Physician Gabor Maté was born in Nazi-occupied Hungary in 1944 to Jewish parents who were primarily concerned with simple survival. His father was interned in a forced-labor battalion, his aunt disappeared, and his maternal grandparents died in Auschwitz.

In 1957 Maté and his mother and father immigrated to Canada, and he went on to get a medical degree from the University of British Columbia in Vancouver. He started a private family practice in East Vancouver that lasted for twenty-seven years. While treating patients, he observed that those who had experienced trauma, stress, and anxiety at a young age tended to repress their emotions and also to have more health problems. He also served as medical coordinator of the palliative-care unit at Vancouver General Hospital for seven years. In the late 1990s he took a job working with HIV-positive drug addicts at several innovative urban rehab programs, including one where addicts are given needles and allowed to inject heroin on-site — the only such supervised-injection program in North America.

With both the chronically ill and addicts, Maté again saw the roots of their problems in “adverse childhood experiences,” such as abuse, neglect, poverty, or parental stress. At a time when medical science was increasingly looking to our DNA for the source of many illnesses, Maté was becoming convinced that experiences in our early years play an even greater role in brain development and behavior. The emotional patterns we learn as small children, he says, live on in the cells of our minds and come back to us as adults.

In his fifties Maté diagnosed himself with attention-deficit disorder [ADD] — a result, he says, of his early childhood in wartime Hungary. Those difficult formative experiences also led him to become a workaholic and a shopaholic, he believes. He credits mindfulness meditation and therapy with helping him cope.

In his first book, Scattered, Maté makes the case that ADD is not a genetically inherited disorder but rather is caused by the environment in which one is raised. He proposes the same for addiction in his book In the Realm of Hungry Ghosts. His other titles are When the Body Says No: Exploring the Stress-Disease Connection and, with Dr. Gordon Neufeld, Hold On to Your Kids: Why Parents Need to Matter More Than Peers. Protecting and strengthening the parent-child bond is crucial, Maté says, and he identifies the lack of support for struggling families in the U.S. and Canada as the root cause of many social and healthcare crises.

For many years Maté wrote a weekly medical column for The Globe and Mail, Canada’s most widely read newspaper. Recently he gave up practicing medicine to focus on his appearances at seminars and conferences, where he discusses disease, addiction, and human development within a social context. Attributing our maladies to heredity is simplistic and disempowering, he says, a distraction from the problems of economic inequality, bad schools, and a declining sense of community.

I met with Maté over dinner in Albany, New York, following one of his intense all-day presentations, at which he’d developed a powerful rapport with an audience of two hundred. It was his fourth program of the week.


440 - Maté - Frisch


Frisch: Medical science has tried to offer genetic explanations for everything from alcoholism to obesity to breast cancer to depression. Why do you think genes can’t account for all our differences?

Maté: The genetic explanation is comfortable because it means that we don’t have to look at people’s lives or the society in which those lives are led for the source of our problems. If addiction is genetic, we don’t have to worry that it’s connected to child abuse, for example.

But studies actually show that, though certain genes might predispose you to addiction, if you grow up in a nurturing environment, those genes are inactive. Most genetic studies completely ignore the science of epigenetics, which is how the environment actually turns certain genes on or off.

Frisch: What led you to become interested in the connection between illness and environmental pressures?

Maté: As a family physician I began to notice that who got sick and who didn’t wasn’t completely random, that people who got sick more often tended to have more stressful lives. And I began to think that the stress had a lot to do with their illnesses.

I am not the first to arrive at that thought, which has been amply validated by research over the decades. Stress is a significant factor in the onset of diabetes, high blood pressure, heart disease, and cancer. But that research is generally not part of medical education. Doctors are trained to understand disease as a random event usually caused by external agents — bacteria, viruses — or genetics. We’re not taught to look at patients’ formative experiences or multigenerational stress patterns. Yet both my own observations and the research literature clearly indicate that you can’t separate people’s bodies from their environments.

Consider all the stresses of life in a society where people feel little sense of control and lots of uncertainty all the time; where people are expected to behave contrary to their true nature; where relationships are often troubled; where parents are not available for their kids because they’re too busy. Under such conditions, you’re more likely to get sick. Nearly 50 percent of American adults have a chronic illness.

