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Changes: Gabor Maté

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Annie [00:00:03] Hello. My name is Annie Macmanus. You are so welcome to Changes. Hello, delighted to have you with me for this week's episode which is a really memorable one. I'm speaking to you from the office at the end of the garden, as per usual, but it is actually the first time I've worked from the office this week because T, god help him, got COVID so he's had to work from home. So we've swapped the way that we work. Instead of me staying at home and kind of pushing everyone at the door after a chaotic half an hour of looking for uniforms and books and bags and all sorts, T is now the one staying at home and I'm the one bringing the kids to school and then walking the 15 minutes after to T's studio where I have been working from. Now I didn't realise how much working from home was kind of affecting me. I am a naturally sociable person. I thrive off talking to people, connecting with people. I like having conversations with people. And because of that, T's studio which is a complex and has a café and there's a buzz, there's people about, it really suited me. I really liked going and kind of running into people and being able to go and have a cup of coffee and have a chat. I just really enjoyed the aspect of it and it made me realise how much I am lacking that by working from home and how much I'm in my own head all day. Which I am anyway, because I spend the majority of my time trying to write. So it was good. It wasn't a change I expected. It just happened. But in doing it it really helped me realise what I need. And you know, now I have to try and put things in place to make sure that I'm kind of not rattling around on my own in the house all day, every day, because it kind of drives me demented. I thought I could set you a very gentle and non-committal bit of homework and ask you this week to think about something you could do, something you could tweak in your daily routine in the way that you live your life that could change your life for the better. It could be anything. It could be cooking something different. It could be doing some different type of exercise. It could be instead of every time you go to WhatsApp your friend, you pick up your phone and you ring them. It could be locking your phone in a box and letting your kids choose what they want to do with an afternoon. Anything at all. The smallest thing that you could tweak just to try out something in a fresh way. Try it. I will do an Instagram post this week and let's compare and contrast our successes and failures in doing a little life tweak. Okay, so onwards and let's hear from this week's guest. 

Gabor [00:02:48] If somebody decides that the price of suppressing themselves has become too much, they can change. It's a question of getting conscious, but change is possible. 

Annie [00:02:58] That is the voice of the renowned bestselling author, physician and addiction expert Gabor Mate. Gabor is in huge demand to speak about his expertise on addiction, trauma, childhood development and the relationship of stress and illness. He's written five books published in over 30 languages. You may have heard me and T speaking about his book Scattered Minds on our ADHD episode, it really helped us understand the roots of T's ADHD and also how to live with it. As well as that book, Gabor has written a book called In The Realm of Hungry Ghosts, which is all about addiction. And he is also co-developer of a therapeutic approach called Compassionate Enquiry, now studied by hundreds of therapists, physicians, counsellors and others around the world. Gabor teaches that as human beings we are creatures of our environment and that our bodies are inseparable from our psychology and social relationships. The way we think directly affects the way we physically feel. He's written a new book, The Myth of Normal: Trauma, Illness and Healing in Toxic Culture. He wrote it with his son over ten years,  and it is, I can tell you because I have it, the size of a brick. But if I was going to try and dumb it down to just a couple of sentences, I would say that in the book Gabor tries to show us that living in Western society, just living in Western society, is trauma inducing. And the concept of normal, what that means can be very, very harmful. Then he tries to help us understand the road to healing. Like so many others, I'm such a big fan of Gabor Mate, but he is not without his critics. Some of his teachings go against common practises in medicine, and some people disagree, for example, with his approach to addiction, arguing that trauma and addiction are not connected. He mentions on occasions in this conversation where people have dismissed his theories. Gabor was born in Hungary in 1944 during the Second World War and is a survivor of the Holocaust. His maternal grandparents were killed in Auschwitz when he was five months old. His aunt disappeared during the war and his father endured forced labour at the hands of the Nazi party. His mother went through a lot to keep him alive. He believes these traumatic early years impacted his whole life and the way he behaves even today. It's part of why he is who he is and why he now helps others. It was a genuine honour to get to speak to Gabor and be in the same room with him for this episode. As he is touring his new book his voice is a stretched, so we removed some coughing to save your ears, and you'll hear him holding back some coughs at times as well. I hope you love this conversation as much as I did. Gabor is the oldest guest I've ever interviewed on Changes, which is why I was quite surprised when he told me where he went to on his recent trip to Berlin. Just before we stopped to do an official introduction to this, you told me that you were at Berghain, the iconic nightclub in Berlin back in May. 

Gabor [00:06:11] Yeah. 

Annie [00:06:12] How was that for you? 

Gabor [00:06:14] For one thing, if I had been on MDMA or something, I know it would have been just a completely mind blowing experience, you know, because of the vibes and the freedom of the people in there. Mind you, I think it's a constrained kind of freedom. Partly, there seemed to be a desperate energy about the place. It wasn't purely about self-expression. It was also kind of escaping from the world, that was my sense. There were acres of skin, of course, of all genders. 

Annie [00:06:42] And ages? 

Gabor [00:06:42] All kinds of ages but- 

Annie [00:06:44] Did you feel of age in there? Did you feel like you were older or? 

Gabor [00:06:48] I didn't have an age sense about it. I was probably one of the oldest people in there but, you know, there were all kinds. There were some really beautiful people in there. I mean, that's a place where you can just watch people forever and not get bored you know and *laughs* how should I say this. I wish that my sexual preferences were broader because there were so many attractive people there *Annie laughs* of all genders you know. Why do I have to be so straight, you know? *Both laugh*. And musically, just even without any psychedelics, which a lot of them seem to be on. But there was such a pulsating and compulsive invitation about the music itself. Just to join in and let your body go, you know? And then in the light of day it looked a bit sadder, once people were on the outside and the sun was shining on them. There was a kind of a sense of loss, of mystery and just people trying to be people.  

