|
Key insights from
In the Realm of Hungry Ghosts: Close
Encounters with Addiction
By
Gabor Maté
|
|
|
What you’ll learn
In the Buddhist mandala, there are six realms of life, each
characterizing a different aspect of human experience. “The realm of hungry
ghosts” is a state of being in which we pursue external things in hopes
that they will satisfy our deep inner longings. In the artwork, these
hungry ghosts are depicted as scrawny, malnourished people with thin necks,
frail bodies, and hunger-bloated bellies. This is the realm of addiction,
where substances, objects, and activities are compulsively pursued to hide
an ache.
As Hungarian-Canadian psychiatrist and researcher Gabor Maté puts things in
his award-winning book, addiction is a state in which “we haunt our lives
without being fully present.” Maté’s own passion and expertise in the
addiction field come from decades spent serving the forgotten down-and-outs
of Vancouver’s Downtown Eastside—essentially a Canadian version of Skid Row.
It’s the side of town filled almost exclusively with hungry ghosts, and he
advocates passionately for an intuitive, but unconventional approach to
treating them. Maté stresses, however, that addictions take many forms,
some that hit uncomfortably close to home.
Read on for key insights from In the Realm of Hungry Ghosts.
|
|
1. Addiction is
far too complex to sum up as a “disease” or a “moral failing.”
What do we have in mind when we say the word “addiction?” In
today’s usage, “addiction” most commonly refers to distinct behaviors
(gambling, sex, drugs, or alcohol). But this definition of addiction has
only been operational for about 100 years. The term “addiction” has been
around a lot longer, and it’s been used simply to describe an activity that
someone is really passionate about, a goal into which you invest
significant time and energy. It’s not confined to a negative pattern of
action. Writers like Shakespeare and Cervantes and politicians from several
centuries ago would use “addiction” to connote a positive ambition.
The more ancient Roman usage of the word addictus referred
to a person who couldn’t pay off his debts. Such a man had become “addicted”
to his creditor. In that context, addiction meant enslavement, which speaks
better to our current moment, in which we see addiction as a kind of
enslavement to a pattern of behavior.
Clinical settings tend to stress addiction’s persistent,
compulsive aspects, and actions a person repeatedly takes even in the face
of harmful consequences to self and others. Definitions like these have
their place, but they're narrow. People are addicted to all kinds of things
and activities—even if those activities don’t land them in jail or on the
streets. To more fully understand addiction and the fundamental processes
involved, we need to think beyond junkies hunting for crack cocaine in back
alleys or the Monday night drunk. There are plenty of behaviors that are
not linked to substances that can be extremely damaging to physical health,
mental health, and relationships with others.
The hallmarks of any addiction are compulsiveness,
compromised self-regulation, habitually falling into it even in the face of
harm, lack of satisfaction, and increased irritability when substances or
activities are not available.
All addictions utilize the brain circuits and chemicals. To
really understand addiction, we can’t view it as a psychological or
spiritual issue divorced from the physiological. Addiction is a complex
phenomenon that connects social, spiritual, political, economic,
psychological, sociological, neurological, and emotional: Each of these
lenses is fully necessary to account for addiction. This complexity is the
reason that calling addiction a “weakness of the will” or a “disease” is
inadequate. It’s not “just” a moral or medical issue. It’s not just
anything. At bottom, it’s an attempt to avoid an inner void, but the
reasons that void is there and the ways one tries to avoid it are as varied
as people themselves.
|
|
|
Sponsored
by Honoring Anna
Amazon 5 star reviews.
Spearfish author,
Douglas Hoff, weaves a tale of unyielding faith, love and honor as he
follows Anna's - a young, hardworking immigrant - journey from an island in
the North Sea to the Dakota prairie and through the Dirty Thirties.
Get the book here.
|
|
2. Some addictions
are shunned while others are celebrated.
Maté often reflects on the uncomfortable similarities
between his patients and himself. Most of Maté’s patients are addicted to
some combination of drugs and alcohol, but he has his own addictions. Even
if it’s not crack cocaine or meth, he still experiences those same patterns
of craving and compulsion and relapse that his friends on Vancouver’s
equivalent of Skid Row know all too well. When he describes what is
happening for him internally in those moments of neediness to his patients,
he is met with knowing head nods. Maté has his moments of compulsively
annihilating himself by burying himself in his work or hoping for a hit of
affirmation at the next conference. The content is different than that of
his patients, but the process is exactly the same: Those feelings of
compulsion, craving, and relapse, and trying to get rid of the
self-loathing that festers in the heart of an addict—they’re familiar to
the doctor as well as the patient.
