doc_paradise | [review] A compassionate look at addiction and addiction management

DISCLOSURE: I am not a medical doctor or medically trained.

Title: In the Realm of Hungry Ghosts: Close Encounters With Addiction

Author: Gabor Maté, M.D.

ISBN: 978-0-676-97741-7

Website: https://drgabormate.com/book/in-the-realm-of-hungry-ghosts/

Writing Style:

Gabor Maté is a gifted writer. He combines medical research, case histories, his personal life story, and political commentary in a storytelling style that makes the difficult material both readable and compassionate.

It’s pretty common for books on trauma to use descriptions of the terrible things that happen to people as illustrative examples. This is useful and appropriate, however some writers sprinkle their books with the equivalent of live grenades. I get it, they are trying to make a point. This is real. This is bad. This is serious. This is horrific.

This book does something different. Maté’s writing shows unconditional positive regard for people while still talking about a long list (see content warning below) of terrible, heartbreaking, and horrific experiences. I like that. It encourages empathy, rather than othering. It also makes the book’s topic more approachable and (perhaps) less emotionally overwhelming. [1]

Summary:

CONTENT WARNING: This book contains descriptions of human suffering, drug use, physical and mental illness, pain, self harm, death, violence, addiction, abuse, murder, assault, genocide, racism, slurs.

In The Realm Of Hungry Ghosts explicitly connects addiction to pain and experiences in childhood development.

Part I - Hellbound Train — Tells the human stories of some of the author’s patients in Vancouver’s Downtown Eastside, their lives and their struggles with addiction, illness, and suffering. It also introduces the author, his ideals, and his successes and failures in being a compassionate physician. This section both sets the stage and humanizes the people and situations.

Part II - Physician, Heal Thyself — Talks about the experience of behavioural addiction through the lens of the author’s own behavioural addictions and personal experiences. It also ties his addictions to his experiences with ADHD, as an infant in the Budapest ghetto, and the deaths of his grandparents in Auschwitz.

Part III - A Different State of the Brain — 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” [pg. 128]. It disconnects the addictive process from substance-abuse and breaks down the brain’s response to neurotransmitters and how they tie into addiction.

Part IV - How The Addicted Brain Develops — Ties addiction to trauma, stress, and the early environment’s effect on brain development. Argues against addiction as a product of a simple genetic cause.

Part V - The Addiction Process and the Addictive Personality — Approaches addiction as a response mechanism for managing the results of adverse childhood events, both what happened that shouldn’t have, and what didn’t happen but should have happened.

Part VI - Imagining a Humane Reality: Beyond the War on Drugs — Examines and condemns present social roots of addiction and drug policy. While this section talks about U.S. drug policy, it focuses on Canada, particularly the treatment of First Nations peoples. It points out what isn’t working in social policies and attitudes, and introduces compassionate approaches and harm reduction.

Part VII - The Ecology of Healing — Returns to the author’s struggles with behavioural addiction and self-healing. It examines some approaches to self-healing and management of addiction. It also touches on the difficulties the family, friends, and partners face. It does not offer a cure for addiction, but rather approaches to sobriety (including one based on OCD management).

There is an epilogue that concludes some of the stories of the people described in the book, several appendices, endnotes with references, and an index.

My Opinion:

My copy of this book has many multicoloured tabs sticking out of it. I have every intention of re-reading sections. It’s an introduction to addiction and the issues related to addiction. It doesn’t plumb the depths to any great degree. Instead, it gives a broad overview and an emotional connection to suffering and addiction in Canada. (Yes, Canada we have a problem.) I found it engrossing. Broadening the definition of addiction to include far more than just illegal substance-abuse was eye-opening. In this context, behavioural addictions are more clearly addictions than in a disease model. I particularly liked his approach to behavioural addictions and how Part III broke down effects based on types of neurotransmitters (endorphins vs dopamine) rather than by drug type.

I was already in agreement with harm reduction methods of treating addiction (such as methadone clinics and safe injection sites), but I didn’t know much about them other than they worked better than punishing the shit out of people. This book explains some of the reasons why. Unfortunately, the storytelling style will make it difficult to quote in Facebook arguments.

Evil Overlord Assessment:

I’m not a doctor, medical or otherwise. I can’t effectively evaluate the medical information in this book. Given that it is both emotionally appealing and convincing… if the medical information is incorrect or problematic… the presentation would make any toxic bits very easy to swallow. This book downgrades genetic factors and the disease model of addiction, both of which are more commonly accepted by the public. Again, I don’t have the expertise to evaluate the validity of either the commonly presented opinion or the medical information in Maté’s book. It appeals to me, for a variety of reasons, and therefore it is convincing.

Footnotes:

[1] Book excerpts area available at: https://drgabormate.com/book/in-the-realm-of-hungry-ghosts/

Disclaimer: I am not a therapist, a doctor, or a professional reviewer. I do, however, own and enjoy reading a staggering number of self-help books and I have opinions. Lots of opinions. One of these opinions is that the underlying assumptions in “self-improvement” and “self-help” books should be unpacked. These reviews may or may not do that, but I will try to acknowledge both some of the potentially useful and potentially problematic aspects of the books I review. The “Evil Overlord Assessment” section specifically looks at some ways that a fictional “Evil Overlord” might use this book to harm or control others for the purpose of World Domination.