#586. Modern Life Is Making You Sick, but It Doesn’t Have To | Gabor Maté

Dan Harris: This is the 10% Happier podcast. I’m Dan Harris. Again, I am, to say the least, extremely grateful for modern medicine. As a frail man, I would not have done well in a world with no Advil or dentistry. And yet my guest today, who is a renowned doctor, says modern medicine is actually overlooking something crucial, the pernicious impact that modern living has on our minds and our bodies. In other words, we're surrounded, per my guest, by these hidden societal and structural sources of stress. And most of us, as well as most of our doctors, aren't thinking about how to treat or prevent these factors that are degrading our happiness and our immune systems. Dr. Gabor Maté is a bestselling author with an expertise on everything from stress to addiction to ADHD. His latest book is called The Myth of Normal Trauma, Illness and Healing in a Toxic Culture. In this conversation, we talked about what he means by the myth of normal, how diseases such as autoimmune conditions are actually–and these are his words–an artifact of civilization. How to begin to tackle what Gabor Maté calls the social sources of illness, his definition of trauma and the difference between big T traumatic events and the trauma of wounding. How trauma in our society is so normalized that we don't even recognize it often. I also probe him a little bit on whether the term trauma is overused, why comparing suffering is a fruitless endeavor, what he means by the necessity to be disillusioned, the power and possibility of psychedelics, and why he thinks we should incorporate shamanic medicine into our Western medical framework and what he means by undoing self-limiting beliefs and how these beliefs show up in your everyday life. Just a heads up before we dive in here. This episode does include some mentions of child abuse, sexual trauma, suicide and addiction. Dr. Gabor Maté, Welcome to the show.

Gabor Maté: Nice to be with you. Thank you.

Dan Harris: What do you mean by the myth of normal?

Gabor Maté: So as a physician, when I look at people's health, life is possible and health is thriving within a range of normal parameters, like a normal body temperature or a normal blood acidity or normal blood pressure range. So in that sense, what is normal is also healthy and natural. But in society, what was considered normal, the things that we used to, the things that we think have to be the way they are, I'm arguing, is neither healthy or natural. So I'm saying that the norm in this society is actually making us sick. In many ways, that's the myth of normal. Also to say that then when people have mental or physical health conditions, we call them abnormal. I'm saying those are normal responses to an abnormal situation. I mean, I know something of your personal history, and I don't know what you suffered from an anxiety attack, but as a journalist covering the wars that you've covered, a certain degree of PTSD would be actually a normal response to abnormal circumstances. So where's the abnormality in the individual or in the culture? I'm saying it's in the culture.

Dan Harris: What are the aspects of our culture that you consider from the historical perspective, you know, the wide perspective of our species, which runs back many millennia, what are you considering abnormal and unhealthy?

Gabor Maté: Well, if I want to know and an elephant is like if you looked at an elephant in one context, you would say the elephant is a big animal that spends most of the time sleeping, gets up every once in a while to eat, walks around a little bit and lies down again. That’s if we study the elephant in the zoo. But if we study the elephant in its natural habitat, we get a very different sense of what an elephant is all about and what their true nature is. Now human beings have evolved for hundreds of thousands of years. We lived in small band hunter-gatherer groups as communal creatures, where the children were with the parents the whole day, but the whole community acted as parents to the kids, where the interests were not individualistic and competitive but collaborative, communal, and connected. That's the only way we survived. And we lived like that until about 15,000 years ago. So our species, which has been on the Earth for, say, 200,000 years, if that could be expressed in one hour until 5 minutes ago, that's how we lived. And then the conditions that civilization has created with increasing inequality, increasing gender disparity, increasing isolation, particularly in modern society, loneliness, the belief that human nature is competitive, aggressive, greedy, selfish. These have created conditions which for human beings it's like studying animals in a zoo under completely artificial conditions that don't meet our essential needs. And in the book, The Myth of Normal, I begin with prenatal life through birth, through childhood, through all of our cultural manifestations. I'm saying we live in a culture that makes us sick because it sets us against our very needs as human beings.

Dan Harris: Just a couple of questions. Is it possible that we can idealize our history in what is often referred to as deep time? The hunter-gatherer societies, were they not problematic and patriarchal and violent and they didn't have good dentistry, etc., etc.?

Gabor Maté: Well, actually, if you look at the people who have researched indigenous peoples in pre-colonial times or non-colonized areas, they tend to live much healthier lives than we do. It's not a question of idealizing, you know, like indigenous people here in British Columbia, they had slaves. Now those were past hunter-gatherer days. But it's not a question of idealizing the past, but it is recognizing that they did live much closer to human needs and nature than we did. And as a result, we've lost a lot. It's not a matter of giving up on the achievements of civilizations, science, technology. Those are astonishing accomplishments. But we also have to recognize what we've lost in being disconnected from our own true nature. So we can't idealize the past, nor can we aspire to go back to it, nor should we want to. But let's get conscious about what we're missing in the way that we're living our lives. And in terms of human relationships and interactions and family life and community, they're much more adept than we are. And the way they parented their kids that were much healthier than the way we parent our kids.

Dan Harris: For what it's worth, and I'm not sure it's worth much. I very much agree with you on you call it our true nature, but you could just also call it the way we were designed by nature to live in community, to have these social connections. And it seems quite obvious that much about the structure of modern society is making us sick because it's denying us these sources of happiness and flourishing and well-being that we really need. And yet, as you indicated, there are so many good things about modern society from modern society - I semi-jokingly referred to dentistry, but obviously modern medicine, many of the technologies that have improved people's lives and brought people out of poverty, etc., etc.

