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In the Realm of Hungry Ghosts: Close Encounters with Addiction [Paperback]

by Gabor Mate, Peter A. Levine
4.7 out of 5 stars  See all reviews (164 customer reviews)

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Book Description

January 5, 2010 155643880X 978-1556438806 1
Based on Gabor Maté’s two decades of experience as a medical doctor and his groundbreaking work with the severely addicted on Vancouver’s skid row, In the Realm of Hungry Ghosts radically reenvisions this much misunderstood field by taking a holistic approach. Dr. Maté presents addiction not as a discrete phenomenon confined to an unfortunate or weak-willed few, but as a continuum that runs throughout (and perhaps underpins) our society; not a medical "condition" distinct from the lives it affects, rather the result of a complex interplay among personal history, emotional, and neurological development, brain chemistry, and the drugs (and behaviors) of addiction. Simplifying a wide array of brain and addiction research findings from around the globe, the book avoids glib self-help remedies, instead promoting a thorough and compassionate self-understanding as the first key to healing and wellness. In the Realm of Hungry Ghosts argues persuasively against contemporary health, social, and criminal justice policies toward addiction and those impacted by it. The mix of personal stories—including the author’s candid discussion of his own "high-status" addictive tendencies—and science with positive solutions makes the book equally useful for lay readers and professionals.

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Editorial Reviews Review Exclusive: A Letter from Gabor Maté

Dear readers,

I've written In The Realm of Hungry Ghosts because I see addiction as one of the most misunderstood phenomena in our society. People--including many people who should know better, such as doctors and policy makers--believe it to be a matter of individual choice or, at best, a medical disease. It is both simpler and more complex than that.

Addiction, or the capacity to become addicted, is very close to the core of the human experience. That is why almost anything can become addictive, from seemingly healthy activities such as eating or exercising to abusing drugs intended for healing. The issue is not the external target but our internal relationship to it. Addictions, for the most part, develop in a compulsive attempt to ease one’s pain or distress in the world. Given the amount of pain and dissatisfaction that human life engenders, many of us are driven to find solace in external things. The more we suffer, and the earlier in life we suffer, the more we are prone to become addicted.

The inner city drug addicts I work with are amongst the most abused and rejected people amongst us, but instead of compassion our society treats them with contempt. Instead of understanding and acceptance, we give them punishment and moral disapproval. In doing so, we fail to recognize our own deeply rooted problems and thereby forego an opportunity for healing not only for them, the extreme addicts, but also for ourselves as individuals and as a culture.

My book, in short, is an attempt to bring light to core issues shrouded in darkness. The many positive responses I’ve received encourage me to believe that I’ve succeeded in making a contribution toward that goal.

Best wishes,
Gabor Maté

A Q&A with the Author

Question: The title of your book has its origins in the Buddhist Wheel of Life. In the Hungry Ghost Realm, people feel empty and seek solace from the outside, from sources that can never nourish. In what ways is our culture trapped in this realm? What can society learn from drug addicts who take the feelings of lack that everyone has, to the extreme?

Gabor Maté: Much of our culture and our economy are based on exploiting people’s sense of emptiness and inadequacy, of not being enough as we are. We have the belief that if we do this or acquire that, if we achieve this or attain that, we’ll be satisfied. This sense of lack and this belief feed many addictive behaviors, from shopping to eating to workaholism. In many respects we behave in a driven fashion that differs only in degree from the desperation of the drug addict.

Question: What makes your book so beautiful is its multi-layered, personal approach. You don’t rely solely on your patients’ stories, but also dig into your personal experience with addiction and the relevance of Buddha’s teachings. What were some challenges you faced when writing so frankly about your own addiction and your family?

Gabor Maté: In a sense my personal issues are not personal at all--just human. Once I understand something, I want to share it. There is no shame in having flaws--just challenges to keep learning. Many people have told me how much they have appreciated my being open like that--it helps them be open with themselves.

Question: Your book ends on a positive note, with the idea that brains do have the ability to change and grow in adult life and even to heal themselves. Does this undermine your previous assertion that you don’t expect most of your severely addicted patients to get clean?

Gabor Maté: No, there is no contradiction here. The human brain is exquisitely capable of development, a capacity known as neuroplasticity. But, as with all development, the conditions have to be right. My pessimism about my clients’ future is based not on any limitation of their innate potential, but on their dire social, economic and legal situation and on the essential indifference of policy makers--and of society--to their plight. In short, the resources that could go into rehabilitating people are now sunk, instead, into persecuting them and keeping them marginalized. It’s a failure of insight and of compassion. We are simply not living up to our possibilities as a society.

