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👻#12: In The Realm Of Hungry Ghosts: Close Encounters With Addiction by Gabor Maté - Book Summary & Key Takeaways

👻#12: In The Realm Of Hungry Ghosts: Close Encounters With Addiction by Gabor Maté - Book Summary & Key Takeaways

How do you recognise Addiction? What is the root cause of Addiction? Are drugs to blame? What is the difference between Abstinence and Sobriety? What is the Four Step Self Treatment Method?

Hello courageous people! 👋 Another week done and dusted which sees us here for edition #12!

This week, our featured book is 📚 In The Realm Of Hungry Ghosts: Close Encounters With Addiction 🖋 by Dr Gabor Maté.

Well this one was the definition of a slog to read at 500 pages 🥵 and fulfils (I hope!) the exact purpose of this newsletter - me doing the hard yakka of reading the book for you and pulling out the bits of gold.

In this there are some hard home truths. Can any of us honestly say we are completely free from the grips of pain and addiction on some level?

I’ll go first and say, ‘Hi my name is Eleanor and I am a processed food addict’ 🙋‍♀️🍔🍟 (this might sound like a joke but I am completely serious, and have been in very hands-on recovery since September 2021—hence my interest in this book and topic. We all have our own stuff, am I right?!)

Let’s go! All text in italics are quotes taken directly from the book, instead of page numbers the references are to Location (Loc) as per the Kindle edition.

😨 Who are the Hungry Ghosts and what do they want?

“The inhabitants of the Hungry Ghost Realm are depicted as creatures with scrawny necks, small mouths, emaciated limbs and large, bloated, empty bellies. this is the domain of addiction, where we constantly seek something outside ourselves to curb an insatiable yearning for relief or fulfillment.

The aching emptiness is perpetual because the substances, objects or pursuits we hope will soothe it are not what we really need.

We don’t know what we need, and so long as we stay in the Hungry Ghost mode, we’ll never know. We haunt our lives without being fully present.” - Loc 373

Always searching. Always hungry. Never satisfied. 😳

🖋 How does the author, Dr Gabor Maté, think about addiction?

Gabor is a medical doctor who has spent most of his career working with hardcore substance users on Skid Row and Downtown Eastside in Vancouver, Canada. To get a sense of his approach to people with addiction, this passage summarises it beautifully:

“I’m not going to ask you what you were addicted to,” I often say to people. “Nor when, nor for how long. Only whatever your addictive focus; what did it offer you? What did you like about it? What, in the short term, did it give you that you craved or liked so much?”

And universally, the answers are: “It helped me escape emotional pain; helped me deal with stress; gave me peace of mind; a sense of connection with others, a sense of control.” - Loc 173

👨‍⚕️ Which brings in Gabor’s mantra through all of his work with addiction:

“The question is never why the addiction, but why the pain?” - Loc 181

🧐 So what are we really talking about when we say “Addiction”?

Let’s be clear about this from the beginning. We are talking about all forms of addiction, from hard drugs to over the counter medications; from fast food to shopping; pornography and social media.

“Addiction can take on many guises, from substances to seemingly “respectable” compulsions that all take a toll on human health and happiness. There are no good addictions. All addictions cause harm; any habit that does not cause harm is, by definition, not an addiction.” - Loc 282

No matter what the focus of the addiction, all forms use the same brain circuits. Short term pain relief and reward at the price of long term inner peace and relationships. Throughout the book, Gabor mentions his own addiction to the—in my view—extremely unexpected and obscure world of classical music 🎻.

His record is spending $8000 (🤯) in one week on various CD’s, hiding his behaviours from his wife and even causing him to step out to shop for more music while one of his patients was in labour, and he did not get back in time for the birth of the baby 😬.

In short, he shares his story as well as those of his patients because addiction can take on all different forms, in all different people. Addiction exists on a continuum, rather than a “have” or “have not” binary assessment.

🎼 What is the difference between an Addiction and a Passion?

Especially when we are talking about addictions with relatively innocuous substances or activities (like processed food for me and classical music for Gabor) it can be confusing to identify what really “counts” as an addiction:

“Any passion can become an addiction; but then how to distinguish between the two? The central question is:

Who’s in charge, the individual or their behaviour?

It’s possible to rule a passion, but an obsessive passion that a person is unable to rule is an addiction. And the addiction is the repeated behaviour that a person keeps engaging in, even though he knows it harms himself or others.

