Tuesday, May 31, 2011

In The Realm of the Hungry Ghosts

"Nothing records the effects of a sad life so graphically as the human body.” 
Fascinating interview with Dr. Gabor Mate, Canadian physician specializing in how early childhood effects brain development.  His latest book is In the Realm of Hungry Ghosts: Close Encounters with Addiction.  There is more on the website democracynow.org.  We talking bout a revolution, yo.

DR. GABOR MATÉ: The hardcore drug addicts that I treat, but according to all studies in the States, as well, are, without exception, people who have had extraordinarily difficult lives. And the commonality is childhood abuse. In other words, these people all enter life under extremely adverse circumstances. Not only did they not get what they need for healthy development, they actually got negative circumstances of neglect. I don’t have a single female patient in the Downtown Eastside who wasn’t sexually abused, for example, as were many of the men, or abused, neglected and abandoned serially, over and over again.
And that’s what sets up the brain biology of addiction. In other words, the addiction is related both psychologically, in terms of emotional pain relief, and neurobiological development to early adversity.
AMY GOODMAN: What does the title of your book mean, In the Realm of Hungry Ghosts?
DR. GABOR MATÉ: Well, it’s a Buddhist phrase. In the Buddhists’ psychology, there are a number of realms that human beings cycle through, all of us. One is the human realm, which is our ordinary selves. The hell realm is that of unbearable rage, fear, you know, these emotions that are difficult to handle. The animal realm is our instincts and our id and our passions.
Now, the hungry ghost realm, the creatures in it are depicted as people with large empty bellies, small mouths and scrawny thin necks. They can never get enough satisfaction. They can never fill their bellies. They’re always hungry, always empty, always seeking it from the outside. That speaks to a part of us that I have and everybody in our society has, where we want satisfaction from the outside, where we’re empty, where we want to be soothed by something in the short term, but we can never feel that or fulfill that insatiety from the outside. The addicts are in that realm all the time. Most of us are in that realm some of the time. And my point really is, is that there’s no clear distinction between the identified addict and the rest of us. There’s just a continuum in which we all may be found. They’re on it, because they’ve suffered a lot more than most of us.
AMY GOODMAN: Can you talk about the biology of addiction?
DR. GABOR MATÉ: For sure. You see, if you look at the brain circuits involved in addiction—and that’s true whether it’s a shopping addiction like mine or an addiction to opiates like the heroin addict—we’re looking for endorphins in our brains. Endorphins are the brain’s feel good, reward, pleasure and pain relief chemicals. They also happen to be the love chemicals that connect us to the universe and to one another.
Now, that circuitry in addicts doesn’t function very well, as the circuitry of incentive and motivation, which involves the chemical dopamine, also doesn’t function very well. Stimulant drugs like cocaine and crystal meth, nicotine and caffeine, all elevate dopamine levels in the brain, as does sexual acting out, as does extreme sports, as does workaholism and so on.
Now, the issue is, why do these circuits not work so well in some people, because the drugs in themselves are not surprisingly addictive. And what I mean by that is, is that most people who try most drugs never become addicted to them. And so, there has to be susceptibility there. And the susceptible people are the ones with these impaired brain circuits, and the impairment is caused by early adversity, rather than by genetics.
AMY GOODMAN: What do you mean, “early adversity”?
DR. GABOR MATÉ: Well, the human brain, unlike any other mammal, for the most part develops under the influence of the environment. And that’s because, from the evolutionary point of view, we developed these large heads, large fore-brains, and to walk on two legs we have a narrow pelvis. That means—large head, narrow pelvis—we have to be born prematurely. Otherwise, we would never get born. The head already is the biggest part of the body. Now, the horse can run on the first day of life. Human beings aren’t that developed for two years. That means much of our brain development, that in other animals occurs safely in the uterus, for us has to occur out there in the environment. And which circuits develop and which don’t depend very much on environmental input.
When people are mistreated, stressed or abused, their brains don’t develop the way they ought to. It’s that simple. And unfortunately, my profession, the medical profession, puts all the emphasis on genetics rather than on the environment, which, of course, is a simple explanation. It also takes everybody off the hook.
AMY GOODMAN: What do you mean, it takes people off the hook?
DR. GABOR MATÉ: Well, if people’s behaviors and dysfunctions are regulated, controlled and determined by genes, we don’t have to look at child welfare policies, we don’t have to look at the kind of support that we give to pregnant women, we don’t have to look at the kind of non-support that we give to families, so that, you know, most children in North America now have to be away from their parents from an early age on because of economic considerations. And especially in the States, because of the welfare laws, women are forced to go find low-paying jobs far away from home, often single women, and not see their kids for most of the day. Under those conditions, kids’ brains don’t develop the way they need to.
