An education in trauma
Medical schools should make more room for the subject of trauma—this, according to acclaimed trauma and addictions expert Dr. Gabor Maté, during a recent stop in Winnipeg.
Maté was joined by more than 1,000 attendees at the National Centre for Truth and Reconciliation’s gathering for residential school Survivors and regional health support and cultural workers in late August, where he delivered the keynote address. He also sat down with the Centre’s executive director, Stephanie Scott, and UM Today The Magazine.
“The average doctor doesn’t hear a single lecture [about trauma] in all of their medical training—not five minutes. You know? They should have a whole course on it. They should have a whole four years of courses on it, actually. Because when it comes to healing, if you can heal the trauma, you can heal the conditions that trauma causes.”
The retired physician shared worrisome stats with the audience of Survivors and support workers from across the country, including: Indigenous people develop diabetes up to 30 years earlier than the average Caucasian and have three times the rate of rheumatoid arthritis.
He also shared his thoughts on addiction, insisting it’s not a disease, nor is it inherited, but rather a manifestation of trauma, an unhealed wound. It is never the primary problem; it is an attempt to solve a problem, said Maté. He shared his mantra: “Don’t ask ‘why the addiction?’ ask ‘why the pain?’” It’s no accident there is a significant, disproportionate plague of addiction in Indigenous communities, he noted.
“They happened to be the ones who’ve suffered most in this country,” Maté said.
He spent more than a decade treating patients with drug addictions in Vancouver’s East Side.
“I couldn’t help but notice after a while that the people who got ill—it wasn’t accidental. It wasn’t random. There are certain things about them and how they lived their lives and how they thought about themselves, and how they related to their world that promoted the illness.”
He invited attendees of the gathering to explore if they have any of these reappearing characteristics: a compulsive concern for the emotional needs of others while ignoring their own; identifying with duty, role and responsibility at the expense of their own rest; repressing healthy anger; feeling like they’re responsible for how people feel and wanting to avoid disappointing anyone.
“Those are the things that lead to illness,” Maté said. “Because what is lacking in all of these is compassion for the self…. You do have to find your own authentic self, which means knowing what you need and offering that compassion to yourself.”
Mandy Buss [B.Sc./06, MD/09], the Indigenous health lead for the department of family medicine in the Max Rady College of Medicine, Rady Faculty of Health Sciences, echoes Maté’s call for more trauma training in med schools. UM helped chart the path with a session developed seven years ago for undergrads about trauma-informed care. Buss oversees the initiative, which involves a Knowledge Keeper and has students walk through a series of cases with a trauma-informed lens.
But a two-hour session barely touches the surface, says Buss, who creates and implements Indigenous health curriculum.
“We don’t really dive into what skills physicians need and I don’t know of too many programs across Canada that actually even touch upon it, let alone talk about the theory.”
That prompted Buss to get involved in a research project on trauma-informed care curriculum in family medicine, with the intent of ultimately increasing its presence in the education of future doctors. “Not only to benefit the patients that we see, but also to benefit the physicians because it can be really dissatisfying when you’re trying to navigate trauma within patients and you feel like you’re not well equipped to deal with it,” says Buss.
“I think we don’t do it because people don’t know how to teach it. We need, really, a lot more research around how do we build those skills.”
Lisa Monkman [B.Sc./00, MD/04], an Anishinaabe family physician and co-chair of the Postgraduate Medical Education Truth and Reconciliation Committee in the Max Rady College of Medicine, agrees that trauma is a much-ignored topic and applauds Buss’ strides to ensure what Manitoba doctors are learning better reflects the needs of all patients.
“What she’s doing is unique,” says Monkman. “Most other medical schools do not have this robust or informed a curriculum that addresses the complexity of [realities]—like racism—and its impacts on Indigenous health.”
In Maté’s latest book, The Myth of Normal: Trauma, Illness & Healing in a Toxic Culture, he references a former trailblazing Harvard University professor and physician from the 1930s, Dr. Soma Weiss.
“Weiss told the medical school class that emotional factors are at least as important as physical ones in the causation of illness, and they must be at least as important in the healing of them,” he said.
More recently, a current Harvard professor who believes in this connection told Maté that to talk about mind-body medicine is to jeopardize one’s career. Another colleague at UCLA shared that she has started asking patients about their trauma and is effectively easing them off medications. She was afraid to use her name in his book.
“There’s a lot of doctors who are getting this information or picking up on this stuff a lot more than they used to be. So it’s changing. But it’s changing on the margins. It’s not changing in the mainstream medical schools. The resistance is incredible,” he said, noting a sweeping transformation is probably a century away.
Monkman suspects physicians’ reluctance to adopt a more holistic approach comes down to a few things: not having the background in trauma care and addictions, but also not having the time in an over-run health-care system.
“It’s poorly understood and also I think that it’s emotionally easier to focus on the physical body and disease processes,” she says. “It takes time to get to know people in the context of their own lives in order to know what’s going to help them in a meaningful way.”
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LISTEN to a related podcast: What’s The Big Idea, featuring Dr. Marcia Anderson [MD/02], vice-dean of Indigenous health, social justice and anti-racism at the Rady Faculty of Health Sciences. In conversation with President Michael Benarroch, Anderson discusses how the University of Manitoba can further ground medical education in anti-racist practices and provide greater health equity for Canada’s Indigenous, Black and racialized communities.
Read more about Maté’s visit to Winnipeg in UM Today The Magazine.