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Stanton Peele Stanton Peele

My Hostile Breakfast With Gabor Maté


Despite his commendable work in Vancouver, I find Maté's flawed theory and methods to be contrary to the values of harm reduction. The reverence he inspires is testament only to his sleight of hand.

18 Substance
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Last November I was invited to Vancouver to deliver a workshop to the British Columbia Psychological Association. Picture my surprise when Gabor Maté—an addiction theorist whose seductive allure I had scorned in Psychology Today—accepted my invitation to meet in the hopes of achieving a friendly rapprochement, despite our differing views.

We met at a muffin place near my hotel. I tucked into a blueberry muffin. Gabor, slender as a rail, ate nothing. Instead, he was spoiling for a fight. He tried everything to attack me short of slinging his saucer. Finally, Gabor looked at me: “Stanton,” he declared, “you have deep unresolved pain.”

***

Maté is the author of the best-seller In The Realm of Hungry Ghosts: Close Encounters with Addiction. (What a great title!) Revered in harm reduction circles for his work in Vancouver, he has become the voice of harm reduction, featured on the Canadian Harm Reduction Network and similar venues.

His renown buttresses Maté’s claim that all addiction is due to trauma. Yet the expansive model Maté espouses—addiction is a disease over which people have no control because of adversity they suffered as children that impacts their brain chemistry—violates the aims and humanistic values of harm reduction. The Maté mythology results from people’s gullibility, Maté’s sharp practices, and those harm reduction advocates who transmogrify real concerns into “poor-me” pop psychology. But make no mistake, Maté is an enemy of harm reduction.

First, let’s account for the sometimes emotional reverence he inspires among harm reductionists:

1. Maté was the staff physician for the Portland Hotel Society (PHS)—the Vancouver inner-city addiction services provider, including Insite, a place for addicts to inject safely. This was humane, necessary and beneficial work. (Disclosure: I have done workshops for PHS.)

2. Maté draws parallels between “middle-class” addictions, like his own to CDs and classical music, and addictions to so-called “hard” drugs like heroin, cocaine, or meth. This “there-but-for-the-grace-of-God-go-I” perspective is always worthwhile and entirely accurate.

3. Maté taps into people’s deepest vulnerabilities and fears, an ability based partly on empathy and partly on circus hocus-pocus. His nonpareil skills serve both good and bad ends. Putting people in vulnerable emotional states can be transformative, although such effects are usually transitory.* Such practices can also be manipulative on Maté’s part, and overrated and self-deceiving on the parts of their recipients.

Now for the truly bad about Gabor Maté:

1. Maté is the ultimate disease theorist—everybody has the disease.

Maté is an extreme environmentalist who doesn’t believe in the heritability of addiction—or of much else. He writes:

“Succumbing to the urge to absolve ourselves of responsibility and seeking easily digestible rationales for complex phenomena—for life itself—our culture has too avidly embraced genetic fundamentalism.”

I agree with this statement entirely. But Maté actually doubles down on the powerlessness and loss-of-control thinking that he decries. In place of genetic determinism, Maté propounds epigenetics—by which he means the “impact of the environment on brain development”—to explain emotional disorders, addiction and all psychological ailments:

“Childhood developmental disorders such as ADHD, ODD, and other mental health problems such as anxiety, depression, personality disorders, etc. can all be traced to either negative childhood experiences or the absence of sufficiently positive ones. Addiction and adult mental health issues also flow from the same source.” [My emphasis.]

Maté’s formulation here, combining horrific abuse with “insufficiently positive” childhood experiences, invites parody: “Jill’s mother worked after school; thus traumatized, Jill developed [FILL IN THE BLANK].”

Maté does a fast shuffle with trauma and slips in the kitchen sink, too:

“If you look at why addicts are soothing themselves through chemicals, you have to look at why they have discomfort and you will see that they have all experienced childhood adversity—the pain and distress that they needed to escape.” [My emphasis.]

Isn’t adversity a standard part of human experience? I agree with Maté that addiction is a response to emotional quandaries and pain, along with difficult life circumstances, sometimes quite temporary ones. I don’t agree that these emotional events are wired into the person forever.

Maté’s view that all psychiatric/ addictive/ psychosomatic disorders stem from childhood trauma (adversity/lack of positives) is warmed-over Freudianism. Striving to establish his scientific bona fides and validate his Freudian ideas, he claims to show that trauma translates into brain changes—so for Maté, the addicted person is as inherently biologically marred as the most ardent genetic determinist wants us to believe.

