Gabor Mate, In the Realm of Hungry Ghosts
[EDIT: Hi. Welcome to my blog -- but why this post? Why is this the one that generates more traffic than any other post around here? Leave a comment, as I'd love to make sure the traffic isn't mostly automated! And frankly, some of my own favourites would be this one, or maybe this one.]
My name is Richard, and I'm an -- no, wait, that's not how to start this. First impressions and all that. Besides, I'm no alcoholic, since I sometimes go for weeks between drinks, rarely get more than a little tipsy, and only read it for the articles.
I spent more than 250 pages being increasingly and searingly annoyed with Gabor Mate, author of this month's book club selection, In the Realm of Hungry Ghosts: Close Encounters with Addiction. There are at least three books smooshed together in the one volume, and while two of them are fascinating and well done, the third one -- at least through the first 250 or so pages -- drove me beyond batty with its pretentiousness, egotism, and arrogance. I want to hear about how addiction works, emotionally as well as neurologically, both in its development and in its persistence. I need to hear about the lives of addicts in the Downtown Eastside of Vancouver, which is Canada's most drug-centred neighborhood, poorest neighborhood, most policed neighborhood, and so on; the lives of these people need to be honoured and recognized, rather than rejected. I do NOT want to hear a fairly well-off doctor equate his drive to purchase CD's of classical music with heroin, and his life with the life of a heroin addict suffering from spinal abscesses, multiple infections and HIV, whose children have died of overdoses and whose partner beats her.
If I hadn't finished the book, and I wasn't going to, that's roughly where this review was going to end up. I was appalled, utterly appalled, by Mate's including himself in this book as an addict. Even after finishing the book, I'm left wondering how he'd distinguish between addiction, obsessive-compulsive disorder, obsessions, habits, and passions, so part of his message didn't get through to this fairly careful reader. There's some incredible material here, and two of the threads are well worth your time, but the other one.... Shameful, is how it seemed to me. Flat out shameful.
And yet. And yet.
There came a point where I started seeing myself in this book, in these behaviours he's describing, even in Gabor Mate himself. I mean, I know that some of my habits aren't the healthiest, and even though I'd like to stop them, sometimes I can't, but addicted? Come on. Save the word for those who need it; let it keep its power. But people who know me well have a sense for how wildly I throw myself into activities. If you read this blog, you may have noticed that the great majority of posts go up when a sensible person has gone to bed. The recent conference, well, let's just say I should have empowered my colleagues to act cooperatively in the planning and execution, but that's not something I'm equipped to do. More personally, well, there've been some habits, some mostly harmless and others much less so.
By the end of the book, I could see why Mate was including himself in this book. His addiction process is the same as that of his patients, and we all need to achieve greater humility in how we face the world, and the people we'd like to think of as lesser individuals. There's room for him in In the Realm of Hungry Ghosts, and I wouldn't have seen myself there if he hadn't managed to find room. I still think it comes across somewhat amateurishly in the first two-thirds of the book, and I wouldn't blame a single person for quitting the book in protest at his including himself this way, but I'm glad to have finished the book. It's an open question, though, if I'd recommend it to other readers.
My name is Richard, and I'm....
My name is Richard, and I'm an -- no, wait, that's not how to start this. First impressions and all that. Besides, I'm no alcoholic, since I sometimes go for weeks between drinks, rarely get more than a little tipsy, and only read it for the articles.
I spent more than 250 pages being increasingly and searingly annoyed with Gabor Mate, author of this month's book club selection, In the Realm of Hungry Ghosts: Close Encounters with Addiction. There are at least three books smooshed together in the one volume, and while two of them are fascinating and well done, the third one -- at least through the first 250 or so pages -- drove me beyond batty with its pretentiousness, egotism, and arrogance. I want to hear about how addiction works, emotionally as well as neurologically, both in its development and in its persistence. I need to hear about the lives of addicts in the Downtown Eastside of Vancouver, which is Canada's most drug-centred neighborhood, poorest neighborhood, most policed neighborhood, and so on; the lives of these people need to be honoured and recognized, rather than rejected. I do NOT want to hear a fairly well-off doctor equate his drive to purchase CD's of classical music with heroin, and his life with the life of a heroin addict suffering from spinal abscesses, multiple infections and HIV, whose children have died of overdoses and whose partner beats her.
