Adverse Childhood Experiences - a doctor's story
Gabor Maté is a medical doctor recently retired from active practice. He was a family physician for two decades and for seven years he served as Medical Coordinator of the Palliative Care Unit at Vancouver Hospital. For twelve years he worked in Vancouver’s Downtown Eastside with patients challenged by hard core addiction, mental illness, HIV and related conditions. He is a best-selling author and is internationally known for his work on the mind/body unity in health and illness, on attention deficit disorder and other childhood developmental issues, and his breakthrough analysis of addiction as a psychophysiological response to childhood trauma and emotional loss.
In a talk in November 2015, he talks about the importance of early years' development. Here are some extracts:
"I'm a retired doctor and I don't work as a doctor anymore. I did work for twenty years in palliative practice. Seven years I was coordinator of the palliative care unit looking after terminally ill people in Vancouver Hospital. For twelve years I worked in Vancouver's downtown east side looking after people with severe addictions, to cocaine, to crystal meth, to opiates like heroin, to alcohol of course. People dying of HIV, of hepatitis C, and every other disease caused by addictions. In my practice, I looked after young families. I looked after people of all ages. I'll tell you what I've learned. The one thing I've learned, I've learned many things, but the one thing I can reduce it to or simply if it to is that virtually everything I ever saw, whether it was cancer, whether it was multiple sclerosis, whether it was depression, whether it was addiction, whether it was ADHD, whether it was colitis, rheumatoid arthritis. You know what it came down to? It came down to what happened in people's childhoods.
"In other words, the major contributor, I don't say the only, but the major contributing factor to the onset of illness, whether it's mental illness, physical illness, whether it's addiction, whether it's behavioral problems, is what happens to people in the first few years of life. That may seem like an astonishing statement and "how is this guy going to prove it in the sixteen minutes that he's got left?" Well, let's give it a try. In the downtown east side, which is Vancouver's drug area, and not only is it Vancouver's drug area, it's also known as North America's most concentrated area of drug use. We have more people there using, injecting substances than any other place in North America in a few square block radius. I can tell you that over a twelve year period, I didn't meet a single female patient who had not been sexually abused as a child; not a single male patient who had not been either physically abused or sexually abused or neglected or abandoned in significant ways.
"In North America, we like to think of addiction as either a choice that people make. If they make that choice then you punish them for it, so we build jails where we keep people who use drugs, or we see it as a brain disease that's genetically inherited. What actually happens is when people are traumatized, that increases their risk of addiction. When it comes to addiction then, what we're looking at is the impact of childhood trauma. Why? Because number one, let's define an addiction. An addiction is any behavior, substance related or not, that an individual pursues because they find pleasure, relief, or they crave it temporarily so they pursue it for the pleasure and the relief despite negative consequences and they don't give it up in the face of negative consequences. I said any behavior, so that could be sex, gambling, eating, shopping, work, relationships, or substances.
"Then if you ask yourself, 'What did that behavior give me? What did I like about it?'. Well, you'll tell yourself it relieves stress. When I'm very stressed, I go home and I eat a lot, or I turn on the TV and I just veg out, or I do drugs, or I go shopping and I spend a lot of money I can't afford to spend. In other words, the addiction serves a purpose. It temporarily relieves stress, or it distracts you from emotional pain that you're experiencing, or it gives you pleasure that otherwise is not available to you. What I'm saying to you is that the addiction is never the primary problem. The addiction is always an attempt on an individual's part to solve a problem. The problem is, why I'm having so much emotional pain and how come I don't know how to deal with emotional pain? Why is there so much stress in my life and how is it that I can't regulate my stresses without an addictive expression? Why am I lacking pleasure?
"If you're feeling shy and isolated and it takes a few drinks to loosen your tongue, what happened to you that you feel so scared of people? In other words, the addiction is not the problem. The addiction is actually an attempted solution. The problem arose because early in childhood you were somehow hurt. When people are traumatized, a number of things happen. One is they begin to feel themselves as deficient. If bad things happen to a child, if the child is yelled at or beaten or sexually abused or told to go to their room when their parents don't like their behavior, or their parents are just depressed or unhappy or stressed, traumatized in their own life, the child thinks these bad things are happening because I'm a bad person. Then you have low self-esteem. Also circuits of the brain are actually shaped by early experiences. So later behaviour is just the compensation. It's not a healthy compensation. It creates more problems.
