The Myth of Normal p.253

Let’s begin with something rather simple, now on the rise: depression, a state I know intimately. The word’s literal meaning is quite telling. To depress something means to push it down, as one might a beach ball in a swimming pool. I like that analogy especially because one can easily feel how much concerted force it takes to keep the ball submerged, and the way it “wants” to find a way back up to the surface. Keeping it down takes a toll.

What is pushed down when a person is depressed is easily identified by its absence: emotion, the continual flow of feelings that remind us we’re alive. Unlike the wrangler of the beach ball, a depressed person doesn’t choose this submersion of life energy—it imposes itself, turning a once-vibrant emotional landscape into arid desert. The only “feeling” that remains, typically, is more sensation than emotion, a thrumming, indistinct pain that threatens to consume everything, and sometimes does.

If we label this depression of feeling a disease, we risk not recognizing its original adaptive function: to distance oneself from emotions that are unbearable at a time in life when to experience them is to court greater calamity. Recall what I called the tragic tension between authenticity and attachment. When experiencing and expressing what we feel threatens our closest relation-ships, we suppress. More accurately, we don’t: our mind does that automatically and unconsciously on our behalf.

Gabor Maté and Daniel Maté – The Myth of Normal: Trauma, Illness & Healing in a Toxic Culture p.253

The Myth of Normal p.214

Though the disease paradigm still embraced by most addiction specialists and treatment programs is more compassionate, it, too, misses the human element. It separates mind from body—or, in this case, brain from mind, seeing the brain in purely biochemical terms. The fact is, personal and social life events, filtered through the mind, shape the brain throughout the life-time. You cannot, scientifically, cleave biology from biography, especially when it comes to a process as psychologically layered as addiction.

Not that there’s no value in considering addiction’s neurochemical side. The brilliant work of Dr. Volkow and others has demonstrated that substances of dependence do, over time, change the brain so that essential functions, such as impulse regulation—which would aid someone in resisting addiction’s pull—become significantly compromised, even as the circuits of reward and motivation become trained on the desired drugs. In this sense, the brain does become an impaired organ, with diminished capacity to make rational choices, obsessively intent instead on satisfying the addictive drives.

We err, however, when we focus on drugs alone: it does not take a substance addiction to bring about changes in brain chemistry. Scans have shown similar deleterious changes in the brains of nonsubstance addicts as well, such as inveterate internet gamers. The compulsive intake of foods that trigger the brain’s reward apparatus can also produce such effects.

For all that, the equation of addiction with a largely genetically programmed, treatable disease is, as mentioned, scientifically and humanely a step forward from the shaming “bad choices” model. Just as we wouldn’t think of blaming the owner of a diseased kidney, it makes no sense to reproach someone for having a “sick” brain, especially if that “sickness” was inherited. The problem is that, in typical medical fashion, the disease paradigm turns a process into pathology. Note, too, that “treatable” is a far cry from “healable”—which says less about the nature of addiction than about the medical system’s failure to understand it . . .

I will only suggest that “disease” is more therapeutically useful as a metaphor rather than a literal fact. As with most chronic conditions, viewing addiction as a dynamic process to be engaged with rather than a demonic force to be feared or battled can ultimately expand the possibilities for healing.

For a more grounded take on addiction, we need to consider not just people’s genes or brain circuitry, but also their real encounters with their world. We need to look closely at people’s life experiences. Addictions of any kind are not abnormal ailments, willfully self-inflicted maladies, brain disorders, or genetic short straws. Properly understood, they are not even that puzzling. As with other ostensibly mysterious conditions named in this book, they are rooted in coping mechanisms. To be sure, they may take on some features of disease: a dysfunctional organ, tissue damage particularly with extensive drug use, physical symptoms, impairment of certain brain circuits, cycles of remission and relapse, even death. But to call them “diseases” is to miss both the point and the opportunity to deal with them intelligently. Addictions represent, in their onset, the defenses of an organism against suffering it does not know how to endure. In other words, we are looking at a natural response to unnatural circumstances, an attempt to soothe the pain of injuries incurred in childhood and stresses sustained in adulthood.

Gabor Maté and Daniel Maté – The Myth of Normal: Trauma, Illness & Healing in a Toxic Culture p.214