Annie [00:07:40] Mmm. I love that you went. Did you have friends that brought you or was that something you wanted to do? 

Gabor [00:07:44] Frankly, I didn't know much about it. So some Berlin friends of mine who had connections to the door person got us in. Apparently it's not that easy to get in. 

Annie [00:07:55] It's not easy. It's infamously hard to get in. 

Gabor [00:07:57] Yeah. 

Annie [00:07:59] Well amazing. So you are here on, as you just told me, an epic five week tour kind of going around the world talking about this incredible book, The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture. I would like to get into that with you, Gabor. And I would also like to talk about change, which is what this podcast is based on. So, if you don't mind, can I start by asking what your relationship to that word is, change? 

Gabor [00:08:27] Well, it's always intriguing, but it's rather neutral. I mean, change can be positive or negative. Generally when people come up to me and say, you've changed my life, I know they mean to something positive but something in me wants to ask, what was it for the better, you know? But you know what? Given how static the world seems to be in some ways- on the one hand there's a rapid change and a superficial level. But in a deep, spiritual, emotional level I think there's a deep status that's going on. So for me, change on the whole is a positive resonance. 

Annie [00:09:04] And we've asked you to kind of think about three big changes in your life before coming in here. So I'm going to go straight to the childhood change. You said the 1956 Hungarian Revolution and Emigration to Canada. So, you were born in Budapest in 1944? 

Gabor [00:09:21] Yeah. 

Annie [00:09:21] What were those first years of your life like? 

Gabor [00:09:24] Well, there was the first year, which was my infancy under the Nazi occupation to Jewish parents. And so, it was frank horror for all the year and bare survival and separation from my mother. And I was quite an ill baby, apparently under the conditions. With a grief stricken, terrorised mother. 

Annie [00:09:47] What was the context of the separation from your mother? 

Gabor [00:09:51] Oh, the refuge where we had found a place to escape from the walled ghetto where people were being killed every day. But that refuge itself was so crowded and the sanitary conditions were so awful and I was so ill, my mother didn't think I would survive more than a day or two there so she handed me to a stranger in the street, asked her to take me to some relatives and they were living under relatively safer conditions. 

Annie [00:10:17] How long were you with them? 

Gabor [00:10:20] My mother says five or six weeks. That's what she says in her diary and I don't know exactly how long.  

Annie [00:10:26] Okay. And I mean, you write about this in your books about how that experience, quite profound experience in your infancy, manifests. 

Gabor [00:10:34] Yeah. 

Annie [00:10:35] In your life still now. 

Gabor [00:10:36] Yeah. 

Annie [00:10:37] Could you elaborate on that? 

Gabor [00:10:39] Well, it manifested this morning because I got a communication from my new publisher, the details of which really don't matter, but my reaction was so much like that of a frustrated infant, you know? I know that probably has to do with the fact that I'm, as you mentioned, I'm in this long tour now. I am rather tired, and I haven't done much emotional work or self-care on this trip. And so I'm somewhat depleted. And then when I'm depleted, I default to my basic frustrated infant mode, and that's what happened today. You know, and as an infant I had a lot of frustration.  

Annie [00:11:16] Yeah. So this disconnection with your mother ends up coming out in different ways as an adult still. 

Gabor [00:11:25] Yeah. 

Annie [00:11:25] I suppose is that a central tenant to your teachings, I guess, this kind of emphasis on those first few years of your life and how they are so powerfully powerful over the rest of your years? 

Gabor [00:11:37] Well, actually, some research seems to indicate that children who have their needs met for the first three years, but then face difficult circumstances afterwards, do much better than children who have those circumstances for the first two years and then everything is okay afterwards. So those first three years are absolutely formative. The human brain by age of three is 80% adult size, whereas the body is 20% adult size. 

Annie [00:12:01] Wow. 

Gabor [00:12:02] So it's a tremendously essential and sensitive period of brain development. And it's in those first three years in terms of our relationships with our caregivers, that we actually form the template that we have of our worldview and how we feel about ourselves and how we regard relationships and all that. And the unconscious mind, which is mostly the right side of the brain, forms before the intellectual life side. And when the emotional brain is unbalanced or doesn't have the right conditions for its development, then the intellect becomes kind of unmoored from essential reality. So the intellect can be very sharp and acute, at the same time completely wrong. Because it's serving the wrong master. 

Annie [00:12:49] Because the emotions aren't there to support it? 

Gabor [00:12:52] Exactly. 

Annie [00:12:53] Right, okay. So Gabor, you also mentioned this journey that you made across the world to Canada. How did that impact you? 

Gabor [00:13:02] Well, there were two big changes there. One is that in Hungary, I'd grown up as a real accolade in the communist system. You couldn't, but grow up like that. My teachers and my parents weren't going to tell me how dictatorial and brutal the Stalinist system was. And I just believed in all the slogans and the pomp and the parades, except for one teacher that I had who very bravely in retrospect, said to me, said to a class in grade five on the winter equinox or the winter solstice, what is it? But he said, boys this is the darkest day of the year. It also happens to be Stalin's birthday. 

Annie [00:13:38] Wow. 

Gabor [00:13:38] But don't tell anybody I said that, he said. 

Annie [00:13:40] Okay. 

