Gabor Maté is a Vancouver physician who gained acclaim for writing about his medical work with the Portland Hotel Society community—an inner city population comprising largely formerly and currently homeless and drug-addicted people. The empirical basis of trauma theory is the research of Vincent Felitti, the longtime head of the Department of Preventive Medicine at Kaiser Permanente, in California, on adverse childhood experiences, or ACE, the primary tool used for trauma assessment.
Maté—in his best selling book, In the Realm of Hungry Ghosts—insists that trauma is the root of all addiction, based on this highly traumatized PHS population. He demands that people examine their lives to uncover their trauma in order to explain their addictions. After that? Not much. Maté is essentially a psychoanalyst who claims that ferreting out childhood trauma solves psychological problems. No research supports this idea. Along the way, Maté lauds Alcoholics Anonymous for curing trauma—without a scintilla of evidence that the 12 steps serve this function.
But before I turn to this massive Maté/Felitti-generated industry and its consequences, I want to talk about Ted Cruz. Yes, the conservative Christian Republican presidential candidate who wants police to patrol American Muslim communities whether or not terrorist activity is known to occur there. I personally would no sooner vote for Cruz than I would for Donald Trump (whose bullying, I pointed out in Psychology Today in 2011, was tremendously effective).
Only, I'm not going to say bad things about Cruz. I am going to focus on the good things about Cruz—his family relationships. As a sidelight, Trump has recently tweeted side-by-side a picture of his own wife, Melania, a beautiful former model, and an unflattering photo of Cruz's wife, Heidi, a quite beautiful "normal" woman, with the text: "Pictures are worth a thousand words." In other words, "My wife is more attractive than yours, so there." In fact, Heidi is the best thing about Cruz—an extremely successful pioneer in the male-dominated financial world who at the same time strives above all to better the world. And God bless her.
Meanwhile, Ted and Heidi Cruz seemingly have a mature, sharing, and mutually supportive marriage we could all strive to emulate. As for Trump, his incredibly insensitive, immature, sexist tweet says all that needs to be said about his qualifications to be an adult, let alone president.
But this piece isn't about Heidi Cruz any more than it is about Cruz's scary theocratic politics. It's about Cruz's efforts to help his older half sister, Miriam Cruz, who died after an endless progression into the world of addiction:
"He fielded phone calls from his half sister when she landed in jail. He kept tabs on her as she bounced from boyfriend to boyfriend, job to job, and in and out of rehab. He took a particular interest in making sure that her son was cared for, including taking out a large credit card advance to send him to a military-themed boarding school. Ms. Cruz, friends said, came to look up to her younger half brother and to rely on his help."
And God bless Ted Cruz for that.
In one near-to-the-end interaction, Cruz and his sister's and his biblical-style father, Rafael, visited Miriam in a decrepit motel where she was living. Perhaps using their religious-based appeals to her better nature (like those contained in the 12 steps, such as Steps 3, "Made a decision to turn our will and our lives over to the care of God as we understood Him," or 5, "Admitted to God, to ourselves, and to another human being the exact nature of our wrongs") they got nowhere.
As Cruz described the interaction:
When Mr. Cruz and his father took her to a nearby Denny’s, Mr. Cruz wrote, they could not get through to her.
Ms. Cruz was hopelessly angry, he wrote in “A Time for Truth.”
“Angry that her parents divorced when she was a little girl, angry that her father missed a high school swim meet of hers.” (my emphasis)
Did Miriam Cruz need to focus more on the wrong and hurts that she had experienced? Was insufficient recognition of her trauma the source of her addiction, as Maté would have it? Or was she already reifying the annoying slights of her life beyond recognition?
Obviously, Rafael had divorced Miriam's mother, not a positive experience for people. In fact, it is one of the traumas identified in the The Adverse Childhood Experiences (ACE) Study, which found far more frequent addictive substance use based on the number of traumatic life events people experienced in childhood: emotional, physical, or sexual abuse; physical or emotional neglect; violence, alcoholism and drug abuse, incarceration, or mental illness within the family; and having been raised by anyone other than two biological parents.
So there is Miriam's problem, right? Only she experienced as positive an aftermath of divorce as might be imagined.
