In the Realm of Hungry Ghosts: Close Encounters with Addiction
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- ISBN13: 9781556438806
- Condition: NEW
- Notes: Brand New from Publisher. No Remainder Mark.
Product Description
In this timely and very much original new book, bestselling writer and physician Gabor Maté looks at the epidemic of addictions in our society, tells us why we are so prone to them and what is needed to liberate ourselves from their hold on our emotions and behaviours.
For over seven years Gabor Maté has been the staff physician at the Portland Hotel, a residence and harm reduction facility in Vancouver’s Downtown Eastside. His patients are challenged by life-threatening drug addictions, mental illness, Hepatitis C or HIV and, in many cases, all four. But if Dr. Maté’s patients are at the far end of the spectrum, there are many others among us who are also struggling with addictions. Drugs, alcohol, tobacco, work, food, sex, gambling and excessive inappropriate spending: what is incorrect with our lives that we seek such self-destructive ways to comfort ourselves? And why is it so hard to stop these habits, even as they threaten our health, jeopardize our relationships and corrode our lives?
Beginning with a dramatically close view of his drug addicted patients, Dr. Maté looks at his own history of compulsive behaviour. He weaves the tales of real people who have struggled with addiction with the latest research on addiction and the brain. Providing a bold synthesis of clinical experience, insight and cutting edge scientific findings, Dr. Maté sheds light on this most puzzling of human frailties. He proposes a compassionate approach to helping drug addicts and, for the many behaviour addicts among us, to addressing the void addiction is meant to fill.
I judge there is one addiction process, whether it manifests in the lethal substance dependencies of my Downtown Eastside patients, the frantic self-soothing of overeaters or shopaholics, the obsessions of gamblers, sexaholics and compulsive internet users, or in the socially acceptable and even admired behaviours of the workaholic. Drug addicts are regularly dismissed and discounted as unworthy of empathy and respect. In telling their tales my intent is to help their voices to be heard and to shed light on the origins and scenery of their ill-fated struggle to overcome suffering through substance use. Both in their flaws and their virtues they share much in common with the society that ostracizes them. If they have chosen a path to nowhere, they still have much to teach the rest of us. In the dark mirror of their lives we can trace outlines of our own.
—from In the Realm of Hungry GhostsAmazon.com Review
He would probably dispute it, but Gabor Maté is something of a compassion machine. Conscientiously treating the drug addicts of Vancouver’s notorious Downtown Eastside with sympathy in his heart and legislative reform in mind can’t be simple. But Maté never judges. His book is a powerful call-to-arms, both for the decriminalization of drugs and for a more sympathetic and informed view of addiction. As Maté observes, “Persons whom we dismiss as ‘junkies’ are not creatures from a different world, only men and women mired at the extreme end of a continuum on which, here or there, all of us might well locate ourselves.” In the Realm of Hungry Ghosts starts by introducing us to many of Dr. Maté’s most dire patients who steal, cheat, sell sex, and otherwise harm themselves for their next hit. Maté looks to the root causes of addiction, applying a clinical and psychological view to the physical manifestation and offering some enlightening answers for why people inflict such c! atastrophe on themselves.
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This book is flying off the shelves, nearly unanimously praised for its compassion and insight. But let the buyer beware. Mate’s prose is very seductive and smooth, drawing the reader in like a magnet (much like his profuse apologies for acting like a total boor with his staff: “Oh, poor Gabor, look how terrible he feels! We’d better forgive him.” Since there are no consequences for his disrespectful and insensitive behaviour, he dodges responsibility and can get away with repeating the abusive behaviour ad infinitum.)
Yes, the man tries, but by his own admission he is pretty screwed up. Racing out to buy CDs has small or nothing to do with sticking a needle in your arm (and it’s a compulsion, not an addiction: there is a universe of difference). He’s trying the ancient “see, I’m just like them” trick, another form of ingratiating himself and beguiling his audience, or at least pulling them in enough to feel sorry for him.
His insistence that he has “made progress” with his own addictive patterns is, to say the least, suspect. He writes $100 cheques to placate his office staff (a completely baffling go, as he is factually buying them off: giving them cash, presumably, so he can be as late as he likes), not to mention $1000 cheques to his wife to buffer his voracious appetite for “symphonic recordings”. Then he swears it all off, adage he won’t buy another CD until 2009.