How it looks externally is irrelevant. The key issue is a person’s internal relationship to the passion and its related behaviours.” - Loc 2102

I know that I don’t have control over my behaviour when I am exposed to processed food, and while other people may be able to be around it and have complete control, that is far from my own experience with it. However, no one would know that from the outside looking in.

❓Other questions to enquire further as to whether something is an Addiction or a Passion are:

Are you closer to the people you love after your passion has been fulfilled? Or more isolated?
Have you come more truly into who you really are? Or are you left feeling hollow?

“Addiction is passion’s dark simulacrum and, to the naïve observer, its perfect mimic. It resembles passion in its urgency and in the promise of fulfillment, but its gifts are illusory. It’s a black hole. The more you offer it, the more it demands.” - Loc 2123

👀 What is the threshold for something to be called an Addiction?

“I’ve heard some people shrug off their addictive tendencies by saying, “I can’t be an alcoholic. I don’t drink that much…” or “I only drink at certain times.”

The issue is not the quantity or even the frequency, but the impact.

An addict continues to use a drug when evidence strongly demonstrates the drug is doing significant harm. If users show the pattern of preoccupation and compulsive use repeatedly over time with relapse, addiction can be identified.” - Loc 2362

In fact, there are four specific hallmarks of addiction:

😵‍💫 Compulsion: compulsive engagement with the behaviour or a preoccupation
😩 Impaired control over the behaviour
😣 Persistence or relapse, despite evidence of harm
🤬 Irritability, dissatisfaction or intense craving when the object—be it a drug, activity or other goal—is not immediately available

💉 Are the drugs to blame?

Before reading this book, I have to admit I had picked up the idea (from various sources) that it is the drugs themselves that are addictive. I would have guessed that a ridiculously high proportion of people who tried injecting heroin would become addicted to it, almost instantaneously.

But I was shocked to learn that this isn’t true - in fact it’s far from the truth:

“Heroin is considered to be a highly addictive drug—and it is, but only for a small minority of people, as the following example illustrates. It’s well known that many American soldiers serving in the Vietnam War in the late 1960s and early 1970s were regular users.

20% of the returning enlisted men met the criteria for the diagnosis of addiction while they were in Southeast Asia, whereas before they were shipped overseas fewer than 1% had been addicts.

The researchers were astonished to find that “after Vietnam, use of particular drugs and combinations of drugs decreased to near or even below pre service levels.” The remission rate was 95 per cent. These results suggested that the addiction did not arise from the heroin itself but from the needs of the men who used the drug. Otherwise, most of them would have remained addicts.” - Loc 2452

🃏 Think of other, non-drug related types of addiction as well:

“Compulsive gambling, for example, is widely considered to be a form of addiction without anyone arguing that it’s caused by a deck of cards.” - Loc 2426

👊 So overall, the take home lesson is that:

“Addiction is a human problem that resides in people, not in the drug or in the drug’s capacity to produce physical effects.” - Loc 2451

🌱 What is the root cause of addiction?

“Addictions always originate in pain, whether felt openly or hidden in the unconscious. They are emotional anaesthetics.” - Loc 866

In our brains, there is a certain area which lights up when we experience physical pain. But did you know that it is the exact same area that is activated when we feel emotional pain as well?

“When people speak of feeling “hurt” or of having emotional “pain”, they are not being abstract or poetic but scientifically quite precise.” - Loc 870

😥 Case Study: Serena

The book is full of people’s stories, but an entire chapter was dedicated to Serena—one of Gabor’s patients on Skid Row—as a demonstration of how trauma can predispose people to addiction. [Trigger warning: sexual abuse, drug abuse. Skip ahead to the next title in bold if you need to keep yourself safe.]

🏠 Serena was raised by her grandmother and grandfather. When she was a teenager she decided to go and seek out her mother, whom she had never met:

“I was fifteen years old when I came down here to Hastings,” Serena says. “I had five hundred dollars in my pocket I’d saved for food until I caught up with my mom. It took me a week to find her. I had about four hundred bucks left. When she found that out, she stuck a needle in my arm. The four hundred dollars was gone in four hours.”

“And that was your first experience with heroin?”

“Yes.” A long silence ensues, broken only by the throaty, weeping sounds Serena is trying to suppress. “And then she sold me to a fucking big fat huge motherfucker while I was sleeping.” These words are uttered with the helpless, plaintive rage of a child.”

😢 For any person, that would be enough to create a lifetime of hurt and an understandable need to escape from that extreme pain, but that wasn’t even the half of it. Serena told Gabor that she grew up in a “perfect home”, and eventually she shared with him what that home was really like:

“I was molested by my uncle and my grandfather, and the drugs keep me from thinking about what happened.”