Gabor Maté: No, it's not a question of arguing with modern achievements, but given the science, given the awareness, given what we know and what we're capable of, why are some people living in poverty? Why are so many people going to food banks in North America in the richest area of the world in their history? Why is there such documentable illness due to inequality? Why is being of color indigenous in Canada a major health risk not just for COVID, but also for malignancy and autoimmune disease and mental health conditions and so on? Why is the rate of suicide amongst young people rising in North America? Why did the United States last year suffer over 100,000 overdose deaths from drugs? Almost twice as many Americans died in one year last year from overdoses as died in the Vietnam, Afghan and Iraqi wars altogether. And the real question is, given all the technology, information and capabilities that we've garnered, why are we doing so badly? Why are more kids being medicated and diagnosed with all kinds of mental health conditions?

Dan Harris: You have answered this a little bit, but you just asked a bunch of questions, starting with the word why. Can you say a little bit more about why you think we're seeing more addiction, more suicide, more illness? What is going on?

Gabor Maté: Well, when you look at illness, you can look upon it as an individual, maybe genetically determined misfortune. That's one way to look at it. But that doesn't explain anything. And why is this misfortune increasing in the modern world despite the advances of modern medicine? Why is there more autoimmune disease now? Why in the 1930s there was a gender ratio of multiple sclerosis that was 1 to 1 and now it's three and a half women for every man. It’s clearly not genetic because genes don't change in a population. Why are more kids being diagnosed with ADHD then? All my fellow physicians basically think that it's a genetic mental health condition. I say it's not genetic at all. It has to do with social conditions. So the question is, do we look at pathology as a misfortune in a particular organ, in an isolated individual, or do we recognize that it's a response to the environment? Now, if we recognize that we have the answer because emotional stress is a significant physical factor, it's not just an emotional event, it's a physiological event. So that modern science has shown the mind and body cannot be separated. It's one unit. When things happen emotionally, they happen physiologically. The emotional factors affect our immune system or hormonal apparatus or nervous system or guts or heart and so on. So a study out of Harvard three years ago showed that the higher the symptoms of PTSD in a woman double the risk of ovarian cancer. In other words, the emotions can't be separated. And an American study showed that the more depression in a woman, the poorer her prognosis with breast cancer is, you know, so the mind and body can't be separated. And as an American physician, George Engle. Pointed out in 1977, we are bio-psycho-social creatures, which means our biology is inseparable from our social relationships, our psychological dynamics. Now we can look at the source of problems in how we live our lives in a social, psychological context. And the more stressed we are, the more illness of mind and body we're going to have. You know, why kids are killing themselves, why more because of ADHD? Because conditions of parenting have become so stressed that kids are being left bereft of the emotional needs aren’t being met. And that's why they're in despair and that's why they're tuning out and that's why they're hyperactive and that's why they're oppositional and that's why they have anxiety. So these are normal responses to abnormal circumstances. Or in my own country, Canada, if you're an indigenous woman, your risk of rheumatoid arthritis is six times greater than the average. And women in general have 80% of autoimmune disease. Why? Because they're the most stressed segments of society for all kinds of reasons. And so then the question arises, is it a case of individual pathology or does it represent a social malaise? And I'm saying that the two cannot be separated.

Dan Harris: I know objectively privileged people who've gotten very, very sick at a young age. So it can be just a genetic thing or bad luck or whatever, but it also can be a societal thing.

Gabor Maté: No, I would push back against what you just said. If I may. I didn't say that only poor or people of color get sick. I said the risks are higher proportionately. I mentioned earlier Indigenous women in Canada have six times the rate of autoimmune disease of rheumatoid arthritis than that of anybody else. This in a population that before colonization had no rheumatoid arthritis whatsoever. But that doesn't mean that in this society stress doesn't spare any sector, any segment, any stratum. But I would say that those people that were privileged economically or socially speaking, who got sick, they had a lot of stress in their lives, including probably childhood trauma and stress and trauma. Scientifically speaking, are documentably significant sources of physical illness because of the mind-body unity. And so you don't have to be core or color or oppress to develop illness. It's just that the more you are oppressed and the more you're stressed, the greater the risk goes up in this society. If you look at the sources of stress, the scientific studies on stress, what drives physiological stress are loss of control, uncertainty, lack of information and conflict. And those kind of stresses permeate all strata of the society. So everybody's at risk.

Dan Harris: This is what I'm trying to get clear on though because even in the hunter-gatherer societies, people got sick and this is in me pushing back on you. This is me just trying to understand that illness does happen. You're just saying the odds go up. If you are stressed and the odds of stress go up. If you are in a marginalized community. Is that close to accurate?

Gabor Maté: There's a lot of truth to that. But again, if you look at indigenous societies, they didn't use to have autoimmune disease at all. Autoimmune disease is an artifact of civilization. I'll give you an example from South Africa. During apartheid days, when black people moved into the cities from their tribal villages, they began to develop rheumatoid arthritis at much higher rates. So the more alienation, the more disconnection and the more stress you get certain kinds of stress, the more illness you're going to have. And now you're having autoimmune diseases and cultures that never used to have them at all due to globalization. In China now, under the impact of industrialization, increased social isolation, the destruction of community, all in the name of economic progress, which has been pretty remarkable in China in the last 40 years or so, they've also developed mental health conditions, ADHD, addictions and so on. So the real question for all of us is how can we maintain economic progress, which of course is very unequally distributed, as we both know, and the inequality is rising over the last several decades. But nevertheless, how can we maintain our modern achievements and at the same time also maintain our health? And that's the challenge.

Dan Harris: You articulate that well, and I want to make a hard run at that question because I know you have a lot to say about it. But before we get there, let me see if you're open to hitting another issue, which you spend a lot of time on in your new book, which is given that so many aspects of modern life appear to be making us sick, what can we do as individuals? Not on a structural level, but as individuals, to reclaim–and this is the word you often use–our wholeness.

