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