In the Realm of Hungry Ghosts

In the Realm of Hungry Ghosts:
Close Encounters with Addiction
by Dr. Gabor Maté

Reviewed by Kim Hughes [reposted from The Toronto Star]

[Note: This is an important book. Mr. Hughes review is good but in my opinion, at points, it appears to lack the element of compassion that Dr. Maté thinks is so important. You can google Democracy Now and see a brief interview with the author conducted by Amy Goodman]

He would dispute it, pointing instead to a deep clinical understanding of the nefarious workings of addiction, but Dr. Gabor Maté is something of a compassion machine, hugely wary of casting the first stone.

How else to regard the one-man M.A.S.H. unit (a physician working Vancouver's squalid Downtown Eastside) whose pitiful patient roster includes hardcore drug addicts who can't stop using despite pregnancy, potential limb and digit amputation and even possible quadriplegia?

Maté's subjects are the living, breathing embodiment of the nation's grimmest statistics for HIV/AIDS, hepatitis, homelessness, crime, abuse, neglect, overdose and death. More than merely poor and disenfranchised, they are truly the lowest of the low, reviled by society and demonized by law enforcement.

Despite that, Maté sees them as people first, addicts second, and particularly deserving of love, acceptance and latitude, given the hell most of them have invariably suffered to arrive at this point.

What's more, Maté sees these front-line addicts as essential links in a cabal toward a complete rethink/revamp of the current approach to understanding and treating addictive behaviours of all stripes, including gambling, sex, shopping and eating disorders.

Sound heavy, progressive, nuts? There's more. With his powerful new book, In the Realm of Hungry Ghosts: Close Encounters with Addiction, Maté hopes not only to make the case for decriminalizing drugs but for changing the way society at large perceives addicts.

As Maté observes at the book's beginning, "Those 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."

And that means you too, mister socially accepted workaholic. Evidently, the so-called biology of addiction places you closer on the spectrum to the dope fiend than you may care to admit.

Basically divided into three parts, In the Realm of Hungry Ghosts first introduces us to many of Maté's most dire patients, those who steal, cheat, prostitute and otherwise harm themselves for their next hit despite debilitating illness, spiritual agony and the sure knowledge that other lives (children especially) are being destroyed.

Next, Maté wades through the vast learning behind the root causes of addiction, applying a clinical and psychological view to the physical manifestation and unearthing some surprising (to the layman anyway) answers for why people do such frightening and destructive things to themselves.

"In the words of one researcher, `maternal contact alters the neurobiology of the infant.' Children who suffer disruptions in their attachment relationships will not have the same biochemical milieu in their brains as their well-attached and well-nurtured peers.

"As a result their experiences and interpretations of their environment, and their responses to it, will be less flexible, less adaptive and less conducive to health and maturity. Their vulnerability will increase, both to the mood-enhancing effect of drugs and to becoming drug dependent.

"We know from animal studies, for example, that early weaning can have an influence on later substance intake: rat pups weaned from their mothers at two weeks of age had, as adults, a greater propensity to drink alcohol than pups weaned just one week later."

Finally, Maté takes aim at the hugely ineffectual, largely U.S.-led war on drugs, challenging the current wisdom of fighting the illicit trade rather than aiding the addict (or potential addict). He shows how controversial measures such as safe injection sites (including the one in downtown Vancouver), are measurably more successful at reducing drug-related crime and the spread of disease than anything the White House (or Parliament Hill) has going.

"As summed up in the Canadian Medical Association Journal, `Vancouver's safer injecting facility (known colloquially as Insite) has been associated with an array of community and public health benefits without evidence of adverse impacts.' The city's current mayor and his three more recent predecessors, including the present premier of British Columbia – no liberal when it comes to social policy – support the continuation of Insite. Despite initial scepticism, so do local merchants and the Vancouver Police Department."

In the Realm of Hungry Ghosts (the title refers to a point on the Buddhist Wheel of Life) is enormously compelling and Maté, as noted, is admirably, sometimes inexplicably, empathetic to all who cross his path.

But easy reading it's not. Addicted pregnant women who have already had children taken away and who continue using heroin and cocaine are repugnant no matter how pathetic their upbringing.

So too are guys shooting drugs into their necks and risking brain abscesses because they can't otherwise locate a useable vein without a doctor's help (you read that right). Furthermore – and Maté would probably admit this – when it comes to addiction, one size doesn't fit all. Not all addicts come from horrendous backgrounds. And not all people from horrendous backgrounds become addicts.

Moreover, Maté indulges some distracting tangents, chief among them a parallel exploration of his own "addiction" to the compulsive purchase of classical music CDs, which surfaces throughout the book. While Maté's attempt to refract the impulses of his drug-addled patients through the prism of his own rash behaviour is conceptually admirable, it also just seems kind of dumb by comparison. Ditto his musings on the reckless deeds committed by Conrad Black.

Still, there is no disputing Maté's core point that the current system for dealing with addicts – heavy on the policing and prosecuting, light on the treatment and R&D – simply isn't working.

This book won't itself spur the sweeping change and legislative reform needed to fix a woefully broken system. But it should get us thinking about how our tax dollars are being spent on ineffective and frequently unenforceable laws.

And it might engender some of Maté's truly noble compassion among those of us who would rather look away than consider the circumstances propelling a zoned-out streetwalker. When it comes to solving the illegal drug problem, every little bit helps.

Kim Hughes is a Toronto freelance writer and editor.