Gabor [00:13:41] Now, I didn't understand it. Why he was saying it or why he was saying not to tell anybody. But he was making a political statement. But it's kind of escaped me. When the revolution broke out in October 1956, all of a sudden the scales fell from my eyes and I was shocked to realise that this whole world system that I believed in, I accepted a whole pack of lies. And that taught me how influencable we are as human beings and how we can actually live in a world that doesn't really reflect reality. And that happens universally by the way. And so there was that disillusionment which, as I say in the book, it's a good thing to get disillusioned because I say to people, would rather be illusioned or disillusioned. Would you rather believe in a fairy tale world or would you rather see reality the way it is? Painful as that might be. The second change was that all of a sudden we left the culture and the country and the language that I knew and we find ourselves in the Wild West of Canada. 

Annie [00:14:43] And you were how old? 

Gabor [00:14:44] I was 13, which is also a time of change.Yeah, it's very uncomfortable. And the family was less together because my parents were too busy making a living. And as kids, we spoke English much better than they did very quickly. So there was both a loosening of the family structure, a very rude and quick cultural shock of a change. 

Annie [00:15:04] Yeah. 

Gabor [00:15:05] And all of sudden, living in a new system that I had to adjust to and learn about. So that was a huge change for me. 

Annie [00:15:11] You say in the book about, our species are actually very good at change when it's incremental. 

Gabor [00:15:16] Well, we are very good at change. Sometimes when it's even rapid. But we're not aware of the costs that it incurs. I mean, young kids growing up today have no idea what it felt to be alive in pre digital days. And it's a completely different ethic and it's a completely different culture. It's a different, complete different way of being. So we're a bit too good at creating change, but in a way that emotional maturity doesn't quite catch up with the changes in lifestyle and changes in ideology and changes in technology. As long as it's incremental, we can make those adjustments. Permanence is rapid as it is now is purely disorienting and alienating. 

[00:15:59] *Short musical interlude*

Annie [00:15:59] Let's talk about this book then, The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture. How do you want to assist in changing people's minds when they read the book? How do you want them to think different about the way they live? 

Gabor [00:16:20] Hmm. The best feedback I get is somebody reads the book and they say, now I really understand myself. 

Annie [00:16:26] Yeah. 

Gabor [00:16:27] So, that's what the book is intended to do, is to help people understand themselves and to accept themselves, including their problems and their dysfunctions and their illnesses and they all came along for a reason. I say for a reason, I don't mean anybody deserves them, but there's always an explanation. So I wanted people to understand their health and their illness. I want them to understand their childhoods. I want them to understand why they feel about themselves the way they do. Why they relate to their partners the way they do, why they work the way they do. Why they see the world the way they do. A rather modest undertaking. 

Annie [00:17:04] I mean it worked, in my case anyway, which is the only case I can speak for. I feel like it's really worked. It's made me look at everything differently. And also a lot of people in my life, it's made me see them in a different way and people who suffer. 

Gabor [00:17:17] Yeah. 

Annie [00:17:17] So give us the headlines, Gabor, in terms of the western world and illness. So if normal as we know it is kind of healthy, right? Then what does that landscape look like? 

Gabor [00:17:29] Well, that's the myth of the normal, it's that what is the norm in this culture is also healthy and natural, which it isn't. So there's a narrow context in which normal equates to health and nature, which is in, say, the medical sense. Where beyond a certain spectrum of temperature, blood pressure or blood chemistry, there's no life possible. In that case, health and what's natural equates with normal. That's the normal range that doctors talk about. The mistake we make is we extrapolate that sense of normal to this culture. We say this is what the norm is. This has got to be healthy and natural. I'm saying that what the norm in this society is in terms of how we handle children, how we handle birthing of babies, the pressures we put on women, the inequalities that characterise society that everyone takes for granted, the power of relationships, the values that we live by, the consumerism that activates so much of our lives, the digital world into which we get sucked in, like into a vortex. These are the norm in terms of that's what's happening, but they're really unhealthy and really unatural. 

Annie [00:18:44] So if normal can in fact be unhealthy and harmful physiologically, mentally, spiritually, even, you've given some examples of how, but what core needs, human needs are being compromised in living in Western society? 

Gabor [00:18:58] So we can look upon and say the needs of children. 

Annie [00:19:02] Right. 

Gabor [00:19:02] And then the needs of adults. 

Annie [00:19:04] Okay. 

Gabor [00:19:05] So children have basically four core needs which if deprived from them, suffering results and mental development results. So the first core need is an absolutely secure attachment relationship and nurturing adult. I'm not talking about a relationship where the parents love the child which is almost always the case, but in which the child actually feels secure. Absolutely secure, safe. Because it's only under conditions of safety that the brain and the nervous system develop properly. So that core safe attachment relationship with parents who are emotionally attuned to the child, to actually get the child's experience. That's the first one. The second one is that within that relationship, the child should have what a psychologist friend of mine calls, rest. Rest mean the child doesn't have to work to make the relationship work. The relationship is just there. The child can't earn it and can't lose it because it's unconditional. So I don't have to take care of my parent's needs. I don't need to take on their stresses. I don't have to be good, pretty smart, compliant, you know, in order for that relationship to be absolutely stable. So that's the second one. The third non-negotiable need of the child is the capacity and the freedom to experience all their emotions. Now, our emotions are not luxuries. They're wired into us, into our brains by evolution. So we have a number of emotional circuits that we share with other mammals actually, which include, for example, the capacity to care. You might call that love. Lust, of course, without which there's no procreation. Seeking curiosity, gaining mastery of the world, anger, which is absolutely essential as a boundary defence, grief, which is that to process loss, fear. So these are essential emotions and the child should have the right and the freedom to experience all of these emotions. I didn't say to engage in all kinds of unacceptable behaviours, but that the emotions themselves need to be validated and supported. In so many families, these are squelched in the child. We also have an essential place circuitry in our brain that we actually are wired to play, as are other mammals. I mean, just look at puppy dogs or cats or lion cubs, bear cubs, they play. Why? Because play is essential. Free spontaneous play is essential for brain development, much more important than intellectual pursuits. And so when, these are deprived from children, as in our society they often are- a lot of play these days is with digital devices. Or with plastic, pre manufactured, totally unimaginative gadgets. Whereas the free spontaneous play which is creative and flows from the child's imagination, that's what promotes brain development. So deprive these four needs, as they often are in this culture, that results in maldevelopment of the child and it results in all kinds of problems that then are then medicalized as if they were diseases. But they're not, they're just a result of the fact that the child in them --- to develop either psychologically or in terms of brain circuitry, the way nature intended them to.

