Trauma Matters: Gabor Mate Day One of Trauma Matters 2019 was led by Dr. Gabor Mate, doctor, renowned addiction expert, speaker, and author on topics including trauma, addiction, stress and childhood development. Trauma is not what happens to you, believes Dr. Mate, but what happens inside you as a result of what happens to you. It’s something with which he is both professionally and personally familiar. It’s also a topic that he believes deserves greater public attention. “I want you to imagine ten people a year die in England because of terrorism. Imagine the degree of outrage and public response and mobilization of national resources. Imagine the resolve to counter this threat. The public expression of solidarity. Yet the health impacts of inequality and poverty have long been demonstrated. We can’t say it’s a lack of information. What there is, is a lack of political will. It’s a relational issue, how the people in poverty relate to the people in power. Which parts of the population do they hold in their hearts and which are dismissed and ignored.” Dr. Mate offered an alternative to the Western medicine view of disease as an entity that exists separate from the individual, with a life and trajectory of its own. In that view, someone with depression has it because their brain is lacking or imbalanced in chemicals. Genetic factors are examined. The focus is on biological events, because it’s the biology of the brain that is disturbed. “I’m going to propose to you today an entirely different way of looking at trauma,” said Dr. Mate. “It’s a relational one. In which the individual’s biology cannot be separated from their social relationships nor their internal emotional dynamics. It’s rooted in history. Depression reflects a person’s life. And a person’s life always happens in the context of relationships.” Throughout his talk, Dr. Mate engaged an audience that included GP’s (general practitioners), therapists, consultants, coaches, and people who had or were experiencing trauma. A couple with three young children asked Dr. Mate how best to avoid passing on their own traumas to their children. The most important thing a parent can do for their child, responded Dr. Mate, was to take care of herself. Another man asked Dr. Mate how best to overcome his sense of inadequacy. “Do you know Usain bolt?” asked Dr. Mate. The man nodded. “Can you run as fast as him? No? Does that make you feel inadequate?” The man shook his head, grinning. Dr. Mate continued. “ The sense of inadequacy does not come from not being able to do something. It comes from feeling like we should be able to do something. But that’s no more realistic than wanting to run as fast as Usain Bolt.” A woman who had been struggling with her trauma for years asked Dr. Mate what it would take for her to finally recover. He responded with a question. “Tell me, if I met the 33 year-old (you), how would she compare to you now in terms of shame, distress, addictive patterns, relational issues? Is there any change? You’re getting there. But you’re putting pressure on yourself. Do you notice that? You’re telling yourself you have to get there in a certain time.” A practicing therapist asked Dr. Mate how best to work with a client who continued to traumatise himself despite her best efforts. “How do you feel when he does that?” asked Dr. Mate. “I feel frustrated.” “Why do you feel frustrated?” “Because I see the way out! I see how he can get better! Because—” “But why are you actually frustrated?” Dr. Mate kept his eyes trained on her, attentive. “I mean, what does that feel like?” “I feel... agitated. I feel like I’m not doing a good job. The maternal part of me wants to take responsibility for him.” Dr. Mate shook his head, kind but indomitable. “Wanting to take responsibility is not a feeling. ‘I’m not doing a good job’ is not a feeling. Tired, hungry, sad—those are feelings.” The therapist offered up: “I feel inadequate.” “That’s not a feeling either.” Dr. Mate paused, then continued. “I feel inadequate is a perception. But it’s not a feeling.” “I suppose…” The therapist thought. “I suppose I feel a certain amount of shame.” “Okay.” Dr. Mate nodded, approving. “Now that’s a feeling state. And how does your agitation and shame affect your very sensitive client?” “Oh, I’m very aware of it.” “So, let me ask you this. These feelings of shame and inadequacy. How new are they?” “They’re not new.” Dr. Mate nodded again. “How far do they go back?” “Oh.” She laughs, rueful. “A long way.” “So. This belief that you’re not adequate—it has nothing to do with the present moment.” Dr. Mate looks at her, and she shakes her head. “What was the first time you saw someone completely helpless and suffering?” She replies almost immediately. “My sister.” “How old were you then?” “Maybe six or seven.” “So it goes back to at least six or seven. This sense of inadequacy, of wanting to help someone, and this shame around not being able to—It has nothing to do with the patient. It’s actually old dynamics for you. What if you realized that you were a fine therapist, and it’s not your responsibility to make your patient stop suffering?” The audience watched this exchange raptly, and one senses this conversation has provoked much food for thought for all. By the end of the day, attendees nevertheless appeared hungry for more. The lines to speak with Dr. Mate throughout the day, during bathroom and lunch breaks, had stretched to the back of the auditorium. Yet there were no mere handshake-meet-and-greets or seconds-long book-signings; instead, anyone able to reach the front of the line was rewarded with minutes of Dr. Mate’s focused and measured attention. Several conversation resulted in audience members later coming up on stage to discuss their personal stories and questions with Dr. Mate in front of the audience. One senses that most attendees left with greater motivation to address the topic of trauma, which Dr. Mate couched within a broader context. Speaking to his audience of therapists, patients, parents, addicts, former-addicts, and more, Dr. Mate posed the following prompt: “Raise your hand if in the last five years you’ve been to see a cardiologist, dermatologist, endocrinologist, neurologist, gastroenterologist—any kind of specialist. Okay? Now, how many of them asked you about childhood trauma?” The audience laughed. “How many asked them about your relationship to your spouse?” asked Dr. Mate, serious. “How you feel about yourself as a human being?” Yet these factors are what drove you to the specialist in the first place.” Trauma Matters 2019 was organised by We Coproduce, a social consultancy owned and run by local people in West London to give local people an equal voice in shaping health-care solutions. Their national network of collaborators use authentic coproduction and radical disruptive innovation techniques to challenge systems that are not working. To do this effectively they use the arts, interactive technology and social media to facilitate democratic spaces for local people to collectively reimagine local health and social care outcomes. “We were thrilled to have Dr. Mate, because he’s a natural disrupter, his voice is absolutely critical in contemporary discussions about the future of health care, to us his thinking around trauma makes absolute sense. “ says Jane McGrath, CEO and co-founder of We Coproduce. We Coproduce collaborators have spent time in hospitals, prisons, forensic units, care homes and women’s refuges and they work with peers, academics, activists, poets, economists and visionaries. “What unites us is our belief that together we can and must change the world,” says Jane.