If I hadn't finished the book, and I wasn't going to, that's roughly where this review was going to end up. I was appalled, utterly appalled, by Mate's including himself in this book as an addict. Even after finishing the book, I'm left wondering how he'd distinguish between addiction, obsessive-compulsive disorder, obsessions, habits, and passions, so part of his message didn't get through to this fairly careful reader. There's some incredible material here, and two of the threads are well worth your time, but the other one.... Shameful, is how it seemed to me. Flat out shameful.
And yet. And yet.
There came a point where I started seeing myself in this book, in these behaviours he's describing, even in Gabor Mate himself. I mean, I know that some of my habits aren't the healthiest, and even though I'd like to stop them, sometimes I can't, but addicted? Come on. Save the word for those who need it; let it keep its power. But people who know me well have a sense for how wildly I throw myself into activities. If you read this blog, you may have noticed that the great majority of posts go up when a sensible person has gone to bed. The recent conference, well, let's just say I should have empowered my colleagues to act cooperatively in the planning and execution, but that's not something I'm equipped to do. More personally, well, there've been some habits, some mostly harmless and others much less so.
By the end of the book, I could see why Mate was including himself in this book. His addiction process is the same as that of his patients, and we all need to achieve greater humility in how we face the world, and the people we'd like to think of as lesser individuals. There's room for him in In the Realm of Hungry Ghosts, and I wouldn't have seen myself there if he hadn't managed to find room. I still think it comes across somewhat amateurishly in the first two-thirds of the book, and I wouldn't blame a single person for quitting the book in protest at his including himself this way, but I'm glad to have finished the book. It's an open question, though, if I'd recommend it to other readers.
My name is Richard, and I'm....
Comments
In order to step into the shoes of an addict, one must recognize your own problematic behaviour or patterns. This is not a pretty process, and one that few people can complete. Go to a meeting sometime to observe the heartbreak addiction can cause.
And Mate? Arrogant? Look no further than your own self righteous and judgemental post.
And I stand by that comment about the first half of the book, maybe the first two-thirds.
Call me judgemental if you want to, but the distinctions between Mate's life and the lives of his patients are vast, vast, vast. The equation he draws is a false one, except in the mechanism at work. I'm not going to accept each complaint against oppression as equivalent just because there's actual oppression at work: someone whose life is threatened because of ethnic identity is categorically different from someone whose life is made a little less comfortable.
But I did say that by book's end, I understood why Mate was including himself. I didn't specifically use the word "humility" in reference to him, but you know, I can't see how one wouldn't see it as a reference to him and with his valuable work. He's a heck of a guy, and I'm delighted that he's been so committed for so long to the extremely important issue of addiction, especially in the DTES. This, however, doesn't mean I have to like how he structures this book.
As for the appeal for me to keep my trap shut until my life's been affected by addiction -- I don't expose all my scabs publicly. Addiction has been part of my life, though I don't want to talk about it. But until late in the book, I still didn't appreciate how Mate included himself as a representative addict.
I'm Gabor's son Daniel. Just stumbled across your review. I appreciate your candor in describing your initial frustration with the book, and how that point of view shifted (at least somewhat.)
Two observations:
1) He doesn't "equate" his addiction process with his patients' -- he does juxtapose them. I can't remember the exact wording, but he says something like "The differences between me and my patients are glaring and obvious; but that doesn't stop me from seeing the (disturbing) similarities." He's had a much more fortunate life than the people he works with, and so his self-destructive patterns "wear dainty white gloves" compared with theirs. Still, there may be something to be learned from looking at the commonalities -- especially since we tend to turn addicts into "Others" in our society. That, I take it, is his point.
