In the Realm of Hungry Ghosts

For Maté, organisms are inseparable from the systems they live in. “What we are looking for is what we are looking with” (360). This has positive and negative aspects. Only the human brain can observe the human brain, which is a powerful but fallible tool. Brains also change due to evolving external environments that then modify the internal environment.  

Maté cites the work of Dr. Jeffrey Schwartz and his colleagues at the University of California, who have shown the brains of people with OCD can establish new circuits: healthy habits, over enough time, can override the abnormal impulses in the unhealthy circuits. Schwartz calls conscious effort “The mind activity that can physically rewire malfunctioning brain circuits and alter our dysfunctional emotional and cerebral responses” (363), which Maté then discusses in the context of mindfulness and awareness. He describes mindful awareness as the ability to be aware of the processes of the mind, using the material of the mind.

Maté refers to fear and resentment as the dominant emotions of addiction, because fear and resentment are likely to prompt unhealthy reactions, which can then lead to toxic habits. He distinguishes two types of mind function: awareness and automatic processes. The automatic mind responds to triggers instantly, based on past experience. It is the disordered mind function of pure reactivity. Awareness is the function of the mind that can observe what is happening in the window between impulse and action. An observant mind can see situations that need change instead of escapism.

Maté concludes the chapter with by outlining the ways in which meditation has helped him treat himself with more compassion. 

Chapter 31 gives Maté’s outline for modifying addictive behaviors, which are based on the work of Dr. Schwarz, with minor changes of Maté’s. First he revisits the overlap in the nature of OCD as an addiction: “OCD has a similarity to addiction in the driven nature of its behaviors” (374). They are both based in anxiety and impulse-control.

Maté proposes five steps in modifying behavior:

Step One: Relabel. To relabel is to note the feeling and tell yourself that you see the feeling for what it is. You don’t need whatever the feeling is prompting you to acquire, you are simply having an obsessive, invasive thought about it.

Step Two: Reattribute. To reattribute is to place the blame on your brain and recognize that it is sending a false message.

Step Three: Refocus. To refocus is to buy yourself time. Dr. Schwarz says, “It’s not how you feel that counts; it’s what you do” (379). He recommends that anyone in the grips of a sudden impulse do something else and let the urge pass.

Step Four: Revalue. To revalue is to acknowledge the consequences of giving in to one’s urges, past and future.

Step Five: Recreate. To recreate is to choose a different life, not what life has chosen for you. 

Maté explains his view on the difference between sobriety and abstinence. When he imagines simply abstaining from his addictions, he feels something akin to panic. Abstinence takes two forms for him: a choice for something greater or a forced resistance to something he craves. Abstinence in one area can lead to eruption in other areas of the addictive process. Both contain potential pitfalls.

Sobriety, on the other hand, “means being free of internal compulsion and living according to principles I believe in. Unlike abstinence, I don’t experience it as a constraint but as liberation” (387).

Maté gives a brief history of his chronic lateness. While he is away at a retreat, he receives an email from Susan, the PHS health coordinator. She writes that the person filling in for him is always on time and it has made a huge difference. Maté saw his tardiness as an excuse of his addiction-prone mind proving that he had control: that he arrived when he chose. He apologizes to Susan and gives her a plan for doing better.

Susan’s willingness to confront Maté about the effect his tardiness has on her and the work at PHS changes him. He commits to telling the truth, and stops lying about his CD purchases. He therefore does not compound his inner shame by lying, and some of the pressure he attributes to his addictive impulses fades.

Maté believes that speaking the truth can show anyone the effects of their behavior on others. Doing so could lead to less of the pressure caused by justifying or hiding one’s addictions. If addiction is a misguided attempt to resolve stress, then avoiding the triggering environments that lead to stress can be critical in lessening addictive acts. 

Maté writes Chapter 33 to those who live with, love, and care for addicts. He acknowledges that living with an addict is difficult. Shaming the addict—which can happen even with good intentions of providing tough love—can trigger rage or resentment. Attempts to convince an addict to end the addiction might meet with hostility. Interventions are likely to fail. Love should be the basis, combined with the absence of judgment. Maté encourages caregivers and family members to think: “It is not what we do that has the greatest impact but who we are being as we do it” (403).

Not taking the behavior of an addict personally may be the greatest challenge. Immature, impulsive behavior threatens to put loved ones in the role of parent, and a parent is not a partner, but a guardian.

While interviewing an addicted woman named Beverley, she tells Maté that she is surprised that he doesn’t view her as a useless junkie. Her perceptions of his attitudes towards her surprise him. He realizes that he is often unaware of how his own behaviors might trigger stress for his patients, and reminds himself that he must work to heal himself to better be able to heal others. 

Maté discusses Alcoholics Anonymous and how the organization’s emphasis on surrendering to a higher power can be off-putting to some people. This resistance “is natural if the Power is identified as the god by whom the child felt betrayed” (411). However, Maté views god as a metaphor, and says that a Higher Power can exist in anything outside of peoples’ basic, egotistical needs.

Spiritual practice can be another addiction or form of avoidance. Focusing on rituals and piety can help people avoid the self-scrutiny that true self-understanding requires. When people practice any form of spiritualism in this manner, it is yet another distraction from the most important facet of self-compassion: true awareness.

The Austrian psychiatrist Victor Frankl says that the “search for meaning” (415) lies in pursuits that go beyond the self. Contributing to the well-being of others can produce a level of satisfaction that attending to one’s own pleasures and appetites cannot.

Maté concludes this final chapter with the observation that there are more spiritual teachers than people willing to truly learn. He writes, “Healing occurs in a sacred place located within us all: when you know yourselves, then you will be known” (421). 

The epilogue gives the brief stories of several more addicts associated with PHS, including Kenyon. Kenyon visits Maté to ask for an increase in his antidepressant dosage. Kenyon has good dreams every night; he dreams of a time when he had a family, and was free of his addictions. When he wakes up, he cries when he realizes that he is still in the Downtown Eastside in Vancouver. He does not want the dreams to stop, but he hopes the antidepressants will help him cry less.