Annie [00:22:29] Mmm. So, if that's the case then, if there's medicalisation of these situations that have happened with children not being given the, you know, enough in terms of their core needs, how does that change how we look at illness? 

Gabor [00:22:43] Well, for example, the subject I wrote my first book about, Scattered Minds and attention deficit plus or minus hyperactivity disorder, is seen as a genetic disease. I say it's neither disease nor is it genetic. There is biology involved but we have to keep in mind that the human biology, including the biology of the brain, is shaped by the environment. So there's an interaction of genes and environment. And the most important- this is what's astonishing, not as a fact because it's almost self-evident as a fact, but as a fact that's not even taught in the medical schools, is that the physiology of the brain, the circuit of the brain, the most important influence on its development is the emotional relationship with the caregiving adults. So, when the emotional relationship is stressed because the adults are stressed, distracted, depressed, economically challenged, the relationship is maybe tense, as it was with my wife and I when my kids were small. What is going on? The child is stressed. Now, if you and I were stressed as adults, we could do something about it. We could change the situation, leave it, something. But when a child's being stressed, there's not a whole lot they can do. They can't leave for sure, and they can't change the situation. So what they do is they tune out as a way of protection. So it's an adaptive response to early life parental stress, which is not the fault of the parents by the way, I's just how their lives are. But if we look at why are more kids being diagnosed these days and medicated? It's because the parenting environment has become so stressed, so one of the few recourses young children have is to tune out. When are they tuning out? When their brain is developing. So now you've got this adaptation against stress, later on diagnosed as this genetic disease, which totally misses the point. 

Annie [00:24:36] You talk about stress a lot in the book and how much western medicine seems to miss out on this very hugely important underlying feature of anyone being ill, which is you know, as you said, their environment and also their emotions and how that feeds into their physiology. I found that stuff so fascinating. 

Gabor [00:24:56] What's even more fascinating is that it's not even controversial, scientifically speaking. You know- 

Annie [00:25:02] Yeah, but why doesn't western medicine- 

Gabor [00:25:04] Because western medicine doesn't look at the science. 

Annie [00:25:06] Ask people, tell me about your childhood. Are you going through stress? You know. 

Gabor [00:25:10] Yeah. Well, let me tell you, I often talk about these three diseases, you know, multiple sclerosis, rheumatoid arthritis, breast cancer in women. 

Annie [00:25:18] Oh, this bit blew my mind. Blew my mind. 

Gabor [00:25:20] So, the first person to describe multiple sclerosis was a French neurologist in the 19th century who said this was a stress driven disease. Sir William Osler, a Canadian physician who was knighted for his work here in Britain by Queen Victoria, he said that rheumatoid arthritis was a stress driven disease. He said this in 1890. A British surgeon, James Paget, said in 1870 that breast cancer was related to a woman's emotional state. Now, they did no research. What they had was their brilliant intuition and the wealth of observation. They were just wonderful clinicians. Since then, for all three of these conditions, we've had oodles of research showing a relationship between trauma, stress, emotional factors and these three conditions.But as you say, you go to the doctor with any of these conditions. Nobody's going to ask you about your trauma, nobody's going to ask you about stresses in your life, nobody's going to ask you, how do you feel about yourself? Do you know what I mean? What are your moods like? They're just not going to ask. This is in the face of all the research so there's this tremendous gap between what science has demonstrated and what medical practice is willing to engage with. When you look at both autoimmune diseases, the rate is rising. When you look at mental health conditions, the rates are rising. Look at the number of kids being diagnosed and medicated, those rates are rising. We can understand those as sort of unexplainable random events. Or we can say there's something going on in this culture, in this way of living that is driving those diseases. And when you look at what I said about the essential needs of children and how this society deprives kids of those essential needs, then it's no wonder that more kids are committing suicide, that there are higher rates of ADHD, anxiety, depression amongst children, more self cutting and all that. These are normal responses to abnormal circumstances. That's how I would put it and so, again, to understand most physical illnesses, there are some physical illnesses that are purely genetic. One of them is in my family - muscular dystrophy. If you have the gene, you have the disease. My mother had it. My aunt had it. They both died with it. But those diseases are very rare, and so most illnesses of mind and body are generated by the environment. I --- on this trip, a British expert, Dr. Richard Bental who's a member of the British Academy, he's a psychologist. And he pointed out that the link between childhood adversity and adult mental illness, scientific evidence linking those two are as strong as the evidence linking smoking to lung cancer. And yet most physicians, most psychiatrists, just don't have a clue. Again, for the paucity and lack of training that they receive. 

[00:28:14] *Short musical interlude*

Annie [00:28:23] You were a physician for many years. 

