Healing as a Subversive Act

Healing as a Subversive Act

Highlights from Symposium 2019

By Gabor Maté

May/June 2019

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.


Gabor Maté, MD, is the author of the upcoming books The Myth of Normal: Illness and Health in an Insane Culture and Hello Again: A Fresh Start for Adult Children and Their Parents.


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Monday, December 28, 2020 1:36:36 PM | posted by Mark Ah Koy
So true in our world today, where there are many adversities that people face, as you have mentioned, but stress and anxiety both reign high as frequent issues in health. Quite prevalent even in young people. It’s almost like our society today lacks resilience or ability to cope with any kind of external pressure.

Tuesday, May 12, 2020 3:55:21 AM | posted by Patti
Well said & with courage. I have always believed that stress is at the root of disease’s.

Sunday, May 3, 2020 11:44:47 PM | posted by Larry Barter
I believe you are touching on what some may call the Bio/ Psycho/Social model of addictions.

Friday, May 1, 2020 6:59:44 PM | posted by Petra Titlbachova
Dear Dr Maté, thank you so much for your powerful article. I cannot wait to read your book. I am a Family Systemic Psychotherapist and Lecturer in London, the UK. I cannot think of a better way of explaning to our new students what we mean by 'systemic' and of teaching them about the importance of wider context. Many thanks, Petra

Saturday, December 21, 2019 4:45:40 PM | posted by Renee Sandler
Thank you for another powerful and thought-provoking article, Dr. Mate. Once again, you remind us how the personal is so profoundly political and how it does us all a disservice to separate the two. And yet we live in a world with a belief system intent on maintaining these disconnections. You ask, "what are we going to do about it? We can’t just hand out more and more medications". Unfortunately, this is precisely what is happening. I think you were right when you said, provocatively, that there is an addict in all of us. A Capitalist economy depends on the majority of us wanting what we don't need. So using your voice to advocate for something profoundly different is, itself, a subversive act. Please keep writing and being an inspiration to myself and many others.

Thursday, October 17, 2019 3:05:38 PM | posted by Tina Marshall
I am an addiction Counselor in Pennsylvania, US. I work as a clinician in a Methadone/Suboxone treatment clinic. What I see, sadly, is our society in the US, is so stigmatized that with us providing MAT's we're referred to as "legal drug dealers". We are assisting people with medication that helps them lead a productive, stable life.

Saturday, June 1, 2019 5:53:14 AM | posted by Claudia Wilcox
Cant wait to get the new books and start reading them. As always, you make so much sense and i agree with what you are saying. I had asthma as a kid and they put me on Tedrol, then ephedrine for years.....up until the 90's. Since getting sober and living a spiritual life I have had only 2 asthma attacks. I believe due to cold and alergy. I have been sober 22 years now and live a pretty much non stressed life. It makes so much sense what you are saying Gabor. Sorry I missed you at the conference this year.

Tuesday, May 28, 2019 7:29:22 PM | posted by Sydney
Hahaha! Censorship is alive and well at 'Psychotherapy Networker.' Not a good sign for a site purportedly informing professionals who ostensibly need to be open-minded in order to do their jobs! You censored my comment that Maté, a non-black Canadian man, is making specious claims about American black women in order to promote his argument. Thanks for informing ME that your site censors very, very broadly. Hope the people who read your site have more open minds than you have as 'moderator.' #orwell

Monday, May 27, 2019 3:59:29 PM | posted by SF
"A study done two years ago showed the more episodes of racism an African American woman experiences, the greater her risk for asthma." I follow several well-known and well-published black American conservatives (economist Thomas Sowell, lawyer/commentator Larry Elder, commentator Candace Owens, etc). I thought of the differences between their analyses of current USA, and left-wing foreigners' (Maté is not black or American) notions of current USA put forth by the left-liberal media. It would be more correct to say, "...the more perceived 'racism'...the greater her risk..."

Saturday, May 25, 2019 2:02:44 PM | posted by Laurie Coker
We work so hard on the ground. Peer to peer support, advocating, education, hoping for systems that will support progress that simply MUST be based in new ideas. But it takes thinking and articulation like this to keep us fueled and hopeful until societies get in step with such vital understanding. So much is wasted in the meantime--wasted resources, wasted lives--until that time. As always, we in the trenches need your infusion of wisdom and hope! Thank you.

Saturday, May 18, 2019 2:56:50 PM | posted by Susan
Deborah I can't agree with you more. Stress is the cause; symptoms express themselves emotionally, physically, spiritually, etc... There is even a philanthropist named Rolf Carriere, I believe, who proposes that everyone have access to EMDR therapy (which does work beautifully) in order to promote world peace!

Saturday, May 11, 2019 6:47:25 AM | posted by Deborah Ullman
Indeed. So the job for some of us, should we choose to accept it -- is to educate ourselves and each other (our young people, most urgently) in relational skills in order to change our hyper-individualized culture, to change that misunderstanding of our human nature as closed individualized systems, to that of our inter-relatedness. This is one way we rapidly change the broader culture: learn and teach how to share and listen to each others stories with emphasis on the supports that get us through!

Saturday, May 11, 2019 2:08:11 AM | posted by CONNIE SCROGGS
This is interesting and thought provoking as I've recognised the division of mental and physical within the medical establishment for many years, even before I became chronically ill after taking a toxic medication. I believe the two can't be divided. The handful of pills I take everyday all affect my mental state and can't be separated from physical affects. My mother clearly needs an antidepressant and a sedative but refuses to take either because they affect "her brain"! Yet, she takes countless pills for heart disease and other autoimmune problems believing they have no effect on her mental state. She is not on a narcotic and neither am I but having been ill for 20 years now and been on meds almost as long wonder how I would feel if I weened off them? Are they really doing me good or have I been trapped , a victim of pharmacology much like it all began. I feel I would not be able to ween off all my meds as I would be in too much pain. I don't think anything about my damaged mitochondria has changed enough to be without drugs. Yet, are they harming me more just suppressing symptoms and the question remains "What am I to do if modern medicine doesn't know what to do" except suppress symptoms?" There are no cures, only bandaids for chronic illness.