Maté muses that he has emotionally abandoned his family in
seasons of workaholism, but his abandonment was the kind that made him lots
of money, gained him recognition, and had people cheering for the
pioneering work he was doing. Whatever prestige certain addictions carry,
and whichever ones we overlook, they are still addictions.
No matter how broken or down and out someone is, there is
not a single person on earth who is empty and lacking to the core of their
being. But this sense of intrinsic inadequacy is how addicts experience
themselves. In an exercise of heartbreaking futility, they cover up that
experience of perceived emptiness with addictive patterns. The problem is
much less what they pursue than the way they pursue it.
The massive amounts of energy devoted to covering up this
deep sense of inadequacy exhaust precious psychological and spiritual
resources, and stunt genuine growth. As one long-time addict and
inmate-turned-writer put it, “It has seemed to me at times that you can be
present in your life only as a kid or when you’re on heroin.” This puts
words to an unspoken script that many discouraged individuals act out,
whether they’re in prison for their runaway compulsions or whether their
compulsions have earned them a nice house and admiration.
|
|
3. Addiction-prone
personalities lack clear boundaries, struggle to self-regulate and control
impulses, and believe they are inherently unlovable.
The notion of pursuing external things and not internal
things is central to what is often called the addictive personality. We’d
be more precise to call it the “addiction-prone personality.” Obviously,
there’s no assortment of personality traits that’s going to inevitably lead
someone to addiction in and of itself, but there are some clusters of
traits that make it much, much more likely that someone will relate to an
activity or a substance in a way that becomes compulsive and out of
control. If your personality is such that you compulsively look for
emotional or physical comfort in external sources, you could be someone who
is more susceptible to the addiction process.
The addiction-prone personality reflects a struggle to
self-regulate. By self-regulation, we mean the ability to distinguish
between the self and one’s own feelings in a given moment. Children do not
have this ability. They are their emotions, which is why they’re
entirely in need of parents to give them a sense of self, and assure them
that they are okay. They need that external parental source to soothe them
and calm them down because kids at a young age can’t control their
emotions.
For many adults, the struggle to self-regulate remains, and
the tendency to look for other sources of support outside themselves never
really leaves them. Reliance on external things is the only way that they
know how to make themselves feel okay, whether that’s with food, alcohol,
pornography, video games, extreme sports, or finding a steady stream of
love and attention from other people—the list goes on.
A key part of self-regulation is impulse control. This is
another area of struggle for the addiction-prone personality. When strong
feelings suddenly rise up—whether they’re excitement, fear, or anger—the
addiction-prone personality doesn't know what to do with them.
A lack of differentiation is another aspect of the addiction-prone
personality. In other words, the boundaries between self and others and
self and one’s own inner experience are fuzzy and indistinct. So if you
have differentiation issues, whatever you feel, you are, or whatever
someone else is feeling, you take on as your own emotions. If someone near
you is experiencing heavy anxiety, that person’s anxiety becomes yours.
When there’s an inability to know what belongs to whom, excess emotional
energy builds up. Without the ability to regulate that, you’ll likely look
for an outside source to provide some comfort and stability. This is what
we do when we’re unable to hang onto our sense of self while interacting
with other people.
The hallmarks of the addiction-prone personality are the
struggle to self-regulate and to control impulses, a lack of basic
differentiation, an unhealthy sense of self, and the deep belief in one’s
intrinsic emptiness. Ultimately, it’s a lack of emotional maturity. This
maturation process is developmental, but many kids never hit these
milestones of emotional maturity. Many adults don’t either. Thankfully,
adults can continue to grow and develop emotional maturity even if it was
not instilled in them as children.
|
|
|
|
4. Early childhood
environment impacts brain development far more than genetics.
It’s hard to talk about addiction without talking about
brain development. And it’s hard to talk about brain development without
also talking about the early childhood environment. A common theme among
the addiction-prone is a traumatic upbringing and incomplete brain
development.
In the early 1990s, President George H.W. Bush called the
coming decade “the decade of the brain.” He was right. In the United States
and elsewhere, there was an enormous surge of research on the brain that
shifted key paradigms. Scientists were forced to discard some old understandings
of how the brain worked. Yet there remains a great deal to be discovered
about the inner workings of the brain. Some experts opine that we need
centuries’ worth of research.