2) He doesn't drive a BMW; he drives a rather compact Honda Civic. :)
best,
Daniel
Thanks for stopping by, and for showing restraint in your reply to what seems to me now a more ranting review than I thought it was at the time.
And I didn't say it in the review, but I was fascinated by your place in the book. I can't go check it, as I borrowed it from a friend, but I do remember being really interested in your dual role as character/person. (If that makes sense, which it may not.)
By book's end, I think in my mind your father did get to the point he was making about seeing ourselves in the addicted, about finding a way to avoid the destructive othering we inflict on people we don't want to identify with. That's why the book worked for me, in the end. But for me, it was such a tough go to get there. The juxtaposition, as you called it, was too jarring for me: it wasn't othering, and that's a good thing, but I read it too like identification, and I got cranky.
As for the car -- I stand corrected :-) Someone on Hornby must have told me he drove a Beemer!
Rosemary Orr
Thanks for your thoughts, Rosemary, and I am sorry for your loss. I'm not knowledgeable enough to disagree all that effectively with Gabor Mate, so I will say only that at times I felt the accuracy with which he was occasionally linking disparate phenomena, and at other times I was very upset by them. As I think you were -- did you read the book, then, or are you just responding to this review?
I extend my heartfelt condolence to Robin's mother but would suggest that there is always an exception, or even multiple exceptions that defy the 'rule' but it, they do not negate the validity of that rule. Further, why is an opiate addiction different from an eating disorder? One has been criminalized while the other has not.
I am intrigued by Dr. Mate's work and how it might alter the attitudes we too often adopt when working with the women who live in our shelters as well as how we can be more supportive of the children who accompany them.
I have just seen Dr Mate interviewed on Democracy Now TV. There is a lot of substance to his theory of diet relating to disease and the imprint of parents on children. For example he addressed a similarity to the effect of overly neat mothers who may imprint male children with the propensity for rheumatoid arthritis.
I look forward to more of your reviews. Having survived several addictions, I am afraid that I have imprinted my sons. But I never congealed my paradigms like they have. They are 30 years younger than me. I am also glad that your "commenters" criticized your review and not you.
Maté's ideas about rheumatoid arthritis are from his previous book, I think, When the Body Says No (a book I read not long after my own body said "no" pretty emphatically). His point there is that stress causes all kinds of odd effects on human health -- animal health, too, but that's not his main point. I remember getting antsy about the particular connections, and while I don't recall the "neat mother" --> "rheumatoid arthritis" link, that's the kind of thing that would have me raising my eyebrows. I'd need to know quite a bit more about the research before I'd walk very far with that particular theory.
And I'm just a book guy who read Maté for a book club, so I'm unlikely to spend much time digging up the research!
I cannot speak to his works on addiction, which is ultimately what your post is about, only to my opinion of his speech at our convention. Maybe he's more reasonable in "In the Realm of Hungry Ghosts". I should really read his stuff and look up his data, but then I fear he'd call me a western doctor who is closed-minded and "clinging to my old beliefs".
I'd like to think, Gabe, that Maté is objecting to the practices of certain doctors and programs, rather than to all of Western medicine, but I wasn't there. Certainly there's room to read his book as if it was asserting either position.
Were there particular comments that had your head a-shaking?
Gabor Mate has gone on the record to say that people should "do as I say, not as I do". This takes something away from the intensity of the message. He seems to have a compulsive need to externalize his considerable load of "stuff" from past and present, through writing, speaking, teaching, etc. I don't think he can stand to just be himself: he has to be "up there", and while his ideas definitely have merit, once you look beyond the beautiful, skillful and somewhat seductive writing, you see problems.
People oh, so want to follow someone - look at that idiot who killed those people in the sweat lodge. It's incredible how it works. Anyone who shows any self-confidence at all becomes a magnet. I always feel as if Mate looks strong, but is about to blow over like a blade of grass in a storm. Tough and fragile at the same time, and that means we MUST keep our critical minds open when we read or hear his ideas. Not that they're bad, wrong or ill-ressearched. But he is a classic example of "take my advice, I'm not using it." Caveat emptor.
