Reposted from The Fix


What if we replaced the word “addict” with: “A human being who suffered so much that he or she finds in drugs or some other behavior a temporary escape from that suffering”?

Part 2 of a 2 part interview. Read part 1 here.

The Fix: In “Trump, Clinton and Trauma,” you detail the pathology of Donald Trump, writing, “What we perceive as the adult personality often reflects compensations a helpless child unwittingly adopted in order to survive. Such adaptations can become wired into the brain, persisting into adulthood. Underneath all psychiatric categories, Trump manifests childhood trauma…. Narcissistic obsession with the self then compensates for a lack of nurturing care. Grandiosity covers a deeply negative sense of self-worth. Bullying hides an unconscious conviction of weakness. Lying becomes a mode of survival in a harsh environment. Misogyny is a son’s outwardly projected revenge on a mother who was unable to protect him.”

Given the apparent danger of such a damaged personality in the White House, what is the American electorate to do? Should Trump be fought against so that he can be impeached and overcome? By providing him with respect and nurturing that he unconsciously desires, could his presidency be turned around for the better? Is there any hope?

Dr. Gabor Maté: Before the election, leading psychiatrists wrote a letter to President Obama advising him that Trump should undergo a psychological evaluation to see if he would be a danger to the country and the world if he were elected. What’s not talked about is what is behind Trump’s obvious pathology. This pathology includes grandiosity, which he’s clearly got; ADHD, which he’s clearly got; and narcissistic personality disorder, which cannot be diagnosed without a first-hand evaluation, but he does seem to have as well. However, what I have not seen discussed publicly is that underlying these categories of psychiatric diagnosis is actually trauma. Trump is an example of a traumatized child who refuses help.

As far as I can recall, Trump’s father was a domineering personality type, a rage-aholic who demeaned his children mercilessly. Within that family, Trump’s mother was not able to protect her kids and the trauma must have been extensive. An obvious result of this trauma is that one of Trump’s brothers drank himself to death. From all indicators, the Trumps were a traumatized and traumatizing family. Trump very famously once said that the world is a horrible place; that’s the perspective of a child that experienced horror and trauma while growing up.

As far as what to do about it, however, you cannot help somebody who does not recognize that they have a problem. For example, when I was in my addictive behaviors, nobody could help me because I was in a state of denial. I was enjoying what I was doing too much or thought that I was. You can’t force treatment on anybody. There’s no way to bring treatment to Trump unless he experiences such a crisis in his life that brings him to the point of self-awareness where he says, “I wonder what happened to me? Why did I do all these things? Why did I create my misfortune?” Until Trump starts asking those questions, the essential questions that anybody with a mental health or an addiction issue has to ask themselves to start moving in the direction of healing, there’s no way to help somebody.

Therefore, it becomes a purely political question. What do you do with somebody who is somewhat unhinged but who also has enormous power? I am not in a position to prescribe to the American public what they should do. I also am not so confident that if his vice president replaced him, we would be in a better situation. I don’t think the policy actually would improve, but rather it would just be less egregious in terms of its manifestation. It’s a political question that’s not for me to answer because I am not an American. It’s really for Americans to decide how they are going to handle this very unusual situation.

However, let me add a point here: In the same article that you cited, John, I also talk about Hillary Clinton’s childhood trauma. Basically, America had two traumatized candidates running against each other for the most powerful office in the nation. The extent of Hillary’s trauma was shown when she had pneumonia in the summertime, she pretended that everything was fine. She pretended she wasn’t sick until she collapsed in public. Such behavior is the result of a traumatized childhood where her mother forced her to suck it up when other kids were tormenting her. There’s an overflow of unresolved trauma in our society, and this is a question that needs to be addressed.

Let’s take another shot at the Trump enigma from a big picture perspective. Is Donald Trump merely the best example of the ongoing corrosion of what is often referred to as the American dream of manifest destiny? In other words, is Trump the “just desserts” of the American hyper-focus on capitalist growth? Is Trump’s election the ultimate expression of a deep, and from a greater historical perspective, rather rapid decline of a post-consumer society that has lost its moral bearings?

I do believe it’s a danger to focus too much attention on the personality of Trump. He is an egregiously troubled and troubling individual. He is addicted to tweeting, power, grandiosity, the demeaning of women, and many other negative characteristics that seem to appeal directly to the worst instincts of other people. In terms of the system, he’s nobody by himself. He was elected. He was a successful person according to the definition of success by our society. He represents that society. He’s not just an individual that is particularly dysfunctional who accidentally became the president of the United States. Rather, he represents deep dysfunctions that reflect the society as a whole. If you remove the personality from the picture, his policies are not that surprising or beyond the norm.

