Exchange Between Gabor Maté and Stanton Peele
Posted on September 23rd, 2014 - Last updated: September 26th, 2019
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Stanton Peele described an unpleasant encounter he had in Vancouver with Gabor Maté last November. Gabor then wrote a series of 13 points. Stanton Peele asks some follow-up questions.
Gabor Maté wrote:
I’ve followed this multifaceted discussion with interest. To me it illustrates the limitations of any one particular view of addiction.
1. Has the disease model some validity?
Yes, as a physician I perceive that in significant ways it shows up as a chronic illness with physiological correlates in the brain and other tissues.
2. Is the disease model an accurate way of explaining addictions?
As many of these exchanges have pointed out, it is inadequate and some ways inaccurate.
3. Are brain abnormalities not identifiable in addicted people?
Sure they are. Do they explain the addiction? No they do not. Do they reflect something important about the nature of addiction? Yes they do. (See Marc Lewis’ wonderful Memoirs Of An Addicted Brain, or my In The Realm of Hungry Ghosts)
4. Is free choice not a feature of recovery?
Of course it must be.
5. Is free choice an adequate response to addiction?
Only for some. Not for many others.
6. Is harm reduction the answer to addiction?
It was never meant to be nor can it be. Is it useful and even a necessary approach for many people’s beginning on the path to recovery? Without doubt.
7. May genetic factors help to predispose to addictions?
They may in some cases. Do they explain most addictions? Not by a long shot.
8. Can we understand either the psychology or physiology of addictions without looking at childhood stresses and, in severe cases, trauma?
Not in my view.
9. Does everyone traumatized become addicted?
Not by a long shot. Was every addicted person significantly stressed or traumatized? Yes, whether they or their clinicians understand this or not.
10. Why do some traumatized people become addicted while others develop mental illness, cancer, or autoimmune disease?
I don’t know.
11. Is there a difference between craving/addiction and physiological dependence?
As Lance points out below, of course.
12. Are 12-Step programs THE answer?
As Lance points it in his recent book, by no means. I gladly blurbed his book, without agreeing with him fully.
13. Can 12-Steps programs be life saving and life enhancing?
I have met many for whom they have been.
We need to keep exploring these questions without convincing ourselves that we have arrived at the final answers. Hence, I’m grateful for this discussion.
Gabor
Stanton Peele wrote:
Gabor – it’s good to have your voice in this discussion.
Let’s ignore all that has been said and get directly to the meat of the matter, shall we?
Tell us, do you believe, as you say, in the “essential” value of AA’s approach of powerlessness and moral inventories?
Or do you agree with my approach in my books and treatment of empowering people and lifting their sense of themselves?
This is a very important difference in the addiction field, don’t you think?
You say to read your words. But you both laud AA, and Lance’s book denouncing AA’s detrimental control of the field.
In your detailed list below, you say you don’t agree “fully” with Lance’s book. WHAT don’t you agree with in it?
Can you also tell us if you think it is valuable to pursue non-abstinent remission/harm reduction from substance addiction?
You say “We need to keep exploring these questions” and that you’re “grateful for this discussion.” So will you answer my questions?
Yours,
Stanton
Dr. Stanton Peele, recognized as one of the world's leading addiction experts, developed the Life Process Program after decades of research, writing, and treatment about and for people with addictions. Dr. Peele is the author of 14 books. His work has been published in leading professional journals and popular publications around the globe.
Does it matter whose way works?
Whose more eloquent or cohesive in their argument over what addiction is and how its best treated?
For me, a recovered low bottom crack cocaine addict, 12 Steps worked. For others it won’t. There’s no single way to treat cancer, to treat depression, PTSD or any other illness. So theres no single way to treat addiction.
Instead of arguing whose way is best, maybe that energy would be best channelled into helping others. And all agree that addiction kills thousands and try to do our best in overcoming it
How the f**k would you possibly get to the bottom of each persons reason to numb,
And if one numbs as I do , having been very traumatized as a child(very)
Traumatizing childhood of course you use substances, you stupid f**ks.
Most of us function until we can’t, or die!