"Miriam was a frequent visitor to Rafael Cruz’s new family, letting his toddler son Ted, nine years younger, pull on her hair and play with her for hours. As a teenager, Ted would sometimes spend the night with Miriam and her husband, Larry Maykopet, who lived a few blocks away from the Cruz home in Houston, Mr. Maykopet said."
In fact, if we were to codify Miriam Cruz's deepest problem, the symbol of what kept her life mired in drugs and addiction, it would be this: she never could raise her sights above the negatives in her life and the damage she had suffered as a result.
As to basic trauma-addiction theory, it is now widely assumed that, as Maté asserts, all addiction can be traced to trauma, and that the search for such trauma is the cure for addiction. I turn to a splendid piece by Ken Anderson, a PT blogger, in the on-line addiction magazine, The Influence, for which I am a columnist, to decisively refute these assertions.
Ken's piece makes three essential points, but fails to note one other.
1. No evidence whatever (see my piece in The Influence on the efficacy of placebos) supports the efficacy of uncovering, and focusing on, trauma or the 12 steps for remedying (a) addiction, (b) the effects of trauma. Indeed, a quite large body of psychological research suggests the reverse, that downplaying and ignoring trauma in one's life is associated with superior outcomes. In one admirably long-term prospective study Anderson notes, "Horwitz et al. used court records to identify victims of child abuse and tracked them down as adults 20 years later. There were 641 subjects in the study; but the study showed that these adult victims of child abuse were no more likely to have substance use disorders than matched controls from the general population."
What could account for this monumentally significant difference in results and therapeutic emphasis between Filetti’s and Horwitz’s work? Anderson correctly divines that people who ignore their abuse experiences are actually more likely to overcome them: “This suggests the possibility that people who forget childhood abuse have better adult mental health than those who recall it.”
2. Most people (94%) who encounter addictions do not suffer a diagnosable trauma reaction, or PTSD.
3. Anderson's post recognizes that trauma theory does far more harm than good.
“If you are one of the 94% of people with a substance use disorder who do not have PTSD, you should not seek out treatment for PTSD, even if you—like most people—have suffered some trauma in your past. There is simply no evidence that PTSD therapy will be helpful to you, and it might even be harmful.” Moreover, “If you have a history of trauma but not PTSD, a good therapist will acknowledge and respect that without doing you harm by dwelling on it.”
4. What Anderson misses: trauma theory has become a societal alibi for ignoring the social causes of both trauma and addiction.
This aspect of the disservice trauma theory performs was captured by the eminent historian Jill Lepore in her trenchant historical and public health analysis titled, “Why Can’t We Stop Child Abuse?” Her analysis can also be applied in every regard to our failure to stop (or reduce) addiction, which, as I have written for The Influence, is trending in the opposite direction.
The murky science of risk assessment relies on attempts to quantify “trauma” and “adversity,” which, on the one hand, are meaningful clinical concepts but, on the other hand, are proxy terms for poverty. (And, worryingly, the study of trauma has both a dubious intellectual history and an abysmal track record, not least because of its role in the sexual-abuse scandals of the eighties and the recovered-memory travesty of the nineties.). . . . (parentheses in original)
The noble dream here is that, if only child-protective agencies collected better data and used better algorithms, children would no longer be beaten or killed. Meanwhile, there is good reason to worry that the ACE score is the new I.Q., a deterministic label that is being used to sort children into those who can be helped and those who can’t. And, for all the knowledge gained, the medicalization of misery is yet another way to avoid talking about impoverishment, destitution, and inequality.
For preventing both violence against children and addiction in our society, which are especially present for those deprived of social resources, we are barking up the wrong tree, led by Maté and his ilk.
Stanton Peele, Ph.D., J.D., is the author (with Ilse Thompson) of Recover! An Empowering Program to Help You Stop Thinking Like an Addict and Reclaim Your Life. His Life Process Program is available online. His book Addiction-Proof Your Child is a model for the emerging area of harm reduction in addiction prevention. Stanton has been innovating in the addiction field since writing Love and Addiction with Archie Brodsky. He has published 12 books, and has won career awards from the Rutgers Center of Alcohol Studies and Drug Policy Alliance. Stanton is a columnist for The Influence.