For example, his denial of climate change falls into a long-term pattern of America denying climate change that has existed since the theory and realization of the effects of climate change first appeared. It’s only very recently that any American in power began to admit that there actually was a problem. In terms of dominating other countries internationally, well, the United States has been doing that for well over a hundred years. In regards to the defining wealth and power as the ultimate markers of success that deserve favor and recognition as opposed to compassion, humanity, and connection with other people, Trump didn’t invent any of that. He’s a product of that belief system. As a result, Trump’s election is the manifestation of something that’s been happening for quite a long time.

People keep saying that Trump is doing everything he can to destroy Obama’s legacy, but I see it differently. I believe Trump is Obama’s legacy. Barack Obama raised a lot of optimistic and idealistic hopes in a lot of Americans. For either systemic or personal reasons or a combination of both, he was not able to deliver on them or admit that he was unable to deliver on them. The resulting disillusionment caused by such a profound letdown had a whole lot to do with Trump’s election. What we are looking at is a systemic reaction and not just the individual quirks of a somewhat bizarre personality.

In your critique of Facing Addiction in America, the Surgeon General’s Report on Alcohol, Drugs, and Health, you write, “In accurately identifying the brain systems implicated in addiction, the report ignores the scientific fact that the brain is a social organ, shaped in its development by the emotional environment in which the developing child grows up. Thus, the brilliant brain scans that show the dysfunctionality of the addicted cerebrum are not the result of addiction originally, but of the childhood circumstances that predisposed the person towards addictive behaviors. The drugs didn’t cause the addiction—they only provided the most devastating outlet for it.”

Why did the Surgeon General principally ignore the role of trauma and its relationship to addiction? If he did know about the role of trauma, could Dr. Murthy’s decision to sidestep the issue be related to the lack of treatment services available to address such deep-seated challenges? 

When he was still the Surgeon General, I heard the Vice Admiral speak. I don’t know what he knows about trauma, but I do know his report endorses the mainstream medical view that addiction is largely an inherited brain disease. Of course, such a view is better than believing that addiction is a choice that people make for which they should be punished. At least, if we think it’s an inherited brain disease, we will be more likely to provide treatment and not judge people and not hurt them even more. He does seem to want to help them, and that’s a good thing.

However, despite all the research on trauma and despite all the studies that show how childhood adversity predisposes a person towards addiction in significant ways, the role of trauma remains largely ignored. Despite the consensus in brain developmental scientific circles that the brain is a social organ that develops through a child’s ongoing interaction with their environment, these facts are not yet taught in the medical schools. Most physicians don’t actually know how the brain develops. In most medical schools, although this is changing somewhat, although rather slowly, but encouragingly, most students never hear a single lecture on trauma.

For example, a few days ago, I met a young woman who was an emergency room physician in Detroit, and she had graduated from medical school in Michigan. Although I knew the answer, I asked her how many lectures she had received in medical school about emotional trauma. Not only had she not received a single lecture, but she also said emotional trauma wasn’t even mentioned once in any of the classes that she took. This absence is astounding when you consider the fact that trauma is the basis of most mental illness and most addiction. Also, and this should be obvious, there are all kinds of secondary physical consequences as well.

There is a physician named Dr. David E. Smith who founded the Haight Ashbury Free Clinic in San Francisco during the hippy era, and he has dealt first-hand with addiction quite a bit. He once told me that the medical profession is traumaphobic. I completely agree with him, and I see it all the time. It’s not just the medical professional, but society as a whole. We are traumaphobic at our very core. We are so afraid to look at it because we deny our own experiences. We are so afraid of our own pain. Despite all the research, we are in constant denial of it. This has been going on for a very long time now. We basically will only acknowledge trauma in extreme cases like the PTSD symptomology of combat veterans, but we are less interested in recognizing how many adults suffer from PTSD because they were traumatized in childhood. To accept such an idea would demand an entirely different set of social attitudes and social policies as well as economic priorities. We would have to question how we support families and the nature of childcare and maternity leaves and paternity leaves and so on and so forth.

Such a list does not even include the challenges presented by present-day law enforcement. It has been presented as the answer for so many years to the drug epidemic despite the fact that it is clearly not working and often causing more harm than good. Law enforcement and the criminal justice system never has been, never will be, and never can be the answer to the drug problem in general and the opioid epidemic in specific. However, despite this failure, we are still unwilling to put resources into the compassionate, comprehensive, and long-term treatment of addiction and of the trauma that lies behind the addiction. If we did this, politicians would have to stop preaching about law enforcement, which is a cheap vote-getter that attacks the most traumatized people in our society. The whole jail industrial complex is designed to make money off of trauma. They would have to let go of their addiction to profit.

