An overview of Gabor Maté's 'In the Realm of Hungry Ghosts'

In his book "In the Realm of Hungry Ghosts: Close Encounters with addiction," Gabor Maté appropriately addresses the extraordinarily complex subject of addiction in a multifaceted, multilayered approach. He presents information gathered through his own clinical work and personal life as well as from the fields of developmental neurobiology, psychology, sociology, medicine, and history.

In seven parts - each of which I'll synopsize - he leaves no rock unturned in his close examination and explanation of addiction.

Part I: Hellbound train

Maté opens his book by presenting in uncensored detail the honest, chilling, and humbling reality of addiction through the sharing of stories of people he has encountered in his clinical work who have and continue to struggle with it. He doesn't protect the reader from the often devastating plight of addiction. He shares just as many stories, if not more, that end tragically as those that end positively. While he doesn't mask how emotionally taxing working as a physician of addicts can be, he also draws attention to the powerful feelings of common humanity and the moments of intense, deep connection, compassion, and empathy experienced by both the patient and himself.

Part II: Physician, heal thyself

In the second part, Maté demonstrates great courage by allowing himself to be very vulnerable to his reader. He does something that, ideally, all mental health professionals should do - though it is most likely that they do not. Maté takes a deep and searching look at himself and his behaviors and recognizes the addict within him. While his addiction is to purchasing classical music and not to substances, he identifies it as the addiction it is, nonetheless.

Maté spends a considerable amount of time differentiating between passion and addiction in this section and gets very honest about why he can't claim the former because, in truth, he's struggling with the latter.

Then he takes it another step forward. Instead of merely confessing the truth to himself and to his readers, he decides to take action by attending an Alcoholics Anonymous (AA) meeting to confront his problematic and addictive behaviors head-on. After all, how can he as a physician expect actions from his patients that he is unwilling to take himself? And what a powerful way to level the playing field and create space for true empathy, compassion, and connection to occur between himself and his patients. Maté's actions certainly set the standard high for other mental health professionals, but that standard should absolutely be met.

Part III: A different state of the brain

Maté really begins to break down the physiological and medical aspects of addiction.

This section is very informative and does a great job at explaining addiction from a medical neurobiological perspective while remaining accessible to the average reader.

Addiction originates and is influenced by a number of factors. Maté stresses the importance of taking all of these factors into consideration rather than picking and choosing which to primarily focus on. He cites a number of interesting studies that reinforce the notion that addiction has preeminent elements which put some people at greater risk of developing addictive behaviors than others. In addition, he cites studies that prove the cause of addiction is not the substances themselves, but the maladaptive structure and function of the brain.

The reader learns how the functioning of multiple specific parts and systems of the brain makes one vulnerable to addiction, fuels addiction, and influences relapses.

Part IV: How the addicted brain develops

As Maté proves by means of countless studies and scientific data, the nature versus nurture debate has been put to rest by the scientific community for quite a number of years now. There is no doubt and no question that environmental factors and influences are substantially more instrumental in determining the development of the brain in comparison to biological or genetic factors. While genetics do play a small role, the dominate determinator of how a person's brain will develop and whether or not they will be more vulnerable to addiction is the environment, experiences, and circumstances they were exposed to both prenatally and postnatally.

The beginning of an infant's life is the most instrumental in regards to brain development, given that it is during this time that the brain experiences the most growth and development. Considering the essentially unanimous conclusion that it is nurture and not nature that ultimately creates addicts, Maté offers his own hypothesis as to why this seems to remain unknown. He concludes that the most plausible reason as to why society has yet to accept this truth as fact is because it would force people to examine themselves and our society, rather than blaming the problem on an inevitable factor that cannot be changed.

Part V: The addiction process and the addictive personality

In this section, Maté presents addiction as existing on a spectrum, rather than simply being something you either have or do not have.

He uses anecdotal stories of his own experiences with his behavioral addictions. He then compares them to the less socially acceptable or admirable addictions of others to reveal the similarities that exist between their behaviors. In both cases, people are turning to a behavior in an attempt to fill a void or satisfy an emotional need. Maté analyzes a number of addictive behaviors to prove that at their core they are more alike than different. Again, he examines how early childhood and the relationship - or lack thereof - between parent and child greatly influences the child's predisposition for developing an addictive personality.

Part VI: Imagining a humane reality beyond the war on drugs

This is perhaps the most powerful and socially relevant section in Maté's book.

He prefaces his arguments by first guiding the reader to see that at the root of our judgments of other people is the fact that they represent or reflect a reality we don't like or don't want to see in ourselves. He condemns the fervor with which we demonize the addict and securely position ourselves as superior to them. That is not a dynamic that condones healing and rehabilitation.

Through numerous examples from a multitude of countries, Maté proves beyond any reasonable doubt that the so-called "War on Drugs" is failing and will continue to fail. In simple terms, he explains the only way to truly reduce drug addiction and the negative consequences it imposes on society is to treat addicts as human beings.

That is with compassion and empathy, rather than adding on to the already horrible reality of their lives.

Maté strongly endorses the decriminalization of drugs and provides ample amount of evidence of the potential positive consequences doing so would yield for both the addict and for society as a whole. Being a realist, however, he argues for harm-reduction efforts to be taken at the very least.

Part VII: The ecology of healing

Overall, this concluding section is intended to both further illuminate the addicted mind for the reader and to support healing. Maté stresses multiple times the importance of being compassionately curious about ourselves. He advocates for the trading of judgment and rationalization for mere understanding with a perspective of curiosity, openness, acceptance, and love.

He then ties together the fact of addiction being the result of environmental factors and the addict's internal psychological space as signifying that both internal and external factors must be taken into consideration for healing to be possible. In one chapter of this section, Maté presents his specific modified method for overcoming Obsessive Compulsive Disorder (OCD) - The Four-Step Self-Treatment Method - to promote healing from addiction. In his modified version, he tailors the steps more towards addiction and adds a fifth step.

Mateé offers an interesting distinction between abstinence and sobriety, heavily favoring the latter. He provides words of encouragement, advice, and a healthy dose of realism for the friends, families, and caregivers of addicts.

He closes the section with a refreshing perspective on spirituality outside the confines of organized religion. He presents it in a way that makes it accessible and desirable for all people. In addition, he stresses the importance of addicts experiencing some form of spiritual awakening to fill the void of self and of divine knowledge that addicts are desperately using their addictions to unsuccessfully fill.