recoverysoul

Spiritual Principles behind the Traditions

In the Realm of Hungry Ghosts


The mandala, the Buddhist wheel of life, revolves through six realms.

Each realm is populated by characters representing aspects of human existence—our various ways of being. In the beast realm we are driven by basic survival instincts and appetites such as physical hunger and sexuality, what Freud called the id. The denizens of the hell realm are trapped in states of unbearable rage and anxiety. In the god realm we transcend our troubles and our egos through sensual, aesthetic, or religious experience, but only temporarily and in ignorance of spiritual truth. Even this enviable state is tinged with loss and suffering.

Some people dwell much of their lives in one realm or another. Many of us move back and forth between them, perhaps through all of them in the course of a single day.

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 Sometimes it comes to a simple-yet-pesky equation: if I can forgive myself, than I have the hope of letting others pass. In letting them go free from the clutches of my inner judge, I in turn am set free. Simple math, sure, but pesky. Maybe awareness is only distance, but the more awareness I get of my old self—rumbling his naïve, dis-enlightened, arrogant way in my memories—the more I’m shocked and sometimes abhorred by “me”. After weeks of drug rehab, there was a day—one glorious, sunlight, early-spring day—that I reaped the rewards of a fearless inner-look at all the muck and skeletons of my being. Sobbing, realizing both the beauty of Life and how much my own cruelty had robbed me of it, I forgave myself, and, like the poets say, was able to move on. Softer to myself, I transferred that to the rest of the people I saw, realizing everyone has their own inner battle.

But the math can be tricky. It wasn’t a “one and done”. Though I know I need to for happiness, I still find it hard to forgive myself at times

Gabor Mate’s heart-felt argument on the medical approach to addiction in his book, “In the Realm of Hungry Ghosts” challenges all of us to extend our powers of forgiveness. Extend it, even, to one of the most demonized segments of society. The addict, Mate argues, is closer to all of us than we’d care to admit, and society pushes said addict to the margins so it can avoid that mirror.

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A physician first (and a pretty damn-good writer), Gabor Mate recognizes the complexity of variables influencing the disease of “addiction”, insisting that for healing to become widespread, the very preconceptions we hold of the addict need to be confronted and challenged. But by God, not challenged aggressively—enough damage already from that rigid, dogmatic judge—but challenged through our compassion.

It is a call for compassion that even I, a recovering addict myself, found a bit of a challenge. The level of understanding Mate suggests seems, upon initial reading…extreme.

But one can’t help but like the author Gabor Mate, both for his obvious compassion and good-heart and his honesty: he admits to working obsessively out of a need to be a prominent figure, and often missing the mark in seeing his patients as people. Mate is not afraid to call himself out, insisting that he shows all the signs of addiction in his self-admitted “workaholism”, an addiction not only overlooked by society but praised.

The books argument takes a clear strategy: Mate paints a very intimate and personal portrait of the skid-row patients he treats, bringing to life the quirkiness of Downtown Eastside Vancouver’s worst cases. These are not just patients, or even just addicts; they are people. And you could kiss Dr. Gabor Mate for realizing that.

When my addict patients look at me, they are seeking the real me. Like children, they are unimpressed with titles, achievements, worldly credentials. Their concerns are too immediate, too urgent. If they come to like me or to appreciate my work with them, they will spontaneously express pride in having a doctor who is occasionally interviewed on television and is an author. But only then. What they care about is my presence or absence as a human being. They gauge with unerring eyes whether I am grounded enough on any given day to coexist with them, to listen to them as persons with feelings, hopes, and aspirations that are as valid as mine. They can tell instantly whether I’m genuinely committed to their well-being or just trying to get them out of my way.”

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 Having worked for two years at a rehab myself, I can only laugh at how true this is: addicts can cut through our defences and pretenses faster than our deepest relationships; if you operate from a place of ego and pretence, you will get struck-down and back-stabbed by their seething, well-established egos. If you operate, however, from a place of vulnerability and deepest-truth, they do respond…

That said, the strength of this book is definitely not “the solution” to the addiction problem or its proposed “new” treatment. Once I finally got over that fact, and realized that “In the Realm of Hungry Ghosts” was not proposing a new solution to the treatment of addiction, I began to perceive and appreciate the particular strengths of the book, and can endorse them for you now.