My guess is that his buying compulsion is now completely out of control. This is because swearing off doesn’t work, and Mate lacks any real insight into himself and his problems. As a replacement for he “fixes” everybody else. It makes him feel excellent, distracts him from his abject self-loathing for a moment, and gives him a sense of power.
And let’s not get into his synopsis of AA and the 12 Steps after attending one meeting. If Mate had attended one class on, say, heart function, would you trust him to treat your angina? Did he, in fact, get away with such polished behaviour in med school through smooth writing and abject apology?
No one seems to be objecting to all this, probably because he has pretty much seduced the reading public. Judge me, when you meet the man, you marvel where all that “compassion” is coming from. He is cold and abrupt, stinging you with grave small barbs, then acting surprised when you react: must be repressed emotion from childhood, don’t you know (for which you must read When the Body Says No). He will dig and dig and dig, pulling out long ribbons of past pain while hiding behind an impenetrable shield. But hey – the man’s just trying to help you!
Mate will permanently get his bread buttered, as he is an opportunist who can use the written word to get what he wants. But readers should beware. This is a man so screwed up that he factually ground his teeth down to stubs. (Was he too proud to go to a dentist?). In fleeting, he does not walk the talk. Myself, I will follow what he advises the minute HE starts doing the same. And it’s not likely to take place. As the ancient adage goes, “Take my advice, I’m not using it.”
Reader’s Rating: 3 / 5
This rather lengthy book presents Dr.Gabor Mate’s perspective on addiction. Incorporating research on brain chemistry, neurobiology with politics, religious philosophy and his sympathetic portrayal of the denizens of the Vancouver skid row where he works, Mate attempts to challenge preconceptions about addiction while attempting to make sense of his own personal challenges. The books also features black and white photos of some of his patients…a worn and grubby looking bunch as well as a single shsot of what looks like a small bike made out of paper clips, a gift from a client. There also is an appendix and footnotes.
I establish the sections on brain chemistry and the mechanics of addiction fascinating. Chapter 31 features Mate’s adaptation of a method made by Dr. Jeffrey Schwartz to relieve the ” brain lock”(where brain mechanisms are stuck causing obssessive copulsives to act out before control can be implemented) makes considerable sense. I wanted to see more on neuro-plasticity.
The rest of the book,sorry to say, is less successful. Gabor inserts himself invirutally every chapter. He compares his rather minor shopaholic tendencies (he buys massive numbers of classical composition CDs)to the addicts, contending that in fact we are all addicted to something and hence should be more compassionate. His points against the war on drugs are darkened by what amounts to an anti-american, anti-police rant.(He also disregards changes made in the criminal justice system, including iplementation of drug treatment and mental health courts as well as repeal of some of the more draconian drug penalties.) His suggestions for addresing addiction, ie legalization, providing clean,safe, shelter are naive. He chooses to minimize the violent, negative and criminal behavior of the addicts as well as the economic constraints challenging governments today. In societies where families are struggling with afordable health care, it is unlikely that Cadillac care for addicts who fail to follow through with treatment or treatment recommendations will be well loved. He does not suggest how his plot should be funded.
I establish some aspects of this book reasonably troubling. He relates the tale of an HIV infected, pregnant addict who gives birth to an addicted baby which eventually winds up in foster home. It would appear as a replacement for of supporting a woman’s choice, he would provide his addicts with a shot of Depo Provara as a replacement for of condemning a child to the hell of the foster system and the same type of parental neglect which results in the brain chemistry that contributes to addictive susceptability. While acknowledging that addicts are generally poor patients, he fails to fully take up the consequences of their irresponsibility, including antibiotic resistant drugs, infecting additional people with disease and the trauma of crime. I know compassion but does he know responsibility?
This book is a challenging read and is thought provoking in many regards. On the down side, it is a bit disorganized and colored by the leader’s inflexible bias.