I’ve seen people that work fine completely f**ked up all day then completely wasted in the evening and then get up and go to work?
Hats off I say. Not me , I’m always all in
I’m 1000 % mate. Trauma trauma trauma
And f**k the other guy’s opinion
All day long. And f**k AA
Gabor Mate is on the right track and healing is done in psychedelic therapy
Unfortunately the government stole our right to this therapy in the sixties
In Canada we still have limited access to ketamine mdma etc.
Even though it’s tested and proven to be effective and harmless and most of all effective and with very few side effects
Yet they will freely continue to prescribe antidepressants
Getting to the bottom of each person’s issues, values, their meaning in life, and how to pursue it. That is a daunting task, but what’s the alternative?
Is Gabor’s approach good for every one? (Younger people, for instance?)
We offer an alternative view and approach. Should any one, other than Gabor, be given the opportunity to do so, or is it imperative that we choose a guru and follow that message forever?
I am unqualified academically; qualified as a facilitator under the SMART program and have facilitated over 2000 meetings over the last four or so years.
My observations are as follows:
1. CBT requires us to understand our body, the electrical a chemical activities therein and so forth. In doing this understanding, it turns out that we have primary responsibility for the solution, if not the cause. Repeating this over a period of time has as one of its by products, the continued nurturing of the self critical impression of a lowering of self esteem. This is sub optimal. (As is a repeated pronouncement that one is an addict or powerless without the support of a Higher Power). But we digress.
2. In terms of effectiveness, the received wisdom is that people prosper in a positive environment. The vast majority of folk who come to meetings are in a negative state of mind and perform only to substantiate their beliefs. It occurs to me that in order to profit from some, most or all of the actions recommended by CBT and other treatments require the recovered to have a vestige of belief that they are worth saving. But why would I initiate forming a conversation or relationship with any one unless I believed that I could offer something of value to the other party? And yet, connection is held by Johann Hari and others as a necessary component of recovery. Something we may experience as a long tail as a result of enforced isolation owing to COVID.
4. To take 50% of meetings initially simply to condition the recovered into a suitable frame of mind reception-wise seems a waste, particularly since progress after the tipping point between negativity and positivity is accelerated and part of an upward virtuous circle.
3.
Stanton Peele clearly has a bone to pick with Gabor, yet does not seem to have the intellectual fortitude to actually rebuke him in any sort of significant way. What is it about Gabor that so frustrates Stanton? I can’t answer that, but I do get the feeling that Stanton’s view of trauma therapy as squarely “negative” is rooted in a form of deep denialism, whereby Stanton’s sense of himself is threatened by the notion that he might not have all the answers, refuses to see the nuance behind such complex problems, and perhaps most importantly, doesn’t wish to uproot his own past to see if it might help him and the care and advice he gives others. This denial is common among care-givers in the field, and it’s unfortunate.
One major thing that Stanton misses in all his supposed rebukes against Gabor’s entire mindset toward addiction and recovery is that Gabor is far from a fringe voice in many of these matters. His views on trauma, for example, are largely echoed by the work of Bessel Van Der Kolk and Bruce Perry, two revered trauma experts (among many others).
Part of Stanton’s shtick is that he can’t ever seem to directly cite evidence of his own, yet wants to try and undermine the important evidence of others by attacking even the slightest inconsistencies or irrelevant data points by constructing his own meaning of said data.
Gabor’s work is not bullet-proof, and he’s never claimed it to be. He does have a belief in trauma being a fundamental cause of our discontents, and according to the weight of the evidence I’ve seen, that opinion is far from unfounded. Perhaps Stanton can jump off his denialist soap-box and see the value in such work, but this is only possible if he deflates his ego enough to the point where his heart may listen.
You can read about his disagreement with Gabor (and his basis for it) in Dr. Peele’s Memoir “A Scientific Life on the Edge” Thanks for posting.
