“The ADD child is emotionally wounded ..... driven by unconscious emotional hunger,” says Dr. Gabor Maté.

First you stress, and then you die

As a doctor who cared for the addicted and ostracized in Vancouver's Downtown Eastside, Gabor Maté asks the question most health care workers avoid: Why the pain?

Maté, the eloquent author of four bestsellers that look into the heart of human darkness, was recently in Toronto for a workshop on trauma and homelessness.

Q: For your workshop on stress, how do you approach stress?

A: It's how we respond to stressors – job problems, relationship issues – that creates the stress. The most debilitating stresses are the ones we unwittingly generate from the inside. People who can't say no, who automatically assume responsibility for the needs of others, who have difficulty expressing sadness and anger – these are the people who suffer more acutely from stress. People who don't express their emotions are more likely to die young. They are programmed into these patterns so early that they don't even recognize them as stressful, until they fall ill.

Q: You talk a lot about suffering in childhood, and how it sets people up for addictions and other maladaptive behaviours. Why is this so?

A: Addicts' brains are impaired by early events. The physiology of the child is shaped by the emotional condition of parents, by the environment in which the child grows up. The brain is hungry for dopamine and endorphins, to feel good, but children raised in depressed, stressed or abusive situations can't get a natural high. Love makes us high. A child looks into the eyes of a nurturing parent and experiences a surge of endorphins.

Without dopamine or endorphins, you feel like a zombie. When parents are highly stressed, they can't be attuned to their children – who seek comfort and relief from the pain they feel.

Q: What do you see as "the work" of adult life?

A: To open up, to feel things. When I was 19, a girlfriend said, "Until you're ready to feel things, you can't be in a relationship." Well, I was a Jewish infant in Nazi-occupied Budapest in 1944. My father was in a labour camp, my mother was under terrible stress – her parents would die at Auschwitz – and I grew up with the awareness of how terrible life can be for some people, through no fault of their own. I learned fast to not upset my mother, to try to not feel things. Shutting down creates emptiness inside. If you can't be vulnerable, you can't grow, emotionally. I justified my existence by making myself indispensable. I was a frenetic workaholic when my children were growing up; I neglected them. My behaviour contributed to their ADD – which is caused, in my view, not by genes but, in sensitive kids, by stress in the nurturing environment. The reason we see so much of it now is owing to the increased stress on parents in our society.

Q: You write that, "Facing the harmful compulsions of my patients, I have had to encounter my own." What do you mean?

A: Many of us have addictive, self-harming habits, because we experience that insatiable emptiness. In my case, I've attempted at times to fill it with work, achievement and compulsive shopping.

Q: How do you describe the ADD child?

A: The ADD child is emotionally wounded, insatiable, driven by unconscious emotional hunger. When I realized I had ADD, at the age of 52, I felt I had discovered what had kept me from attaining psychological integrity, wholeness.

Q: Have you grown out of your ADD?

A: Yes and no. I still lose things and I'm still late for planes, but I laugh about it now. I'm not down on myself about trivial things, and I no longer need medications to focus and get things done.

Q: What is addiction?

A: It is a sign, a signal, a symptom of distress. It is a language that tells about a plight that must be understood, as Alice Miller put it. Gamblers, alcoholics, shopaholics, Internet addicts, overeaters – they're all manifesting internal pain. Addiction is self-medication. The biggest driver of addictive behaviour is stress. In the Downtown Eastside, every female patient of mine was sexually abused as a child. Most hard-core addicts suffered severe neglect and abuse early in life. It's all about pain. Drugs are the emotional anesthetic.

Q: Explain the title of your latest book, In the Realm of Hungry Ghosts: Close Encounters with Addiction.

A: The realm of hungry ghosts, to use Buddhist terminology, is the domain of addiction, where we constantly seek something outside ourselves to curb an insatiable yearning for relief or fulfilment. We don't know what we need, and so long as we stay in the hungry ghost mode, we'll never know. We haunt our lives without being fully present.

Q: Why did you give up your work with drug addicts in Vancouver's Downtown Eastside five months ago?

A: Because I'm so busy teaching and writing my next book, about bullying. Through teaching, I can bring my healing work to many more people and, perhaps, help change social attitudes toward addiction, mental health issues and toward our understanding of physical illness.

Q: Why is the U.S. war on drugs is "doomed to perpetual failure?"

A: It has had 100 years to demonstrate its failure, because it is directed not against the root causes of drug addiction, but only against some drug producers, low-level traffickers and, mostly, abject users.

Q: Are you in favour of the decriminalization of street drugs?

A: Prohibition doesn't work. It creates a drug underworld, an underground economy that keeps people addicted. Addiction happens because people are traumatized, not because drugs are available.

Q: You talk about aging gracefully. What does that mean to you?

A: It's a process of letting go of all the psychological baggage we took on earlier in life. A process of relearning to look at the world with wonder and delight.

Q: Have you reached a point where you feel you're okay, you're enough?

A: No matter how many books I write and sell, no matter how hard I work, from the point of view of the ego, I will never be enough for myself. But I know better.