Reader’s Rating: 3 / 5
Many reviewers have criticized Gabor Maté for including, in his lengthy discussion of drug addiction, an analysis of his own behavioral addiction to purchasing classical composition CDs. While I agree that Maté’s analysis, but sincere, is a thin mask of humility atop what could be better identified as rhetorical, if not psychological, self-indulgence, I don’t agree that Maté equates his struggles to persons of his patients, the hardcore drug abusers living in Vancouver’s Downtown Eastside. Maté claims that all addiction exists on a continuum, and he is careful to distinguish his patients’ addictions–and their pains–from his own. Some reviewers have acknowledged this honor, but many of persons same reviewers still complain about Maté’s analysis–though it isn’t permanently clear why. In response to these reviewers, and to potential readers with a critical eye, I want to give a few of my own reasons for resisting Maté’s self-analysis.
Maté says that addiction exists on a continuum, but he only provides a detailed analysis of two basic examples: his patients’ addictions and his own. Maté mentions a wide variety of additional addictions, but because he does not provide an in-depth analysis of any of these additional expressions of addiction, it is simple for readers to mentally place his two case studies–his patients’ addictions and his own–much closer together on the spectrum of addiction than Maté may intend.
Another reason I tend to resist Maté’s self-analysis is that the way he treats his own addiction, as compared to the way he treats his patients’ addictions, does not seem to support his assertion that all addiction exists on a continuum. By attending an AA meeting in an attempt to “heal” his behavioral addiction, Maté blurs his own honor and collapses the distance between his addiction and substance addictions. This is not to say that we, as a society, do not want to treat all persons, and all addicts, equally. Equality is a moral notion, and a excellent one. But equal treatment does not mean treating all people according to the same methods and standards. The officially authorized system does not, for example, punish children and adults in the same manner, even if they commit the same crime. The same goes for our systems of reward. We don’t give a child a year-end bonus for a job well done in school, as we might a productive employee at the office, but we might give her a new toy or some additional age-appropriate gift. And the analogy doesn’t apply only to age differences; we give special treatment to many different types of individuals–the disabled, the infirm, the poor. Even a baseball pitcher receives different powerful training than a fleeting stop. And so, in the same way that you wouldn’t go to a plumber to fix your transmission, you probably shouldn’t go to AA to fix your shopping habit. Maté admits that AA did not work for him, but he seems to justify this response as a personal aversion to group therapy. While that may be the case, I reflect something larger is at work–and I reflect it would be a mistake for a bunch of shopaholics to start showing up at AA after reading Maté’s book. Though Maté says his addiction is different than his patients’ addictions, he does not act as if that were really the case, and I would venture to say that this incongruity has caused him, as well as his readers, reasonably a bit of unnecessary distress.
And yet, I want to end on a positive note. Despite some serious reservations about the prescriptive side of Maté’s book, from AA and spirituality to his half-formed solution to the War on Drugs, which probably deserves comment in some additional review, I reflect that In the Realm of Hungry Ghosts does something that few books on addiction try to do: it shows compassion. If you need definitive answers, both personal and social, to the problem of drug addiction, this is not the book for you. If you judge that addiction is primarily biological in scenery, this is not the book for you, either. You won’t find anything about the neuroscience of compound addiction in this book that you can’t find in the average college textbook on psychology–and in equally dry and uninspired language. Maté does not judge that addiction is primarily biologically caused, and so, when he talks about the science of addiction, his voice falls flat. The power of this book is not in the lessons it teaches, but rather, in the tales it shares. If you want to judge that addiction is largely a learned behavior, and can therefore be unlearned, if you want to judge that, somehow, an individual can control her addictions, or if you simply want to approach the issue from a new perspective, a more sympathetic perspective, a more human perspective, read this book–especially the first section. Maté’s empathy with the drug addict will surely go you.
Reader’s Rating: 3 / 5
There is a lot of information in this book, a fantastic deal of it painful, vital, informative and eye-opening. There is some that isn’t, too.
Mate addresses addiction to substances and behaviors both officially authorized and illegal in a variety of different ways. The first section of the book is taken up by encounters with addicts primarily street people, patients of Dr Mate on Vancouver’s skid row, its addict colonies. He goes into their back tales, their addictions and behaviors, and their prospects for the future. Generally he treats them with patience, a fantastic deal of empathy, sometimes frustration, but generally sympathetically. How these people came to renovate as they did is vital, and in fact I felt his sensitive treatment of these people – and they remain people – was just about the strongest part of the book.