Whatever else remains to be discovered, the general outlines
of the existing research are becoming crisper, and the findings have blown
open the nature-nurture debate—in favor of nurture: Early childhood
environment is a stronger predictor of brain development, emotional
stability, and life satisfaction than genes.
Even the best genes in the world won’t make a difference
without an environment where the right neurological circuits, networks,
chemicals, and systems can be established. Think of the world of
agriculture: Say you have a seed that you’re about to plant, a seed
containing the most ideal genetic material available to produce that
delicious fruit or vegetable. Without the proper conditions, like
nutrient-rich soil, adequate water, plentiful sunlight, and a moderate
temperature, the plant can’t grow and reach its full potential. Say you
have two of those seeds, and you plant one in an ideal environment with
everything it needs to thrive and you plant the other in a spot that gets
little water or sunlight. Even if the genetic material is exactly the same
in both seeds, you will still end up with two very different plants. The
same holds true when we talk about children and their developing
brains.
The main systems in the brain that drive addiction processes
are the attachment reward system, the incentive-motivation system, stress
systems, and the prefrontal cortex regions that relate to self-regulation.
These are all heavily shaped by environmental factors. To give just one
small example, studies have found that, from rats to humans, the mammalian
brain reaches optimal potential when the young are stroked and cuddled and
held—or, licked, in the case of rats. The more cuddling, the stronger the
circuitry that reduces anxiety. Babies that were cuddled more also tend to
have more receptors for benzodiazepine, a chemical that naturally calms the
stressed brain.
So for anyone who wasn’t held and cuddled at all by mom as
an infant and young child, anxiety is likely going to be much higher. The
brain doesn’t have nearly as many receptors that transmit the calming
chemicals. Studies like these can help us understand the addict’s world
better and extend more compassion. People who take to the streets searching
for dollar-per-pill benzos to calm their rattled nerves are looking for a
little bit of relief because their bodies don’t produce those chemicals on
their own. This hunt for artificial tranquilizers tells us less about “weak
wills” and more about childhood deprivations and trauma. Their brains never
really stood a chance.
Thankfully, early childhood environmental experiences, while
formative, are not destiny. Neither is genetics. The brain is a robust
organ that will heal if given the opportunity, and it’s never too late for
new circuits to be developed. Moreover there’s something about us beyond
the wirings and the firings and the flow of chemicals, something almost
spiritual that never dies even in deep addiction.
|
|
5. Maté’s
experiences in Vancouver’s Skid Row made him a believer in harm reduction
policies.
What is harm reduction? It’s a holistic approach to the drug
problem that goes beyond simply advocating cold-turkey abstinence from
drugs and punishing those who fail to abstain. It’s a more relational tack
that offers some combination of housing, safe injection sites, legal
prescription alternatives like methadone to replace their dependencies on
contrabands, as well as sites to swap out used needles for new clean
needles—reducing complicating factors like HIV and Hepatitis C.
Ultimately, harm reduction is about providing an environment
that is accepting and hospitable enough to reduce their suffering, where
addicts form relationships with caretakers, and that provides them with the
external and internal resources needed for someone to truly stop using.
Maté’s introduction to harm reduction came while he served
as a psychiatrist with a Vancouver non-profit called the Portland Hotel
Society. This organization serves the addiction community in Eastside by
converting former luxury hotels into functional domiciles where the
“nonhousable” can stay for free. The nurses took Maté to one such hotel to
see a 30-something year-old man from Quebec who was, by all accounts, “a
difficult patient.” When Maté entered the hotel room, the patient was
swearing as he attempted to inject his neck with some unknown cocktail. He
was on the verge of seriously injuring himself, so Maté offered to help him
inject more safely. He asked the nurses to prepare a tourniquet for the
man’s arm, and coached him on how to make the vein more prominent in his
arm, so the man could inject the mystery liquid—whatever it was—more
safely.
Maté could hardly believe himself in that moment. Was he
really helping a patient self-inject an illegal, mind-altering substance in
a roach hotel? But then he wondered what the alternative would have been.