Gabor [00:28:25] Yeah, 32 years. 

Annie [00:28:26] At what point did you start realising that there was holes in the Western practises of medicine? 

Gabor [00:28:32] Well, I was always interested in systemic thinking, looking at the larger picture. I had a English and history degree before I went to medicine. In contrast to most of my classmates who were strict science students, they never lifted their heads out of the test tube like it was always about just the biology. 

Annie [00:28:46] Okay. 

Gabor [00:28:47] But having said that, in family practise and also in palliative care, which I did for seven years, looking after terminally ill people, I couldn't have noticed that people's emotional states and traits had a lot to do with who got sick and who didn't. And what I didn't know is that there'd been all this research, pointing to exactly the same fact, but nobody told me about this research. So, I'll take an astonishing story. I went to the British Columbia, Canada's where I live, in Vancouver. I went to the British Columbia Cancer Agency, which is a clearing house and treatment facility for malignancy. I went to the head of the psychology department and I said, I'm writing a book on the relationship of stress and cancer and stress and illness, and I'm wondering if you can help me. She said, well we don't believe there's any connection. Then I went to the library in the same building. I phoned hundreds of papers showing the relationship of emotions to malignancy. They didn't even know what was in their own library. That's how bad it is. 

Annie [00:29:46] Having read the book, I find it quite scary. It feels like there's just this huge, gaping hole in people's awareness of how much of their feelings affect their body and their physiology. How can, at all, the way that medicine is practiced, change? Can you see it changing? 

Gabor [00:30:05] I certainly see a lot of my colleagues walking the same path that I have. I mean, they just- they don't necessarily leav medicine, but they practice with a different consciousness. And when they do, they find it very rewarding, actually. Because they feel they have- 

Annie [00:30:19] There needs to be a certain element of confidence to do that right? Because it's not what you're taught. 

Gabor [00:30:23] A lot of doctors don't have the confidence, they don't have the openness, they don't have the emotional intelligence, they're not taught that, they don't know the information and they're under such stress, you know. But I do know that when people, I mean, when I was giving a talk in New York a few weeks ago, this woman comes up to me to have a book signed and she said, I'm a recovering interventionist cardiologist. She got so stressed doing her work because it was so narrowly focused, that she left medicine and now she's an artist, you know. But I also know physicians who take this information and apply it in their practice, and as a result, their work becomes so much more satisfying. Cause all of a sudden they're dealing with-

Annie [00:31:03] They have bigger pictures. 

Gabor [00:31:04] The whole person rather than just with an organ, you know? 

Annie [00:31:07] Yeah, yeah, yeah. I'm conscious of people listening to this for the first time and coming across your work for the first time. I want to really hammer home this whole, your teachings about the mind and the body. And one bit again I found really fascinating was the nice bit. So can you elaborate on that? This idea of people having certain personality traits that will directly influence whether they get ill or not? 

Gabor [00:31:31] Sure. So there was a paper presented at the International Motor Neurone Disease Congress in ALS, it's called in North America, in Munich, Germany, back in the eighties or the nineties. And these neurologists from the Cleveland clinic presented a paper which they pointed out that when people come to their diagnosis for a motor neurone disease, of which most famously Stephen Hawking died, and he's an interesting case about which I should say something in a moment, but when people present to the clinic for diagnosis, they undergo electro diagnostic testing. Their nerves are tested. The technicians who do the test will write on the side of the test, this person can't have ALS, she's not nice enough. Or, I'm afraid this person has ALS, he's too nice. And what the neurologist said, that despite the obvious, unscientific nature of their observations, almost invariably they proved to be correct. Now you do a survey, this has been done as well, of neurologists, and they say that ALS patients are extraordinarily nice. They just don't make the connection with the illness, they just noticed this is a curious factoid. But when you look at what this extraordinary niceness is all about, remember I said we have an anger circuit in our brain? 

Annie [00:32:46] Yes. 

Gabor [00:32:47] It's about the repression of anger. They're so nice that they're not assertive at all and they are suppressing their healthy anger. Now, healthy anger. If I were to intrude on your space right now, either emotionally or physically, a healthy response on your part would be to get angry with me. No, you'd say. Back off. That healthy anger would protect your boundaries. Now, what we know about the emotional system, the hormonal apparatus, the nervous system and the immune system is that they're not separate systems. Scientifically they're one unit. Different manifestations of the same unit. Healthy anger is there to protect your boundaries. So is the immune system there to protect your boundaries. To let in what's healthy and nurturing, and to keep out what is dangerous. Now, when you repress your healthy anger, you're also messing with your immune system. So you're much more likely to get malignancy or autoimmune disease. That's the connection. And physiologically, it's not that difficult to grasp. And so people that repress healthy anger have diminished activity of their immune system. Or just as healthy anger that you suppress, if you keep it in, turns against you in the form of self-loathing or depression. The immune system can also turn against you. And now you've got an immune system attacking you, and that's called autoimmune disease. 

Annie [00:34:08] And there's a much higher percentage of women who suffer from that. 