The sexual abuse began when Serena was seven years old and persisted until she gave birth to her child, at fifteen. All the while, she was looking after her younger siblings.

“I had to protect my brother and sister, too. I’d hide them in the basement with four or five bottles of baby food. They were still in diapers. When I was eleven years old, I tried to refuse my grandfather, but he said that if I didn’t do exactly what he told me, he was going to do it to Caleb, too. Caleb was only eight then.”

“And your grandmother didn’t protect you?”

“She couldn’t. She was drinking so much. She began drinking every morning. She was drinking until my daughter was born.” - Loc 1209

Serena had her first baby when she was just fifteen. The father was her mother’s boyfriend.

😔 I don’t know about you, but on hearing these types of stories and the extreme pain that people have endured it honestly makes all the sense in the world why they would turn to drugs and other substances or behaviours in order to cope.

Addiction follows pain and trauma. It does not appear out of the blue simply in response to being exposed to enticing substances or activities.

🤔 What if nothing “extreme” has happened to me? Am I still at risk of having, or developing an addiction?

There might be many of you reading this and thinking that while Serena’s story is devastating, it of course makes sense. But what if nothing quite so extreme or traumatic has happened in your life?

There could still be pain enough in your past for you to have or develop an addiction.

“The less effective our own internal chemical happiness system is, the more driven we are to seek joy or relief through drug taking or other compulsions.” - Loc 2826

In the absence of “extreme” trauma, what else could contribute to our own internal happiness system not working properly?

It is likely the origin lies in our childhoods, specifically if our parents were not attuned to us. This can cause a lesser amount of dopamine (feel good chemical) receptors to be present in the brain and predispose us to addiction.

“Children who have not received the attentive presence of the parent are, as we will see, at greater risk for seeking chemical satisfaction from external sources later in life.” - Loc 2810

Now please note before we go any further:

“Parent-blaming is emotionally unkind and scientifically incorrect. All parents do their best; only our best is limited by our own unresolved or unconscious trauma.” - Loc 348

So this is not an exercise in assigning blame, but it is an exercise in identifying pain.

🥰 What is Attunement in a parenting sense and why does it matter?

Attunement is a specific emotional requirement for us as infants and children in order for our brain’s self-regulation circuits (and if we can’t self-regulate, we turn to external sources instead which can turn into addictions) to develop properly:

“Attunement is, literally, being “in tune” with someone else’s emotional states. It’s not a question of parental love but of the parent’s ability to be present emotionally in such a way that the infant or child feels understood, accepted and mirrored. Attunement is the real language of love, the conduit by which a pre-verbal child can realize that she is loved.

Attunement is a subtle process. It is deeply instinctive and is easily subverted when the parent is stressed, depressed or distracted. A parent can be fully attached to the infant—fully “in love”—but not attuned. For example, the infants of depressed parents experience physiological stress not because they are not loved, but because their parents are not attuned with them—and attunement is especially likely to be lacking if parents missed out on it in their own childhoods.

Children in poorly attuned relationships may feel loved, or be aware that love is there, but on a deeper and essential level they do not experience themselves as seen or appreciated for who they really are.” - Loc 3917

Even in the most loving homes where there was no overt abuse, and parents who had only the best of intentions, sometimes the love still might not translate fully in a way that the child can take it on board, predisposing them to addictions.

🚶‍♂️How do we begin the journey towards Sobriety?

“To expect an addict to give up her drug is like asking the average person to imagine living without all her social skills, support networks, emotional stability and sense of physical and psychological comfort.

Thus for all the valid reasons we have for wanting the addict to “just say no”, we first need to offer her something to which she can say “yes.”

We must provide an island of relief.” - Loc 5162

An island of relief can come in many forms, but can include a change of environment to one which is more supportive to recovery, being honest with family and friends, curiosity about the pain we have experienced and cultivating our self-compassion and self-love. Cultivating an island of relief can be the first step in the journey towards Sobriety.

😬 What is the difference between Abstinence and Sobriety?

There are two ways we can abstain from our addictions:

“A positive and even joyful choice for something else that has greater value for you,

forcing yourself to stay away from something you crave.” - Loc 6062

The former feels like a warm hug, while the latter is white knuckling and gritting your teeth the whole way through.

Gabor talks about when he realised there was a distinction between abstinence and sobriety:

“For me personally, sobriety 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.” - Loc 6076

🍟 I was only able to identify for the first time that I had processed food addiction last year. Prior to that, I had been through periods prior to that where I had tried to stay away from it, or eat less and every day it felt like a fight and a struggle. The pull, the urge, the cravings never went away and I would inevitably snap.