On top of that, the U.S. has an inequitable healthcare system that provides good care to some but minimal care to others, and the debilitating expense of healthcare stresses patients further.

Frisch: We all experience stress, but we don’t all get sick. What makes some people more prone to illness than others?

Maté: People who have a chronic illness of any kind — cancer, multiple sclerosis, rheumatoid arthritis, fibromyalgia, inflammatory bowel disease, chronic neurological and skin disorders — often fit certain personality profiles. For example, they tend to pay a lot more attention to the needs of others than to their own. They get caught up in their job or their role as a caregiver rather than looking after themselves. They also tend to suppress the so-called negative emotions, such as sadness and anger. They try not to acknowledge these emotions even to themselves. And, finally, they tend to think they are responsible for how other people feel and to be terrified of disappointing others who are important to them.

So an overwhelming sense of responsibility and self-suppression is what tends to characterize the chronically ill.

Frisch: Have there been studies that support this?

Maté: Yes. In some studies of women who are having breast biopsies, psychologists could predict with relative certainty who would be diagnosed with cancer based purely on personality profiles. They were right as much as 90 percent of the time. The so-called cancer personality has been studied particularly in relationship to multiple melanoma, a type of skin cancer. Of course the personality doesn’t cause the disease, but it does increase your risk of getting it.

Frisch: Are there different personalities for people who have cancer and people who have, say, heart disease?

Maté: Well, there are two kinds of people who are prone to heart disease. One type is the rageful Type A workaholic. After a fit of rage, your chance of having a heart attack or stroke doubles for the next two hours, because your blood pressure is up, your adrenaline is up, clotting factors are increased, and your blood vessels have narrowed. In the long term you’ll suffer high blood pressure, constriction of the arteries, and so on.

The other type of person who gets heart disease is the emotional suppressor. They express no anger at all, not even healthy anger. They tend to get diseases of the heart muscle. Instead of the coronary arteries being damaged by high blood pressure, the cardiac muscle is weakened.

Frisch: Why shouldn’t we make an effort to stay calm? Doesn’t anger hurt relationships?

Maté: To say that we shouldn’t have anger is like saying that we shouldn’t have rain: we may not like getting wet, but without it there’s no irrigation. Healthy anger is a necessary response to a boundary invasion. It’s our way of saying: You’re in my space. Get out. You see this behavior in animals, too. It’s not a question of should or shouldn’t; it’s a part of our makeup. The role of emotion is to keep out that which is dangerous or unhealthy and allow in that which is helpful and healing. So we have anger and revulsion, and we have love and attraction.

Now, rage is always unhealthy. Rage is anger that is disproportionate to the situation. It usually arises from past experiences, not present boundary issues, and it keeps going on and on. It’s not discharged once you’ve protected your boundaries. It’s the result of frustration that’s built up for many years, like a pressure cooker that explodes.

Anger that is repressed can also turn inward. People who repress their anger can actually suppress their immune system, making it turn against itself. When that happens, you’re going to get autoimmune disease. Anger and the immune system have the same purpose: to protect boundaries. The immune system does its job of attacking foreign particles, and anger does its job of keeping out human invasions.

When you suppress your response to a boundary invasion, you’re going to become stressed. If I started rifling through your purse, for instance, and you didn’t object but instead repressed your anger, you’d feel very stressed, because you’d be worried I’d take your money. It takes tremendous energy to suppress emotions. The act itself is stress producing.

Self-suppression is not innate. It’s a learned coping style. When you’re a child and your parents can’t handle your feelings, you learn to suppress them to maintain your relationship with your parents. But what was a coping response in the child becomes a source of illness in the adult.

Frisch: Does positive thinking protect people from illness?

Maté: A genuinely positive attitude that’s based on real experience and authentic power does protect people. If you realistically see the world as a place where you can get your needs met most of the time, you’ll be healthier.

The compulsive positive thinker is in trouble, however, because he or she is in denial of reality. Some people are not comfortable with their own pain, so they cover it up with positive thoughts in a desperate attempt to avoid what’s there.

Frisch: Does low social status or oppression make people less healthy?

Maté: Yes. The major triggers for stress include uncertainty, lack of information, and loss of control. The more you are not in charge of the circumstances of your life and the decisions that affect you, the more stress you will be under. In a study of the British civil service, lower-ranking civil servants had a greater risk of heart disease than their superiors. Low socioeconomic status makes it more likely that you will be exploited and that your needs won’t be met. Of course, other factors such as poor nutrition and housing conditions can also contribute to ill health.