Gabor [00:34:11] Of the two major genders in the society, which is the one expected to stifle their healthy anger, it's women. And to serve the needs of others. And not to think of their own needs and to take on the stresses of their environment. The New York Times had a headline article called Societies Shock Absorbers during COVID. How women took on the stresses of their husbands and they felt guilty if their husbands were stressed. You know, so that's why women have more autoimmune diseases, because it's the immune system. It's not their fault. They're acculturated to do so. And this goes back to childhoods where, you know, good little kids don't get angry. Or the message that the kid gets is that angry kids don't get loved. And so to get the love, you suppress the anger, you suppress the anger. And then later on you're diagnosed with this, that or the other. And if you resist, where does it come from? Now, if you look at Stephen Hawking, he had a very emotionally unsupportive childhood. And when he was diagnosed at age 20, I think he was given two years to live. Now, as we happen to know, he lived more than five decades and became one of the world's leading, if not the world's leading physicist. And he stopped being nice. He would run over people's feet with his wheelchair if they bugged him. But what Hawking also had is women who absorbed his stresses, like his first wife became totally depleted emotionally. I'm not blaming anybody for anything. I'm just saying, first of all, as physicians, let's get a bit humble about it. Let's not tell somebody that they're going to live for two years and then they live for 55 years or 50 years longer and we don't even ask why. Shouldn't they at least wonder what happened here? And shouldn't we at least question the certainty of our understanding of things? And shouldn't we begin to see that this niceness that people talked about actually is more than just the milk of human kindness. It's also about the repression of healthy aggression. 

Annie [00:36:07] Yeah. I mean, you have a list in the book of all the things within that kind of nice bracket, you know, the kind of self-sacrificing, you know, taking on other people's emotions, feeling guilty, you know, putting yourself last, all of that. And as you say, these are all normalised things and people can be celebrated for being, oh, they're so nice. They're so, you know, they're lovely. They're really generous, blah, blah, blah, blah. 

Gabor [00:36:27] Well, you know the expression the good die young? 

Annie [00:36:30] Yeah. 

Gabor [00:36:30] They do. 

Annie [00:36:31] Oh my God, I've never really thought about that. My brain's just exploded. 

Gabor [00:36:37] They die young, and all these people come to your funeral and they celebrate how nice and kind and generous you were. Now, I'm not militating here against kindness and generosity. I think that's part of authentic human interaction. But when it comes at your own expense and you extend that kindness and generosity to others while denying it to yourself, which itself is an outcome of childhood trauma, then you're in trouble. But the good news is that people, when they fall ill and they wake up to what they've been doing themselves, and they change their patterns, they learn how to say no, that has a remarkable impact on their health. 

Annie [00:37:15] I mean, that's what I was going to ask you for. Anyone listening now who feels like they could be described as some of those things we're talking about, is there a way to change kind of behavioural patterns like that? And how do you do it? 

Gabor [00:37:27] Well, certainly there's a way to change it. We develop these traits not because of they're genuine personality traits that we're born with, no babies are born denying their own needs. You'll never need one. And no one day old baby will ever desist from expressing their needs --- if they need to. So it's something that we learn and we learn it because we get the message somehow through any number of mechanisms. But we learn the message that if we're being truly ourselves with our emotions and our needs, we're not quite acceptable to our environment. So therefore, to belong, to have that attachment relationship, we give up on our authentic connection to ourselves. Now, as children we have no choice in the matter. As adults we can ask ourselves, do we still have no choice in the matter? Do I still have to go for the attachment, for the relationship at the expense of my own needs and my own genuine self-expression? If somebody decides that the price of suppressing themselves has become too much, they can change. They can change by a very simple exercise. Sit down every day and just ask yourself, where today didn't I say no when there's a no that wanted to be said? And somebody asked me to meet them for coffee and I didn't feel like it but I went anyway. When on the job I was asked to take on another project and I was already overwhelmed. When my spouse wanted to have sex and I didn't feel like it, but I did anyways for the sake of getting along. And what was the impact on me of not saying no in those situations? I mean, how do I really feel afterwards? So you can work on this stuff and just that exercise, people tell me have changed their lives. So it's a question of getting conscious. But change is possible. 

[00:39:09] *Short musical interlude*

Annie [00:39:20] Can we talk about addiction, Gabor? You are an addict, is that safe to say? 

Gabor [00:39:26] No. 

Annie [00:39:26] No. 

Gabor [00:39:27] Because I don't say that about anybody.

Annie [00:39:28] You don't say that of anyone? Okay. Talk to me. 

Gabor [00:39:32] Nobody is an addict. That's not who they are. 

Annie [00:39:34] Okay. 

Gabor [00:39:35] If I could outlaw the word addict, and anybody who wants to use the word addict, they would have to say so-and-so's a human being who's had so much pain in life that they have an addiction through which they're trying to soothe themselves,  I will accept that. Okay. But that doesn't make them- that's not who they are. The addict. 

Annie [00:39:54] It's too defining. 

Gabor [00:39:55] Yeah, it's too confined, nobody is simply their dysfunction. You know? So that's why I resist that languaging. 

Annie [00:40:04] Okay. So have you had addictive tendancies and behaviours? 

Gabor [00:40:09] Sure, I have. 

Annie [00:40:10] And it's quite an interesting one in that it's not up there with the top kind of like, when you think addictive tendencies, you know, gambling or drugs, you know. Tell us about the one that you had. 

Gabor [00:40:22] Well, if I may, let me give you a definition of addiction first. 

Annie [00:40:26] Please. 

Gabor [00:40:26] Okay. So an addiction is manifested in any behaviour in which a person finds temporary relief or pleasure and therefore craves. But then suffers negative consequences as a result of, and doesn't give up despite the harm. So creating pleasure relief in the short term. Harm in the long term. Inability or refusal to give it up. That's what addiction is. And I said any behaviour. So that could certainly be related to cocaine, crystal meth, heroin, alcohol, nicotine, glue sniffing, whatever. It could also be gambling to eating to shopping, to working pornography, to the internet, to the cell phone, to gaming, to extreme sports, to anything under the sun. Bulimia. The issue is not the behaviour as such, it's your internal relationship to it. If it provides temporary relief, pleasure and you crave it, suffer harm, don't give it up. You've got an addiction. So, I don't know if I can turn the table here for a moment, but yeah,  just ask you if according to that definition, have you ever an addictive pattern in your life? And I don't care what by the way, I'm not asking what. 