You said I'd spent 90% of my words criticizing 33% of the book. Really, it's more like 75% criticizing 70% of the book: I said I was focusing on one of the three stories, but the one I focused on takes up most of the book.
And yeah, I do make assumptions. Those are the short-cuts we live by so we don't have to work things out anew every single time. Sure, sometimes it means that I'm wrong to assume people reading my blog will expect an individual response, and sometimes it means that a reader here will be wrong to assume I'm providing an objective review. But if we keep at it, we'll get over whatever conflict arises.
Here's what I said almost 18 months ago, in reply to someone else arguing much the same thing you did:
"He's a heck of a guy, and I'm delighted that he's been so committed for so long to the extremely important issue of addiction, especially in the DTES. This, however, doesn't mean I have to like how he structures this book."
Thanks for stopping by, though. You might like Brian Brett's Trauma Farm, too, as well as Janisse Ray's lovely Ecology of a Cracker Childhood - click the titles for links.
I wish you well with your important work.
I completely get what you are saying about the addiction to CD's and such. I felt the same way as I read that part of the book - it almost seemed silly that he was calling it an addiction. But in the context of the book it really does help to bring the concept about addiction down to the basics.
Too many people have their own destructive behavior but don't notice it because it's not drugs or alcohol or the other "obvious" destruction.
After reading his book I discovered I am fully ADD and it explained so much and his story about his own addiction (as trivial as it may seem on the surface in comparison) really helps to relate to the non-abused, non-drug using "addictive" personality.
YOu should pick it up...
The simple fact is the phenomenon of addiction, in the abstract, is that the addictive phychological process doesn't change in respect to the effects of the behavior(good or bad)
If you want to get philosophical, Buddhist treat an addiction as an attachment which binds the host to suffering. As the mind progresses along the path of deeper and deeper addiction, the behavior solidifies. The Sanskrit term is Sankhara...kind of like a self-amplifying feedback loop.
If you want to get metaphysical...you could say the the soul attracts that which it secretly most loves...and FEARS...and HATES.
It shows a level of understanding by Gabor to freely associate his own behavior and the resulting addictive patterns within the scope of the abnormal pathologies of addiction.
...and it's nice to see Richard begin the process of self-awareness which leads to a better understanding of social behaviors...and a better understanding of life.
"Enough for me the mystery of the eternity of life, and the inkling of the marvellous structure of reality, together with the single-hearted endeavour to
comprehend a portion, be it never so tiny, of the reason that manifests itself in nature."
--Einstein
The simple fact is the phenomenon of addiction, in the abstract, is that the addictive phychological process doesn't change in respect to the effects of the behavior(good or bad)
If you want to get philosophical, Buddhist treat an addiction as an attachment which binds the host to suffering. As the mind progresses along the path of deeper and deeper addiction, the behavior solidifies. The Sanskrit term is Sankhara...kind of like a self-amplifying feedback loop.
If you want to get metaphysical...you could say the the soul attracts that which it secretly most loves...and FEARS...and HATES.
It shows a level of understanding by Gabor to freely associate his own behavior and the resulting addictive patterns within the scope of the abnormal pathologies of addiction.
...and it's nice to see Richard begin the process of self-awareness which leads to a better understanding of social behaviors...and a better understanding of life.
"Enough for me
the mystery of the eternity of life, and the inkling of the marvellous
structure of reality, together with the single-hearted endeavour to
comprehend a portion, be it never so tiny, of the reason that manifests
itself in nature."--Einstein
I find some of your statements to be rather misguiding, patronizing/condescending, or judgmental instead of “philosophical.”
The claim that “in addiction, people's ability to direct the will is weak or nonexistent,” is a matter of debate because addiction is not a one-size-fits-all behavior. The ability to direct the will (or whatever it means) exists; the problem is that it’s directed towards self-defeat.