In African American men the death rate from prostate cancer is more than twice the rate among white American males. If you look at men in Africa, they have the same rate of developing cancer in their prostates as men everywhere — it’s fairly universal — but they don’t have a high rate of death from prostate cancer. I credit the Africans’ high-functioning immune systems, which has to do with the fact that they’re not as stressed as African American men, who deal more often with loss of identity, loss of status, loss of control, loss of power.

There has been a dramatic increase over the past several decades in the number of women being diagnosed with multiple sclerosis as compared to the number of men: “an increase in the ratio of women to men of nearly 50 percent per decade,” according to one U.S. expert. Women are now three to four times more likely than men to get MS. Such changes cannot be explained genetically, since genes don’t change in a population over such a short time frame.

There’s a lot of literature connecting MS to stress, and it’s easy to see why women might be more stressed, especially now. They’re still playing their traditional role of stress absorber, soaking up the worries of their spouse and children, as they always have. Now they also have to be out in the workforce, and they are doing so with less support, because the community and the extended family are less available. And traditionally women are trained not to express their so-called negative emotions.

Frisch: When people already have a chronic or degenerative disease, can changing the way they deal with their emotions help them overcome it?

Maté: In some cases. I know people with stage IV cancer who have changed their lifestyle and their emotional patterns and done very well, surviving a decade or more beyond their prognosis. They also changed their relationships and what responsibilities they took on. They started saying no when they didn’t want to do something. And why not? When they wouldn’t say no, the cancer came along to say no for them.

I don’t want to be simplistic about it. Not everyone can be saved. But with many of these illnesses, flare-ups could be avoided, and the inexorable progression and deterioration slowed or even stopped, if people started living differently, not controlling their emotions but changing how they relate to the world based on their emotions.

Frisch: You seem to be careful in your work not to blame people for their illnesses. Still, when you say there’s a connection between illness and emotional behavior, some might think you are holding the patients responsible for their own disease.

Maté: It’s not that I am careful not to blame. It’s that there’s nobody to blame. People don’t develop these behavior patterns deliberately. These are coping mechanisms based on family-of-origin problems. If I suppress my emotions because my parents couldn’t handle my anger when I was two years old, how am I to blame for that? At some point these coping mechanisms helped us survive.

I also don’t blame parents: these are unconsciously transmitted, multigenerational dynamics. Parents do their best, but we live in a highly stressful culture.

Frisch: What about individual responsibility? Where does it come in?

Maté: You have to understand the word responsibility. It implies that one has the ability to respond. Once I understand something, once I’ve thought it through, then I can respond consciously. Only after it makes sense to me can I start taking responsibility.

So is it true that some people bring on their own illnesses? In a certain sense, yes. How they live affects their health. Nobody argues that smoking doesn’t increase the risk of lung cancer. But even in those cases there are people who smoke to soothe some stress or pain that they didn’t create for themselves. It’s not entirely their choice.

Consider all the stresses of life in a society where people feel little sense of control and lots of uncertainty all the time; . . . where relationships are often troubled; where parents are not available for their kids because they’re too busy. Under such conditions, you’re more likely to get sick. Nearly 50 percent of American adults have a chronic illness.

Frisch: How should we raise our children to ensure they become healthy adults?

Maté: First we need to do away with the behavioral under­standing of children, which dominates parenting in North America. We insist on looking at the behavior of the child and asking, “Do we like this or not?” If we don’t like it, we try to change the behavior. But we rarely ask, “Why is the child behaving this way?” The behavior is a symptom, a secondary issue. The real task is to understand what is actually bothering the kid. The child doesn’t necessarily understand it himself. It’s not his job to understand it. It’s the parent’s job, the teacher’s job, the doctor’s job, the psychologist’s job.

As long as we restrict ourselves to either punishing or curtailing children’s behaviors, it’s like giving an asthmatic cough medicine: it might suppress the symptom, but it does nothing about the inflammation that’s causing it.

If a child’s “acting out” is a result of a disturbed attachment relationship to her parents, to punish the behavior only further wounds the child, who didn’t deliberately choose that behavior and has no idea why she’s being punished for it.