Gabor Maté: Yes. So the essence of trauma is actually a disconnection from the self. Now, how to say this clearly: that's not in itself a bad thing. I think as an extreme example, if I'm being abused as a child, it's unbearable for me to be with the emotional pain and fear and terror of what's happening to me. So to disconnect from myself is a survival mechanism. But it also means that now I am separated from my emotions and from my gut feelings, which put me at risk for stress later on. So those early adaptations that are necessary, like in my case I talk about my infancy, as a Jewish infant, under the Nazis. Tuning out from the terrible things that were going on around me was my way of surviving. Later on, I'm diagnosed with ADHD because I have a hard time staying present, because staying present was so painful for me as an infant, and that's happening when my brain is developing so that absent-mindedness, that tuning out gets programed into my brain because that's another piece of news that unfortunately science has established, what medical practice doesn't appreciate is that the human brain is shaped by your emotional interactions with the environment. And so the essence of trauma is that disconnection from the self, which at the time served the survival function, but later on it becomes a problem. And so, you know, you live in New York, where I live in Canada, it gets pretty cold in the wintertime. We adapt to that by putting on warm clothing. But what would happen to us if in the heat of the summer we're still wearing that warm clothing that we donned in the wintertime, it would make us sick? So the same adaptations that in the one context helped us know will undermine our health. That's the nature of traumatic adaptations in childhood, is that they're necessary for immediate survival, but then they create pathology later on. And so the individual task is to reconnect with the self that trauma disconnected from us. That's a shorthand way of saying something that I spent many chapters in the book on outlining the pathways to wholeness. In fact, if you look at the word health itself, the source of the world “health” is an Anglo-Saxon word for wholeness. And in Hungarian, which is my mother tongue, literally to say health is to say wholeness. And so, yes, health doesn't mean coming back to ourselves.

Dan Harris: I think it's worth getting specific about definitions. When you say trauma, what do you mean and how universal is it? Because I've had plenty of illness in my life., not catastrophic, but I don't think by my layman understanding of trauma that I've ever experienced it. And I think there are probably a lot of people listening to this who have experienced trauma for sure, and others who don't see themselves in that word.

Gabor Maté: How open are you to an inquiry about your own experience right now?

Dan Harris: Always.

Gabor Maté: So let me first of all, talk to you about trauma and then let me ask you a few questions, if that's okay with you.

Dan Harris: Of course.

Gabor Maté: Okay. So trauma, again, that has a word origin, it is the Greek word for wound or wounding. So trauma is a wound. Trauma is a psychological wound that then is stamped in the body and the nervous system and the brain and then the physiology or organs. Now, trauma is not the bad thing that happened to you. Trauma is what happened inside you as a result of what happened to you. So I gave my own example. I was given to a total stranger at age 11 months by my mother. I didn't see my mother for five or six weeks. That saved my life as a Jewish infant under the Nazis. I would not have survived in a place where my mother had to live. However, that wasn't the trauma. The trauma wasn't that she gave me to the stranger. The trauma was the wound that I suffered in my relationship to myself. And what does an 11-month-old believe implicitly when they're given away to a stranger by their mother? That they're not loved, that they're not lovable? That's the trauma. So the trauma is not what happened to me, which is that was given to a stranger. The trauma is what happened inside me, which is I develop a sense of not being worthy. And I spent much of my life trying to prove my worthiness by becoming a workaholic doctor, for example. Now, there are two kinds of traumatic events, what I call Big T traumas, which is the documented and much studied adverse childhood experiences such as physical, sexual or emotional abuse, parent dying, addiction in the family, violence in a family, neglect, the parent being jailed. These are all impose traumas in the child and you can study them proportionately. The more that the child experiences, the greater the risk for addiction, for mental health problems, for autoimmune diseases, for malignancy and all kinds of other issues. That's a big T traumatic events. But there's another kind of trauma of wounding. And keep in mind that trauma means wounding and not because terrible things happen to children, but the good things that should have happened that didn't happen. Human children are born with certain needs. In the book, I outline what their essential needs are. I can hurt you by doing bad things to you, but it can also hurt you by denying your needs. So that's trauma. In this society, hardly anybody escapes that because of the way we raise children is so estranged from what the human child actually needs with that little introduction. If I can ask you a few questions. Okay.

Dan Harris: Of course, I appreciate the introduction, just to say.

Gabor Maté: Okay. Anybody ever hit you as a kid?

Dan Harris: I was spanked occasionally. Yes. I remember once in a great while my one parent or the other would, you know, fold me or my brother over their knee and spank us on the tush. And our nanny would occasionally smack us on the tush with a spatula.

Gabor Maté: Okay. Do you have kids?

Dan Harris: Yes. One boy, Alexander, who’s eight.

Gabor Maté: Okay. How old were you when you were, as you say, hit on the tush and you say that rather dismissively. But how old were you then?

Dan Harris: I'll cop to that, by the way. I don't recall my age.

Gabor Maté: Well, give me the earliest rough estimate that you can muster. Hmm.

Dan Harris: Maybe five or six.

Gabor Maté: Would you hit your child when they were five?

Dan Harris: No, and I wouldn't in him now. And I can't foresee ever hitting him.

Gabor Maté: Why would you not hit him?

Dan Harris: I don't think teaching kids that violence is the right answer.

Gabor Maté: No, wait a minute, that's a pedagogical answer. Why would you not hit your kid?

Dan Harris: Yeah, that's true. I love them so much that if I when I see him in pain it would give me pain, so why would I cause him pain or me pain?

Gabor Maté: You perceive that it would cause your child pain if you hit him?

Dan Harris: Yes.

Gabor Maté: What does it feel like for a child to be hit by the person on whom they rely for protection and support and love? What would your son experience if you hit him at age five?

Dan Harris: Perhaps small T trauma?

Gabor Maté: No, never mind small or big T. What would they experience emotionally?

Dan Harris: Fear. Okay. Betrayal. Physical pain.

Gabor Maté: Okay. So when you experience fear, betrayal and physical pain who would you speak to about it?

Dan Harris: You would talk to your parents? Ideally.

Gabor Maté: No, I'm asking who did you speak to?