A true understanding of the role of trauma would require a huge systemic adjustment. If we look only at addiction treatment programs, the need for such a systemic adjustment remains. They still focus only on the behavior of addiction as opposed to the driving engine of addiction, which is trauma. They would have to change what they are doing, and it does not appear that they are willing to make such changes at this time. Even if it means saving lives and also saving money in the long-term, our society is all about the short-term status quo of the checkbook and avoiding any added expenses in the present. Any true systemic change is going to require time, effort, and investment. A large part of the resistance to accepting the role of trauma is the resistance to taking this step.

In “BEYOND DRUGS: The Universal Experience of Addiction,” you write that “to ostracize the drug addict as somehow different from the rest of us is arrogant and arbitrary.”

Beyond this willful ignorance, doesn’t there remain a profound societal stigma against people with substance use disorders and drug use across the board? Even when faced with a growing opioid epidemic, don’t most people still see the disease of addiction not as a disease, but as a “moral” failing? How do you overcome such ingrained prejudice and change the universal perception of people with addiction as criminals that deserve to be punished? How do you make the addict more human to those who lack the experience that may have led up to or precipitated the addiction?

John, you know what I find to be consistently true as I travel around and speak to a very wide range of audiences across this country. In any audience that I address, whether it’s the meeting of successful businessmen in Arizona or a gathering of young entrepreneurs in Los Angeles or a professional group of addiction counselors in Newport Beach, one thing always remains the same. Whenever I ask these groups of often hundreds of people, if they have had any kind of addictive pattern in their lives according to my definition – any behavior that a person finds pleasure or relief in and craves, but suffers negative consequences and can’t give up – virtually everybody raises their hand. This is true for practically any audience I address in any context.

Addictions and addictive behaviors are rife in our society, and they are all over the place. Virtually all of us have one or another going at any given time. It may not be substances, but my definition of addiction does not mention substances; it’s any behavior that has those characteristics. That’s the first point. The second point is that we are in a society in denial. We deny our dysfunctions. Therefore, it makes us feel better when we can point out and look at somebody that seems inferior to us. By doing this, we believe we can feel better about ourselves by somehow thinking that we are different. There is a lesson here that can be found in most of the spiritual traditions and taught by most of the great spiritual teachers. The lesson was particularly well-expressed by Jesus when he said that before trying to remove the speck from your brother’s eye, take the plank out of your own. Don’t be a hypocrite.

Although not in a deliberate sense, it’s still hypocrisy. Since it’s too painful and too threatening to our self-image to acknowledge our own addiction, or at least, the full negative impact of our addictive behaviors, we choose to point out the difficulties of other people so we can feel a sense of superiority. Such distinctions of differentiation between myself and others can be made on practically any level, including race, gender, nationality, religion, the color of skin, or any other difference. When you watched the progress of the American election, Trump was a perfect example of this. Anything that he could point out and make fun of that would make him feel superior, he did, and a good portion of the American public not only accepted this behavior but wholeheartedly embraced and lauded him for it.

Beyond these differences, we also can do it on the basis of functionality or dysfunctionality. For example, drug addicts tend to be more dysfunctional than other people because their chosen way to find pain relief has been criminalized. Such dysfunctional behavior gives us the right in our society to look down upon them, ostracize them, and think that we are superior to them. Not only does it help us to avoid looking at ourselves, but it also makes us feel better about ourselves. It’s an ego defense mechanism that helps us forget about the plank in our own eye.

One of the best things that I have experienced is when people come up to me and say, “Thank you. I have read your book and it opened my eyes. Now I can see these people in a way that I was never able to see them before.” If people can just listen to the other person’s experience, then they could see them and feel compassion for the pain that they are experiencing. It might be necessary to take away the word addict because the word is now packed with so many negative connotations of stigma. Every time you want to say the word “addict,” you have to say instead: “A human being who suffered so much that he or she finds in drugs or some other behavior a temporary escape from that suffering.” What if we were forced to say that every time we wanted to say addict?

In other words, what if we actually began to care about and listen to the stories of these people? That’s why I believe the job of people like you and I, John, is to tell these stories and to encourage people to listen to the real-life experiences of people suffering from this disease. Once they hear the real-life experience, most people can relate and most people can understand. It’s the absence of knowing the experience of the other that causes such judgment, stigma, and fear.