Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Book Review: Gabor Maté’s In the Realm of Hungry Ghosts

In the Realm of Hungry GhostsIn the Realm of Hungry Ghosts

Close Encounters with Addiction

Gabor Maté, M.D.

North Atlantic Books, 2010

Hungry Ghosts is a brilliantly conceived, richly researched and eloquently written account of a decade of encounters with addicts and addiction. Maté offers a deeply insightful understanding of how addiction arises in ordinary people’s lives and how to open ways toward transformation and healing.

Maté is the staff physician for the Portland Hotel, which provides housing and medical care to addicts in “the drug ghetto” (as he calls it) of the Downtown Eastside of Vancouver, B.C. Portland Hotel residents often have mental illness, HIV, sexually transmitted diseases, and other life-threatening problems besides drug addiction. This book not only tells the stories of his patients and his work treating addiction, but he also models the kind of compassion toward addicts that he’d like to see happening in society. “Facing the harmful compulsions of my patients,” he writes, “I have had to encounter my own.”

Gabor Maté, M.D.

The “hungry ghost” image in the title comes from a Buddhist story about the “denizens of hell”: the inhabitants of this realm have small mouths and large, empty bellies, representing the “aching emptiness” that the active addict feels and seeks to fill with things outside the self.

Not “Why the Addiction,” but “Why the Pain”?

Maté is a Hungarian Jew born in Budapest in 1944, two months before the Nazis occupied Hungary. While he was still a baby, his grandparents died in the genocide. He believes his early life was deeply scarred by the horror of that time: though the Jewish kids were dearly loved by their parents, “they inhaled fear, ingested sorrow. . . . What they knew—or, rather, absorbed—was their parents’ anxiety.”

One of Maté’s central messages is: The question is never, “why the addiction?” but “why the pain?” The addict, he says, has usually sustained similar traumas in childhood that result in certain traits that are common to addicts: poor self-regulation, lack of boundaries between self and other, a sense of deficient emptiness, impaired impulse control, and an inability to self-regulate under stress.

Maté sees himself as a workaholic and compulsive shopper—he once dropped $8,000 in one week on classical-music CDs—and he identifies these compulsions as true addictions, though of a less life-threatening sort than the drug and alcohol addictions of his patients.  He attributes his addictions to his compulsive need to anesthetize the deep terror he “absorbed” as a child, growing up in decimated post-war Europe, before his family emigrated to Vancouver. His examination of his own history not only gives him compassion for the suffering of the addicts he treats, but it also provides his readers with a unique understanding of the origins of addiction and possibilities for its treatment—and for addicts’ ultimate transformation.

Genetics: Are We Doomed to Become Addicted?

Maté debunks the popular idea that we “inherit” addiction or alcoholism. He quotes several addiction specialists as determining that “there is no gene for alcoholism” and that “the liability trait for alcoholism is not static”—in other words, becoming an addict or alcoholic depends at least as much upon ever-changing environmental factors as it does upon genetics. He uncovers the weaknesses in addiction-research based on studies of twins. He argues that genes influence temperament and sensitivity, which go on to influence the way we experience the environment.

Maté is not interested in blaming anyone for the phenomenon of addiction—genes, parents, God, the weather. He is only interested in assigning responsibility (including to the self, so he does not see addicts as victims) and changing what can be changed.

Even if, against all available evidence, it were demonstrated conclusively that 70 percent of addiction is programmed by our DNA, I would still be more interested in the remaining 30 percent. After all, we cannot change our genetic makeup, and at this point, ideas of gene therapies to change human behaviors are fantasies at best. It makes sense to focus on what we can immediately affect: how children are raised, what social support parenting receives, how we handle adolescent drug users, and how we treat addicted adults.

No Single Way to Heal

One thing I love about this guy is that he doesn’t think there’s One Right Way to recover. He argues that the 12 steps and 12-step communities have extraordinary healing potential for addicts (an appendix includes one of the most thoughtful and helpful meditations on the steps that I’ve ever read); he offers an interpretation of Dr. Jeffrey Schwartz’s Four Step program (to which Maté adds one step). He presents research about other ways recovery can happen, and he argues that part of the healing is on a cultural level. He defends harm-reduction and methadone maintenance. I would like to hear what he has to say about Suboxone.

A valuable book for anyone seeking to understand her own addiction—and for those who love an alcoholic or addict.

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  1. Anything about sex addiction–what is his experience with it, does he believe in it, does he find it as a cross-addiction with alcoholics/drug addicts, what does he think about the dopamine theories behind porn use and online gambling, etc.

    This book sounds genuinely fascinating. Thank you for a thoughtful write-up!

  2. This guy is so awesome. I first saw him speaking in Toronto a few years ago. Here is a link to part of that speech which was broadcast on TVO. This speech was life changing for me.

  3. Glad to see a review of this book–absolutely life-changing for me in understanding both the bio-chemistry and trauma-issues behind my own addiction–and utterly humanist in its core belief in self-knowledge as a vehicle to change.

  4. guinevere

    July 16, 2011 at 5:18 pm

    @Jez… so great to see you here, girl. Your questions are noted. I have been asked to review books/media for Renew Magazine (stay tuned for more about this), and I’ll be trying to snag an interview with him for that outlet as well.

    @invisigal, thanks for the link!

    @Marni… Tippi darlin, is that you? 🙂 x/g

  5. Hey Guinevere and all — Gabor’s my dad and I do content management for his website. Thanks for blogging about the book! You can find out tons more about his work and writings, as well as get contact info for him, at his website .

    Daniel Maté (Brooklyn, NY)

  6. guinevere

    July 26, 2011 at 4:20 pm

    @Daniel, thanks for being here–hope we get the chance to speak with your dad sometime soon! He does awesome work. cheers G

  7. I am almost finished this book. I love this guy. I have watched many of his videos as well. This is a wonderful review.

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