It’s in relationships that people develop the coping mechanisms that may later make them sick. If my relationship with my parents demands that I become their caregiver because they’re alcoholics, then I’ll likely become a chronic caregiver and will ignore my own needs. The children of alcoholics suffer a lot from anxiety, depression, and physical illness because of how they cope. But they had no choice but to cope that way.

Frisch: You say no one is to blame for a poor attachment relationship between parent and child, but don’t the parents still have to change their behavior to break the cycle?

Maté: Absolutely. The older child’s brain, and even the adult’s brain, has the capacity to develop new executive circuits under the right conditions. Since the child’s most important relationship is with the parents, if the mother and father take better care of themselves and of one another and of the child, the child can significantly grow out of ADD or learn how to handle it better.

When you’re a child and your parents can’t handle your feelings, you learn to suppress them to maintain your relationship with your parents. But what was a coping response in the child becomes a source of illness in the adult.

Frisch: Aren’t there cases in which a child’s acting out or ADD can’t be traced back to a lack of proper attachment to the parents?

Maté: Sometimes the question is not so much of attachment, but of attunement: the capacity of the parent to be emotionally in tune with the child. Many children are well attached to their parents, but the latter are too stressed or too distracted to be attuned to their kids. Stress on parents in this society is why we are seeing so many more kids being diagnosed with disorders.

Frisch: Why is attachment so essential for humans and other animals?

Maté: Attachment is simply the drive to be close to other creatures — to take care of them or be taken care of by them. The attachment drive is what we call “love” in lay terms.

It’s not essential for all animals. Reptiles hatch from the egg, and off they go. There’s nobody to take care of them; the mother turtle is long gone by the time the eggs hatch. Some of the offspring survive, but most of them don’t.

In avian species the infant has to attach to the parent to be nurtured and in order to model behavior and to learn. Mother birds instinctively care for their young and sometimes will risk their own lives in order to save their infants.

The more helpless the infant, the longer the period of attachment. In human beings it goes on longer than in any other creature because of the immaturity of the human infant.

The parent-child bond is our most important relationship; through it we experience the world. The child doesn’t experience poverty in the abstract; the child experiences whether the parents can provide for him or her. When a parent comes home stressed, the child experiences the parent’s emotions and, through them, the world that stresses the parent. The attachment relationship gives us our concept of the world: Is this place hostile? Is it friendly? Is it nurturing? Is it indifferent?

It’s also through the attachment relationship that we learn about relationships in general. Can people be trusted? Can we be vulnerable and express who we are, or are we going to be attacked for it? Do we need to protect ourselves and hide and shut down?

In the attachment relationship we also learn who we are: Are we good? Are we bad? Are we acceptable? Are we worthwhile? All of this depends not on what the parent thinks of us but on how the parent unconsciously acts toward us. If my parents enjoy me, then I’ll have good self-esteem. If my parents are so stressed and worried and depressed that they can’t enjoy me, even if they love me, then I will have low self-esteem, because children invariably make everything about themselves.

Frisch: How do other theories of learning and human development deal with attachment?

Maté: Educational theory tends not to understand it. Educators focus mostly on subject matter and little on the relationship between the teacher and the student, which is actually a strong determinant of how well a child will do in school. A kid who is well connected to adults will learn more easily. And the parents are the primary adult relationship.

In today’s climate teachers are under scrutiny and may themselves be graded by how well their students do on standardized tests. If you want to be a “successful” teacher, all you have to do — it doesn’t matter how inept you are — is teach in a nice middle-class neighborhood with intact families and well-adjusted kids, and you’ll get great scores. But if you take on the job of working with kids in poorer areas, where the families are challenged by poverty or racism and the children are constantly stressed, you might as well give up trying to present yourself as a successful teacher.

Frisch: Why don’t you advocate any particular set of parenting techniques?

Maté: Parenting is not about techniques. Parenting is about a relationship. You may read all the latest books, but if your relationship with your child is not well established because you’re too stressed, too busy, or too involved in your career, even the best techniques will not work.

In the context of a healthy relationship your proper parenting instincts will be triggered. When you’re with a baby, and the baby starts making big eyes at you and smiling, what’s your response? But when we are disconnected from our kids, because we haven’t been present enough in their lives, they don’t trigger our parenting instincts; they trigger our anxieties, our resistance, or our rage, and then we parent from those places.