He moves on to the chemistry of the drugs, and of the brain, and how they interact, and what makes a substance addictive or attractive. The fact is, Mate points out, that it’s the person who is addictive, the drug itself is not by itself the addiction. It is a vehicle recruited to satisfy the craving already existing in a person. Many people take drugs or alcohol and do not become addicted; why is it that others do?
There is a excellent deal of additional information on the development of the brain itself, from the very beginning through childhood through adulthood, as well as its ability is some cases to partially self-heal, to continue growing and to adapt to sudden changes. This information will make the reader give some very serious consideration to parenting, to child development, and the like, even in the absence of drug or addiction issues. I also felt this section of the book to be well clarified, perhaps a small too technical, but very powerful stuff.
On the additional hand, the leader has a trend to make himself the theme of the book a small bit too regularly, at least for this reviewer. Dr Mate discusses issues that have affected, and continue to affect himself (and his family tree by extension) in the realm of behavioral addiction or compulsion – ADD, and a compulsion for purchasing classical composition CDs. I must confess I don’t know if I reflect this is helpful or not. On the one hand, he clearly wants to make the point that addictions come in various guises, and wants to be able to tell to his patients as being one of them in at least some tiny way, and hopefully being more long-suffering and non-judgemental and understanding as a result; on the additional hand, if addictions are by their scenery destructive, unhealthy compulsions, roads to personal ruin, then while an extremely large and highly unwieldy collection of Beethoven works may run to money, this is hardly going to bankrupt the leader, a very successful practitioner, leader and speaker, and hardly falls otherwise into the category of anything additional than something of an expensive leisure activity. His son may have felt to some extent neglected as a result; but it seems likely that if not for this reason, then he may well have felt neglected for another in its absence. Nobody ever feels as though they were treated precisely as they would have liked by their parents.
Further, like a fantastic number of Canadians, Mate doesn’t care for the United States, and despises George Bush. And, like a fantastic number of Canadians, he also wants to make sure we all know it, and obviously thought it vital enough to slot in this information in various locations in his book. Criticism of the US attitude to drug addiction is certainly a valid topic for discussion in this book; but even in a tome of 450 pages, I don’t know that it is absolutely imperitive to take up the issue of Bush in a flak jacket on an aircraft carrier adage stupid things unrelated to anything else in the book, least of all its ostensible topic.
The leader finishes by discussing suggested treatments for addicts, from harm reduction techniques, to a suggested vastly improved political/health approach to addiction in contrast to the highly destructive War On Drugs that has clearly failed on every level (no disagreement there). His discussion on approaches loved ones and friends can try reveals just how hard this aspect of the problem is – criticism and guilt, while they seem to be the tough-like one considers virtually the defaulting mode for approaching an addict, are much more likely to exacerbate the situation than like, acceptance and constructive engagement. For many – most? – no approach is going to work to ‘fix’ the problem, and one must go to a harm reduction mode.
Mate knows a fantastic deal about addiction in various forms, and the reader will take away from this book some understanding of the various issues that combine to make an addict an addict, and will hopefully also learn how to lower the risks of inducing the same needs and cravings in others, particularily their own children. That said, the book is very long, and occasionally the reader feels taken on detours that are of lesser interest and weight.
Reader’s Rating: 4 / 5
Taken as a whole, I establish this book moving and real. The tales of addicts pull no punches and the comparison of our addictive tendencies in everyday life to hardcore drug addiction works for me. As a ex- psychiatric social worker, I’ve had some contact with the same population as Dr. Mate and share his belief that our “war on drug” is a failure in both conception and implementation. He states clearly that people take drugs to avoid pain. I’ve seen so many clients self-medicate on illegal substances that I have no option but to agree. How do you declare “war” on that?
He offers some possible solutions or at least approaches. Persons show both deep compassion and an understanding of the underlying dynamic of addiction. Whether they would work or not, I couldn’t say. But the value of the book is not in solutions but rather in Mate’s ability to make the suffering and situations real, to help us tell to people who are addicted not as them, as addicts, but as real individuals who take the only path they see to escape their pain. It’s a “there but for the grace of God, go I” attitude, which de-demonizes the self-destructive behaviors. In that, it succeeds.
The book is not linear. It’s more an extended questioning of the addiction process, and as the process is complex and convoluted the exploration becomes so too. The tales Mate tells are heart rending and well told. He is a right witness for addicts and deserves to be read.
Reader’s Rating: 4 / 5