And so, if it’s all caused by genetics, we don’t have to look at those social policies; we don’t have to look at our politics that disadvantage certain minority groups, so cause them more stress, cause them more pain, in other words, more predisposition for addictions; we don’t have to look at economic inequalities. If it’s all genes, it’s all—we’re all innocent, and society doesn’t have to take a hard look at its own attitudes and policies.
AMY GOODMAN: Can you talk about this whole approach of criminalization versus harm reduction, how you think addicts should be treated, and how they are, in the United States and Canada?
DR. GABOR MATÉ: Well, the first point to get there is that if people who become severe addicts, as shown by all the studies, were for the most part abused children, then we realize that the war on drugs is actually waged against people that were abused from the moment they were born, or from an early age on. In other words, we’re punishing people for having been abused. That’s the first point.
The second point is, is that the research clearly shows that the biggest driver of addictive relapse and addictive behavior is actually stress. In North America right now, because of the economic crisis, a lot of people are eating junk food, because junk foods release endorphins and dopamine in the brain. So that stress drives addiction.
Now imagine a situation where we’re trying to figure out how to help addicts. Would we come up with a system that stresses them to the max? Who would design a system that ostracizes, marginalizes, impoverishes and ensures the disease of the addict, and hope, through that system, to rehabilitate large numbers? It can’t be done. In other words, the so-called “war on drugs,” which, as the new drug czar points out, is a war on people, actually entrenches addiction deeply. Furthermore, it institutionalizes people in facilities where the care is very—there’s no care. We call it a “correctional” system, but it doesn’t correct anything. It’s a punitive system. So people suffer more, and then they come out, and of course they’re more entrenched in their addiction than they were when they went in.
AMY GOODMAN: I’m curious about your own history, Gabor Maté.
AMY GOODMAN: You were born in Nazi-occupied Hungary?
DR. GABOR MATÉ: Well, ADD has a lot to do with that. I have attention deficit disorder myself. And again, most people see it as a genetic problem. I don’t. It actually has to do with those factors of brain development, which in my case occurred as a Jewish infant under Nazi occupation in the ghetto of Budapest. And the day after the pediatrician—sorry, the day after the Nazis marched into Budapest in March of 1944, my mother called the pediatrician and says, “Would you please come and see my son, because he’s crying all the time?” And the pediatrician says, “Of course I’ll come. But I should tell you, all my Jewish babies are crying.”
Now infants don’t know anything about Nazis and genocide or war or Hitler. They’re picking up on the stresses of their parents. And, of course, my mother was an intensely stressed person, her husband being away in forced labor, her parents shortly thereafter being departed and killed in Auschwitz. Under those conditions, I don’t have the kind of conditions that I need for the proper development of my brain circuits. And particularly, how does an infant deal with that much stress? By tuning it out. That’s the only way the brain can deal with it. And when you do that, that becomes programmed into the brain.
And so, if you look at the preponderance of ADD in North America now and the three millions of kids in the States that are on stimulant medication and the half-a-million who are on anti-psychotics, what they’re really exhibiting is the effects of extreme stress, increasing stress in our society, on the parenting environment. Not bad parenting. Extremely stressed parenting, because of social and economic conditions. And that’s why we’re seeing such a preponderance.
So, in my case, that also set up this sense of never being soothed, of never having enough, because I was a starving infant. And that means, all my life, I have this propensity to soothe myself. How do I do that? Well, one way is to work a lot and to gets lots of admiration and lots of respect and people wanting me. If you get the impression early in life that the world doesn’t want you, then you’re going to make yourself wanted and indispensable. And people do that through work. I did it through being a medical doctor. I also have this propensity to soothe myself through shopping, especially when I’m stressed, and I happen to shop for classical compact music. But it goes back to this insatiable need of the infant who is not soothed, and they have to develop, or their brain develop, these self-soothing strategies.
AMY GOODMAN: How do you think kids with ADD, with attention deficit disorder, should be treated?
DR. GABOR MATÉ: Well, if we recognize that it’s not a disease and it’s not genetic, but it’s a problem of brain development, and knowing the good news, fortunately—and this is also true for addicts—that the brain, the human brain, can develop new circuits even later on in life—and that’s called neuroplasticity, the capacity of the brain to be molded by new experience later in life—then the question becomes not of how to regulate and control symptoms, but how do you promote development. And that has to do with providing kids with the kind of environment and nurturing that they need so that those circuits can develop later on.
That’s also, by the way, what the addict needs. So instead of a punitive approach, we need to have a much more compassionate, caring approach that would allow these people to develop, because the development is stuck at a very early age.
AMY GOODMAN: You began your talk last night at Columbia, which I went to hear, at the law school, with a quote, and I’d like you to end our conversation with that quote.
DR. GABOR MATÉ:  Naguib Mahfouz, the great Egyptian writer. He said that "Nothing records the effects of a sad life” so completely as the human body—“so graphically as the human body.” And you see that sad life in the faces and bodies of my patients.