The medical team could have tried to persuade the patient not to use this
time. But that would have been far from the cure that was needed. It was
more strategic at that moment to communicate to the patient, “We care about
you.” He was going to use, no matter how eloquent their dissuasion, so why
not equip him to do it in a way that wouldn’t bring him more harm than he
was already in? Building this bridge of trust opened that patient up to
greater trust and openness to medical advice in the future, which led to
further conversations about his past wounds—the real source of the
addictive behavior.
Sadly, this particular patient died years later of
conditions linked to HIV, but the harm reduction approach prolonged his
life far beyond what it might have been without the medical staff’s support
and relationships. It also improved his quality of life, and alleviated
some of his suffering along the way. In a place like Downtown Eastside, not
every story is going to end happily. Life is messy, and it would be naïve
to expect a cure-all. Still, harm reduction is the best chance for stories
of triumph and not just stories of tragedy.
|
|
6. Harm reduction
gives addicts a better shot at long lasting recovery than the threat of
harsh punishment.
When some people hear “harm reduction,” they think of a
coddling, enabling program that perpetuates addicts’ habits rather than
curing them. But those who think being cured from an addiction is simply no
longer using drugs and staying away from alcohol haven’t understood
the nature of addiction.
For the people in downtown Eastside, full-fledged addiction
is (among many other things) a medical condition they have had for years.
But the hungry ghost condition is also made possible (and made worse) by a
lack of meaningful relationships and support, deep self-hatred, and
consistent rejection from more “acceptable” members of society. And
punishing the addicted or letting a friend overdose “to teach them a thing
or two” actually teaches them nothing. The parts of their brains that
process information and plan effectively are offline, and most are unable
to think beyond the next hit and basic survival needs. Punishment isn’t
nearly as instructive as people suppose.
To be clear, there is no magic bullet for getting rid of an
addiction. Health care services can’t do much to resolve these deeper
issues, but they can help with some of the symptoms and suffering that the
addicted suffer—not to mention the pain of marginalization that drug
addicts commonly experience.
One of the common objections to reducing the harm and
suffering that addicts experience is that they are undeserving of such
treatment. “They’ve made their bed, so let them sleep in it” is the guiding
logic. But how different is that from saying, “Doctors shouldn’t treat
chronic smokers for their bronchitis and emphysema, nor adrenaline junkies
who break their limbs on ski slopes or cliffs, nor morbidly obese
individuals for their cholesterol and heart issues.” No doctor and few
people would expect the medical system to withhold care because these
issues were self-inflicted, but many people have serious misgivings about
treating addicts in suffering.
Harm reduction is not choosing coddling over tough, punitive
love. It’s the decision to play the long game instead of the short game.
People mistakenly assume that harm reduction measures have given up on
abstinence, but nothing could be further from the truth. Harm reduction
holds out hope for a true abstinence, one that comes because drug addicts
have found something better, like meaningful connection, trusted community,
and alternatives to compulsive behavior. But people employing harm
reduction measures also recognize that someone neck deep in a habit on Skid
Row is in a lot of pain—and at this moment they probably lack the support
and emotional and spiritual resources to cold-turkey abstain without
falling right back into this or another harmful habit.
In a word, harm reduction tries to create an ecology of
healing. It’s more holistic. It attempts to create an environment of
acceptance, a place of trust, where the patient can begin to believe that,
“Even if I inject in this safe site that’s been set up for me, these people
don’t look at me differently.”
Harm reduction is not just policy. It’s also an attitude of
hospitality toward those whom society tries to forget. By cultivating an
atmosphere of hospitality and acceptance, there is opportunity to repair
some of the deepest wounds in addicts, the very wounds that are the biggest
blocks to true abstinence in the first place.
At the core of every addiction is the compulsion to avoid an
inner void. Everyone has those—not just the street-involved of Eastside
stealing and prostituting their way into their next hit, but a political
power-craver looking to win an election, a workaholic burying himself in
his job, or a shopaholic who can’t stop buying more clothes. Part of
improving the situation for drug addicts is to recognize that, at our
roots, we are not all that different, that their struggle is our own.
|
|
Endnotes
These insights are
just an introduction. If you're ready to dive deeper, pick up a copy of In the
Realm of Hungry Ghosts here. And since we get a commission on
every sale, your purchase will help keep this newsletter free.
*
This is sponsored content
|
|
|
This newsletter is powered by Thinkr, a smart reading app for the
busy-but-curious. For full access to hundreds of titles — including audio —
go premium and download the app today.
|
|
No comments:
Post a Comment