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The book is no replacement for those in the throes of a hard addiction. It never claims to be. A recovering addict myself, I don’t see this book providing any “solutions” that the 12 steps don’t already cover. Gabor Mate (the author) freely admits the strength of AA and the 12 steps, and has a deep respect and a clear, informed appreciation of how these programs help those who might “get recovery”. The book is not for the addicted sufferer looking to get out of his or her destructive cycle.

But it is uniquely adept at helping those sufferers of “less-hardcore” addictions (Like a good doctor, Mate medically defines addiction as: any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the live of others). Mate himself explores throughout the book his “addiction” to…this might seem unbelievable, even laughable, at first glance…classical music. That’s right: Mate admits to maxing out credit-cards and lying to his wife about the reality and depth of his Classical Music purchases. Mate even tried an AA meeting for his problem (where, I was proud to read, the members welcomed him and considered his problem as serious as alcohol).

[addictions]—whether to drugs or to non-drug behaviors—share the same brain circuits and brain chemicals. On the biochemical level the purpose of all addictions is to create an altered physiological state in the brain. This can be achieved in many ways, drug taking being the most direct. So an addiction is never purely ‘psychological’; all addictions have a biological dimension.

…as we delve into the scientific research, we need to avoid the trap of believing that addiction can be reduced to the actions of brain chemicals or nerve circuits or any other kind of neurobiological, psychological, or sociological data. A multi-level exploration is necessary because it’s impossible to understand addiction fully from any one perspective, no matter how accurate.

However, the book is not a new solution, or an examination of an old one, but a two-fold argument: (1) Mate argues for a drastically altered policy and approach to how addiction is dealt with socially, and (2) a convincing, facts-only picture of how the brain operates in a severely addicted person.

I operate often, as a condition of my admitted disease, from a perspective of “the solution” to the great Problem of addiction. I know all too well what it’s like to focus only on the problem, the complex “whys” of my need to use, or all that was wrong in my life now, and all the wrongs done to me in the past, and how many challenges I had to face and how I couldn’t possibly do any of it! This is not say that some of the problems were hard, or the suffering of my past not painful. But it is a fought-for realization that a solution exists when I’m not only focusing on why “I can’t” do it.

It’s a one day at a time solution, and recovery from addiction demands I stay close to this perspective.

But it’s not the context the book is operating on. And as challenging as it was for me at times to view the world from its context, I am swayed by its argument.

Which is no less than to supply hard-core, IV-injecting drug users with their very drug of choice, in a safe and controlled setting. Dr. Mate even describes facilities where this is already occurring: a sort of milk-white, sterile lounge, where addicts will get injected by trained-practitioners with heroin, and then stumble into a cozy, lounge where other “sufferers” hang out during the fix. He calls it the “harm-reduction” approach. Rather than punish further the repeat-offender with more prison sentences and probation, Mate argues that we help end the vicious circle of shame and guilt and moral judgements, and instead compassionately (and safely) administer the substances that the addict will do anything to get.

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Not all addicts will accept methadone as a substitute (just as for some others whose drug of choice is morphine, neither methadone nor heroin will do). In such cases we can leave the addict to fend for herself in the underworld jungle, or we can offer heroin or morphine unadulterated by who-knows-what impurities, to be self-injected in a clean environment with uncontaminated needles. We are neither condoning nor encouraging addiction: the addiction exists and will continue to savage that person’s life no matter what we believe.”

I admit to struggling with this line of thinking as I read it. From my recovery sensibilities, it seems like accepting the behavior, and making just more excuses on behalf of the addict so he can stay in the victim-role. For, the major part of the addiction solution (and most therapeutic solutions) is for the sufferer to assume the role of responsibility, despite how wronged he or she may have been in the past. So, as a society offering needles and drugs for the addict at will, aren’t we only further enabling the addict? By “helping” the person relieve the harm, aren’t we only hurting the person further, cementing him or her more solidly in their addiction?

Well…

Yes, and no. I came of the mind that there are two distinct problems: the first is the society’s perception and punishment, and the second is the addiction. From the second viewpoint, Dr. Mate’s harm-reduction approach may be only creating more. But, as radical as it may first sound, I think the harm-reduction approach makes senses when we keep it in mind from a band aid-level solution, a slapped-on, emergency preventive to stop any further bleeding.