This claimed brain malfunction is the crux of Maté’s model of the causes of addiction. In a key chapter of Ghosts, titled “Their Brains Never Had a Chance,” he throws out a broad net:

“Not only can early childhood experiences lead to a dearth of ‘good’ brain chemicals, it can also result in an overload of others [bad ones]. . . .The hormonal pathways of sexually abused children are chronically altered. Even a relatively ‘mild’ stressor such as maternal depression—let alone neglect, abandonment, or abuse—“ disturbs brain functioning for the rest of children’s lives, he tells us.

Maté and neuroreductionist Nora Volkow take the same position: Addiction is the result of measurable brain changes. But whereas Volkow ties these hypothesized causes of addiction to either regular drug use or genetics, Maté attributes them to childhood experiences. And while Volkow tries to establish this brain damage through generic MRI images, Maté is the furthest thing from a brain scientist. He really uses the idea of brain damage as a symbol for Freudian trauma. Volkow reckons this can be fixed medically. For Maté, the solution to brain malfunctioning is uncovering trauma through the psychoanalytic process.

Do harm reductionists really agree with Maté that addiction is a permanent brain disease, steeped in early childhood experiences?

My latest book (with Ilse Thompson) is full of evidence and practical applications to show that rejecting a vision of ourselves as reflecting our worst experiences and periods actually gives us the best chance to survive and flourish.

2. Maté demonizes drugs.

While much is made of Maté’s generosity of soul in recognizing that he and other middle class people are just as likely as the people he served in Vancouver to become addicted, he doesn’t really believe that the two groups are the same. He writes in Ghosts, “Differences between a behavioral addict like me and the hardcore Skid Row addicts may place us worlds apart in social functioning and status.” The severe impairment of “hardcore addicts” (Maté’s term) is critical. But Maté claims the life differences between him and other middle class “behavioral” addicts, and poor inner-city addicts, are due to the latter’s drug use.

Do harm reductionists agree that drug users are special kinds of addicts—the true addicts whose lives are ruined because they use drugs? Like the drug warriors whose punitive measures he and I revile, Maté makes the mistake of identifying drug use with addiction—as if no one ever used a drug without becoming addicted. In fact, a small minority of users of the drugs on which Maté focuses—heroin, cocaine, crack, meth—are addicts. The National Survey on Drug Use and Health finds that fewer than 10%—often far fewer—of those who have ever used these drugs are currently addicted to them.

Maté, surprisingly given his work with Insite, is a drugs-are-evil determinist. Like others whose knowledge of drugs comes solely from treating addicts, Maté sees only the worst of drugs (not counting psychedelics, more about which later). He seems unaware that his “Skid Row addicts” aren’t the whole universe of drug use.

Thus Maté attacks the primary tenets of harm reduction. He doesn’t comprehend that the controlled use of demonized, “addictive” drugs is commonplace. He also fails to understand that non-abstinent improvements in addicts’ lives may lead to remission.

3. Maté agrees with AA that addicts are powerless, that they can’t recover on their own, and that abstinence is the only solution.

Maté sees addicts as powerless—which makes him a big fan of AA and the 12 Steps:

“The principles of the 12 steps are essential: the recognition of the powerlessness over addiction. You gain power and end your denial by acknowledging your powerlessness. . . . Spiritual emptiness is addressed by that acknowledgement of a Higher Power and then, of course, that’s repeated through the moral inventory of your behaviors and their effects on other people. [My emphases.]

Do harm reduction advocates agree with Maté about the effectiveness of making a list of your sins? Do they agree that it is essential for addicts to recognize their powerlessness? Doesn’t this belief in people’s “powerlessness over addiction” qualify for Maté’s warning (vis-à-vis genetics) against “succumbing to the urge to absolve ourselves of responsibility and seeking easily digestible rationales for complex phenomena”?

For Maté, because addiction is an outcropping of the permanent scars addicts bear, there can’t be recovery without deep therapy. Nora Volkow shares this belief in addicts’ absolute need for intervention—despite the repeated evidence, including the US government’s own research, that most accomplish recovery for themselves.

Maté has just one disagreement with AA, which doesn’t change his basic support for the 12 Steps’ abstinence fixation:

“My only issue [with 12-step programs] is that they never address the original cause of the addiction—the childhood trauma—which I think keeps people in a stuck place. That is not a rejection of the 12 steps—just a suggestion that they could be deepened. For people that had religion pushed down their throats or were abused by religion, there are programs like LifeRing, which is a [secular] 5-step program.”

This supposed hero of harm reduction proposes no non-abstinence approaches, such as motivational interviewing, to resolve addictions or substance problems. What about all those music CD addicts like Maté? Strict abstinence for them, too?

What misleads harm reductionists is of course Maté’s humane work with inner-city addicts and, now, his therapeutic use of psychedelic drugs. But he prizes these drugs strictly for their ability to expose trauma, after which drug use is not necessary, and should be abandoned.

