritual wisdom that “a finger pointing at the moon is not the moon itself” – focus on your own journey, your own experience, and not on the particular method or system you’ve chosen to help you on your way.
3) Stress & Illness / Mind-Body Health / WHEN THE BODY SAYS NO
One may wish to explore and accept the full range of medical treatments available – and at the same time one needn’t believe that that’s enough, or that’s where one’s options end. In addition to whatever physical modalities or treatments are offered or accepted, when the time is right and the person is ready, there’s tremendous value to cultivating a real understanding of how one has lived one’s life, maybe in ways that haven’t been supportive of oneself. That exploration can provide insights and possibilities for change that can greatly improve the quality of one’s life, with or without a serious disease. Healing (which, in its origins, literally means “making whole”) is a matter not just of physical modalities but of understanding how we generate stress, and learning how not to generate stress.
Both in the literature and in particular examples that I’ve witnessed very close-up, there is ample evidence that this kind of approach can promote healing, prolong life, and most importantly improve the quality of life for people with illnesses. There are people who have lived much longer, or much healthier, than their medical prognoses would have predicted.
I hope that health professionals will also find this information valuable in providing better and more comprehensive care.
So yes, in a sense I am saying you created the conditions for your disease, but only with two crucial asterisks attached to the words “you” and “created”. You certainly didn’t create it deliberately, nor did you create the external conditions you grew up in; and in a way it wasn’t really you, if by “you” we mean the part of your mind or soul that makes conscious, rational, purposeful choices. Rather, over time, your emerging personality did what it needed to do to stay intact, and it developed some strategies that have backfired over time. It didn’t know any better, and there’s no point in regretting or belabouring this – only in using this knowledge to empower yourself now.
Taking responsibility means recognizing that you’re the one who can now begin to recognize those patterns (which until now have remained hidden and automatic) and start to do the work to change them – which is really just the work of honouring and (literally) embodying your own, true, authentic self. Sometimes it takes a catastrophe to bring us back to ourselves, to what’s really important. For some people that takes the form of a loved one dying or a horrible accident. I know this may be hard to accept right now, but you might want to consider the view that your disease has actually come along to bring you back to yourself. The great spiritual teacher A.H. Almaas talks about “a part of you that loves you so much that it will make you suffer greatly, to teach you – because what else can it do? That’s its job.”
It’s my belief that diseases like cancer, ALS, multiple sclerosis and so on, that cause so much suffering for people, all come along to teach something – and that if the lesson is learned, with compassion for oneself, then the “teacher” has done its job and can then take a hike. That’s not a guarantee, but I’ve seen many examples of people who have taken on their illnesses in this way and either survived or far outlived what medical science would have predicted, or at least greatly improved their own quality of life while alive. And the research literature confirms this.
I do think it’s useful to listen to the language used by disease sufferers themselves, which can have an eloquent, poignant, and sometimes eerie precision in describing how their personalities and emotional worlds prefigure their diseases. There a few examples that I cite in the book, including Jonathan Swift, author of Gulliver’s Travels, who actually predicted his own dementia (he later died of Alzheimer’s disease) in his poetry, and also in his conversations: on a walk with a friend once, he pointed to a decaying tree and said, “I shall be like that tree; I shall die first at the top.” Jacqueline du Pré, the world-famous cello prodigy, once told her sister Hilary in childhood, in a secretive whisper, “Hil, don’t tell Mum but… when I grow up, I won’t be able to walk or move.” In both cases, these sensitive souls were not just making uncanny future predictions; they were expressing in metaphor what they already felt inside, what their world was like. These premonitions can also be stored in the unconscious; take my ALS patient who, after a lifetime of recurring nightmares of being buried alive, walked into a doctor’s office following her diagnosis to see a poster that said “ALS is like being buried alive.”
Since the mind and body are inseparable, it’s perhaps not surprising that these premonitory metaphors can grow into concrete physical realities, but it’s still striking – and a reminder of the importance in medical care of really listening to people’s stories, their experiences, their very language, for clues about how they experience the world.
4) Attention Deficit (Hyperactivity) Disorder / SCATTERED MINDS
One is that like many people, you may simply not be aware of the stresses you’re under. As I explored in When the Body Says No, people are very often much more stressed than they’re consciously aware of because they’re so used to it. As a consequence they don’t distinguish or notice their stress, because it seems normal to them.