Dan Harris: Oh, me. My parents.

Gabor Maté: You talk to them about it?

Dan Harris: Yes.

Gabor Maté: You said I'm afraid right now. You said I'm in pain right now.

Dan Harris: Oh, while they were hitting me. Yeah. No, I can't remember that. I don't have very clear memories of being hit, honestly, but I highly doubt that I would have said something to that effect to them in that moment.

Gabor Maté: Had you said it, you would remember it. True. Okay. Now, if you son, if Alexander felt pain and fear and didn't speak to you about it, how would you explain that?

Dan Harris: He must not trust me enough to tell me.

Gabor Maté: What's it like for five year old not to trust their parents?

Dan Harris: Confusing.

Gabor Maté: Confusing. That's an intellectual answer. What's it like emotionally?

Dan Harris: Confusing. Scary.

Gabor Maté: Okay, now. Good. Thank you. Then tell me again that you weren't traumatized. Okay.

Dan Harris: Well, fair enough. Yeah. I think I walk around telling myself a story. That is not entirely untrue.

Gabor Maté: I'm sure your parents loved you, and they did their best. I'm not accusing them of anything. You know, All I'm saying is children are wounded in ways we don't even recognize because we think they're normal. And when you look at the studies on spanking, by the way, they show that kids are just as traumatized in many ways, as kids are hit more severely. That's what the science shows. And what I'm saying about trauma in this society. It's so normalized we don't even recognize it. And just that question, who did you speak to, whether you heard or not? Who did you speak to? Were you ever bullied as a kid, by the way.

Dan Harris: Yes.

Gabor Maté: How did that feel like?

Dan Harris: By the way, I was bullied and I bullied.

Gabor Maté: I got it. That already tells me you were traumatized. Why would you need to bully somebody? Because you need to feel bigger and better.

Dan Harris: Yes.

Gabor Maté: Why did you feel that? Because you didn't feel good, right? And didn't feel strong. These are all signs of trauma, I'm telling you. So trauma is very common in this culture. And by the way, who did you speak to when you were bullied?

Dan Harris: Sometimes nobody. Sometimes I did tell my parents.

Gabor Maté: If your son was bullied and he didn't talk to you about it, how would you explain that?

Dan Harris: One shame. Fear.

Gabor Maté: Right. And the first day you were born if you weren't happy. Did you express it?

Dan Harris: Yes.

Gabor Maté: So suddenly you learned that your parents weren't available for you. And that's a disconnect. Okay. And that's very painful.

Dan Harris: Hm.

Gabor Maté: Look in the book. I give a very well-known example that nobody recognizes as traumatic. If I told you about a four-year-old girl who was bullied either by neighborhood kids and she was into her home to her mother for protection. And the mother says there's no room for cowards in this house. No, you get out there and deal with the bullies. How would you see that as parenting? How would you see it? 

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Dan Harris: Malpractice.

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Gabor Maté: And what's the impact on the child?

Dan Harris: I would imagine the child would not feel that they could trust their parent anymore as a source of comfort in adversity.

Gabor Maté: And they must be vulnerable. They have to suck it up. This story was told on public television in front of millions of people the night that Hillary Clinton was nominated for the Democratic candidacy for the presidency. The story was told as a wonderful example of resilience-building, parenting, and nobody commented that what was really being celebrated here publicly was the traumatization of a four-year-old. And the message she got was not that there's no room for cowards in this house because a four-year-old kid looking for help from the mother is not a coward. You tell a mother orangutan not to come to the defense of a child or a mother elephant or a mother bear. What was being celebrated here was a traumatization of a four-year-old. The message is there's no room for you to be vulnerable. You better suck it up. And 60 years later, when she develops pneumonia during the election campaign, remember what she did with it.

Dan Harris: She hid it.

Gabor Maté: She hid it. She collapsed with dehydration and fever in the street. And nobody in the United States commented, “This is how normal trauma is in this culture.”  I'm not talking about politics here. I'm talking about our a normalization of trauma, although that has an impact on politics and not to be partisan about it. Her opponent is an even more traumatized individual when you look at his childhood. So the American public had the choice between the two traumatized individuals to run their country.

Dan Harris: I really appreciate this discussion about trauma because the word gets used a lot and I think not very helpful, nonspecific ways. And the way you're clarifying it is helpful because as I started to say earlier, I have this story, which is not entirely untrue, that I've just been extraordinarily lucky. My parents were, I have no defense for the spanking other than that it was the culturally done thing at the time. But they were incredibly loving and supportive, and I did feel really comfortable with them. And I grew up in a leafy suburb of Boston, etc., etc. And here I am talking to you who survived the Holocaust. And so by contrast, my story to myself is, you know, you have no business associating yourself with trauma.

Gabor Maté: Okay, look, then, if you were five years old and if you came to me, I got hit and I got bullied by neighborhood kids. And I'm really afraid and in pain. And I can't talk to my parents about it because you say you're comfortable. No, you weren't. If you were comfortable, you would talk with them about it. So there was some gaps in that comfort. Now, by the way, not criticizing your parents. I passed on my trauma to my kids. I'm not here to castigate anybody. I'm just talking about how it works. But let's say you come to me at age five. Well, let's say your son comes to me at age five. Put Alexander in that situation. He's being bullied and he's not talking to you about it, but he's talking to me. If I said to him, Look, Alexander, okay, you're being bullied and you're afraid and you don't trust your father to tell him about it. But hey. You're not starving and you're not going through a Holocaust. No big deal. Would that be fair to your son if I said that to him?

Dan Harris: No. 

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Gabor Maté: But you're not being fair to yourself either.

Dan Harris: Hmm.

Gabor Maté: You notice that?

Dan Harris: I do. And I appreciate you pointing it out.

Gabor Maté: Yeah. So that lack of self-compassion, which is one of the big themes in my book, is a typical marker of trauma. Okay.

Dan Harris: Hmm.