As great a scientist as Einstein was, his specialty wasn’t on human behavior or brain processes, but in physics. As far as I know, compulsions come from within our brain, the same as “internal needs.”
It won’t be hard for Anyone—including you and me—“to make the leap to the realm of addiction.” As long as we have a limbic system and our amygdala keeps all its functions, the prospect of engaging in compulsive behaviors is alive and well. Isn’t it by repetition the way in which we learn habits? Toss in the pleasure factor and you’ll have a nice recipe for a persisting behavior that anyone would work around it in order to keep it going.
I see a contradiction in the statement, “The simple fact is the phenomenon of addiction, in the abstract, is that the addictive psychological process doesn't change in respect to the effects of the behavior (good or bad)” because we are talking about a symbiotic process; one lives off the other; one influences the other in a continual process that can be reversed by guess what, another habit of purposely changing the thinking patterns.
This takes me to that behavior which “solidifies.” The brain’s plasticity can prevent this from happening by our purposeful reversing of the thinking patterns and perhaps by making some modifications in our external environment (the things we can control) and how we go about our lives. Therefore regaining homeostasis in certain neurochemical processes in the CNS. Unfortunately, mythology all too often gets mixed with the social structures that are supposed to help people prevent deeper involvement, but these structures keep failing at this task.
Some time ago, I learned that hate comes from painful experiences that in turn come from fear. Fear is the primal emotion, not love. I suspect that love is a fairly recently learned emotion in human history, and that human empathy and cooperation as a matter of survival was there all along.
I find it quite annoying how you play the Judge in-chief role when you toss your condescending attitude on the author of the blog:
“...it's nice to see Richard begin the process of self-awareness which leads to a better understanding of social behaviors...and a better understanding of life.”
Somehow these statements make me reflect on how grandiosity can be a pervasive theme among us humans.
Also, you don't have to be so insecure. He's trying to figure out a solution. He's not judging you as an addict.
And I'm also from Canada, incidentally, so although you're right that I'm not crazy about his writing in this book, his nationality has nothing to do with my assessment of him.
I am a recovered addict from the downtown streets, actually right on the corner of PAIN & WASTINGS!! Now in the role of helping others, the only thing I have pivitol is that I LISTEN!!! Thats it. 80 thousand student loan and all I do is LISTEN!!!!
Just food for thought!!!
Just a few words of support. I read your entire review and I heard and understood its ambivalent but cautiously positive, if equivocal, tone (and yet, and yet...). Then I read the comments. My comment is this: It takes courage to put reviews on the internet, because ambivalence and complexity don't sit well with many people. We like things either all good or all bad. And if somebody is less than glowing about one of our personal idols, be it Lady Gaga or the good doctor Mate, watch out! It's fascinating how people get angry at you without actually finishing or absorbing your review. Ad hominem attacks are so much simpler.
Having a point of view ain't easy.
Best regards.
Roger
Mind you, Google's algorithms have made this humble post one of the entire web's leading comments about Dr. Maté's work on addiction, so maybe he should give me a royalty or something....
I was also sorta taken aback when he equated his CD addiction with substance abuse, but I then realized that I was making an unfair judgement. An addiction, after all, is an addiction. I think that the difference is in how easy it is to hide from a potential observer.
If a person is addicted to, let's say, purchasing CDs, this sort of addiction, while it may cause some financial problems (assuming it is a really out-of-control addiction), and possibly problems with space at home or wherever they're being stored, would be difficult for an onlooker to *see.* While that addiction might cause significant stress for the person experiencing it, they still look okay and act okay so to an onlooker, it doesn't seem like such a big deal. But maybe it is for that person.
On the other hand, addictions that involve intoxication are easilly seen by an observer no matter how hard the intoxicated individual (even in their intoxicated state) tries to hide it, or tries to 'act normal.'
People who have gambling addictions might have completely dismantled lives but a stranger probably couldn't see that just by looking at them. A hoarder might have to climb mountains of junk to get to a bathroom, but when they leave the house, no one would know that.
