In his influential 2009 book In the Realm of Hungry Ghosts: Close Encounters with Addiction, Hungarian-Canadian physician and author Gabor Maté argued that most addictions are primarily driven by unprocessed trauma rather than stem from moral turpitude or lack of willpower.
In his new book, The Myth of Normal, Maté widens the scope to a comprehensive analysis of the relationship between “trauma, illness, and healing in a toxic culture,” as he sees it. Maté argues that western societies have created a world that’s fundamentally unhealthy.
“By its very nature our social and economic culture generates chronic stressors that undermine well-being in the most serious of ways,” contends Maté and asks, “How are we to understand that in our modern world, at the pinnacle of medical ingenuity and sophistication, we are seeing more and more chronic physical disease as well as afflictions such as mental illness and addiction?”
Maté asserts that modern medicine inappropriately separates mind from body, but “living people cannot be dissected into separate organs and systems, not even into ‘minds’ and ‘bodies.’” For Maté, “health and illness are not random states in a particular body or body part” but “an expression of an entire life lived.” That lived life arises from “a web of circumstances, relationships, events, and experiences.”
In the case of addiction, Maté—like most experts—roundly condemns the “bad choices” explanation as ludicrous since, as he writes in the book, he never “met anyone who, in any meaningful sense of the word, ever ‘chose’ to become addicted.”
But he is also skeptical of the brain disease concept as “you cannot, scientifically, cleave biology from biography, especially when it comes to a process as psychologically layered as addiction.” Maté suggests that “disease” is more therapeutically useful as “a metaphor rather than a literal fact… For a more grounded take on addiction, we need to consider not just people’s genes or brain circuitry, but also their real encounters with the world.”
And those encounters are frequently traumatic, according to Maté’s analysis. “Addictions represent, in their onset, the defenses of an organism against suffering it does not know how to endure. In other words, we are looking at a natural response to unnatural circumstances, an attempt to soothe the pain of injuries incurred in childhood and stresses sustained in adulthood.”
Controversially, Maté contends that almost everyone (in western countries) has experienced not just stress but actual trauma because we exist in a “toxic culture.”
“A typical American life in 2022 might include spending 50 hours a week mostly alone in a cubicle, riddled with chronic stress but on track for a promotion,” wrote Travis Lupick in his review of the Maté book. “Evenings pass isolated in a tower, where a doorman ensures strangers and even neighbors are kept at bay. You swipe down into the bowels of Instagram until you fall asleep.”
Our healthcare system supposedly ignores this background scenario when treating the victims of such a culture of disconnection and loneliness. Maté believes the prevailing understanding of “normal” to be false, neglecting the roles that trauma and stress, and the pressures of modern-day living, exert on our bodies and our minds at the expense of good health. “For all our expertise and technological sophistication, Western medicine often fails to treat the whole person, ignoring how the toxicity of today’s culture stresses the body, burdens the immune system, and undermines emotional balance.”
Maté has been rebuked for his extreme focus on trauma, and now he has essentially declared our entire society “traumatic.” Psychologist and addiction specialist Stanton Peele has criticized Maté’s claim that all addictions are due to trauma. Although Maté criticizes the disease concept of addiction, Peele charges that Maté is “the ultimate disease theorist” because everybody supposedly “has the disease. Maté is an extreme environmentalist who doesn’t believe in the heritability of addiction—or of much else.”
The American Society of Addiction Medicine (ASAM) updated its definition of addiction in 2019 to read: “Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.”
In chapter 15 of The Myth of Normal, Maté offers a definition of addiction that isn’t all that different from ASAM’s, although he shuns the term disease: “Addiction is a complex psychological, emotional, physiological, neurobiological, social, and spiritual process. It manifests through any behavior in which a person finds temporary relief or pleasure, and therefore craves, but that in the long term causes them or others negative consequences, and yet the person refuses or is unable to give it up.”
All of this shows that addiction is a complex, intricate condition that cannot easily be pinned down with a few sentences. Maté is certainly correct to say that individual life experiences are important factors.
As addiction author Maia Szalavitz suggested in Unbroken Brain, it’s not simply about misusing substances, either: “Drugs are powerful primarily when the rest of your life is broken…By itself, nothing is addictive; drugs can only be addictive in the context of set, setting, dose, dosing pattern, and numerous other personal, biological, and cultural variables. Addiction isn’t just taking drugs. It is a pattern of learned behavior.”
In his brilliant history of addiction in the United States, The Urge, Carl Erik Fisher noted that in our attempts to comprehend addiction, a complex situation with a multitude of factors is too often reduced to a simplistic scenario. “What is necessarily a complex web of intersecting forces is too often reduced to one simplistic story: trauma, brain disease, an evil and unstoppable drug, a bad pill-mill doctor, a hereditary taint, or a weak will, or poor morals.”
Treatment — where theory meets (or does not meet) practice
Contributions to the canon of addiction and behavioral health knowledge like those from Maté, Szalavitz, Fisher, and many others offer vital insights and illustrate the evolving and complicated nature of addictive disorders. In some cases, the theories espoused and research published by numerous authors directly impact addiction medicine practice. However, just as skilled clinicians can employ multiple treatment modalities and approaches to treat clients effectively based on their needs and preferences, no single theoretical understanding of substance use and mental health disorders explains every case, nor do most people experiencing these conditions meet a set of common criteria. All people, regardless of socioeconomic status, presence or lack of adverse childhood events, and other traumas, and those of every gender, age, and cultural group, experience these conditions.
While many healthcare professionals, experts, and policymakers agree that specific cultural stressors, such as high economic disparity, intense political polarization, problematic social media use, commercialization and marketing of addictive substances, prevalent violence, climate concerns, and more, contribute to the development of mental health and substance use disorders, clinicians on the front lines encounter clients impacted by varying degrees and an infinitely variable combination of these factors. In practice, understanding theories about the broad underlying causes of behavioral health disorders is meaningful but tangential to the daily work of therapists and clinicians providing treatment.
Because the causes of behavioral health disorders are so varied and nuanced, understanding the issues every client and family system experiences is crucial to achieving successful clinical outcomes. Through in-depth diagnosis and assessment over an extended period, clinicians can gain an informative picture of the underlying factors contributing to developing and exacerbating each client’s conditions and tailor treatment around that individual set of needs.
At New Paradigm Recovery, experienced therapists, intensive assessment, close case management, and clinical flexibility offer clients and clinicians the opportunity to develop detailed personal and family histories that reveal a tapestry of underlying issues. This understanding informs effective treatment options and other supportive services that promote improved quality of life, well-being, and recovery. The multidisciplinary New Paradigm Recovery team is well-versed in trauma-informed care and family system issues and trained in numerous evidence-based approaches to better tailor individual treatment plans to personal experiences and needs.
Learn more about New Paradigm Recovery’s intensive outpatient treatment programming and other services at (703) 214-5888.