Gabor Maté: Where you would say to yourself, I was lucky compared to you. You don't know the rest of my childhood. Maybe I was luckier than you in some ways, it doesn't do to compare suffering. We all have individual versions of it.

Dan Harris: Coming up, Dr. Gabor Maté talks about his list of the four A's and the five comparisons and what he would add to his list as a fifth A and what he means by the necessity to be disillusioned. 

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Dan Harris: You have done a lot of great foundational work in this conversation up until this point. If you're cool with it, I'd like to go back to, you know, if the world is making a sick, how do we thrive? And you dedicate a lot of time to this in your book. If it's okay with you, I'd like to start with one of the areas where you start, which is the four A's and the five compassions. Can you unpack the four A's and five  compassions for us?

Gabor Maté: Sure. So in my work as a physician, both in family practice and in palliative care work and also in addiction medicine, I came to understand that people's emotional patterns are inseparable from their physiology. Nobody told me this in medical school. But then there's all this incredible scientific research showing exactly the same thing, which also means that if we gain some emotional intelligence and balance, that can positively affect our physiology as well. So some of the principles of emotional healing or what I call the four A's–and by the way, if I were to write a book over again, I would put in the fifth one, the four A’s–our agency. In other words, we take charge of ourselves. We no longer are just subject to the experts or to our own unconscious emotional dynamics. We take charge. So when people get sick, don't just assume that you've had this misfortune and this genetic bad luck, but that, yeah, there are things about your life that you can change, that you can gain agency over that's going to promote your health. So that's agency. Then there's acceptance, which is simply recognizing how things are not tolerating how things are, but accepting that this is how it is now. There was a study out of Massachusetts that looked at 2000 women over a ten-year period. Those women that were unhappily married and didn't talk about their feelings were four times as likely to die as those women who were unhappily married, who did express their emotions. So those women who talked about their feelings, they accepted reality. They didn't necessarily like it, but they accepted that this is how it is and they were willing to talk about it. So that's acceptance. Now, authenticity is an essential theme in my book because, as I pointed out earlier in our conversation, that disconnecting from ourselves, our authentic selves, is the essence of trauma. So reconnecting how many times people are afraid to say no to other people because they're afraid of offending somebody? They want to say no to some task or some expectation, some demand of the world, but they too concerned with fitting in. So they don't say, no, they're not being authentic. That's going to cost you. When you don't say no, that's going to cost your body and your mind. You're going to pay a heavy price for that little “no” that you didn't say. When people don't know how to say no, their bodies will do it for them in the form of illness. So authenticity, connection with ourselves and then healthy anger. If I were to get rude with you right now, or if I turn the conversation into kind of an aggressive assault on your psyche, one of your healthy responses would be anger. No, you don't do that. Healthy anger is a boundary defense. We have a circuit in our brain for anger. Nature. Give that to us for a good reason. It's to maintain our boundaries. But in some families, my parents listen to the advice of certain stupid psychologists who tell parents that angry kids should be punished and should be given a timeout. The child gets the message that if I'm angry, I'm not acceptable to my parents. But if I'm unacceptable to my parents, I can't live. So in order to be acceptable, I have to suppress my anger. Now, given the scientifically proven and documented and over-documented genetics of emotions and the immune system, when you suppress your anger, you're also suppressing immune system. And that makes you more prone for autoimmune disease where the immune system turns against you. By the way, that's why women get 80% of autoimmune disease, because who's in a society taught more than other people to suppress, to healthy anger and to fit in and to be nice and to be accommodating and to be peacemakers and to absorb the stresses of other people. So healthy anger is the fourth A. I'm not criticizing women, by the way. I'm saying that's a cultural artifact. And the great American Black writer James Baldwin said that to be Black in the States is to live in a place of suppressed anger. Why do you think Black men have a much higher rate of high blood pressure? It's nothing to do with genetics. Their African relatives don't have high blood pressure. It's because of the suppressed anger very often the suppressed tension, hyper tension. So anger is a huge role in health. I'm talking about healthy anger. I'm not talking about rage. I'm not talking about losing it. That's also unhealthy. I'm talking about healthy bonds resetting anger because anger is a boundary defense. What's the immune system? It's a boundary defense. And the two are one system. 

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Dan Harris: Mm-hmm. 

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Gabor Maté: Another safety that I would put in there is probably something that you'd be comfortable with, given your own writings and your own experience is awareness. Which is necessary for all the other four years. There was a lack of awareness on my part. The left on the left thought awareness from this book. But I put it in. But by the way, let me just something that I have to say to the brain that jumps all over the place. So there's an association that came up for me. I saw that one of the people that endorsed your book online is  Mark Epstein. 

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Dan Harris: Mm-hmm. 

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Gabor Maté: And Mark Epstein is a Buddhist teacher whose work I've followed for decades. And in his book, The Trauma of Everyday Life, he says that the traumas of everyday life can leave all of us feeling that motherless children. And he was actually basically talking about the ubiquity of trauma in this culture, just as I talk about it. But he's certainly somebody that advocates awareness. And mindfulness, you know, is one of the healing modalities.

Dan Harris: Massive figure in my own life. Mark Epstein is a great friend. So you've got four days now, five A’s and also five compassion. What are the five comparisons?

Gabor Maté: So a great spiritual teacher of mine age almost said once that only in the presence of compassion, will people allowed themselves to see the truth. And Chekhov, Anton Chekhov, the great writer and playwright. He also trained as a medical doctor, and he also said that compassion is the healing agent. Now, why is that the case? What I'm talking about is painful stuff. Trauma is painful stuff. I mean, I've said some stuff to you that if you really think about it might bring us some pain in you.

Dan Harris: Indeed.

