by Gabor Maté
Published by Vintage Canada 2009 ISBN 978-0-676-97741-7

Reviewed by Sarah Kay

In the Realm of Hungry Ghosts is Gabor Maté’s latest book and recounts his experiences working with addiction in Downtown Eastside, Vancouver. It has been hailed as the definitive read on addiction. The title of the book is an allusion to the Buddhist realm of the same name where people are permanently empty and hungry. It is the realm of addiction. Maté claims there is no mystery to addiction. It is the lost connection with one’s essence. Our structured minds, conditioned by the western, consumer society we live in are always wanting. This wanting leads to craving, followed by a temporary relief when that which is desired is obtained. Often what is obtained is done with no thought or ability to see long-term affects or negative consequences. Then the emptiness and hunger starts up again. We seek solutions from the outside instead of facing up to the pain and emptiness within.

The book looks at how ‘adverse childhood experiences’, ACEs, such as abuse, violence, poverty, stresses and addictions take their toll on the individual in relation to disease. The emotional stresses and traumas ingrained in early childhood live on in the cellular memory and there is a risk of impaired neurobiological development. The higher the ACES accrued in a person’s life, the greater the risk of mental illness, disease and addictions.

The book analyzes in great depth the causes and effects of addictions on the individual and on society. Maté quotes the latest research on the state of the brain and substance abuse, how the addicted brain develops or is impaired, addictive processes and the addictive personality. He also has a chapter entitled ‘Physician Heal Thyself’, where he talks about his ADD (attention deficit disorder), which is closely related to his addictive personality. As he says, “...my addictions, be it purchasing music or the perpetual juggling of several projects in my professional life, serve to fill an emptiness. The idea of ‘just saying no’ left me with a sense of loss.” A particularly poignant description of early trauma is when Maté eats, and he says, “...unless I take particular care, my habit is to bend low over the plate and shovel the food into my mouth as if it’s about to disappear. And yet only one time in my life have I starved or experienced deprivation: during my first year in the Jewish ghetto of Nazi-occupied Budapest. That was enough to program my brain with the image of an uncertain, unyielding and indifferent world.” There is also a section on the failure of the war on drugs, something which continues to be hotly debated around the world: what is the best form of harm reduction and what might the most compassionate social policies be? Mate offers some suggested solutions, but mostly asks the questions for what continues to be a worsening social problem.