The main trap parents fall into is thinking that this child is my child just because I am the biological parent. In the emotional sense the child is mine only if he or she is attached to me. In this society we tend to take that attachment for granted, but we can’t afford to do that. In older cultures parents used to be with their young children every hour of the day. In this society we often don’t see our kids for most of the day, so our status as parents is on shaky ground. When we’re not around, our kids tend to connect with people besides us, particularly other kids, who often supplant us as the primary figures in our children’s lives, even though we’re the caregivers and pro­viders. Children are looking for an emotional connection. When they find it in other kids, they’re less concerned with what we as parents expect or demand of them.

Frisch: But what about stay-at-home parents who find themselves starting to go stir-crazy when they’re with their child all day long?

Maté: Why do they go stir-crazy? Because they’re alone with the child in an isolated home. That’s not how people are meant to parent. We’re meant to parent in a community. Indigenous women don’t go stir-crazy. They’re out in the village, relating to other adults the whole day.

Frisch: Day care is a necessity for some. How can those parents maintain the attachment relationship?

Maté: First of all, I believe no young child should be put in day care on the grounds that it’s good for him or her. By and large, children should be with nurturing adults, not with other infants and toddlers in a day-care setting, unless the adults in their life are dysfunctional.

But there are compelling economic reasons for many children to go to day care. In such cases there ought to be reciprocal relationships between the day-care workers and the parents. As Gordon Neufeld, who wrote a book with me, says, the parents in the morning pass the attachment baton to the day-care workers, and in the evening they get it back.

When Gordon was in Provence, France, he saw that the parents or grandparents would walk the children to school, and the teachers would meet them at the school door. On Sundays the whole family, multiple generations, would stroll together in the village. You see this in Spain too, and in many immigrant families in North America. You don’t see it so much with white families in the U.S. anymore. When the child’s primary attachment is with a multigenerational set of nurturing adults, then the child is not driven to connect primarily with the peer group.

Frisch: Yet somewhere we got the idea that kids should be with children their own age.

Maté: Which is ridiculous. Children should be playing with kids of multiple ages, both younger and older, ideally under the guidance of nurturing adults.

Frisch: Why do you strongly warn parents and teachers not to use “timeout” with kids?

Maté: To be clear, I’m talking about punitive separation, where the child is made to go to his or her room for bad behavior. If the parent is really upset and needs to take a timeout and go into another room to avoid yelling at the kid, that’s good.

But when you say to the three-year-old, “If you don’t behave, you’ll go sit in the corner,” you’re threatening to take away the thing that children are most afraid of losing: the adult’s presence. It will get the child to behave, but what are you doing for his or her long-term sense of security and belonging and ease in the world? What are you doing for the child’s sense of what a relationship is all about? You’re sending a message that relationships are conditional on pleasing others.

Frisch: How should parents discipline their kids?

Maté: In North America we equate discipline with punishment, but the word shares the same root as disciple. And what is a disciple? A disciple is somebody who follows, somebody who learns. The question is: How do we get our kids to follow us, so they learn from us? We don’t do it by attacking them. We do it by a warm, nurturing relationship in which we set the example. They’ll want to stay on our good side because it’s so great to be connected to us. That’s how you discipline kids.

Frisch: You object to the pathologizing of children’s behavior through the use of terms like “oppositional defiant disorder.” What’s wrong with the psychological viewpoint?

Maté: The problem with those diagnoses is that they describe behavior but don’t explain it. If a child is oppositional, why is she or he oppositional? Generally children are oppositional because they’re disconnected from adults. They resist being pushed or directed by adults to whom they don’t feel connected. If you push them harder, they’re just going to push back with even greater force.

Oppositionality cannot be solely the trait of the child, because it implies a relationship. You can’t be oppositional when no one is there. It’s the whole relationship we have to look at, not just the child’s half of it.

Child psychology misses the source of the behavior with all these labels. When psychologists say a child is “acting out,” what it really means is a child is expressing through behavior the emotions that he or she doesn’t have the words to express, as in a game of charades, in which you’re not allowed to speak and have to act out to communicate. We should deal with acting out not by controlling the child or somehow blaming the child for the behavior but by understanding the dynamics behind it. What is the emotional reality of that child? What do the child’s actions represent that he or she can’t tell us in words?

Frisch: What about teenage rebellion? Is it a problem or a natural developmental stage?

