Pubdate: Mon, 25 Jan 2016
Source: Vancouver Sun (CN BC)
Copyright: 2016 Postmedia Network Inc.
Contact:  http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Gabor Mate
Note: Dr. Gabor Mate speaks and writes extensively on addiction. He 
is part of a Jan. 30 workshop, Who Do You Think You Are, that 
explores links between our early environments and addiction. Tickets: 
www.banyen.com/events/gabor-mate
Page: A10

A PROBLEM POORLY UNDERSTOOD

People in Pain: It's Time to Update Our Teachings and End the Stigma 
of Mental Health and Addiction

A recent Simon Fraser University study showed expensive services in 
Vancouver's Downtown Eastside do not result in improvements in mental 
health or legal problems for residents of this notorious 
neighbourhood, often called Canada's poorest postal code.

To ask, however, why many in the DTES do not get "better" is like 
wondering why patients keep dying or being sick in our hospitals, 
despite all the health care dollars expended on treatment, or why, 
despite repeated treatment, mentally ill people keep getting 
readmitted to psychiatric wards.

The answer is simple: That's where ill people go.

As the SFU study showed, most people come to the DTES from other 
areas of the country. The problem is not that of the DTES but that of 
Canada, of a society that generates mental illness and addiction, 
often in the same individuals, and then does not know how to handle 
them. It is the vexing problem of a health care system that poorly 
understands and even more poorly manages both mental disease and 
addiction, and of a legal system that exacerbates both.

Calling addicted people "offenders" may accurately describe their 
legal status, but obscures the reality that they have been, 
throughout their lives, offended against. None of them chose to be 
addicted or mentally ill, any more than someone chooses to develop 
cancer or rheumatoid arthritis. In each case, the addiction or 
psychological dysfunction is the outcome of childhood trauma 
superimposed on, in some cases, a genetic predisposition. The latter 
is less of a factor than mostly people think: The defining cause of 
addiction is always severe emotional hurt at a vulnerable stage in life.

In my 12 years of work as a physician in the DTES, I never met a 
female patient who had not been sexually abused as a child or 
adolescent, nor a male who had not suffered some form of severe 
trauma. Large-scale population studies have also proven childhood 
adversity is the common precursor of addictive behaviour in adults.

Addictions are attempts to escape pain, no matter what form they take 
- - whether to substances such as alcohol or heroin, or to behaviours 
like shopping, sexual roving, gambling, compulsive Internet browsing 
or video games. The degree of pain may vary, but the fundamental 
question is always, not why the addiction, but why the pain? The 
primal adversity need not be overt trauma, but always involves more 
emotional loss than the child could have borne or the adult can sustain.

Imaging studies have repeatedly demonstrated the brains of addicted 
people are lacking normal function in areas where pleasure, reward, 
motivation and impulse regulation are controlled. We do not blame 
people if their hearts are abnormal; we do not make them into 
"offenders" even if their own life habits contributed to the cardiac 
disease. Yet we stigmatize people and declare them outside the law if 
their brain functioning is impaired. And we do this, despite the 
undisputed findings of modern science that the human brain is shaped 
in its development, especially in the development of the circuits 
mentioned above, by the child's emotional environment.

Such facts are not yet taught in our institutions of higher learning. 
Many addiction treatment providers and mental health workers are 
unaware of them, let alone law enforcement personnel, corrections 
workers or judges. In the context of a system that marginalizes the 
most hurt and vulnerable segment of our population, we ought not be 
surprised that, despite the work of many dedicated people in the 
DTES, our results seem meagre. Or do they?

How much worse off would these DTES residents be without the services 
they received? How much medical or legal expense would have been 
incurred? How many would have died? Further, what if places such as 
Surrey or Edmonton or Toronto opened supervised injections sites, 
such as the Hastings facility Jane Philpott, our new Health Minister, 
just visited and found so inspiring? What if certain municipalities 
in B.C. and the Lower Mainland dropped their insular and retrograde 
"not in my backyard" policies and came to the support of their 
troubled fellow citizens?

If we asked ourselves what part of us is so judgmental and impatient 
with people we call addicts, we would find, to our discomfort, that 
they represent aspects of ourselves we would rather not acknowledge. 
Easier to ghettoize these spectres of our society's dysfunction and 
bemoan the cost.
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MAP posted-by: Jay Bergstrom