Dr. Gabor Maté. His introduction made my heart pound and I felt dizzy. I considered leaving the auditorium; my fear was coming true. I might not be ready to talk about addiction. I definitely wasn't ready to hear about his case study, Robyn, dying of infection on the streets of Vancouver's downtown east side, skin grafts being rejected because she continued to use them as injection sites in spite of her doctor's warnings. Opting for a wheelchair as osteomyelitis progressed - rather than giving up her drug.
But he didn't stay there. He painted the picture quickly, and then stepped far far away from it, so far I didn't really see it anymore, diving into a discourse about the biopsychosocial perspectives of psychology and medicine. And then he stepped so close to the painting I couldn't see the whole thing, and that was less scary too. I couldn't see this human, Robyn, anymore, only her amygdala. And that was okay too.
He talked of the loss of his father in Budapest, taken by Nazis, before his explicit memory. He talked of how his mother's anxiety and sadness over this loss caused him to become anxious and sad, as an infant. He said his mother phoned the doctor. She said, Please help, Doctor. Something is wrong with Gabor; he will not stop crying.
To us he said, I was an infant. What did I know of Nazis and extermination camps? Nothing. I just sensed my mother's pain.
The doctor told his mother, All the Jewish babies are crying.
All the Jewish babies are crying. And those babies grew up into adults who struggled with attachment disorders and addictions, though they had no memory of what caused their pain. This is implicit memory.
Stephen Harper insults the Aboriginal people of Canada with his empty apologies for what happened to them in residential schools. He pushes forward with his plan for an oil pipeline from Alberta to the west coast, cutting straight through Aboriginal Canadian land. Their implicit pain becomes explicit at his hands, and he apologizes and poses for photos in his Christmas sweater. And sets aside more money to build prisons to hold the adults whose futures were taken away from them as children by his Conservative government, dooming them to lives of pain and self-medicating.
Maté suggested that as counsellors we need to stop asking why the addiction exists, and rather, focus on why the pain exists. The pain that leads to addiction. This is a courageous question, or rather, a question that may require more courage than I have to listen to its answer. The kind of vulnerability this requires may be too painful to bear.
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7 comments:
It sounds as though the good doctor struck a key point, i.e. address the cause of the pain. But I wonder at the difficulty in this. A psychologist friend once told me that symptoms are easier to treat. Most of the time trying to treat the underlying cause requires years and years, and he bemoaned that the patient continued to suffer through those years. He advocated the reward-punishment thing to change behavior. "Quick, smarter, easier" he used to say.
I don't know who is right. I sometimes fear that years of psycho-therapy introduces more problems than it solves.
But, and it is a big 'but', it doesn't sound right to ignore the basis of it all either.
Maybe I won't be a Psychologist when I grow up after all.
Isn't that the main difference between psychoanalysis and behavioral therapy? One tries to determine the reasons for the pain behind the behavior, the other simply tries to modify the symptoms.
This is an implicitly and explicitly raw post. The similarities between the Holocaust and the abuse by North America's dominant culture of our original people are stunning. The rates of addiction and suicide on reservations are the highest in the US, and they also have the worst schools and medical care in the country. Unfortunately, those of us who find this abomination painful are outnumbered by politicians who stand for nothing but election.
Jerry, the difficulty in addressing the source of pain is absolutely overwhelming. Your friend is a behaviourist and that kind of therapy works well for some disorders. But not addiction, because the problem is that when a person is highly addicted there is no reward great enough and no punishment painful enough to make it worthwhile to give up the drug. My sister lost her family, lost her child who was the only source of happiness she knew. And this still was not enough to stop her from using. Nothing was, not even death. Treating symptoms is a good idea, but it has to happen in tandem with searching the root cause. And that really is a daunting task.
Susan, I think Maté was definitely interested in psychoananalysis, but his interest was in three spheres simultaneously: biology, psychology, and sociology. So he felt doctors/therapists needed to address the clients' biological (not just genetic) inheritance, psychological make-up, and social environment. It's a lot for one person to try and understand all that at once, but the argument, of course, is that you cannot separate the body from the mind from the environment in which it lives. And I agree. He also said the solutions should arrive organically and naturally when we examine all these factors. That's the part I'm not totally convinced of.