Seeking common ground with Gabor, I noted his work with psychedelics as a chance to teach people how to manage drug experiences. But he told me that teaching people competency in drug use is the last thing on his mind. I emailed him in March this year:

I DO like this title—Substance Use Competency. It is interesting to play that idea out—including dealing with people’s traumas (without allowing them to grow to life-overcoming proportions) while also actually teaching them to manage substance use (as you are doing in Mexico). Perhaps we can combine around this.

Gabor responded by rapping my knuckles:

We are not teaching substance use competency with this process. The goal and process is to help people shed the physical and psychological patterns of old trauma, so that they are no longer trapped in the past. If successful, substance use is no longer an imperative. [My emphases.]

The last thing in the world Maté wants people to do is to take drugs as a normal part of life experience. In this way, he is no more a harm reductionist than Nancy Reagan.

4. By translating complex social phenomena into psychoanalytic trauma theory, Maté comes up with simplistic, unhelpful treatment methods.

It is true that people with more traumatic, distressed lives have worse outcomes. Who are the highly traumatized? Overwhelmingly, they are people at the lower end of the economic and social ladder. By translating social problems into psychoanalytic events, Maté bypasses the need to remedy life deficiencies and social ills—always a harder sell than the rooting out of trauma. But focusing on personal pain—even millions of people’s personal pain—has no impact on the social conditions leading to addiction.

Maté’s answer for addictive problems is that people uncover the source of their demons: “Once you’re traumatized as a child, you will continue to be traumatized as an adult [until you get help] because you will not have the emotional balance necessary to heal the trauma.”

Maté belongs to the school of therapists who ferret out your secret trauma even if you have forgotten it, or if your “adversity” (Maté’s word) doesn’t rise to the level of abuse. Many people are enmeshed in their trauma as a way to explain their problems, yet there’s just no evidence that this is an effective treatment.* Like a faith healer who “cures” people by the laying on of hands, Maté never troubles to present evidence to back his approach.

Maté has meanwhile discovered a quick route to recovery—the psychedelic drug ayahuasca. When I met him last November, he described having just returned from a Mexican ayahuasca ceremony. These Castañeda-like shamanistic rituals enable people to “see” the traumas causing their diseases—and not just addiction! Maté advocates “the use of ayahuasca in the healing of all manner of medical conditions, from cancer to addiction.”

Yes: Not only can Maté and ayahuasca cure your addiction, they’ll cure your cancer! Crystals and apricot pits, anybody?

5. Maté thinks he can have it all ways.

Maté has convinced many leaders in the field that he favors harm reduction when actually he is an abstinence devotee who lauds AA. Thus, when I met with Gabor, I was amazed to learn that, like me, he was writing a blurb for Lance Dodes’ book, The Sober Truth, described as “An exposé of Alcoholics Anonymous, 12-step programs, and the rehab industry—and how a failed addiction-treatment model came to dominate America.”

How on earth could Maté support Dodes’ book while praising AA to the sky? Here’s his blurb:

“As always, Dr. Dodes offers a humane, science-based, global view of addiction. The Sober Truth is an essential, bracing critique of the rehab industry and its ideological foundations that we have much to learn from.”

Reading this, you wouldn’t know that The Sober Truth had a bad word to say about AA! Maté’s double-jointed flexibility in presenting his views to curry the favor of different audiences is quite impressive.

***

Which brings us back to his diagnosis of me in that Vancouver cafe: “You have deep unresolved pain.”

Telling the mark something everyone can respond to emotionally is the oldest medium’s trick in the book, as in “Someone close to you has passed, and you never told them how you felt about them.” The “psychic” is aiming to produce an emotional “breakthrough” he can play off of.

I finished my muffin and left. It had taken meeting Gabor Maté to realize what a charlatan he really is.

* In a comprehensive review of clinical trials of alcoholism treatment, psychotherapy was ranked 46 and confrontational therapy 45 in effectiveness out of 48 therapies, while brief interventions and motivational enhancement were ranked 1 and 2 on the evidence, according to William R. Miller, Paula L. Wilbourne, and Jennifer E. Hettema, “What Works? A Summary of Alcohol Treatment Outcome Research,” in Reid K. Hester and William R. Miller, eds., Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 3rd ed. (Boston: Allyn & Bacon, 2003), pp. 13–63.

Stanton Peele has been empowering people around addiction since writing, with Archie Brodsky, Love and Addiction in 1975. He has developed the on-line Life Process Program. His new book (written with Ilse Thompson) is Recover! Stop Thinking Like an Addict with The PERFECT Program. His website is www.peele.net.