Gabor Maté: The Good, The Bad, and the Ugly

Gabor Maté is the revered physician who has ministered to Vancouver's inner-city addicted population. Although not a psychiatrist, Gabor is essentially a Freudian.  The Hungarian-born Canadian has fashioned a best seller, In the Realm of Hungry Ghosts, that locates all addiction in childhood trauma and pain. 

Here are the good, the bad, and the ugly of Gabor's approach. (Disclosure: I've met with Gabor and occasionally correspond with him.)

1. The Good. By noting that addiction isn't driven by a particular drug, or by drugs at all, Gabor directs the focus for addiction in the right direction—away from the addictive object and towards the experience of the individual. A man I respect, Gabriel Sayegh, of the Drug Policy Alliance, is indebted to Gabor for understanding his experience growing up (link is external) and his becoming addicted to meth.

2. The Bad. In locating addiction in the pain people feel, Gabor strikes a chord for people.  If you say to people, "Your are in pain," they will come up with painful memories. But some experiences are more traumatic than others and have more serious consequences, while people differ widely in their reactions to what may be traumatic, or may not be.  In fact, a large majority of those who experience abuse don't become addicted to drugs or alcohol—thank God.

3. The Ugly. Gabor's is a disease theory. In order to sound scientific, he discusses potential neurologic consequences of trauma. But he casts his net so wide in locating childhood trauma that there is no way of deciding what is really traumatic and gradating the neurological impact of these stimuli/experiences. 

The worst aspect of Gabor's theory is that locating addiction-causing experiences in neurological imprints of supposed trauma makes the causes of addiction seem permanent, even as most people outgrow addiction (link is external). Here is how I evaluate Gabor's theory in Recover! Stop Thinking Like an Addict:

As important as is Maté’s work with addicts, his simplistic vision of addiction in which abuse history and imagined biochemical changes become the essential causes of people’s self-destructive behavior can be as incapacitating as genetic neurochemical deficiency models. It is not enough to say that this model is highly conjectural. It also isn’t true—that is, it makes little sense of the world. 

In the first place, the overwhelming majority of abuse victims and other trauma sufferers don't develop drug addictions or alcoholism. (Gabor would say they develop other forms of addiction or illness.)  "Worst of all," Ilse Thompson and I write, "focusing on childhood as the determinant of addiction detracts from our awareness of people’s natural tendency to overcome abuse and addictive experiences."

As one person wrote me: "I am very fond of your writing and Dr. Mate's, and I can see your point very clearly about childhood trauma being the new disease theory. It shifts from disease to disability, which is wonderful for easing stigma, but disempowering for the addicted person."  So, as empathic as Maté the theorist, writer, and helper can be, we need to get beyond his trauma—>brain damage—>addiction vision.