Stanton, i agree its hard to know what exactly causes addiction. It seems to have to do with pain specifically. Im not explictly under the opinion that Gabor holds that it is based solely in childhood trauma. Its nuanced and hard to know and prove. I see where your coming from with saying that trauma work is self sabotaging but im under the opinion theres nuance to real trauma work. I think we all carry a degree of trauma within us to an extent, life itself is challenging and carry’s a degree of suffering. This is unavoidable, i like the idea of a “myth of normal”
I think the real work is in acknowledging this, tracing things back and finding an understanding based in acceptance. I think simply being positive and not actually fucking listening to ourselves and our pain and our own damn experience is the real toxicity and doesn’t work. I know this cause its simply not true, positivity arrises when we no longer need to lie to ourselves about our real feelings and reality, when we can be with ourselves in compassion and feel angry, hurt, betrayed etc.. allowing these to be seen and experienced. The distinction is not getting lost in the thoughts and storys and allowing these feelings to play themselves out. Its uncomfortable but deeply healing. Allow them to pass and for real genuine authentic positivity and gratitude to arrise. Only from there we c an probe and ask questions and begin to understand our own experience and the actual “why” to our deepest feelings and reality.
We need a balance of both approaches, I think Gabor gets this and this is what his practice is about. Its not about losing yourself in your story and your past. Its about coming out of comfortable bullshit denial, facing who you really are, shining the light of your awareness, truly loving the wholeness of yourself, paying attention and finding necessary change. People need real love not just positive thinking and delusional stories of positivity which deny there own direct experience. Its an integration of both the approaches. I dont think you can find positivity without addressing our negativity and inherent human roots down to hell.
https://lifeprocessprogram.com/life-process-program-podcast-episode-3-are-we-trauma-infomed/
My addiction recovery community includes Mate’s work in our program and it’s incredibly helpful
Luke, I will try to outline my thoughts on the dangers of Gabor Maté’s trauma approach to addiction.
The impact of Gabor’s trauma-based approach in the addiction field is negative, and strongly so. I say that first recognizing that serious negative life events (or more like ongoing negative conditions, which the ACEs actually are) are critical risk factors in young people’s development.
Nonetheless, these things are true:
1. No set of negative early childhood events, up to and including the most severe, definitively orients a person’s life towards addiction. A large majority of those in even the most severe ACE categories will not become addicted.
2. Worst of all, Gabor locates the impact of these events in permanent brain changes. Aside from being fictive, this construction is harmful, as well as being untrue to the life courses of — once again a solid majority — of those with addictions, who will instead outgrow and overcome them.
3. The solution to ACE-caused trauma and subsequent negative health and psychological conditions is to eliminate (as much as possible) the occurrence of these events. This is a social issue, and not a later-life therapy one.
4. Indeed, the vast bulk of therapeutic literature (cf. Seligman’s positive psychology movement) shows that focusing on past negative life events prevents psychological and therapeutic progress. Rather, exceeding these experiences requires minimizing them in the person’s outlook, ongoing forward planning, and developing the life and emotional skills needed to do so.
5. Gabor’s most crowd-pleasing move is to select someone from the audience who claims that they developed an addiction or other negative psychological condition without having undergone childhood trauma. Gabor then craftily questions the person to ferret out some supposedly secret trauma they underwent.
This is not a therapeutic technique, but a circus show. Every sensible person should know this. Discovering (more likely inventing), then concentrating on, previously undetected childhood trauma (often very loosely defined) deters people from dealing with, and making progress in, their problematic life issues.
The trauma approach is anti-therapeutic. In particular, the focus on past trauma depletes people’s confidence, energy, and belief in the possibility that they can overcome trauma and deal with immediate life and emotional problems.
As a mind experiment, imagine answering a call from a person considering suicide. Who in their right mind would say, “Imagine the worst thing that has happened in your life, and keep that as your main focus going forward”?
What happened to getting to the meat of the matter? And it looks like it was misinterpreted as to why Mate referenced Lewis’s book and Mate’s book..
And Mate gives his reason for referencing Lance’s book, that the 12 steps aren’t the only way… For real Stanton, show some interpretive coherence in what Gabor is saying, and come up with a better reply, cause as far as it looks, you just asked more questions and didn’t get to the meat of any of it. All the while Gabor Mate’s explanation carried a clearer presentation of his points and simple delivery of his stance on things, while stanton’s delivery is vague and makes no attempt to clear things up.