I think that his objective in relating his experience is to show that we are all subject to our chemistry. An addiction can be visible, invisible, accepted, tolerated and/or intolerable, but it's still an addiction. This attitude helps society come to common terms with addicts because the fact of the matter is that we all have the potential to experience that ourselves no matter how seemingly innocuous something might appear or not appear.
But GM is not in recovery. Because he doesn't have the addiction, which must be abstained from, and for which harm reduction is simply suicide (or murder) on installment plans.
Harm reduction doesn't work. Ask the addiction doctors who actually get people to LIVE instead of stay dead.
The story of the functioning opiate addict surgeon who practices til 120 years old on his daily regimen of dope is used as a rationalisation for keeping people on dope and methadone in this book. Think about how that relates to a hope to die junkie, not Mate's conscience or drive to power. The addict cannot stop and will not, until it is over. GM knows F all about that kind of powerlessness.
Has he ever been able to stop himself from injecting himself with opiates he's stealing from his workplace? Tried to kill himself with them? Not at all. Are there doctors out there who have? Yes. Do they buy into Mate's conflations, rationlisations and justifications? Not a bit.
Sometimes Gabor's flying on his amphetamines, sometimes he's not. Sometimes he's full of grandiosity and his ego's running, the show, sometimes it's not. Sometimes he's buying some extra CD's... and ALL the time he's not going down because of it. Seems like he's doing the best HE can with whatever motivations he has, to help the way he can, but not having a spiritual program that takes the ego out of the equation.
Seems like he's been to 2 meetings and bailed - because he doesn't have it bad.
His comparison of his little CD habit with the low bottom addict is all he can do.
He's all problem, and add to the problem. Very little solution from what I can see. Just keep sick people getting sicker, and give them a little dope along their way to the morgue, thank you very much... no hope for you!
He has no f'n clue how hard it is to get and stay clean. I don't trust this self appointed guru, neither do the better addictions MD's I know. If he was serene and grounded, maybe. But you never know when he's flying on speed. For fek's sake.
i read "in the realm of hungry ghosts" one year ago. and my reaction was quite similiar to the reviewers. the book is unorganized (well, GM does have ADD...), and some parts of it are not that easy to get throught. but ultimately totally worth it - esp if you have addiction issues.
I am an addictions counselor. Today a patient recommended the book and suggested I read it. I ame across this blog. The comments have given me some food for thought. I think I will take my patient's recommendation and read it. Thanks
But as the comments here indicate, there's a distinct mythology around the book and its author. (Not exactly a cult, as that's unfair to Maté, but it feels like that at times.) Anyone who doubts the book publicly is in for some critiques, and almost certainly some insults. I always read that phenomenon as a terrible sign for the book itself, entering the world of faith and enmity, rather than readership and response.
We all have lop-sided perceptions on many areas in our lives. The main one here is that Dr Mate is somehow not qualified to address the subject matter. What a person has as material possesions does not make him/her larger than the person with less. But, he seems a humble man, with a real life childhood, that has created a "Valuë"in his life. That value is to help humanity in some manner.
And guess what - he gets paid.
And so do others that do work!!!
The universe gives more to those than can handle more. Let it be.
We are all addicts, some are high priority addictions and some are low priority addictions.
Throw the first stone!!!
With gratitude.
I work with many wonderful collegues in similar work, but few of them are medical porfessionals. I am a social worker serving people that are high utilizers of the emergency department in a close by city. I want to thank-you for re-invigorating our commitment to the work and the plea for compassion and harm reduction as being the most effective approach. I am looking forward to your visit to UW in the near future.
Sincerely,
Ann Allen
I am a social worker in a nearby city and work with similar patients. My population are high utilizer of the emergency dpeartment, most are homeless and addicted, mentally ill and chronically ill. Your plea for compassion and harm reduction helps me to remain committed. I have always said, every person we serve has their own story. It is wonderful to see it put on paper. I wish I had your ability to relay stories. Thank-you for work and services to people in such great need.
I look forward to seeing at UW in the near future.
Ann Allen, LICW