For, as much as AA and the 12-steps may give the strength to actually live up to my ideals, and as much as it pains me to say—not every addict is going to get recovery. And I agree with the basic text of Alcoholics Anonymous—not so much agree but have been witness to born testimony—that “some of us suffer from grave and emotional mental disorders, but many of us do recover if we have the capacity to be honest with ourselves.” Yes, ideally, everyone is able to recover. In the meantime, however, a vast number out their aren’t recovering, perhaps we can soften our judgemental approach to the repulsive behavior of the addict. Maybe it can be like Dr. Mate says, where we are neither condoning or encouraging addiction, but offering less harm until the attraction of the ideal—the goal of recovery and no drug use at all–is allowed to take hold.

It’s an argument that follows on the wings of the book’s major strength: the neuroscientific, medical-model perspective on the addictive process. Though the argument for social policy may not be persuasive (and seems to be the major reason Dr. Mate wrote the book in the first place), the book is worth reading for this aspect alone.

And, as the research overwhelmingly shows, most hard-core “junkies” have extreme trauma that led to the mal-adaptive behavior in the first place. So while we may be repulsed at the lying, scheming, and stealing behavior the addict will use to fuel his disease, the only response that is appropriate when reading the cause of the addiction in the first place is one of compassion.

Research on rats even shows that when a nurturing environment exists, the rats will actually choose to stay away from a readily available (and strong and pure) solution of morphine. They will stay away from it even, when already physically dependant. As long as the rats have a nurturing environment in which they can make the choice. As the researcher said, “Nothing that we tried instilled a strong appetite for morphine or produced anything that looked like addiction in rats that were housed in a reasonably normal environment.”

But what about the rats who didn’t grow up in a “reasonably normal environment”? “Caged rats consumed up to 20 times more morphine than their relatively free living relatives.”

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 The science suggests that the addict had very little choice in his mal-adpative behavior. The tragedy that occurs in early life that leads one to want to sooth the terrible feeling is painted by the science as not some lack of moral uprightness, but a normal strategy to deal with the chemicals in the brain. It’s a very intricate argument, backed by research and logic, and it’s not my purpose to repeat it all here. I can only recommend the book on the basis of this fascinating research alone.

Far from being the autonomous dictators of our destinies, genes are controlled by their environment, and without environmental signals they could not function. In effect, they are turned on and off by the environment; human life could not exist if it were not so…

…there is a new and rapidly growing science that focuses on how life experiences influence the funciton of genes…as a result of life events, chemicals attach themselves to DNA and direct gene activities. The licking of a rat pup by the mother in the early hours of life turns on a gene in the brain that helps protect the animal from being overwhelmed by stress even as an adult.”

The very strength of the research and neuroscience of addiction were what left me still wondering: was the proposed “harm-reduction” strategy really the best way to go? The problem still remained: just because I had a thousand good reasons to use drugs, even if I had been abused and traumatized in the past, it wasn’t going to get me any less addicted by blaming my problems on the past. So while all the research is interesting, from an understanding point of view, it still came down to the timeless tradition of waking up to the present moment, and taking responsibility for your part in the process.

I’m fairly certain that a lot of rapists and child-molesters were also abused and tramautized; most murderers also probably have tragic pasts. As a human being, I think it’s essential to feel compassion and try to understand that there is something good in all of these people. As a society, however, some sort of judgement needs to be made on the behavior, and must be shown as unnaccetable. There needs to be a system of punishment for society to work.

I can speak from personal experience—if there wasn’t a system of crime and punishment in the first place, I would have never been forced to sit and take a look at my behavior. If the option would have been available to get admintered heroin from sympathetic doctors, if the judge would have looked at my addiction as hopeless, than I would still be in that destructive cycle.

Maybe the definition of compassion needs to be examined.

Arguments are always more persuasive, however, when it nods towards the other side. And Dr. Mate has a clear understanding of the solution, and is not compromising that as the final ideal:

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“Spiritual awakening is no more and no less than a human being claiming his or her own full humanity. People who find themselves have no need to turn to addiction, or to stay with it. Armed with compassion, we recognize that addiction was the answer—the best answer we could find at one time in our lives—to the problem of isolation from our true selves and from the rest of creation. It’s also what keeps us gloomy, sad, and angry. Not the world, not what’s outside of us, but what we hold inside traps us. We may not be responsible for the world that created our minds, but we can take responsibility for the mind with which we create our world. The addicted mind can project only a universe of grasping and alienation. Many of us conduct our lives just in that way. It’s for us to choose consciously what world and what future we wish to live in.”

