Is addiction a choice? | Big Questions with Gabor Maté

Not that I'm claiming to be a fully cooked meal, but I'm certainly much more ripe than I used to be. A lot of us are normal and unhealthy at the same time. Can people change who they are? They need to become who they are. Hello, my name is Gabor Mate, and I'm here at Penguin in England to answer some big questions. So the assumption in legal circles and throughout the whole what's rightly called the criminal justice system, because it is a criminal system, the criminal justice system in its criminality makes the utterly unscientific, unfounded and false assumption that people choose to be addicted. Now, first of all, I worked with severely drug-addicted people in Vancouver's Downtown Eastside, the Western world's most notorious area of drug use, by the way, is in Vancouver's Downtown Eastside. In my 12 years of work there, I met not a single female patient who had not been sexually abused as a child. Now, who the heck chooses to be sexually abused as a child? All the men have been severely traumatized in multiple ways. Who the heck chooses to be traumatized in childhood? The addiction, then, is an attempt to soothe the pain that's imposed by childhood trauma. Nobody wakes up in the morning and says, my ambition is to become a drug addict and break the law. I mean, think about it. It's a response to pain. Not only that, but those traumatic experiences shape the brain itself, the physiology of essential brain circuits, in a way that will bias that brain towards addictive behaviors, including with substances. I won't go into the neurophysiology of it now, but it's simply brain science. That's not even vaguely controversial. But, of course, even physicians don't learn about it, let alone judges, lawyers or prosecutors. Another point is that if we actually understand what an addiction is, we realize that drugs are only a small part of the addictive spectrum. I define addiction as manifested in any behavior that a person finds temporary pleasure or relief in, and therefore craves, but suffers negative consequences in the long term as a result of, but does not give up despite negative consequences. So craving pleasure, relief in the short term, harm, inability to give it up. That's what an addiction is. Now, notice in that definition, I said nothing about drugs. Yes, they could involve substances, some illegal, like heroin, some even more toxic than heroin, but legal, like alcohol. The definition also includes people who are addicted to gambling, to shopping, to eating, to work, to the internet, to pornography, to sex, to power, to a whole lot of other human behaviors. Why are we ostracizing a particular segment of the addicted population where virtually all of us in this particular stressful culture have some addictive patterns in our lives, or have had. So it's criminal. And this whole belief that addiction is a choice is so unscientific as it would be laughable if its consequences weren't so tragic. So, the myth of normal. What does it actually mean? Well, norm, first of all, is a statistic. But it doesn't say anything about healthy or not healthy, just that it's in a certain range. Now, in medicine, there's legitimate use of the word normal, where the norm is actually identifiable with natural and healthy. But, for example, to give you an egregious, defensible scenario, if everybody in London tortured their pets, then not torturing your pet would be abnormal. That's just a statistical statement. It's got nothing to do with health, or well-being, or naturalness. Now, in our society, a lot of behaviors, practices, policies, cultural norms, are not just the norm in the statistical sense, in that most people engage in them, but they're also confused with healthy and natural. Which, as I've been saying in this conversation, they're not. So that's what I mean, first of all, by the myth of normal. There's this myth that what we've got here is normal. It's not. Not when it comes to understanding human needs and human health in a holistic sense. The other sense in which I talk about the myth of normal is that there's this belief that those of us that are quote-unquote healthy, then there's the rest of them who are abnormal. I'm saying, no, first of all, health, whether physical or mental, is a spectrum. It's not that you can sort of delineate the healthy from the unhealthy. These are normal, these are not normal. That's a very dangerous game, number one. Number two, the illnesses of body and mind are actually normal responses to an abnormal cultural milieu. The fact about human beings is that we're not solitary, isolated creatures, either physiologically or psychologically, emotionally or spiritually. So our physiology is bound up. In fact, it's a unit with our emotional and psychological, spiritual existence. That's the reality of human beings. The second reality is that none of that can be separated from a social and emotional environment. So that how we feel about ourselves has a huge impact on our physiology. And how we feel about ourselves is very much determined by our relationships from in utero onwards. From our existence in the womb, we're being affected by the emotional states of our mothers. That's been demonstrated in multiple studies. It's not even in doubt. But the emotional states of our mothers depend on so much else other than just how they feel as individuals. On their social class, on their relationship with their partners, if any, on their own childhood