I am heartbroken at the way the Canadian government treats its Aboriginal people, and I'm sure USA shares this shame. Canadians tend to think of themselves as belonging to a forward-thinking nation with a clean record of treating people equally, but it isn't just our history of racism and attempted genocide that refutes this; it is right here in our present. Our Conservative majority normalizes marginalization of the non-dominant culture.
I think there is a growing trend toward a biopsychosocial approach, and mind and body are inextricably linked. My own bias is to, as best as possible, get the person changing behaviors while looking into the source of the problem. But it's far easier said that done and ultimately you have to meet the person where he/she is. I am wary of people who only take a behavioral approach (or cognitive-behavioral, the darling of insurance companies) or only take an analytical approach. We are just too complicated for that.
To me, what you describe sounds similar to what this doctor recommended. Providing relief from symptoms (ie. troubling behaviours) while still trying to get to the root of the problem.
School boards here love CBT as well, and I assume that's to do with its ability to present empirical evidence that it works. But I find statistics confusing... and misleading... and when I, as a counsellor, am encouraged to do something that goes against my gut instinct, I don't think I can do a good job of it anyway. So I remain unconvinced. Although I found CBT pretty successful with OCD, it doesn't seem to be so great for more complex problems... but maybe this is my lack of experience. I have a lot to learn.
(Me with coffee in hand).
You know I am not clever, so I am not sure about different therapeutic techniques, but I can speak from the inside, I suppose.
We have a programme over here called STEPPs designed specifically for us mad 'ans who have personality disorders which are unlike the rest of the world who also have personality disorders which are often more detrimental to the world. I digress. I never got along with STEPPs. It worked primarily with how to distract at the point of crisis. I suppose I was a bit of a damp cloth in the few sessions I attended, and I left the instructors saying, Hm, a lot. They didn't know how to react.
Because what I was saying was that in those moments of crisis, nothing, nothing came close to wanting to drink/wanting to drink drive/wanting to self-harm. There was 'no other choice' in that moment. And though you can learn to pause, I genuinely think this has little purpose in the long run. Firstly you are merely delaying an inevitable action, which, in fact, can worsen over the minutes of taking a pause. And secondly, where does it go? All that anger and pain? As far as I can see, it gets sucked into the body again only to prepare itself for something staggering next time.
Now, I am somebody who has learnt to not react as I did. But this was not through any therapy. All well and good, think all, as I am not drinking, not driving, not putting others and myself at risk or making them unhappy. I can say that this, for me, is far worse. The pain, the anxiety, sits there. It has no place to go. A pressure cooker which builds and builds with no release.
The problem, as you say, is not how to deal with the moment, but how it got there in the first place. And when that is deeply buried or, as in your example and perhaps mine, known only as a sort of air you breathe as a child without connecting any events to it, it is hard to dig away at. There is also an accompanying shame; not because you are feeling as you do, but you cannot really locate why you do. It is some strange inner rash, and you do not know the cause and it is hard to soothe. It is also very 'inner'; isolating, without real definition, largely without a set of terms which others can relate to. How do you truly describe an atmosphere? A misty coating to the skin, the body, the mind; something other-worldly. Something which, thinking about it, can only really be described adequately with the language of a child.
Am I making any sense? I know I am pretty stupid, but I hope I am making some vague sense here.
Sorry for the long post.
xxx P
You make perfect sense, actually, and you affirm what I think (and more importantly, feel) about this kind of thing. That the problem is so much more complex than we realise, and so much more complex than we know what to do with. Psychologists analyze away, offer mental exercises to try and help. And doctors look at the genetics of addiction, and sociologists point at society... but in the end, all these things interact in complicated ways and how does anyone really know how to affect change when there is so much going on? It's discouraging sometimes. This doctor offered hope that we help just by being empathetic witnesses. But it's definitely not enough.
(Me with coffee in hand too, and longing for a comfy couch instead of an office chair.)
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