Annie [00:41:34] Yes. 

Gabor [00:41:34] Okay. My question is, what did it do for you in the short time that you appreciated it? What did you like about it? 

Annie [00:41:42] Hmm. There was, I guess a feeling of light relief afterwards, a feeling of nothingness. 

Gabor [00:41:50] And that was a welcome change from what was there before? 

Annie [00:41:53] I guess, angst. 

Gabor [00:41:54] Okay. So it's anxiety. 

Annie [00:41:56] Anxiety, stress. 

Gabor [00:41:57] Angst, anxiety. 

Annie [00:41:58] Confusion. 

Gabor [00:41:59] Okay. So, so that inner piece that you're, I think you're now describing. Is that a good thing or a bad thing? In itself. 

Annie [00:42:08] At the time. Well, yeah, it's a good thing.

Gabor [00:42:13] Yeah, in itself. It's the nature of addiction that creates more problems as we go along, but it does provide something temporarily. In other words, addiction wasn't your primary problem. Addiction was your attempt to solve a problem of angst or lack of inner peace. And so the medical way of looking at addiction as this is a genetic disease, is absolute scientific nonsense. First of all, nobody's ever found these genes and we could talk about them forever. But trust me, nobody's ever found the genes that if you have them, you'll be addicted. If you don't, you won't be. No such genes exist. Some genes may make it more likely, but they don't determinant it. Nor is the addiction a choice that you made. Nobody chooses to be living in angst. That angst that you're describing is, I would say, an outcome of childhood trauma. So thst addiction is an attempt to solve the problem of the emotional states induced by trauma. So my mantra on addiction is described in this book, and my previous work is not why the addiction, but why the pain. And for that, you have to understand people's lives. And in my case, my addictions have been to work and in my particular case, to also compulsive shopping for classical music. 

Annie [00:43:21] Yeah, I mean, I'm really interested in that, as was my husband when we read the book and you talked about that. At what point did you realise that was an addiction of some sort? 

Gabor [00:43:31] I realised that long before I did anything about it. 

Annie [00:43:33] Okay. 

Gabor [00:43:34] And the addict as a whole addicted brain has a whole lot of ways of justifying its own behaviour. So in my case, because I was a workaholic and stressed and tired, I said to myself, well, I have the right to enjoy myself with music, you know? So one addiction justified the other. 

Annie [00:43:50] Yeah. It's a kind of reward system?

Gabor [00:43:52] The brain is very clever in finding justifications. But in any case, I was aware of it long before I was ready to give it up. 

Annie [00:44:00] And you worked with addicts in Vancouver for quite a long time. 

Gabor [00:44:03] Again, I worked in a district of Vancouver that is without a doubt the most concentrated area of drug use anywhere in the Western world. So that in a few square block radius, we have more people using, injecting, inhaling drugs of all kinds and all of the medical consequences of abcesss, HIV, hepatitis and mental health conditions and so on. Often people living in the street, homeless. So I worked there for 12 years with that population. 

Annie [00:44:32] And what did that do for you? 

Gabor [00:44:34] Well, it certainly taught me about trauma because of the hundreds of women I worked with over 12 years, not one of them had not been sexually abused as a child. And many of them were indigenous Canadians or first nations population that was horribly traumatised by colonial policies and persisted in the formal way until very recently and still persist in the form of unspoken prejudice to the present day. So I learnt about trauma. I also learnt to see human beings in a very full sense, like these people. They were not addicts. That's not who they were. Very often very sensitive, very intelligent, very humorous, very resourceful people. I mean, I couldn't survive in the street the way they did for a day. It takes incredible ingenuity. I also learnt how fundamentally similar to them- you know, I mean, I'm not comparing things. I mean, I was a middle class, world renu, renu, renu-. 

Annie [00:45:28] Renumerated, is that what you mean? 

Gabor [00:45:28] Renumerated, thank you, physician, you know, respected and all of this. But the same psychological not to the same degree. They suffered much more than that. But the same kind of emotional pain, same kind of emptiness that you're trying to fill through the addiction. The same kind of dishonesty that results from addictive behaviour. Denial, compulsion, I could recognise all that in myself. 

Annie [00:45:57] Do you think there's a reason why you've kind of dedicated your life to trying to help people? 

Gabor [00:46:04] I can tell you a story about that, which has to do with when I'm one year old and away from my mother and very ill, too concentrated. My uncle goes to some danger to find a Christian paediatrician to come and see me. 

Annie [00:46:19] Sorry, how old were you when this happened? 

Gabor [00:46:20] Just under a year. 

Annie [00:46:21] Still in Budapest? 

Gabor [00:46:22] Sill in Budapest, 1944, December. And, the doctor comes to see me and she's very decent, very humane. She's come to see this Jewish kid, you know, who's living in semi hiding with a large number of other people and she doesn't betray anything. And she looks after me and examines me and gives me the treatment. And when she leaves, so I'm told, according to the history written by my elder cousin who was there to witness it, she patted my head and she said, don't worry, my little fellow, you'll pay them back later. Yeah. I didn't know that story. 

Annie [00:47:06] Wow. 

Gabor [00:47:06] Yeah. 

Annie [00:47:07] And so you did. 