Gabor Maté: Now, only in the presence of compassion will people allow themselves to see the truth. And what is compassion? So I have distinguished five levels of compassion in my own therapeutic work with myself and others. First of all, what I call ordinary human compassion, which by ordinary I don't mean mundane or useless, I just mean our capacity to recognize the suffering of other people and to feel bad when other people suffer. You know, if I see a homeless person, I should feel bad, and most people do. So that's the level of ordinary human compassion. Compassion in suffering comes with. So compassion means being able to be with the suffering of other people in an empathic way. That's the first level of compassion. I worked in Vancouver's Downtown Eastside with North America's most concentrated area of drug use. The people in Vancouver, if you've been to the Downtown Eastside, you don't see anything like that anywhere in North America. In terms of the outdoor drug market, the people using the desperation, the poverty, the illness and so on. And it's not enough to feel bad for them. The second level of compassion is what I call the compassion of understanding. You also have to understand why they're that way. If you look at addiction in general and specifically of the people in Downtown Eastside, they all suffered significant trauma over a 12-year period, when I worked there with hundreds of female patients, not one had not been sexually abused as a child. So it's not enough for me to feel bad that they're suffering. I should ask why they're suffering or they were traumatized. The drug use is just a desperate attempt to soothe the pain. That's what it is. And so that's the compassion of understanding. The third level of compassion is what I call the compassion of recognition, because I also live in a leafy, lovely area of Vancouver, in a beautiful house. And I've been privileged, a middle-class physician with remuneration and rewards and social respect. But you know what? The hunger to kill the emotional pain inside myself, the need to fill myself on the outside with activities and shopping and so on. The dishonesty and the shame that I experienced. I was the same as my patients. And when I told them about my addictive patterns, which were not to do with drugs, but it had to do with behaviors, you know what they said? They shook their head and they laughed. Dog, you just like the rest of us, aren’t you? And that's what I call the compassion of recognition when I see in myself that I'm not different as a human being. I might be more privileged in significant ways, and I'm not comparing myself to the suffering of those people, but in many ways, I wasn't different from them. I was just as capable of manipulation and dishonesty, ignoring my family to pursue my addictive drives which were rooted in my own trauma. That's what I call the compassion of recognition. The fourth level is compassion of truth, which means that, see, if I didn't want to cause you discomfort, if my interest was purely to save your discomfort, I would never have asked you about your childhood. But I'm more interested in the truth. And I'm more interested if I can help you to recognize the truth in your own life and more interested in that than whether or not I caused you pain. It wasn't my intention to cause you pain. My intention was that you should recognize some truth about your life. You got to be committed to the truth to help people. But you have to do so compassionately because without compassion, people are not willing to face the truth. The fifth level of compassion and this little journey through the compassion spectrum is what I call the compassion of possibility. I recognize in you, I recognize in me. I recognize in my Downtown Eastside patients their essential humanity, their goodness, and their capacity to heal. And I recognize that even when they don't. So that I mirror that back to them. And that's what I call the compassion of possibility or the capacity of transformation. When you don't look at people through the prism of their behavior or how they look to you, whether they're scruffy. Whether they look hostile. Whether they look troubled, confused, ugly or beautiful, whatever those terms mean. You look at them to their essential humanity. You see the possibility of goodness and transformation. And that's what I call the compassion of possibility.

Dan Harris: There are so many big and compelling ideas contained within the 4/5 A's and the five flavors of compassion. It's the question that comes up in my mind after having you walk us through these ideas is how do we operationalize them in our lives?

Gabor Maté: Well, it begins with the self-inquiry and begins with self-compassion and recognizing where we're not being compassionate to ourselves. It begins by learning the truth about ourselves. It also begins on a social level. But in the last chapter of what I call the necessity to be disillusioned. And people often say, you know, I got disillusioned. And I say to them, Would you rather be illusion or disillusioned? You know, would you rather believe the false view of reality and write a book called Enlightenment Now? Or do you actually look at how things really are? So I think the necessity to be disillusioned about our own lives and about society in general is the first necessary step. You have to look truth in the face and say, this is how it is and accept that this is how it is. Now, what are we going to do about it? What are we going to do about it? In my own personal life, as long as my trauma is running my life, I'm like a puppet on a string. I'm like Pinocchio. And you know what Pinocchio says at the end, when he becomes a real boy, he says how foolish I was when I was a puppet. Well, this liberating myself from the strings of my traumatic imprints has been and continues to be a lifelong journey for me. But it's essential. In the social level it's the same thing. Do we don't tell ourselves that we're living in the best possible society in the history of the world? Or do we look at all the things that are not working and why they're not working? And what can we do as a community, as a commonality, as a species, as a society to liberate ourselves from these traumas that are so omnipresent, that are so every day, as Mark Epstein points out, so ubiquitous and so unrecognized, what are we going to do? That's the question I will leave the reader with. But if the reader engages with the question with a sense of possibility, then I'll have done my job.

Dan Harris: You say you've been wrestling with becoming a real boy for many, many years for your life. What are the modalities that you've employed to do that therapy? I know you've worked with psychedelics. What are the how's of this work?