Maté: Genuine rebellion has to do with wanting to be free, wanting to be an independent entity in your own right. You rebel so you can become an individual. But much of what passes for healthy teenage rebellion is not rebellion at all. It’s simply the child’s desperate attempt to take on the values and behaviors of the peer group, to attach to a different set of authorities.

Healthy rebellion is about self-assertion, not knee-jerk resistance or contempt: “Yes, Mom and Dad, I understand you want me to do it this way, but I have to do it my own way.” There’s nothing contemptuous or rancorous about it. The sullen resistance that many kids have toward their parents is based on the fact that they have lost any relationship with them.

Frisch: How did being a Jewish baby in Nazi-occupied Hungary shape your life?

Maté: It’s now understood that the human brain develops in interaction with the environment, and that the first three years of life are the most critical. The emotional context in which children spend their formative years has a lot to do with how they perceive the world, which affects their health later on.

As an infant, with my father absent due to forced labor and my mother under constant threat of death and all the horrors going on around us, I had a very stressful environment. This means that stress became my base line. People with that kind of physiology will actually seek out stress almost as a comfort zone. I imagine I felt not very welcome in the world, so I’ve worked hard to justify my existence. Crucial brain circuits involving attention and motivation are affected by early stress — hence my ADD and depressive tendencies. Finally, when the baby can’t be listened to or held, he can’t safely discharge his emotions. They get stuck inside and then released later in life in inappropriate situations.

So those early experiences had a huge negative impact on me. On the other hand, they also made me look for the truth of things. What is going on in this crazy world? That’s always been the question I’m asking. Just what the heck is this all about, and how do we make sense of it? If it’s a problem, how do we keep it from happening to other people?

Frisch: Doesn’t adversity also help us develop resilience?

Maté: Resilience doesn’t come from adversity; it comes from love. I don’t know how resilient I am. I don’t do well when things don’t go the way I’ve planned. For what resilience I do have, I credit my mother. Despite all those terrible circumstances, she did her powerful best to love me and get me through.

Frisch: What is attention-deficit disorder like for you?

Maté: ADD has three major features that may be present. Hyperactivity is one. I’ve certainly always had difficulty sitting still. I’m a rather restless, fidgety person. The second is difficulty focusing. I have a hard time paying attention when I’m not very interested in something, and I’m easily bored. My mind wanders. Absent-mindedness leads to disorganization. On the other hand, this is balanced by a kind of hyperfocus. If I’m highly motivated, I’ll focus on something to the exclusion of everything else. Third, I have poor impulse control, which shows up in behaviors such as impulsive shopping and interrupting people in a conversation. To one degree or another I’ve had those traits since I was a child.

Frisch: Yet you only came to believe that you have this disorder later in life.

Maté: I’m far from the most severe case you’ll ever meet. I found out about it almost by accident in my early fifties. When I read about ADD, it was clear that I fit the profile. But if I’m motivated enough, I can do what needs to be done. For example, I got through medical school. It wasn’t easy, but I did. My ADD would show up in my personal life and my workaholism and my tendency to take on too much and juggle too many balls.

I’ve always wanted to write books, but I could never do it before I learned about my ADD. I couldn’t stay on track long enough to complete one. I could write newspaper columns overnight and work against deadline, but putting a book together was beyond me until I came to terms with how my brain functions.

Frisch: Do you take medications for ADD?

Maté: I have, and they helped me, but I don’t take them anymore. I just don’t need them, because I look after myself better. I’m not against medications, but they are not the answer — although for some they could be part of the answer. ADD is not a disease but a problem of development: medications suppress symptoms, which may be all right for a while, but they don’t support development.

Frisch: How much of a role does diet play in the development of chronic diseases and disorders like ADD? How about environmental toxins?

Maté: Kids with ADD have highly sensitive temperaments, which is probably genetic. And sensitivity means you’ll be more affected by any environmental factors, including emotional and physical ones. The latter include sugar, food additives, pollutants, and so on.

Frisch: What are some ways to help people with ADD?

Maté: The first step is to recognize that children reflect their environment, so you don’t want to immediately try to deal with it by giving them a pill. Instead we should ask how we can create more stress-free and emotionally supportive environments for children — at home, in school, and in day care. Wherever children are, they need emotional support and relationships with nurturing adults. Physiologically this is as effective as giving them Ritalin. Nurturing adult contact releases dopamine in a child’s brain, which is what Ritalin does. Dopamine is the incentive-motivation chemical.