However, where Mate sways me in the end is his particular focus group: the homeless, destitute, and life-long drug users. These are resource-less people. And I think the current system may not be serving them well. And as the research shows, these “hard-core”, life-long users have incredible biological and neurological obstacles to overcome. But I can only recommend, if you have an interest in addiction, to pick up “In the Realm of Hungry Ghosts” and decide for yourself.

Dr. Mate knows—and it is a beautiful knowledge—that a public policy of “harm-reduction” does not replace (or for that matter, is even intentendes as) the solution of “recovery” for addiction. In fact, the last chapter is one of if not the major strength in the book. His elegance when describing the spiritual quest in general—and the beauty of the spiritual descriptions of his Native American patients—is one I’m a bit jealous of. The purpose of this site is to try and provide the distilled essence of Timeless values all religious traditions have, and Gabor Mate summed it up in one paragraph (okay, so 3):

“There are people who are not addicts in the strict sense, but only because their carefully constructed ‘personality’ works well enough to keep them from the painful awareness of their emptiness. In such a case, they’ll by addicted ‘only’ to a false or incomplete self-image or to their position in the world or to some role into which they sink their energy or to certain ideas that give them a sense of meaning. The human being with a ‘personality’ that is inusfficient to paper over the inner void becomes an undisguised addict, compulsively pursuing behaviors whose negative impact is obvious to him or to those around him. The difference is only in the degree of addiciton or, perhaps, in the degree of honesty around the deficent self.

Spiritual work and psychological work are both necessary to reclaim our true nature. Without psychological strength, spiritual practice can easily become another addictive distraction from reality. Conversely, shorn of a spiritual perspective we are prone to stay stuck in the limited realm of the grasping ego, even if it’s a healthier and more balanced ego. Our soul-needs for meaning and connection remain unsatisifed. Therapy strives to make the deficient self stronger by uncovering the sources of a person’s emotional pain and releasing the rigid defensive patters built up against it. Spiritual exploration ploughs the same ground but is less concerned with ‘fixing’ or improving things than with rediscovering what is whole and has not been absent, just obscured. As Edmund Spenser wrote, ‘For there is nothing lost but may be found, if sought.’

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What form of spiritual seeking a person chooses is determined by place, culture, belief, and personal inclination. On this question there can be no prescriptions; nor would I be the one to provide them. In retrospect I can see that the God-rage I trembled with as a small child was the beginning of my movement toward enlightenment, a goal that I may yet be far from attaining. I may have the equivalent of sevearl Mount Everests left to scale, or perhaps I have only to reach out with my little finger to rend the veil of illusion between my soul and the most sacred realities. I cannot know, and it’s uselss to speculate. Being on the path is what’s important, and we each need to tread a path on our own, no matter how many may have walked it before us. ‘Be a lamp unto yourselves,’ the Buddha advised his followers, just as Jesus taught his disciples to seek the Kingdom of God within.”

So I sit today, still on the path, some days finding it hard—when I’m distracted from the main path—to forgive myself. But I can’t forget the lessons I’ve learned, the sights I’ve seen when I took that deep look inside. And the more pain I feel the more humility I can gain. The more compassion I can have for my fellow human beings. “Once a student’s eyes are open, instructors appear everywhere. Everything can teach us. Our most painful emotions point to our greatest possibilities, to where our authentic nature is hidden. Compassion for ourselves supports our compassion for others. As we open to the truth within, we hold a safe place of healing for others. Healing occurs in a sacred place located within us all.”

Thank you, Dr. Gabor Mate, for never forgetting the true process of healing in all your medical training.

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One comment on “In the Realm of Hungry Ghosts

  1. kloncke
    September 20, 2012

    Hi Mike (I think that’s you?)

    Thank you for this beautifully written and wonderfully contextualized review of Dr. Maté’s book! We would love to re-post it on buddhistpeacefellowship.com (Turning Wheel Media) in connection with a giveaway of a signed copy of In The Realm of Hungry Ghosts. If you’d be willing to offer it, please email me at katie [at] bpf [dot] org. Thanks!

    Katie Loncke

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