MH@H Book Reviews

Book Review: In the Realm of Hungry Ghosts

Book cover: In the Realm of Hungry Ghosts by Gabor Maté

In the Realm of Hungry Ghosts by Dr. Gabor Maté offers powerful insights into the vulnerable, human side of addiction. It draws on his encounters with patients while working as a staff physician at the Portland Hotel, an ultra-low barrier supported housing building in Vancouver’s downtown eastside, Canada’s poorest postal code. Ultra-low barrier housing like this supports people with complex mental and physical health problems, addictions, and social problems; people end up here after being evicted from everywhere else.

It’s easy to judge people whose lives are consumed by their addictions… until you hear their stories. Fetal alcohol exposure, childhood sexual abuse, trauma on top of trauma, on top of trauma… As one chapter title says, “their brains never had a chance.” If one were to sum up the adverse childhood experiences scores of the Portland residents alone, the number would be massive.

Maté argues that when people feel calmer after using stimulants, that’s almost a sure sign they have ADHD. Likely, the stimulant use was an attempt to self-medicate. Yet many prescribers are reluctant to give ADHD meds to people with additions.

The author explains that drugs don’t cause addiction; addiction happens when vulnerable people are exposed to potentially addictive drugs. Cravings will then cause them to compulsively seek out those drugs. The book discusses the brain and body systems that are involved in addictions, including the way opioid use taps into primal attachment needs. Relevant research findings are incorporated in a reader-friendly manner.

The book also covers the failure of the war on drugs approach, offering suggestions for a more humane alternative, including harm reduction as a necessary small step.

Maté describes his approach to working with this patient population as compassionate curiosity. He’s open about his own compulsive tendencies and work on self-compassion. It’s refreshing to see someone writing from a professional perspective incorporate their own vulnerability.

I spent several years working in the same neighbourhood as the Portland Hotel. The concentration of pain and suffering in one small neighbourhood can be overwhelming. Society often rejects its residents as less than human. Yet underneath the addiction and the desperate behaviours that fuel it, the humanity is still there. This book does a remarkable job of revealing that humanity, and demonstrating that addiction is not a choice, not a weakness, and not a moral failing. The world needs more people who are willing to look through this lens.

In the Realm of Hungry Ghosts is available on Amazon.

You can find my other reviews on the MH@H book review index or on Goodreads.

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30 thoughts on “Book Review: In the Realm of Hungry Ghosts”

  1. Beautiful people in need and beautiful people helping them. Everyone with needs and the quest to find new ways to meet them that do less harm. Sounds inspiring

  2. Sounds like an interesting read. There sure is a lot of stigma and judgement around addiction, and rarely do people think twice before judging to consider what may lie in their past, like trauma or fetal alcohol exposure. I’m not too sure about Maté’s point that “when people feel calmer after using stimulants, that’s almost a sure sign they have ADHD.” I’ll reserve comment on that but I’m not too sure. In some cases, sure, but I don’t think it’s ‘almost a sure sign’. That said, it is disconcerting that ADHD diagnosis and treatment isn’t as forthcoming when it is needed if someone has an addiction. His view on addiction is also interesting, that drugs themselves aren’t the problem but it’s when a vulnerable person is exposed to them that they become addictive. I’d half way agree but there are always cases where that doesn’t quite fit. But that’s the thing, isn’t it, none of it is black and white, and there’s no one-size-fits all approach to explaining it or treating it. What I do love about the sound of this book is the compassion. There definitely needs to be more of that when dealing with addictions and those in need of support. xx

    1. Yeah, his views on the matter are definitely not universally agreed on, and he’s also pro-ayahuasca, which is controversial, but the compassion is definitely there.

    2. Thinking a bit more about what you said about person vs drug, pretty much anyone who takes long-term opioids is going to develop physical dependence, but only some will develop psychological dependence and addiction. Interesting to think about what might separate those two groups of people.

  3. Exactly: most people seem to want to forget that we are ALL people, human beings, first and foremost.
    Thank you for this excellent post, Ashley.
    -Shira

  4. His podcast on the subject with Tim Ferriss was excellent, as is the book. Thank you for the reminder, it needs a revisit.

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