Gabor Maté: Yeah, well, if I may say, I do outline a lot of that in the book itself. But to give you a quick answer and by the way, it is a lifelong process. Sometimes I share with people my epitaph. You know, what it's going to stay on my gravestone. It's going to be carved, “It was a lot more work than I had anticipated.” So so this task of becoming a real boy is really a lifelong one. If my experience is any measure of that and I'm far from finished with it, but I would say the how-to involves emotional work. So that may mean therapy or a rigorous self-examination. It involves relational work. The biggest lesson and school for me has been my marriage relationship. And I've been married 53 years now, and at some point I had a decision to make: do want to be right or do I want to be married? Do I want to be a victim or do I want to be a partner? And when I say a victim, a perceived victim, where I see my problems and my triggers has been the other person's fault, or do I want to grow up and take responsibility? And fortunately, I'm a marriage where that seeking for truth in ourselves and in the other has been an ethic that we've shared not consistently and not always successfully, but it's been a significant theme in our lives and continues to be so individually. Internal emotional work, relational work, spiritual work. In one of my books, I said that I have a profound relationship with meditation, I think about it every day, which is I'm more, you know, I think about it more than I do it. And, you know, with my A.D.D. brain, I can literally sit there and chant a mantra in my head for 20 minutes and be thinking about everything else for that whole 20 minutes. But, you know, my spiritual work, I think, is really important. And as much as I laugh at my own lack of discipline, it's an important theme in my life as well. A colleague and a mentor and friend of mine, Dan Siegel, a psychiatrist, just wrote a book called Intraconnected. Not even Interconnected, Intraconnected. And our inner ourselves are themselves connected with everything in the world and then talks about this concept of “MWe.” “Me” and “we” put together in one world. So that part of healing really has to be a recognition of our sociality that we are bio-psycho-social creatures. And I've been fortunate enough to have some input from indigenous healers, both in South America but also here in Canada. And the big theme is interconnection. And in the indigenous sense, health rests on the four quadrants, the mental, which means that intellectual and emotional, the social, the physical and the spiritual, and we have to find health and connect all those four quadrants. So that's in a small nutshell. My idea of health is both individual, interpersonal, intrapersonal and social and spiritual.

Dan Harris: Coming up, Dr. Montag talks about the power and potential of psychedelics, the importance of incorporating shamanic medicine into our Western medical framework, what he means by undoing self-limiting beliefs, and how to begin to tackle what he calls the social sources of illness. 

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Dan Harris: I believe you've said and please correct me if I'm wrong, that your work with psychedelics has helped make you kind of lighter over time. If that's true, what's the mechanism?

Gabor Maté: So Sigmund Freud once said that dreams are the royal road to the unconscious, because during the dream state, your conscious mind goes to sleep and the childhood emotional circuits wake up and they tell you what you're carrying in your unconscious. Now, I would say that psychedelics are the royal road to the unconscious, because again, we have to parentheses this–this has to be in the right setting with the right guidance, the right leadership. This is not you take some substance, off you go. I don't recommend it–as a physician and the healer, I've worked with psychedelics for over a dozen years now and have seen what they can do for physical illness, for addictions, for mental health conditions. Very powerful healing possibilities. Why? Because the psychedelics in the right context with the right guidance, they remove the membrane between the conscious and the unconscious. So you get to see all the stuff that you're carrying unconsciously with your awareness. Run your life, the fear, the hatred, the panic, the anger that you've suppressed or separated from. Psychedelics also make it possible for you to see your true essential, connected, loving nature, which subverts your sense of an individual, aggressive, competitive individualist so they can show you the difficult stuff that you're carrying. They can also show the beauty that we all share, the oneness. Now, shamanic medicine, the shamans are trained in ways that Western physicians can't even dream about. This is not to say that they're better. If I broke my leg or if I needed a valve replacement in my heart, I wouldn't go to a shaman. I would want to go to a Western medical doctor, you know. But there are huge areas of health that Western medicine doesn't know what to do with, which comes to chronic mental health and chronic physical health issues. The best we can do is to mitigate the symptoms. Traditional medicine, shamanic medicines have a lot to offer. They're not the panacea and it's not one or the other. It's a question of recognizing value where we see it. So when shamans in the jungle work with me, they saw things about me in one night of chanting without asking me a single question. And they saw right into my soul. And what I needed, you know, is that 10 million Western-trained physicians couldn't have done over 10 million years. So I don't idealize psychedelics, and I'm not an evangelist for them, but I've seen their possibilities and they're immense. So and with those many others who are advocating for their rational use, their research, and as we come to understand them, their incorporation into our healing armamentarium.

Dan Harris: When it comes to healing, there's another process that you recommend in the book, and it has to do with, I believe your term is “undoing self-limiting beliefs.” What's that about?

Gabor Maté: Well. So my mother gives me to a stranger in the street of Budapest. I conclude from that that I'm not lovable and I’m not wanted. What else could I conclude? So then, 35 years later, I'm a workaholic medical doctor. I'm a workaholic because if I believe I'm not important and I'm not lovable, one way to make yourself lovable and important is to go to medical school. Now they're going to want you all the time when they're sick, when they're being born, where they're dying. They're going to want you all the time. So you got to prove to yourself a lovable you are how important you are. But the very fact that I'm not lovable just because I'm a human being and that I'm not important just because I exist. That's a limiting belief. Because the fact is we're all lovable, because we’re all human beings, we're all just, you know, we're born that way. I shouldn't have to prove to anybody that I'm important. If I should have a stroke tonight and I couldn't work anymore, I couldn't speak anymore, does my importance of a human being diminished by one iota? No, it doesn't. And so that fact that I'm not important, that's a limiting belief imposed by trauma and healing implies undoing those limiting beliefs that I have to justify my existence, that I have to be pretty. They have to be attractive. That I have to be acceptable to others. These are all limiting beliefs, and they limit our capacity to be truly ourselves and to really be fully alive in this world. So that's what I mean by undoing limiting beliefs.

Dan Harris: Is there a first step by which we can find out what our limiting beliefs are and work on them?

Gabor Maté: Well, there are many first steps where I can recommend a very easy one. This little word no that I talked about before, where in your life do you have difficulty saying no? By no, I mean, what is a no that wants to be said, but you don't say it. And that shows up in two major areas, personal relationships or work. So let's say I come to New York where we happen to live and my phone you up and say, Dan, do you want to come for a cup of coffee? You don't feel like it because you're tired and you have other things on your mind, but you're afraid to disappoint me. So you don't see the no that wants to be said. So you come for coffee with me. Now, what's going to be the impact of that on you? What do you think?

Dan Harris: Maybe add to my burnout because I'm not taking care of myself.

