In the Realm of Hungry Ghosts

a book by Gabor Mate’ – Recommended

Gabor Mate’ is a physician who works with street addicts in Vancouver, BC. He uses their stories and his own experiences to explore the effects of addiction, possible causes and to offer ideas on how to treat and prevent addiction. The stories are raw and his ideas are sometimes controversial. He presents them in well reasoned language accessible to the lay reader. His passion for reducing the harm of addiction to the addict and society results in the book having a somewhat political agenda. I generally react with resistance and skepticism when someone is trying hard to sell me their ideas. In this case it was hard to argue with his position. Still, my perception that he was pushing a political agenda brings many of his arguments into question though I haven’t the training or the knowledge to critically assess them. As one who has felt the full force of substance and behavioral addiction his ideas however impractical do seem to make sense.

The book is divided into four general sections. The first section discusses the effects of addiction on the Vancouver, BC street addicts with whom the author works. These are the most destitute and hopeless addicts imaginable. Their stories have a defining similarity, at least according to Mate’. Each of the addicts suffered childhood stress from some form of abandonment and/or emotional or physical abuse.

The second section of the book links these childhood events to the addict through a number of tests on brain development and chemistry. The author is most emphatic that the old paradigm of genetic cause should be replaced with the more “evidence-based” environmental model of addiction. He cites many studies and clinical tests on lab animals and human subjects that “prove” addiction is the result of faulty or incomplete brain development as a result of the stress passed from mother to baby not genetics.

This distinction between genetic cause and environmental cause is important to Mate’ because he is promoting a drastic change in how society reacts to and deals with addiction and addicts. If addiction is primarily caused by genetics there isn’t much that can be done for them. We would just need to continue the “war on drugs” that has siphoned a huge amount of resources away from treatment to the interruption of supply from the manufacturer to the street dealer. A genetic cause also absolves us from responsibility for the addiction. What can be done at the family and societal level for genetic predisposition?

However, if environmental influences to brain development are the major causes of addiction then a totally new approach is warranted. How children are raised and how society supports the family and the parenting of children should, in the author’s opinion, be the primary focus of addiction treatment and prevention. If it isn’t our genes then there is much that can be done.

The third section of the book discusses how to deal with the problem of addiction. Society views addicts with distrust and distaste. They are reprehensible failures and deserve to be ostracized and kept apart from the “good” citizens. If addiction begins in environmental conditions not genetics, as the case Mate’ has built suggests, then these societal attitudes are the same attitudes that affected the child’s brain development to begin with. In other words, these attitudes support and prolong the addiction. He spends considerable effort in showing how the war on drugs has failed the addict and society.

Gabor Mate’ proposes as an alternative to the war on drugs an enlightened and compassionate approach from political entities and society in general. He feels that the attitude of moral superiority over the addict needs to be converted into compassion. Secondly, if environmental influences are the cause of addiction then changing the environment of the addict must be solution. Mate’ claims that many neurologists believe the stunted brain development and chemical imbalances caused by environmental causes can be reversed. Therefore, we need to change the current environment of the addicts as outcasts and show them compassion and acceptance.

The largest contributor to the ostracization of the addict from society is the criminalization of his substance dependency. Therefore, Mate’ suggests that all substance dependency be decriminalized and that the substance be administered in a controlled environment. This is the most controversial of his proposals. He supports this approach with anecdotal evidence from the United Kingdom.

The final section of the book is about healing and the spiritual approach to dealing with addiction. He offers considerable scientific evidence that increasing awareness through meditation can help reverse the effects of prenatal and early childhood stress. In an appendix he provides his insights into each of the 12-Steps. He has not worked the 12-Steps. He has attended one 12-Step meeting. It has been my experience that there is much more to the steps than can be perceived with just a reading or intellectual evaluation of them. I appreciate his effort, though (ok, that was maybe a little sarcastic).

Sometimes I read something that finally expresses in words what I have been unable to say. I found such a passage in this book:

There are people who are not addicts in the strict sense, but only because their carefully constructed “personality” works well enough to keep them from the painful awareness of their emptiness. In such a case, they’ll be addicted “only” to a false or incomplete self-image or to their position in the world or to some role into which they sink their energy or to certain ideas that give them a sense of meaning. The human being with a “personality” that is insufficient to paper over the inner void becomes an undisguised addict, compulsively pursuing behaviors whose negative impact is obvious to him or to those around him. The difference is only in the degree of addiction or, perhaps, in the degree of honesty around the deficient self. – Page 419

For most of my life I had “papered over” the emptiness I felt with success and all of the accoutrements of the American Dream. My “personality” worked. The waiting addiction was kept at bay. I was a disguised addict. I could feel something amiss but didn’t have the language, insight, or the support to express it. However, being paper thin, this fabricated life had no resiliency. It was only a matter of time before an event punched through to the emptiness below and the waiting addiction was allowed to flourish.

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