"A Canadian study showed that when children are abused, when they grow up to be adults, their risk of cancer goes up nearly fifty percent. Why? Because the abuse or the trauma creates coping mechanisms. One of the ways to cope would be is if you get the message that you're not good enough, that you are not worthy enough, then you might spend the rest of your life by trying to prove that you are. How do you that? By being very nice to everybody, by never saying how you feel because they might not like how you feel, by never expressing healthy anger when somebody's crossing your boundaries, by working too hard to prove that you're worthwhile. Then you spend the rest of your life compensating by taking on too much and you're stressing yourself. Those stresses have an impact on your physiology. They have an impact on your immune system. They have an impact on your cardiovascular system, on your heart, on your nervous system. They can cause disease. Most diseases that most of my colleagues, the physicians, think they're just random, arbitrary diseases. They're not random and arbitrary at all. They're the result of life long stresses that result from a child's attempt to compensate.
"Today, due to economic circumstances and greater isolation, the breakdown of extended families, the breakdown of communities, all the uncertainties of modern industrial life, parents are getting more stressed and therefore the kids are getting more stressed. It's not a question of the parents not loving their kids. It's not a question or blaming parents. It's not a question of parents not doing their best. The parents are more stressed, and the more stressed the parents are, the more stressed the kids are. When the kids are emotionally stressed, that also effects their physiology. Human relationships are actually necessary to maintain healthy human life. We're social creatures. It also means that in a society where kids are growing up increasingly without their parents because the parents are too busy working, they have to, and where children are more and more without that support of the clan and the extended family and the community, you're going to get more people growing up in isolation. Then we try and compensate for that with our cellphones and our internet, which doesn't really do it for us because for real intimacy, for real contact, you need human connections, not mechanical connections. What we're seeing is a whole set of dynamics that leave children more hurt and more isolated.
"The first few years are so important. If you have children, make those three, four, or five early years the most important years of your life to devote them to your children. If you as an adult are suffering from depression, anxiety, addiction, illness or whatever, go back to your childhood and find out how you were hurt and heal that hurt. Then you can heal yourself."
Watch Gabor Maté's talk here:
Please refer also to my blog re research into Adverse Childhood Experiences and also my blog on how one community reduced incidences of child suicide attempts, teenage pregnancies, truancy, etc by become trauma-informed.
How can you help parents in your community?
As Christians, we also know of testimonies of people who are in trauma and have been healed by God. Here is a extract from Gemma's story from the Alpha website:
"Although I have a great family, my upbringing was tough after the loss of my brother at such a young age. My family and I didn't know how to deal with the grief. It eventually played out in other ways: by my teenage years I was into going to raves and doing drugs. By the time I left school I had lost contact with all of my close friends and although I was dating someone, the relationship was unhealthy with lots of emotional abuse. He introduced me to cocaine and it ruined me. I became totally hooked. I relied on him to supply me with it. I had hit rock bottom, but then things got worse. My parents told me that they were getting a divorce.
"On the outside I pretended everything was fine but inside I couldn’t cope with the news and didn’t deal with it well at all. I was drinking more than I ever had. In fact, I would drink myself unconscious regularly. Days would go by before I ate something and my pay check would only fund my ever-growing addiction to drugs.
"I remember one evening, I was sat on my bed and just felt completely dead. I literally felt that I had lost the ability to feel anything or to love anyone, let alone be loved back. Then it hit me, why should I just struggle through life when I could just end it and get it over with? But there was something in me that was whispering “not yet”.
"As I carried on my day-to-day routine, a girl I worked with, Lisa, mentioned to me that she was a Christian. It didn’t mean much to me at first but I found myself in these long conversations with her about what she believed and what faith was all about. I wanted to know more. She invited me to Alpha and I thought, why not? I don’t have much to lose? Each week I would arrive at Alpha with a million questions but gradually more than that. I arrived with a sense of hope. For the first time in a long time I actually felt excited about something. The people there received me just as I was – they loved me just as I was.
"I was invited to the Weekend Away and I wasn’t sure what to expect. But then, during of the sessions they invited us to say our own prayers. I did. I didn't even know if God was real but I thought well the worst that can happen is He isn't and I don't really have much to lose do I? At that moment, as I prayed, I felt a change in my body, a kind of heat, like something was happening, I encountered the Holy Spirit. I suddenly felt as though after years of abusing myself, I was clean.
"My whole life flipped on its head. I now believed God was real and he loved me no matter what had happened to me or what I'd done. When I went home I didn't want to do drugs anymore. I'd gone from a cocaine addict to a Christian! I didn’t want to hurt myself anymore. I was living for something bigger, for God. It felt like I wasn’t the person I used to be and my life was transformed.
"Today I am really involved in my church and the friends I have there feel like family. I also have my own amazing family - I'm married to Tom with two wonderful children Willow and Robin."
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From a talk by Gabor Maté, 15/11/2016