The other is that, like I said before, these kids who develop ADD tend to be highly sensitive – sometimes exquisitely so. Just as a sensitive Geiger counter is going to detect smaller seismic disturbances than a less sensitive instrument, so too will sensitive kids pick up on stresses in the environment that may not affect a more stolid or placid child. Consequently it takes less stressful stimulation to cause emotional pain in a sensitive child. And I make the case in the book that ADD traits like tuning out and distractability first develop as emotional defense mechanisms against this kind of distress.
All the more reason, then, to take a careful look at the child’s environment with an eye to uncovering hidden stresses, so that you can address them.
The first thing to understand is that the purpose of medication should never be to control behaviour or to improve grades or other external results; the proper aim is always to help the child function in the world and feel better about herself. Improved performance may ensue from that outcome – and if so, great – but the focus needs to be on enhancing the child’s own experience of life. That also means that medication should never be forced on the child, or given in the face of the child’s determined resistance, and would ideally be administered with her consent and participation. And the child should never get the impression that approval or acceptance from the adults in her life is contingent on her taking medication. Any short-term gains would be far outweighed by the disastrous long-term consequences, because healthy development (which is what the ADD child needs in the long run) requires trusting, loving, non-coercive relationship.
Secondly, if you do go the route of medication, there’s no reason to stick with a medication that has unwanted side effects, like the “zombification” you’re worried about. Each medication is different and every brain is different, so individual drugs are going to affect people in different ways. There are also variations in dosage that can be tried to eliminate side effects.
Overall, as concerned as I am about their overuse and misuse, I’m not against medications in treating ADD. I’ve prescribed them – in fact I’ve taken them – and have found that they can be helpful, if they’re prescribed and taken in a judicious, targeted, and insightful way. They are never “The Answer”, but they can certainly provide some help, as long as it’s understood that the long-term goal needs to be healthy development, not just the management of symptoms.
Look, first of all, it’s called a “disorder” for a reason – and I make clear in the book that I don’t consider it a disease, but rather a disorder – which is simply, it dis-orders things in one’s life, creates a lack of order or workability. So I’d simply ask: does it create disorder in your life? If it doesn’t, and your life and personality are working for you, then there’s no problem and therefore nothing to fix. On the other hand, if you notice that there are aspects that cause consistent and unwelcome consequences in your life, then it’s something you probably want to look at.
Second, so-called “ADD traits” are not the same as the positive traits you’re talking about, and addressing the one won’t inhibit the other. It’s a common misconception, borne of the fact that people who have ADD tend to be highly sensitive – but it’s actually that very (inborn) sensitivity, not the ADD, that’s the source of you being so creative. Sometimes artists with ADD are afraid that they’ll lose their ability to think in a rapid-fire, free-associative way, which they consider vital to their creative process. But that doesn’t go away when you properly address the ADD component. What do go away, or become more manageable, are the more problematic aspects like impulsivity, or impatience, or interrupting people, or forgetfulness, or disorganization, or tuning out. Those aren’t functions of a creative mind but of an immature brain that’s stuck in some early stages of development; if anything they can be impediments to your true creative self-expression. Addressing your ADD traits should get some of that out of your way so that you can be more effective in your life and your creative pursuits. And that’s what it’s all about, after all – not “fixing” your personality, but making life more manageable and enjoyable.
5) Parenting / Peer Orientation / HOLD ON TO YOUR KIDS*
*For further support on this topic, I recommend that parents visit Gordon Neufeld’s website, which has plenty more excellent information about attachment-focused parenting, his area of expertise.
What’s also different is that kids used to look upon bullies as outsiders and misfits, whereas nowadays bullying behaviour is often a sign of social power and status. You find entire groups of “popular” kids picking on the unpopular ones – the “strong” many persecuting the weak “few” – and this is considered normal. Technology and social media, which are very much geared and marketed toward strengthening the peer culture, give kids an additional power to do each other significant emotional harm. We’ve never seen such levels of childhood and teen violence and suicide as we do in today’s Western society, particularly in North America.
All of this results, we argue, from the peer culture taking precedence over safe, orienting attachments with adults. And all of the anti-bullying “education” programs in the world won’t make a difference unless this fundamental, and disastrous, phenomenon is faced and dealt with.