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Autumn 2008 | Vol 12 No 1

Review

Wayne Skinner

In the Realm of Hungry Ghosts: Close Encounters with Addiction

How often does a book that intends to offer an evidence-informed, comprehensive analysis of addictions end up on the bestseller list? Such has become the fate of Gabor Maté’s In the Realm of Hungry Ghosts: Close Encounters with Addiction.
The title does catch one’s attention. The reference, explains Maté, comes from Buddhism, where the mandala, the circle of life, includes the realm of the hungry ghosts, whose inhabitants are achingly empty and unfulfilled, constantly thirsting for things outside themselves, without being fully there for others. This, Maté argues, is the domain of addiction.

This may be a fitting depiction given Maté’s work as a doctor with the Portland Hotel in Vancouver’s Downtown Eastside, where he works with street people whose lives have been ravaged by intravenous drug use, homelessness, mental illness and violence. If it were only “them” – marginalized people we perceive, depending on our values, knowledge and experience, as either threats to or victims of the social order – the book wouldn’t offer much new. But Maté argues that addiction is a continuum, not a discrete category for a few people from which the rest of us are exempt. He points to our cultural preoccupation with consumption and possession as manifestations of an addicted society. He defines addiction as “any repeated behaviour, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others.”

Although Maté shows how powerful neurobiological processes are in the addictive process, he opposes current moves in science to reduce addiction to the brain, arguing that “addiction has biological, chemical, neurological, psychological, medical, emotional, social, political, economic and spiritual underpinnings – and perhaps others I haven’t thought about.”

For Maté, addiction is a single process with many diverse manifestations. And all too often it is accompanied by mental and physical illness, interpersonal conflict, legal troubles, social disadvantage and developmental histories of neglect, abuse and trauma. It is the developmental experiences of childhood and adolescence that Maté sees as a particularly significant incubus for the emergence of addiction problems. Using clinical vignettes, his own story and the literature on addiction, he examines the biological, psychological, social and spiritual dimensions of addiction, weaving these threads into a fabric of increasing complexity.

But how do we get out of the realm of addiction and into a more hopeful space? In the end, Maté turns his attention to recovery and the healthier regions of the mandala, but has surprisingly little to say about how to make the journey. He cautions that the brain on drugs doesn’t have much chance to be either fully conscious or self-compassionate enough to break out of addiction. He speaks out in favour of harm reduction and the need for a spirit of compassionate curiosity towards people with addictions and related problems. The Buddhist response to the hungry ghost, by the way, is similar – to offer nourishment; the bodhisattva emerges as a harm reduction worker.

In the end, Maté turns to spirituality and offers a eulogy to the 12 steps. Along the way, he humanizes the reality of addiction, revealing its close connection with other health and social problems. He puts the stereotypes of addiction into a new context by making himself an object of self-analysis. He proposes that our stigmatization of people with severe addictions stems from our unwillingness to acknowledge the addictive nature of our own lives and the role of appetite, consumption and possession in society. If the book succeeds, it is not by offering tidy proposals to solve a sprawling problem, but by reaching a wide audience, provoking more open, active (and not always polite) dialogue about what we think addiction is, and what needs to be done about it.

In the Realm of Hungry Ghosts: Close Encounters with Addiction. Gabor Maté. Knopf Canada, Toronto, 2008, 480 pp., $34.95.

Wayne Skinner is deputy clinical director of the Addictions Program at the Centre for Addiction and Mental Health in Toronto.