Gabor Maté: Exactly. Okay, so that's what I'm asking. Where in your life do you have difficulty saying no. Sit down for 5 minutes. Take a piece of paper and write down. This exercise is in the book. But where in your life they have difficulty saying, no, it's either work or personal relationships. The second question is what's the impact? Well, burnout in many cases, illness or depression or anxiety or sleeplessness. That's the impact. The third question is what is the belief behind your difficulty saying no? So if I come to your town or where you happen to live and we have a cup of coffee and you say yes and you feel like saying no, what's the belief that has you saying yes when you want to say no? What's the belief? What do you believe? If I say no, then…

Dan Harris: I'm going to let them down. They're not going to want to stay friends with me.

Gabor Maté: Exactly. So there's limiting beliefs or it's my responsibility not to disappoint somebody else.

Dan Harris: Yes.

Gabor Maté: And how they feel is my responsibility. Number one, I'm only acceptable as long as I'm compliant. I can't be myself in this relationship because if I myself don't like me, it's that simple, people. So start with that question. Now, there's other questions that follow, and there's a chapter on this in the book, but just that question of where I do have difficulty saying no, what is the impact? What is the belief? I'm told that has changed the life of a lot of people.

Dan Harris: I believe that I mean, even in just my cursory beginning investigation, in the interstices of your sentences here, that I can see that that's a rich field for exploration for myself. We're in the homestretch here, so I do want to make sure I get back to a question. And you dedicate a lot of time to this in the book. So this is a big question. But if you can give us a sense of what can we do structurally to keep the beautiful and mind-boggling conveniences and technologies of modern life while making sure we create a society where people aren't continuing to get sick psychologically, physiologically, and both?

Gabor Maté: Yeah, well, we have to tackle the social sources of illness, which documentably is inequality, is racism, is a belief in human nature as competitive, aggressive, selfish, greedy and individualistic. None of that is true. We have to incorporate trauma education. All the discussion that we had today on the mind-body unity and trauma and the impact of trauma on human health. The average medical student doesn't hear a single lecture about any of this in all their education. Incredible. This is in the face of all the science. We have to incorporate trauma education into education. All these kids who have troubled behaviors with ADHD and oppositionality, and the bullying, and being bullied, learning problems, behavior problems. They're all acting out the markers of trauma. But the average teacher sees them only as behavior problems to be corrected and controlled and suppressed. We have to introduce trauma education into the education of our pedagogues. In Canada, 50% of the women in jail are indigenous. Indigenous women make up 6% of our female population. 30% of the people in our jails are Indigenous. They make up 5% of our population. Why? Because they're the most traumatized segment of our population by colonialism and by ongoing racism, by the residential schools and all their horrors, by the abduction of the children from their homes, by the state and the church. That went on for over 100 years in Canada. And there are similar dynamics in the States. Of course, in the States you also have the history and the legacy of slavery and so on. And yet the average lawyer never hears a single lecture on trauma. Can you believe it? But they don't. And if you do the research on who is in jail, traumatized people for the most part. We punish people for being traumatized. So let's get trauma conscious. That's achievable, doable. All the science is there. All the evidence is there. We have to turn our attention to that.

Dan Harris: This has been a fascinating, fascinating discussion. I usually conclude with two questions. One is, is there something I should have asked but didn't?

Gabor Maté: You know, the conversation has been so wide-ranging and so deep. And thanks to your willingness and courage, so personal, that really I can't think of a single thing that we haven't talked about at this point.

Dan Harris: And I appreciate that. If you'll bear with me, you can. Many of my guests don't like doing this, but I'm going to try to push you a little bit to plug your book. Any previous books, anything else you're putting out into the universe? For our listeners who want to learn more from you, how can they do so?

Gabor Maté: Well, thank you. So the book is called The Myth of Normal Trauma, Illness and Healing in a Toxic Culture. The book is being published in almost 30 languages internationally. It's been a eight-week New York Times bestseller. I have four other books. My first one was on ADHD when I was diagnosed with it. It's called Scattered Minds. A look at the Origins and Healing of Attention Deficit Disorder, in which I argue that it's not disinherited a disease but a response to the environment, and it can be healed that way. My book When The Body Says No, on the relationship between stress and illness, emotional stress and physical illness. My book on addiction is called In the Realm of Hungry Ghosts: Close Encounters of Addiction, in which I point out that addiction is not an inherited disease or a disease at all, and certainly not a choice, but it's a response to trauma. And Hold on to Your Kids: Why Parents Need to Matter More Than Peers, which I really beg you to read, because it's a very important parenting book. And I say that without arrogance in this case, because I'm not the main writer of it. The main writer is a friend and colleague and mentor called Gordon Neufeld and Gordon's work showing that kids get too connected to peers in this culture, as a result, parents lose their influence, and that is toxic for their healthy development. If you go on YouTube, it's impossible to avoid me. Just put my name in there, dozens. So my lectures have been uploaded to YouTube. My website is Gabor Maté, to my Instagram handle, whatever Instagram is, I never go on Instagram. My daughter handles it for me, but it's Gabor Maté and I have a Twitter handle, apparently. Again, I don't deal in Twitter, but you can find me there as well. And there's a documentary about my work called The Wisdom of Trauma, which you can access online. The wisdom of trauma dot com Easy to find, and I hope you'll look for me.

Dan Harris: Dr. Maté, I'm grateful to you for your time.

Gabor Maté: Thank you. And for you. Thank you very much.

Dan Harris: Thank you again to Dr. Gabor Maté. Thank you to you for listening. If you feel so inclined, it would be awesome if you could leave us a rating and a review. Five stars if you're up for it. And finally, thank you to everybody who worked so incredibly hard on this show. 10% Happier is produced by DJ Cashmere, Gabrielle Zuckerman, Justine Davie, Lauren Smith and Tara Anderson. Our supervising producer is Marissa Schneiderman, and Kimmie Regler is our managing producer, scoring and mixing by Peter Bonaventure of Ultraviolet Audio. Nick Thorburn of the great indie rock band Islands wrote our theme. We'll see you all on Friday for a bonus.

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