Monday, May 30, 2011

Patience is a Virtue

My Mom quoted that line from Shakespeare.  A lot.  It is not a virtue with which my family is especially gifted.

 May has been a bit of a tough month for me.

Not to worry, everything is fine, it's just very old stuff surfacing.  And I don't really think I want to say anymore about that here and now, but I do want to check in, and say hello, I'm here, I'm OK, I am just PROCESSING some stuff.  (You know, kinda like when the colored beach ball spins around on your computer screen.)  I'm still working away over here, but just don't have a lot of words yet.

I am trying to have "patience with all that is unsolved within my heart"...  And hoping, like Rilke advises, to learn to love the questions until I can live my way, someday, into the answers.

Thursday, May 5, 2011

The Skinny on Hormonal Fat

Okay,  true enough:  I told Nina, my oncology nurse, that of all the symptoms brought on by Arimedex (painful achey joints, sudden debilitating tiredness, and significant increase in centrally-located pudge) the one I was least concerned about was the weight gain.  Hey, I've had practice being fat!  

But the truth is, it has been discouraging to experience my weight going up up up (again) after years of working to bring it down.  (Okay, sure, the cancer/not-being-able-to-eat-thing accounts for the last 25 lbs that fell away last summer.)  It has come back so suddenly that I have not grown accustomed to it, and I am newly aware of just how uncomfortable it is--- and that's besides the challenge it presents to my ego and my aesthetic sensibilities.

I am also newly aware of how often we are invited to hate our bodies in this culture (and I still think that applies especially --although not exclusively-- to women).  I have to remind myself, Hey, you know-- I can still walk around in this body (not as far or as fast as I used to, but it gets me from here to there).  I can see, smell, hear, taste, feel  and experience beauty.   I can go to the bathroom (Yay!  No, really, if you've never been challenged in this area you have NO IDEA how grateful I am).  And when I consider all the thousands of functions my body takes care of without my even being aware of it -- I don't remind myself to blink or or breathe or circulate blood.  If I want a drink of water, my body picks up the glass without my brain even consciously issuing the command--  I really have to admit that there is so much more going right in my body then going wrong.  For a 50+ year-old vehicle with some major issues, it is holding its own pretty damn well.    

