Gabor Maté on Bio-Psycho-Social Medicine

by Ri Bornstein


Dr. Gabor Maté is a leading voice for the compassionate treatment of addiction and trauma. His work as a physician spans family medicine, palliative care, and clinical rehabilitation. Books covering childhood development, (“Hold on to Your Kids”) and trauma (“When the Body Says No”) are internationally best-selling arguments for a humanist approach to medicine and parenting woven with anecdotes from his years of practice. I recently attended a talk he gave on the relationship between stress and illness. ]For the majority of the talk Dr. Maté focused on the inter-relatedness of three domains of disease and health: social conditions, psychological states and reactions, and biological/chemical phenomena. He cited George Engel’s “Bio-Psycho-Social” paradigm to summarize the interactivity of these systems and gave many examples from his own family medical practice as well as cases from different colleagues and studies. 

    Maté told us that most medical students are encouraged to approach disease as an exclusively biological event that rarely if ever requires information about a patient’s emotional or social circumstances in order to be successfully treated. Maté claimed that this hierarchical system resulted in a majority of treatments being only partially effective or understood.  Current research, he explained, is opening up the interrelatedness of the body’s biological symptoms and emotional states.
    He rattled off a long list of statistical correlations between trauma and chronic disease: Women with PTSD symptoms have a statistically higher likelihood of ovarian cancer. Men who were sexually abused are 3X more likely to have heart attacks and have a 50% increased chance of having cancer. 

He also told a few anecdotes about patients of his who, after addressing serious emotional issues, were relieved of physical symptoms from what they believed to be unrelated conditions.  A woman with scleroderma, a hardening of muscle groups throughout the body, was able to walk for the first time in years and focus on her writing after processing a childhood trauma in therapy.
    What really interested me was his descriptions of the interconnectivity of the body’s regulatory systems. Hearing an insult, for instance, generates responses in the limbic system, fight/flight/freeze, that raises the heart rate, shifts hormones, affecting the cardiovascular system and the gut. Stress and social isolation disrupt the body’s ability to co-regulate hormonal, neural, vascular and other systems. 
Physiology, he said, connects the hormonal system, vascular system, and emotional regulatory regions of the brain. As there is a unity of the components of a cell, so is there unity to these systems.

Maté stressed that we have to understand the body’s organs and systems as coextensive branches of the nervous system and connected to our emotions. One of his examples was that expressions we often use to describe embodied feelings (“gut feeling”, “You are in my heart”) have physiological underpinnings. These intuitions aren’t metaphorical, they’re biologically factual. Our memories and experiences are stored and reacted to by organs and systems throughout the body.
    I also appreciated his concise description of traumatic symptoms, which he addressed in the Q & A: i) Repressing our own needs. ii) Suppressing or overindulging anger (this one he didn’t give much information about). iii) Rigid identification with a role rather than self (this was fascinating to me, I hadn’t heard it before. Hiding from self and obsessively attaching to a role to fulfill in work or personal life) iv) Hyper responsiveness to stress.

I’m looking forward to reading his older work. I’d also like to get a copy of the new work that focuses on this material.

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