experiences, including traumas, on the work they have to do, and many other social factors. And I'm only talking about in the womb. So already, children or infants of mothers who are stressed during pregnancy have biological markers of that stress in their bodies. Already at birth. These influences act on us throughout our childhood and, of course, throughout our adult existence. Because what we are is what has been called biopsychosocial creatures. Our biology is not separable from our psychological, emotional experiences in a social context. So therefore, the nature of the world that we live in has much to do with our physiological health and with our mental health. Is this society making us sick? Let's look at the statistics. Anxiety is rising internationally. Childhood diagnoses of ADHD and other mental health conditions is rising internationally. The rate of autoimmune disease is rising. So in a sense, what I'm saying is there's qualities of this particular society that actually make people sick. Some of those qualities are physical, such as the food that we eat and the pollutants in the environment. Many others are emotional and psychological, such as the ruthless competition that isolates people from each other. In Britain, they had to appoint a minister of loneliness. The rates of obesity are rising throughout the world, dramatically. Children are now developing metabolic diseases that only adults used to have. In the United States, 70% of the population, of the adult population is at least on one medication. 50% are on two medications. So yes, I'm saying in this book, that's my whole point, is that this particular culture, this particular society promotes illness. So that illness is not an aberrant event. It's not an abnormality. It's a normal response to what is basically a very unhealthy culture. And by culture, I don't just mean the physical aspects of it, but also the emotional, political and social aspects. Can people change who they are? They need to become who they are. My whole point in this book, and whatever I've learned as a physician and as a therapist and a teacher, and just as a human being, who myself had my own struggles to become myself, it's not a question of changing who we are, it's a question of becoming who we are. And my whole critique of this culture is it takes us away from who we are. And it's a struggle to get back to that. Now, can people achieve that? Yes. I can tell you personally, the answer is yes. Not that I'm claiming to be a fully cooked meal, but I'm certainly much more ripe than I used to be, in a very positive sense. I've seen all kinds of transformations in people. I've seen people with significant illnesses find in that disease some teaching that led them back to themselves, which actually promoted their healing. Can people change to become themselves? The answer is very much yes. In fact, it's a need of human beings. And when we're alienated from who we are, disconnected from who we are, we suffer. We suffer, and we suffer mentally or spiritually, and very often physically as well. As God exists, there's one of those questions where one would have to really understand what the questioner means by God. I grew up as a militant atheist. Now, as a child, I mean. Now, I grew up in communist Hungary, leaving Hungary when I was 13 after the Hungarian Revolution. There was a joke in Eastern Europe. You could be honest and intelligent or a member of the Communist Party. In fact, you could be any two of those three things, but not all three at the same time. If you're honest and intelligent, you couldn't belong to the party. If you're honest and belong to the party, you couldn't be very intelligent, and so on. And I had the same relationship to God. God could be omniscient, all good and all powerful. In fact, two of those three things, but not three at the same time. If God was all powerful and all good, then he doesn't know very much. Otherwise, why did my grandparents die in Auschwitz? And why did I, almost as an infant, end up in an oven myself? So he could be all good and all powerful, but he can't know much. Or he can be all powerful and all knowing, but he can't be very good, and so on. So the God that I was faced with, this image of the all-knowing, all-powerful, all-good entity that had some kind of a physical existence in some other realm that ruled this earth, was nonsense to me from the time that I knew my mind. But there's something greater and deeper in that concept that had to do with the oneness of all, and the connection, and the power, and intelligence of the universe, and the goodness that's around us. I had no concept of that. I'm not a worshiper, but I'm no longer uncomfortable with the word God. When I think of the word, I do mean it in that all-encompassing phrase for which the word itself is really quite inadequate. And it's inadequate mostly because of how it's being used. But that there's such an experience of holiness and godness, I fully accept that. Not that I fully have had it, but I also know that it's real. It's not a question of belief. And nobody can or should ever be talked into any particular way of understanding God. It's more an experiential reality than certainly as a concept, or just as a rigid belief. So yes, in that sense, yes. In most other senses that the word is used, no. Thank you for watching. You can get my book, The Myth of Normal, in hardcover, audio, or e-book by clicking the link below in the description. And thanks again.