Still...  I was more comfortable about 35 lbs ago.  Is there something I can do about this?  What IS the connection between every molecule of estrogen being sucked out of my system and this newly inflated spare tire?  Well, I've done some looking into it -- after all, Curious Minds (especially female minds over 45) Want to Know.  Here's the scientific skinny:
Hormones Involved in Weight Maintenance
Estrogen: Estrogen is the female sex hormone that is responsible for causing monthly ovulation. During female menopause, your estrogen levels decline rapidly, causing your body to stop ovulating. However, estrogen also seems to play a big role in menopausal weight gain. As your ovaries produce less estrogen, your body looks for other places to get needed estrogen from. Fat cells in your body can produce estrogen, so your body works harder to convert calories into fat to increase estrogen levels. Unfortunately for you, fat cells don't burn calories the way muscle cells do, which causes you to pack on the unwanted pounds.
Progesterone: During menopause, progesterone levels will also decrease. Like estrogen, lower levels of this hormone can be responsible for many of the symptoms of menopause and that includes weight gain, or at least the appearance of it. Water retention and menopause often go hand in hand since water weight and bloating are caused by decreased progesterone levels. Though this doesn't actually result in weight gain, your clothes will probably feel a bit tighter and you may feel a bit heavier. Water retention and bloating usually disappear within a few months.
Androgen: This hormone is responsible for sending your new weight directly to your middle section. In fact, weight gain during menopausal years is often known as "middle age spread" because of the rapid growth of the mid-section. Often, one of the first signs of menopause is an increase of androgen in your body, which causes you to gain weight around your abdominals instead of around your lower half.
Testosterone: Testosterone helps your body to create lean muscle mass out of the calories that you take in. Muscle cells burn more calories than fat cells do, increasing your metabolism. In natural menopause, levels of testosterone drop resulting in the loss of this muscle. Unfortunately, this means a lower metabolism. The lower your metabolism is, the slower your body burns calories.
Terrific!  At least now we know-- it is Real, it is, in some ways, Not Our Fault.  But.  Is there anything we can do about it?  Pretty much the same old, same old:

Eat a balanced diet. Avoid refined sugars and indulge in fruits and vegetables. 
Avoid crash diets. Starvation will only cause your metabolism to slow down, causing you to gain more weight later on.  
Don't lose large amounts of weight. Being very thin can lead to an increased chance of developing osteoporosis. 
Limit your intake of caffeine, nicotine, and alcohol. These can exacerbate water retention.

Remain active. Do aerobics to increase your metabolism and burn fat. Do weight bearing activities such as walking and cycling to increase muscle mass and ward off osteoporosis.

But here's some advice beyond the usual suspects:
Instead of hating your new body, try to be more accepting of yourself. 
Focus on being healthy and active, not trying to fit into your old clothes. 
Yeah.  I hear that.  Accepting where you are, not despising what you have. Cultivating gratitude.  For the first year of our practice together, my yoga teacher Meg would end nearly every session by saying, "A grateful heart leads to a peaceful life."  The presence of pudge can definitely present a daily challenge to my ability to cultivate gratitude for my body.  

Theodore Roethke has a poem that goes, in part:

God bless the Ground!  I shall walk softly there,
And learn by going where I have to go.

Yeah.  As another poet said, 
Aye, there's the rub!

Sunday, May 1, 2011

May Day! May Day! We Need a New Paradigm, STAT!

Sir Ken Robinson is talking about a revolution!
 Changing Education Paradigms
This guy is brilliant!
Find this video and more with Ken Robinson on You Tube.  He made a big splash at the TED conference a few years ago and has several books out.  If you are an artist, an educator, or just  a fully functional human being, you know we need a new way of thinking about education. 
Please share.