When you look at the major health indicators in our society, what do you see? Every three weeks, the number of deaths from drug overdoses equals the total death toll from 9/11. The number of people diagnosed with autoimmune illness is going up, and mental health issues are snowballing. The number of children being diagnosed with one or another so-called medical disorder—whether it’s ADHD, anxiety, depression, so-called conduct disorder, oppositional defiant disorder, pervasive development disorder, not to mention the autism spectrum issues—keeps growing. More and more kids are being medicated all the time. Anxiety is the fastest growing diagnosis among our youth.
How do we explain why these problems are burgeoning? As a medical doctor, I was trained in the mainstream medical tradition, a perspective that sees the mind and the body as separate from one another, and the individual as separate from the environment. In this framework, society and culture play almost no role in the onset or the dynamics of illness. Everything is reduced to individual biology or individual behavior. So addictions, for example, are seen as personal choices, which make the solutions behavioral: either educational or punitive. In either case, all we’re trying to do is influence individual behavior, pretty much as B. F. Skinner would’ve done in a laboratory with rats.
Basically, if you want a rat to go to a certain part of a cage, you give it sugar, and if you want it to avoid that part of the cage, you shock its foot with electricity. You don’t care what the rat’s internal experience is, and you don’t care what the rat’s relationship is to the environment in which it lives. You just want to make it avoid something or move toward something else. On a social level, that’s our approach to addiction.
Following from that viewpoint, we have the recently resigned U.S. Attorney General Jeff Sessions wanting to bring back programs from the ’80s and ’90s that tell people to just say no to drugs. “If we can have these programs again,” he says, “people won’t make bad choices.” He actually uses the word choices. And that’s the dominant model of thinking in our society: that people behave, stay well, or get sick fundamentally based on the personal choices they make. How successful that choice model has been in preventing addiction is shown by the fact that the number of people dying from overdoses continues to climb. But that little fact doesn’t shift mainstream thinking, and it certainly doesn’t have any impact on legal thinking on addiction.
The other approach to addiction, of course, is the biological view. In this medical model, addiction is seen primarily as a disease of the brain, a result of the interaction of someone’s genetic predisposition with certain substances. So whether it’s a choice that somebody makes on a conscious level, or whether it’s a disease that somebody is programmed to have because of personal biology, we reduce it to the level of the individual. The problem with that perspective is that it cannot possibly explain why the problem of drug abuse is getting so much worse on such a large scale. The real sources are individual trauma in an increasingly isolating and dislocated culture. But our society loves to reduce everything to the level of the individual, because then we don’t have to look at the social factors.
A study done two years ago showed the more episodes of racism an African American woman experiences, the greater her risk for asthma. You can’t explain that only in individual biological terms. And we’ve known for a long time that the more stressed parents are, the more likely their children are to have asthma. Interestingly, the common treatment for asthma is to give people stress hormones to open up the airways and reduce inflammation in the lungs. Stress hormones happen to be the most common prescription across all medicine.
Whether you have an inflammation of your nervous system, or connective tissue, or skin, or lungs, or joints, or intestines, you’re prescribed cortisol, which is the stress hormone. And yet we never ask ourselves in medicine, “Gee, we give you stress hormones for everything. Is it possible that stress may have something to do with this illness?”
It seems obvious, and yet we don’t ask ourselves these kinds of questions. And I think there’s a powerful reason for that: once we do, we’d have to see that stress is a social interaction. Stress has to do with conditions beyond people’s biology or individual psychology. And recognizing that would challenge how we see the world and how we run our society.
Of course, looking at interconnections, rather than individuals, to explain what happens to us as human beings is not a new idea. Twenty-five hundred years ago, the Buddha taught that nothing arises on its own, that our being is connected to every other being. He put it in terms of looking at a leaf or a raindrop. “When you look at that leaf or raindrop,” he said, “contemplate every moment, all the interconnections that were necessary for its creation.” So with a leaf, for example, the photosynthesis depends on the sunshine, the earth, the sky, the water, the irrigation. That leaf contains the sun and the sky and the earth.
Intellectually, we all know this, but when we walk through the world, myself included, we don’t live in that kind of consciousness of interbeing. And this separation, this individualization is then reflected in how we look at health, how we look at mental health, and certainly how we look at society.
Modern science is coming around to that holistic view again with, for example, the study of interpersonal biology. One way to understand interpersonal biology is from a social perspective: how our nervous system functions and how our brain functions aren’t personal. Our thoughts or emotions aren’t purely individual phenomena. So when we look at something like the asthma of the person of color who suffers from racism, we understand it’s not simply the personalized physiological response of an isolated human being: it’s a social malaise.
The question is: what are we going to do about it? We can’t just hand out more and more medications. We have to look at the stresses that, on a social level, affect people. Some people, for historic and economic and social reasons, might be affected more than others. But that imbalance affects all of us—we’re all part of the same system. In that sense, we all partake either in the creation or the amelioration of that person’s proclivity or propensity to suffer an asthmatic episode—or addiction, or most other physical or mental health conditions.
In essence, healing is a highly subversive act in our culture. Whether in a medical or more direct psychotherapeutic sense, our work with people is about subverting their self-image as isolated, simply biological or simply psychological creatures, and helping them see the connections among their existence, the nature of the culture we live in, and the functioning of all of humanity. It’s about challenging the idea that someone’s value is dependent on how well they fit into an abnormal, unhealthy culture. Ideally, as healers in the broadest sense, that’s what we should be doing.
PHOTO BY SAM LEVITAN
Gabor Maté, MD, a family practitioner for over three decades, is the author of four bestselling books, including When the Body Says No: Exploring the Stress-Disease Connection and In the Realm of Hungry Ghosts: Close Encounters with Addiction. His upcoming books include The Myth of Normal: Illness and Health in an Insane Culture.