In the Realm of Hungry Ghosts

Maté attends a funeral for Sharon, a beautiful young woman whom he had met six years prior. She had been using heroin since leaving a recovery home, and the most likely cause of death was overdose.

He asks, “How to understand the grip of drug addiction?” (29). Maté asks several of his patients why they use drugs when they understand the dangers. In various ways, they each respond that they are more afraid of living sober than of dying high. 

Maté believes that addiction is about escaping distress, not chasing pleasure. Pain is always the source of addiction. Maté quotes statistics about childhood abuse leading to drug abuse, and tells three heartbreaking stories about his patients and their pasts. He asks the reader to contemplate why it is easy to empathize with a child, but not with the addict the child becomes.

Addicts use drugs to feel excited, rather than dull. The dullness is a product of “the internal shutdown of vulnerability” (40). Losing vulnerability creates a void.

Two addicted women, Aubrey and Shirley, describe the easing of inhibitions they get from cocaine. It also feels like a release from responsibilities, or a source of energy for the depressed.

Jake is a cocaine addict in his mid-30s. He says that the lifestyle of addiction has become normal for him, and he’s no longer sure if he would enjoy normal life. Maté tells him that if you drop a frog in boiling water, it will jump out. But if you heat the water by degrees, the frog will not know that it is in danger. It will boil to death, slowly. The frog reminds Jake of himself.

Maté talks with Serena. She refuses HIV care because she doesn’t want to feel controlled. The addicts have a hard time asking doctors for help because their poor health stems from an illegal activity. Before her grandmother raised her, Serena’s mother sold her to men for money, and her own uncle molested her, beginning at age seven. PHS has been the only place where she feels safe. She asks for an antidepressant because she is grieving for the grandmother, who died three months prior. The grandmother had raised her until she was 15, when Serena left her grandmother to find her mother. Her mother, however, proceeded to sell her to men. Serena began using heroin to cope with the abuse and her mother’s betrayal.

Before hearing her story, Maté viewed Serena as a manipulative addict who would tell him whatever she thought he needed to hear, just to get prescriptions from him. He now feels humbled by his own ignorance, arrogance, and what he feels is a complete inability to help her. 

Maté speaks with Angela McDowell, a heroin addict. Angela’s grandfather, a shaman in her tribe, the Coast Salish, raised her. She claims that her tribe can predict death. One year before he died, her grandfather took her to have a “spirit bath” (60), a cold-water cleansing ritual done with cedar leaves. Her grandfather chose her to carry on his spirituality when she heard drums during the ceremony. She now believes that her life’s mission is to heal others, even though she is ravaging herself with drugs. 

Maté describes a pregnancy in which a mother gives birth to an opiate-addicted infant. It appears in the form of a pregnancy journal that Maté keeps, beginning in June 2004. The mother, Celia, describes the sexual abuse she suffered as a child. She visits Maté with her boyfriend, Rick. They outline a plan for her recovery during the pregnancy, but she continues using.

Rick leaves her in November. She goes to the Oak Tree recovery clinic and Rick returns. The remainder of her pregnancy is a succession of fights, arrests, and cocaine binges.

Rick takes the baby home after she is born and then weaned from her mild opiate addiction. A court order forbids Celia from visiting. Rick then relapses with alcohol and protective care takes the baby. When the baby is six months old, Celia visits Maté for her methadone prescription. She is hopeless and numb. Maté wonders what will happen to the baby, and hopes that, “unlike her mother, she can come to know herself as something other than her own worst enemy” (75). 

Ralph is a middle-aged man with a Mohawk and a Hitler mustache. He is intellectually gifted but aggressive and crazed when under the influence of drugs. He hates Jews, and claims that they starved his grandfather during World War II. Maté is a Hungarian Jew, and listens calmly. However, whenever Ralph shouts Heil Hitler during sessions, Maté ends the meetings.

During one session, Ralph quotes Faust at length. That night at home, Maté reads the passage and feels moved by Ralph’s translation. He imagines Ralph out on the street that night and “in his heart he wants beauty no less than I—and, no less than I, needs love” (83). While he reads, he ponders his belief that a spiritual void makes someone more prone to addiction.

Ralph describes Goethe’s Homunculus in a hospital bed while he’s treated for a life-threatening sepsis. Without the drugs in his system, Ralph is thoughtful and apologetic about his Nazi rhetoric, which he claims he does not believe. After release, Ralph returns to Hastings, and to drugs. When he visits Maté again, they argue when Maté cannot meet his unrealistic demands for housing and food. Ralph leaves in a rage. When Maté leaves that evening, he sees that Ralph has drawn a black swastika on the wall near the first-floor exit. 

Maté gives several, more upbeat accounts of what he sees as instances of grace and humanity among the addicts. They are often courageous and treat each other with love and compassion. He then describes an addict named Josh who has an intuitive ability to understand and exploit other people’s vulnerabilities and insecurities. One day, Maté “lost it” (90) on Josh and then has to apologize to him for his outburst, which Josh had provoked. He is surprised when Josh empathizes with him, and says that he cannot imagine how difficult it must be to work in a place with so much negative energy.

Few people get to experience unconditional acceptance, and addicts may never have experienced it. Maté sees a dignity in the people who have had to make themselves tough in response to the absence of nurturing.

In another instance, Maté suggests that a patient named Remy write a letter to the family of the man he killed. Remy writes the letter, but gives it to Maté as a keepsake. In the letter, Remy apologizes to the family. His contrition helps him take a step forward in the way he views himself, even though the letter is unsent.