After facing the fact that I was dealing with a full blown addiction (as hard as that was to admit to myself) that truly made the difference in my own shift from forced, difficult abstinence to the peaceful freedom of sobriety:

“In choosing sobriety we’re not so much avoiding something harmful as envisioning ourselves living the life we value. What sobriety looks like will vary from person to person, but in all cases it has the individual, rather than the addictive compulsion, in the lead.” - Loc 6083

“Anyone who has successfully achieved sobriety knows that no evanescent pleasure can be compared with the peace that comes from living in integrity. Many people think of commitment as a limitation of possibilities. Rather than a limitation, it is a source of joy.” - Loc 6183

That doesn’t mean sobriety doesn’t have its own challenges and that it isn’t really tough sometimes, but it sure feels better to be running towards freedom than to be stuck in a cage.

😌 What is the Four Step Self Treatment Method?

In the final section of the book as well as in the Appendices, there are various discussions and approaches for potential treatment. Depending on the nature of our addictions we may need professional help to overcome them, however there are strategies we can try independently as well.

This is the Four Step Self Treatment Method (with a bonus fifth step Gabor snuck in there at the end):

✍️ Step 1: Re-label

Label the addictive thought or urge exactly for what it is, not mistaking it for reality. When we re-label, we give up the language of need. I say to myself: “I don’t need to purchase anything now or to eat anything now; I’m only having an obsessive thought that I have such a need. It’s not a real, objective need but a false belief. I may have a feeling of urgency, but there is actually nothing urgent going on.”

🧠 Step 2: Re-attribute

Learn that this is my brain sending me a false message. This step is designed to assign the re-labelled addictive urge to its proper source. State very clearly where that urge originated: in neurological circuits that were programmed into your brain long ago, when you were a child. It represents a dopamine or endorphin “hunger” on the part of brain systems that, early in your life, lacked the necessary conditions for their full development. It also represents emotional needs that went unsatisfied.

🎾 Step 3: Re-focus

Buy yourself time. Although the compulsion to open the bag of cookies or turn on the TV or drive to the store or the casino is powerful, its shelf life is not permanent. Being a mind-phantom, it will pass, and you have to give it time to pass. Your initial goal is modest: buy yourself just fifteen minutes. Choose something that you enjoy and that will keep you active: preferably something healthy and creative, but anything that will please you without causing greater harm.

🏆 Step 4: Re-value

In the Re-value step you de-value the false gold. You assign to it its proper worth: less than nothing. What has this addictive urge done for me? You will ask. It has caused me to spend money heedlessly or to stuff myself when I wasn’t hungry or to be absent from the ones I love or to expend my energies on activities I later regretted. It has wasted my time. It has led me to lie and to cheat and to pretend—first to myself and then to everyone close to me. It has left me feeling ashamed and isolated. It promised joy and delivered bitterness. The real “value” of my addictive compulsion has been that it has caused me to betray my true values and disregard my true goals.

🐣 Step 5: Re-create [Bonus Step!]

It is time to re-create: to choose a different life. You have values. You have passions. You have intention, talent, capability. In your heart there is love, and you want to connect that with the love in the world, in the universe. As you re-label, re-attribute, re-focus and re-value, you are releasing patterns that have held you and that you have held on to. In place of a life blighted by your addictive need for acquisition, self-soothing, admiration, oblivion, meaningless activity, what is the life you really want? What do you choose to create? - Loc 6025

These steps are not a quick fix or a magic bullet. As we continue on the path to recovery and sobriety we will revisit these steps and landmarks often, but we do so knowing that we will continue to become stronger and better equipped to deal with the challenges as we go.

So there we have it, the realm of Hungry Ghosts. It can be scary and confronting to look them in the eyes, but better if we can see them for what they truly are and recognise the hold they have over our lives.

This is tough work, but it is the work. Let’s keep going on this journey together, figuring it out one day at a time.

Until next week,❤️🙏 Eleanor

If you found this edition valuable, why not share it with a loved one? 🥰

🧠 Resources & Links

🖥 Addiction resources & links on Dr Gabor Maté’s website

📸 Follow Dr Gabor Maté on Instagram - 196k followers

🐥 Follow Dr Gabor Maté on Twitter - 72k followers

📕 Next week’s book

Coming out next Friday 22nd April 2022 is edition #13 featuring:📚 Atlas Of The Heart🖋 by Brené Brown

If you’re not already, subscribe now to get the next edition straight to your inbox! 📬