In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Maté (Berkely: North Atlantic Books, 2008. 520 pp)

Born in 1944 in Budapest, Hungary, Gabor Maté and his family moved to Canada in 1956. Maté earned a B.A. in English from the University of British Columbia and a teaching degree from Simon Fraser University. Later, he returned to school to become a medical doctor. Dr. Maté ran a successful family practice in East Vancouver before taking a position in Vancouver’s Downtown Eastside neighborhood. Maté has published 4 books and has earned an Outstanding Alumnus Award from Simon Fraser University and an Honorary Degree from the University of Northern British Columbia. Dr. Maté recently was appointed Adjunct Professor in Simon Fraser University’s School of Criminology.

Straight-Up Sin, Full-Stop

The theological positions governing my upbringing had no room for addiction. A straight-up sin, full-stop. The only avenue by which to address the problem was abstinence. If you engage in addictive behaviors, you better cease or expect discipline. This black-and-white mentality removes context form any scenario. Socio-economic status. Ethnicity. Nature. Nurture. It doesn’t matter. Your addiction is wrong, even if dealing with it is more difficult than a novice pianist attempting to perform Chopin.

Bringing to light the realities of addiction defines the overarching purpose behind In the Realm of Hungry Ghosts. Systematically, Gabor Maté places a face on addiction, designates the root causes of addiction, and concludes with possible solutions to the problem.

The Face of Addiction

To begin his thesis, Maté reminds the reader of the human component to addiction—it may occur in different ways but we all fight addiction.

Maté writes,

“At heart, I am not that different from my patients—and sometimes I cannot stand seeing how little psychological space, how little heaven-granted grace separates me from them” (21).

Whether drugs, alcohol, sex, work, music, comic books, Facebook, or gardening, humanity has a tendency to grant a ridiculous and unhealthy amount of focus on specific actions. These impulses are hungry ghosts, the insatiable spirit deep within the psyche of every human being.

“The inhabitants of the hungry ghost realm are depicted as creatures with scrawny necks, small mouths, emaciated limbs, and large, bloated, empty bellies. This is the domain of addiction, where we constantly seek something outside ourselves to curb an insatiable yearning for relief or fulfillment. The aching emptiness is perpetual because the substances, objects, or pursuits we hope will soothe it are not what we really need. We don’t know what we need, and so long as we stay in the hungry ghost mode, we’ll never know. We haunt our lives without being fully present” (1).

Unwilling to reside strictly in the conceptual realm, Maté expounds addiction through many personal stories he has encountered during his time treating the poor and afflicted in Vancouver’s Downtown Eastside. Maté gives addiction a face; he illustrates the deeply personal narrative of people suffering.

Root Causes

Having personalized addiction, Maté spends the middle portion of In the Realm of Hungry Ghosts exhibiting the root causes of addiction.

The popular opinions of addiction surround the concept of personal choice. The drug addict has chosen drugs; the fault lies with her alone. But, Maté pushes back, suggesting a deeper nurture-based reason underlying addiction.

“The three environmental conditions absolutely essential to optimal human brain development are nutrition, physical security, and consistent emotional nurturing. In the industrialized world, except in cases of sever neglect or dire poverty, the baseline nutritional and shelter needs of children are usually satisfied. The third prime necessity—emotional nurture—is the one most likely to be disrupted in Western societies. The importance of this point cannot be overstated: emotional nurturance is an absolute requirement for healthy neurobiological brain development” (193).

Given the current state of research, Maté contends for a new view on addiction which removes much of the vituperative arguments against addicts. The nurture component of a person’s upbringing carries immense pull regarding how someone will develop.

Maté adds,

“As a rule, whatever we don’t deal with in our lives, we pass on to our children. Our unfinished emotional business becomes theirs. As a therapist said to me, ‘Children swim in their parents’ unconscious like fish swim in the sea’” (253).

Possible Solutions

Since children swim in their parents’ unconscious, Maté urges us to reconsider the ways we treat addiction as a society.

For starters, Maté is unequivocally against the war on drugs. Targeting addicts through the law and requiring complete abstinence has not only done nothing to diminish addiction, it also adds more danger to the streets, similar to what the U.S. encountered during the prohibition era.

“More fundamentally, the war is doomed because neither the methods of war nor the war metaphor itself is appropriate to a complex social problem that calls for compassion, self-searching insight, and factually researched scientific understanding” (298-299).

Perhaps instead of out-right war and abstinence only positions, a position of harm reduction better suits alleviating the issue of addiction? Maté argues for controlled substance use under doctor supervision, contending that these controlled environments remove the threat of death by overdose and allow the addict to gradually wean off destructive substances.

Dealing with addiction is complicated and Maté urges his readers to think more broadly about ways to approach the dilemma.

Where to Go from Here?

Truthfully, I don’t know what to do with In the Realm of Hungry Ghosts. I haven’t put much thought into the methods through which we deal with addiction. Simplistically, the assumption has been around the matter of will. If you’re doing something destructive, stop.

Yet, I’m also aware of the difficulty and pull of addiction. I’ve experienced enough of addiction to know that someone saying, “Stop,” won’t necessarily solve anything. So maybe a position of harm reduction and compassion is a better approach than a full-stop methodology.

Maté’s thoughts are persuasive and shocking. Addiction is real; it’s everywhere; and a simple charge of abstinence doesn’t address the root issues. Even though my upbringing fights against these thoughts, I can’t help but recommend In the Realm of Hungry Ghosts. Read it, at the very least, to expand your conception of what addiction means in this world.

Verdict: 4 out of 5

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