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I had the privilege attending an intimate learning event with world renowned Author and MD Gabor Mate. Dr Mate writes about the role of childhood adverse experience and the traumas of every day life causing chronic stress and physical health problems in adults.
Here are my main takeaways and reflections on how this can be used by doctors, psychotherapists and health professionals to manage stress in themselves and their patients.
(Trigger warning if anyone is unaware of Gabor Mate’s style, very frank but warm and compassionate)
We treat a lot of conditions with exogenous steroids as our own supplies are exhausted or response down-regulated due to chronic stress
Substances and behaviours are not addictive, it’s the responses to these things that’s addictive. Don’t ask what’s the addiction, ask what’s the pain they are trying to sooth
Feeling you need to validate your existence with achievement or by “being good” is a adaptive response to lack of an essential need in childhood
A plethora of conditions including multiple cancers and autoimmune conditions increase with stress
Stress results from uncertainty, lack of information or loss of control. All of these things increase with deprivation
Number one regret of palliative care patients is they lived a life to please or impress others rather than be true to themselves (really resonated with me)
Second regret is they weren’t able to express emotions.
Repressed anger (being totally unaware you are angry but having physical manifestations) linked to heart disease, migraines, some cancers (incl lung and breast), in part caused by diminished NK cell activity.
“Fatal beliefs” include “I’m responsible for how others feel” and “I can never disappoint or express my needs”. Take caution.
Not blaming people for their illnesses due to stress, repressed emotions or other adaptive survival responses as they are multi-generational and patterns are often unconscious.
If you want to tell if parents are stressed check a child’s urinary cortisol (raised)
If the mother is stressed; the child is stressed.
Human brain “potential” is governed by genetics, the expression of structures and networks depends on the environment
ACE studies repeatedly show worse development and increased chronic disease risk
Disagreement with current parenting philosophy of child time outs alone if angry or sad; gives the impression they can either have authenticity or attachment and not both. Given the choice, children will always choose attachment and often suppress their emotions.
This can create “implicit” memory with no conscious recollection but plays out in adult life as “infant” behaviour (not my term). A small trigger causes a disproportionate lingering reaction.
When you can’t say no yourself, your body will say no.
Diagnostic criteria describe but don’t explain the origin.
Children learn to say No at 18 months (authentic) but then unlearn it due to social relationships and pressure.
Enriching social relationships are protective for trauma, loneliness is destructive
Healthy anger is something that is raised to set a boundary to avoid physical conflict, it ends quickly then dissipates.
"Unhealthy anger” lingers, eg rage
We live in a toxic environment, more like a zoo than the setting in which we evolved over 200’000 years. Seeing animals in a zoo is unrepresentative of the behaviour in nature. One would argue that sadness, anxiety and anger are completely reasonable responses to our current habitat. Often these feelings are medicated rather than empathised with and explored (mentioned perimenopause and PMS as manifestations)
Children are “wounded” during development by 1) bad things being done to them 2) good things being absent (not the same thing)
Children need unconditional acceptance, love, safety, belonging, and rest. They need to experience emotions and to be held and validated by adults. They also need free spontaneous play in nature.
Women said to have higher autoimmune disease incidence due to being “societies shock absorbers” often taking on more care responsibilities and feeling guilty for not doing enough, leading to increase stress.
A weekly reflective exercise with a partner is having 4 minutes each listening without support or interruption to the other answer the question “Where in your life do you have difficulty saying no”. (Very powerful)
Guilt is a good thing, it often shows you have said no. Sometimes you will lose attachments by saying no
Children are born with the need to attach. They will imprint on anyone they are with. Children should be more attached to their parents than to their friends.
Compassionate enquiry, a signature treatment developed by Gabor Mate was demonstrated with 3 people. Asked volunteers about their childhood, found a moment their needs were not met, focused on body sensations, encouraged self compassion. (I suspect a world famous Psychotherapist GP Author had some borrowed grace to do this without push back from people)
Overall, I resonated with Gabor Mates work and trust him as a respected author and for having bold opinions based on data but also a wealth of his own anecdotal experience.
Practically his teachings are difficult to implement in short consultations as a medical doctor and I was left feeling he had explained the “why” but the “what next” boiled down to forcibly telling people that they needed to appreciate their childhood trauma was causing all of their inflammatory medical problems.
His approach is tempered by a “no blame” ethos which I resonated with and use personally. Reframing “negative” emotions into showing positive values and having hidden benefits is a therapeutic tool in itself.
He used role playing methods to role reverse with a volunteer on stage and ask them to be compassionate to him as a client , something she found difficult to do for herself. This is a tool known as the paradoxical double standard technique and can be tremendously powerful with people who are nice to others.
Obviously even a 6 hour lecture would represent only a small portion of the 5 or so books he’s written and it’s made me want to read more of his work.
He was quite scathing of Cognitive Behavioural Therapy (CBT) as a "useless" modality as it did not focus on the body or on childhood trauma. A little strong in my view, considering that everything in his approach boiling down to changing beliefs and self narratives (ie cognitions) from self defeating patterns (perfectionism, emotional perfectionism, anger phobia, achievement addiction) into more empowering renditions.
What Gabor Mate does well is empathise. He explains that every condition has a justifiable cause rooted deep in childhood and adulthood trauma. Being heard and empathised with can be incredibly powerful but I believe this is not effective long term on its own. It’s necessary but not sufficient let’s say.
He also does well to assess subconscious resistance we have to change by reframing negative emotions into positives, thus reducing the push/push back dynamic therapists get when they tell clients their thinking and emotions are “defective and must be changed”. It’s not defective, it’s a representation of positive core values.
I think he could benefit from actionable methods to teach other clinicians how to change beliefs from self defeating to self empowering. His current assertive style is vague and I can imagine I could be poorly received or even damaging to some clients.
Personally I use TEAM CBT in my therapy practice which is a collection of different cognitive, behavioural and psychodynamic tools in a structured protocol (Testing, Empathy, Assessment of resistance, Methods)
Testing (mood surveys before and after sessions to see what works), Empathy (listening without judgement or willingness to help, save or change initially), Assessment of resistance (finding the GOOD reasons NOT to change thoughts and emotions) and finally Methods to highlight the errors and exaggerations in negative thoughts and using role playing and exposure techniques to change “untrue” distorted thoughts into “true” and powerful thoughts that instantly reduce the stress response when believed at a gut level.
Results can be quick because you are not pushing clients to change, you are highlighting the cost/benefit of feeling a negative emotion and empowering people to choose to work with you rather than for you).
To get a flavour or TEAM CBT in action using work stress I have created a new rapid program called REACT. By practicing changing thoughts with a slightly more benign issue of work stress (compared to let’s say bereavement or personal diagnosis) it can give people confidence in quick ways to change thought patterns as a tool to reduce stress alongside lifestyle, nutritional and pharmaceutical tools.
If you want to try it out I’m offering it free for a limited time here on my website. Just click here and choose your job, subscribe to the mailing list and receive your free tool to use anytime you feel stressed with a work challenge.
The form is anonymous but feel free to let me know how you get on by commenting here or on my social media channels or emailing tom@mindmovehealth.com.
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