In people with ADD the incentive-motivation parts of the brain seem to be underfunctioning, so when you give them a medication that elevates dopamine levels, they focus better. They’re more motivated. But that’s not the only way to motivate or focus people. I think we overuse medications on children. The real question is: What else are we doing to help the child’s brain development? The answer is often nothing, except hand out pills and try to control their behaviors.

Frisch: Some people believe ADD is a made-up diagnosis for restless kids who are bored in class.

Maté: Well, there are lots of boring classes, and being restless in one of them does not qualify you for the diagnosis. The traits and behaviors must show up in a number of areas in one’s life. And they have to create a problem. I don’t talk about a “disorder” unless the behavior creates a lack of order.

There’s no single test that can definitely diagnose ADD. There are some statistically significant findings from brain scans and EEGs, but they’re not diagnostic.

Frisch: In the U.S. almost 50 percent of all adolescents now meet the diagnostic criteria of one mental-health disorder or another, including ADD. The numbers keep going up and up. Are we diagnosing more kids because we’re better at it or because more kids have problems?

Maté: Nobody knows, but people who’ve been in education for a long time will tell you that they see more troubled kids than they used to.

There’s less and less connection with parents and fewer other adults around. The clan, tribe, community, or village is gone, so the parents don’t have enough support, and often both of them have to work, and then they come home totally stressed. Where, exactly, are infants going to get that unconditionally available, consistent attention that they need?

Parenting is not about techniques. Parenting is about a relationship. You may read all the latest books, but if your relationship with your child is not well established because you’re too stressed, too busy, or too involved in your career, even the best techniques will not work.

Frisch: How does the way that hunter-gatherers take care of their babies differ from the way that parents in North America take care of theirs?

Maté: You don’t see ADD in hunter-gatherer societies because of three qualities they provide in child rearing. Number one: Small children are always in close, nurturing physical contact with adults. They’re carried everywhere. They’re rarely put down, and they’re certainly not left without nurturing adults even for a moment.

Number two: The child is cared for by a whole set of nurturing adults, not just one or two. There’s a tremendous sense of safety and security in that. As the saying goes, it takes a village to raise a child.

Number three: Hunter-gatherers don’t believe that a five-month-old should be independent enough to “cry it out” and put himself to sleep. That kind of practice is encouraged only in so-called civilized societies. When children in a tribal society are distressed, they are immediately picked up and soothed, before their brain is overwhelmed by stress hormones during a crucial period of its development. Stress releases cortisol, which interferes with the hippocampus, the memory center. And stress overwhelms the emotional centers of the brain. When children don’t learn how to regulate their stress internally, they’re prone to do it later through drugs or addictive behaviors, such as overeating. When do people eat too much? When they’re stressed. Going home and stuffing yourself with a bag of cookies is an attempt to temporarily soothe the emotions and the stressed brain.

Frisch: Don’t some hunter-gatherer societies engage in practices that might harm the parent-child bond, such as corporal punishment or clitoridectomy?

Maté: There are barbaric practices in some hunter-gatherer societies, although I’d have to research whether or not clitori­dectomy, for example, is a practice of hunter-gatherers or of primitive agricultural cultures. I certainly don’t wish to idealize or romanticize any culture. I’m just looking at what works, and the studies have shown that many common characteristics of hunter-gatherer societies promote healthy development.

Incidentally, when the Puritans came to North America, they were shocked that the natives didn’t beat their kids. To these Christians “sparing the rod” meant spoiling the child.

Frisch: You have a lot of experience with drug addicts.

Maté: Yes, for twelve years I worked as a physician in the area with probably the most concentrated drug use in North America, the Downtown Eastside of Vancouver, British Columbia. My book In the Realm of Hungry Ghosts begins with the experiences of these people on the Downtown Eastside: hard-core drug addicts with multiple health challenges, such as HIV, hepatitis, and mental-health issues. They all had traumatic childhoods, which led to addictive cravings and also gave them the emotional pain that their addictions were meant to soothe.

