A Conscious Examen
Posted by Margaret Manning Shull on April 16, 2012
Dr. Gabor Maté is a controversial figure in the world of medicine. Maté, a private family practice physician for over twenty years, and the coordinator of the Palliative Care Unit at Vancouver hospital, now helps addicts as a staff physician at the infamous Portland Hotel. The Hotel is the only supervised, safe injection site in North America for IV drug users. Many of his patients, in addition to being hard-core drug addicts suffer from mental illness and HIV. For their care, nurses supervise their drug use by providing antiseptic, clean needles, water, showers and other basic services. He has written about his experiences working with addicts in his book In the Realm of Hungry Ghosts.
On first glance, many might find his work unethical. How could he assist drug users in perpetuating their addictions? In a recent interview, Maté discusses why he provides a safe space for those who are the most hopeless and helpless: “Childhood trauma is the universal template for severe addiction. These drug addicts all began life as abused children. Finally they have a place where they feel accepted and safe for the first time in their lives, so it’s a beginning of the possibility of treatment.”(1)
Maté provides what many consider a more holistic model for treating addicts because he believes their underlying emotional and psychological damage fuel their addictions. Attending to these needs—even in the midst of addiction—provides a crucial key for long-term healing. The Portland Hotel, in Maté’s view, is often the first place for which attending to the emotional and psychological needs occurs for many. “The essential point to grasp,” Maté argues, “is that in neither case are we dealing with conditions that are written in genetic stone. Therefore they are reversible. We have to ask ourselves what conditions we need to provide in order for people to develop…If you’re a gardener and your plant is not developing properly, you ask yourself what condition does that plant require? It’s the same thing with human beings.”(2)
Regardless of how one might view Maté’s unconventional treatment philosophy, his deep concern for the entire emotional landscape of these hard-core addicts should not escape notice. In addressing the deepest emotional wounds of his patients, he is able to recognize their humanity even as most of these addicts seek to destroy themselves. He is able to honor dignity and worth even as these addicts view themselves as worthless. By seeing their addiction as a symptom of a larger emotional neglect, he gets to the heart of what human beings require to thrive: to be recognized, to be known and to be loved as unique human beings.
Maté’s work came to my attention as an unusual coalescence with the Ignatian practice of the conscious examen. In this traditional Christian practice, a person simply reviews the events of the day to see where God was present. But it goes beyond factual recounting to examine feelings and desires that bring both consolation and desolation. The conscious examen invites the individual to look beyond “symptoms” of daily events to see the ways in which God was present in the deepest aspects of one’s life. All that which produces joy or sorrow are fertile places for God’s activity. Ignatius expected that God would be revealed in our consolation and our desolation because he believed that God would speak through our deepest feelings and yearnings.
This gave me great hope as I wrestled with those parts of my story that are filled with desolation. How can it be that plumbing the depths of despair could actually produce consolation? Not the kind of consolation that covers over dark feelings in an attempt to supplant them, but a consolation that emerges as a result of knowing that God can be found in the depths of my own despair? Just as Dr. Maté understands that exploring the deep wounds of emotional and physical abuse hold the key for the treatment of drug addiction, so too the possibility of discovering God in the midst of our complicated humanity.
Scholar Walter Bruggemann says it this way: “[T]he way God’s word impinges upon human history is concrete talk in particular circumstances where the large purposes of God for the human enterprise come down to particulars of hurt and healing, of despair and hope.”(3) In the same way that Dr. Maté believes the emotional and psychological story of his clients holds the key to treating their addictions, so too our deepest longings and desires, our lived experience in this world, no matter how mundane or seemingly trivial, no matter how awful and dark, no matter how joy-filled and hopeful open a door to the presence of God. Nothing is excluded from telling the story of who we are and of how God is at work in the events of our lives.
Oh God, unto whom all hearts are open, all desires known, and from whom no secrets are hid.Oh God, you have searched me and known me….You know it all. Where can I go from your Spirit? Where can I hide from your presence?
Margaret Manning is a member of the speaking and writing team at Ravi Zacharias International Ministries in Seattle, Washington.
(1) Terrence McNally, “Why Do People Become Addicts?” Interview with Dr. Gabor Mate, AlterNet, October 19, 2011.
(3) Walter Brueggemann, Texts That Linger, Words That Explode (Minneapolis, MN: Augsburg Fortress Press, 2000) 44, emphasis mine.