Gabor [00:47:09] So, yeah, I've been doing that. Yeah. Not to self romanticise. I also wanted to be a doctor because I wanted to be important in the world and I wanted a white coat and a sense of authority and, you know, expertise. And I also wanted to make a good living and be secure economically. It was all that stuff. But the urge to heal, I think, does go back to somehow make my own suffering have some meaning in the world. 

[00:47:33] *Short musical interlude*

Annie [00:47:43] So with your adult change, Gabor, can you tell us what you thought of for that one? 

Gabor [00:47:49] The adult change was, that in the sixties I was a student radical. This was the time of the Vietnam War and I was very militantly against that and in fact, I spent most of my undergraduate years away from the classrooms and engaging in radical politics. There were some psychologists around who would say that this rebellion of the younger generation is actually just anger at their parents. It has nothing to do with the political issues at hand. I hated that. But they were right. There were not as right as they thought they were. The issues that we were militating against, the injustice in the world, the massacre of innocents, the lies of the media and of the military and of the politicians. They had to be challenged. They had to be opposed. But the emotional motivation, the rage that I had around it, had everything to do with my own unresolved trauma and my anger around it. So, at some point, much later on actually, I realised that I need to pay at least as much attention to the internal world as I do the external one. So that was the biggest change I would say. And that has actually led me to, to be here right now, if I hadn't engaged in that. I had an aunt who herself was an Auschwitz  survivor, and she saw stuff about me that I just wasn't ready to see. I was in my early twenties. And she wrote to me once quoting Polonius, the famous, to thineself be true. You know, I didn't know what the heck she was talking about, but decades later I found out I wasn't being authentic. I was not connected to myself, which itself is a strong impact. 

Annie [00:49:29] Can I ask you for the sake of those people listening in a world that feels ever more scary sometimes to live in, and just also on a more micro level, lonely when it comes to technology and the onset of that and the new ways that we connect with people, thinking that what's our conversation can replace a real life- 

Gabor [00:49:48] Yeah. 

Annie [00:49:49] You know, conversation. You know, as someone who's, as you said, discovered their internal world and has to work at that and has worked at that and exploited their whole lives since then, how can people tune into themselves? How can people be and learn how to be authentic if they feel like they're not there yet? 

Gabor [00:50:08] Well, I would ask anybody who poses that question. I mean, who's actually asking the question? 

Annie [00:50:15] I am. 

Gabor [00:50:16] Yeah, but what in you is asking the question?

Annie [00:50:18] As in why am I asking that question? 

Gabor [00:50:20] Not why. What aspect of you? What in you was asking that question? 

Annie [00:50:26] Errrr. 

Gabor [00:50:26] I know that seems like a trick answer, but it really isn't. I'm going somewhere with this. 

Annie [00:50:30] Yeah. No, no, I get you. I feel like I'm thinking of that on behalf of the people listening who may be listening to you, thinking that they want to do work. But I'm also thinking on a personal level of feeling more and more detached from the world because of how the phone kind of insidiously comes into my life and- 

Gabor [00:50:52] Yeah, so what I'm trying to say- 

Annie [00:50:52] Creates this screen I suppose. 

Gabor [00:50:54] Exactly. So what I'm saying is that the person in you who's asking the question, and the one inside anybody who listens with whom that question resonates, that's the part that recognises the inauthenticity. And who recognise's it is the authentic part. 

Annie [00:51:11] Okay. 

Gabor [00:51:12] So actually, the thing is just to keep asking the question. And then to notice with some, with a fair degree of, in fact infinite if you can, self-compassion when you're not being authentic. When in a relationship or in a public setting or private setting or any setting, you say to yourself afterwards, ahh that wasn't quite me. Well, who's noticing that in the first place? Only that part of you that insists on being authentic. Being authentic and being yourself. And then you can ask yourself. Hmm, despite my commitment to be authentic and coming from myself, in this case I wasn't. So instead of condemning oneself, more just ask, why wasn't I? What belief did I have? What's the belief that I had? Oh, if I was being truthful or authentic, they wouldn't like me. That's one of the stories. Those stories always go back to childhood. It's not that difficult, we just notice the one who's noticing, and we just notice what is being noticed and we just enquire into what's going on here. So it's not as daunting as all that. And you know what? You can be in this world without having to sequester yourself and without being inauthentic in it either. It's possible. As people have often said, to be in the world without being of the world. 

Annie [00:52:38] Gabor, I can't thank you enough. Thank you so much for your time. And I really hope that this epic expedition of talking about the book affords you some rest at some points *laughing*. 

Gabor [00:52:49] Yeah, I'll get there. 

Annie [00:52:51] *Laughing* ahh, I'll maybe see you on the dance floor at Berghain sometime. 

Gabor [00:52:55] Thank you for this conversation. Thank you very much. 

Annie [00:53:02] Thank you so much to Gabor Maté and fuck you all. I'm no longer being nice for the sake of my health *laughing*. Seriously, I mean, as I said to him in the room, my brain exploded when he said that. Only the good die young. It's like God! I'd love to know what you thought of this conversation. Please let me know. Hit me up on Instagram, review the episode and do go get that book. It's called The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture. It's out now. There'll be a link in the show notes. You should check out the episode I did with T All about ADHD as well. And if you're interested in hearing experts talk about their fields and the changes they're trying to make, I think you'd like the Dr. Gwen Adshead episode as well from the last series, which rather than why we get ill, it looks at why people commit violent crimes and whether you can change the mind of a murderer. Also a fascinating listen. So thanks so much for listening. We'll be back next Monday as always. Changes is produced by Louise Mason through DIN Productions. Remember what I said! You've got homework. Try and go and tweak a little part of your life this week and let's discuss it. Thanks so much.