Large-scale studies in the U.S. have shown that the more childhood adversity there is, the greater the risk of addiction. Sexual, physical, or emotional abuse; the death or incarceration of a parent; violence or addiction in the family; a rancorous divorce — these are stressful experiences. That doesn’t mean everybody with those experiences will become an addict, but the more of these experiences you have and the more severe they are, the greater your risk of addiction.

I worked at Insite in Vancouver, the only supervised-injection clinic in North America. People can actually bring their illegal drugs there, and they’re not arrested. They can inject under supervision with sterile needles and swabs and clean water, so there’s no disease transmission. Dozens of lives have been saved because when people overdosed, there were medical professionals there to resuscitate them. Insite is being kept open by a Supreme Court of Canada decision, which overruled the government’s attempts to close it down.

The experience of being treated well and with compassion has a huge positive impact on addicts’ sense of well-being and connection to the world, which makes it more likely that they’ll move toward overcoming their addictions. Right upstairs from Insite there was a place called Onsite, a detox facility that people could come to directly from the street.

The success rate of any rehab — even an expensive one — is not high. In the long term, recovering addicts need good nutrition, mindful-awareness practices (including meditation and yoga), and expert psychological counseling, but they rarely get all of that.

Frisch: Is there no evidence of a genetic predisposition to addiction?

Maté: There are genetic predispositions to addictions, but they don’t cause addiction by themselves; they just increase the risk. In both animal and human studies subjects don’t become addicted if they receive the proper nurturing, even in the presence of predisposing genes.

Frisch: How do you respond to the notion that addiction is caused by a lack of willpower and people should just say no?

Maté: To say addicts lack willpower is a meaningless pejorative. Why does somebody lack willpower? How does willpower develop? What undermines its development? The most common finding on brain scans of drug addicts is that the part of the brain that regulates impulses doesn’t function well.

We all struggle with willpower. How many people do you know who’ve ever kept a New Year’s resolution? Spas and gyms make their profits on people who sign up and then don’t show up.

Frisch: Do animal studies of addiction shine any light on its causes?

Maté: In fact, yes. The more you abuse, stress, or isolate animals, the more addicted they’ll become. If you place them alone in tiny cages with nothing but a lever that dispenses drugs, they’ll push that lever until they die. But if you give them lots of room to move, lots of company, materials to play with, and good nutrition, they won’t become addicted at all. Even when you try to make them addicted, you can’t.

Frisch: How do you help addicts overcome the shame and guilt they feel for being addicted?

Maté: Dealing with shame is an important part of recovery. The shame often predates the addiction, but the addiction magnifies it. I’ve had a shopping addiction, and when I was engaged in it, I ignored my kids significantly. I feel a lot of guilt over that. It’s hard work to forgive oneself for such behavior, without condoning it, of course.

The tragedy is that the trauma is passed on from one generation to the next. Children of addicts often become addicts because they grow up in a similar environment.

And to go back to hunter-gatherers, there was no addiction in North America before the coming of the Europeans. Even though there were substances here like peyote and psychedelic mushrooms and tobacco that could have been abused, they were used only to enhance consciousness rather than escape it. Only when the natives were dislocated and oppressed did they develop addictions.

Frisch: How could North American society do a better job of supporting families?

Maté: First of all by recognizing the importance of the family ­— not just giving it lip service, the way conservative political-action groups do, but really looking at what families need. Frequently the family-first groups want to cut social programs that actually support families. When women on welfare have to go back to work after a year or two, their kids go to inadequately staffed day cares — and those kids are going to have trouble later.

You want to support families? All you have to do is ask: What do children need? What do families need? In Canada maternity leave is six months to a year. In the U.S. the average maternity leave is six weeks. Even a baby rat needs its mother for four weeks.

Families also need communities in which people gather and talk instead of being suspicious of each other. They need a healthy culture, not the sexualized and horrifically violent culture that’s beamed into our homes through the television. They need to see people show respect and love for each other, not contempt, and cooperation and connection instead of relentless competition.

Frisch: Besides the social, environmental, and genetic factors that shape us, many religions and spiritual traditions believe that we are born with a destiny to live out or a karmic account to settle. What is your perspective on this?

Maté: My mind doesn’t stretch to past lives and karmic accounts. I don’t dispute or denigrate other people’s beliefs, but to my way of thinking, enough happens in this life to explain how we are without having to reach back into a previous existence. We certainly create karma for ourselves here, however, in each and every moment.