Read an Excerpt from In The Realm of Hungry Ghosts

I believe there is one addiction process, whether it manifests in the lethal substance dependencies of my Downtown Eastside patients, the frantic self-soothing of overeaters or shopaholics, the obsessions of gamblers, sexaholics and compulsive internet users, or in the socially acceptable and even admired behaviors of the workaholic. Drug addicts are often dismissed and discounted as unworthy of empathy and respect. In telling their stories my intent is to help their voices to be heard and to shed light on the origins and nature of their ill-fated struggle to overcome suffering through substance use. Both in their flaws and their virtues they share much in common with the society that ostracizes them. If they have chosen a path to nowhere, they still have much to teach the rest of us. In the dark mirror of their lives we can trace outlines of our own.


“A riveting account of human cravings, this book needs to get into as many hands as possible. Maté’s resonant, unflinching analysis of addiction today shatters the assumptions underlying our War on Drugs.”
—Norm Stamper, former Seattle Chief of Police and author of Breaking Rank: A Top Cop’s Exposé of the Dark Side of American Policing

“In this brilliant and well-documented book, Gabor Maté locates the source of addictions in the trauma of an emotionally empty childhood, making it a relational rather than a medical problem. Such a radical thesis of cause leads to human connection rather than traditional treatment as the cure. This passionate and compassionate book, filled with scientific evidence and personal narratives, should be on the shelf of every person interested in the pervasive challenge of addiction.”
—Harville Hendrix, PhD, author of Getting the Love You Want: A Guide for Couples and cofounder of Imago Relationship Therapy

"Dr. Maté’s latest book is a moving, debate-provoking, and multi-layered look at how addiction arises, the people afflicted with it and why he supports decriminalization of all drugs, including crystal meth.… [In the Realm of Hungry Ghosts] reads not only as a lively textbook analysis of the physiological and psychological causes of drug addiction, but also as an investigation into his heart and mind."
The Globe and Mail

“In this comprehensive and courageous book … Maté relates, with compassion and honesty, the poignant stories of severe substance addicts – the hungry ghosts, in Buddhist-realm terminology – whom he treats. And it is the addicts’ stories and the clear logic of the latest science and statistics that Maté shares which convince the reader that society’s attitudes toward, and treatment of, addiction must change. …. This 480-page tome, exhausting in delineating and substantiating its causes, remains a remarkably lyrical, engaging read.”
—In Recovery Magazine

"It’s time to give Maté … the Order of Canada for this erudite and sensitive book about the lives of Downtown Eastside intravenous-drug users, the neurobiology of addiction, and the folly of the war on drugs. It’s compulsively readable and packed with new scientific discoveries about addiction. If you know the parent or sibling of an addict—or the prime minister, for that matter—please give him this book."
The Georgia Straight

"I recommend this wonderful book for anyone struggling with the heartache of addiction personally or professionally. Dr. Maté makes the thought-provoking and powerful arguments that human connections heal; and that the poverty of relationships in the modern world contribute to our vulnerability to unhealthy addictions of all manner. His uniquely humane perspective—all too absent from much of the ‘modern’ approach to addictions—should be a part of the training of all therapists, social workers, and physicians."
—Bruce Perry, MD, PhD, Senior Fellow, Child Trauma Academy, Houston, and coauthor of The Boy Who Was Raised as a Dog

"Gabor Maté’s connections—between the intensely personal and the global, the spiritual and the medical, the psychological and the political—are bold, wise and deeply moral. He is a healer to be cherished and this exciting book arrives at just the right time."
—Naomi Klein, author of No Logo and The Shock Doctrine

"With unparalleled sympathy for the human condition, Gabor Maté depicts the suffocation of the spirit by addictive urges, and holds up a dark mirror to our society. This is a powerful narrative of the realm of human nature where confused and conflicted emotions underlie our pretensions to rational thought."
—Dr. Jaak Panksepp, Distinguished Research Professor of Psychobiology, Bowling Green University, Adjunct Professor of Psychiatry, Medical College of Ohio, and author of Affective Neuroscience

"With superb descriptive talents, Gabor Maté takes us into the lives of the emotionally destitute and addicted human beings who are his patients. In this highly readable and penetrating book, he gives us the disturbing truths about the nature of addiction and its roots in people’s early years–truths that are usually concealed by time and protected by shame, secrecy, and social taboo."
—Vincent Felitti, MD, Clinical Professor of Medicine, University of California, and Co-Principal Investigator, Adverse Childhood Experiences Study

"Dr. Gabor Maté distills the suffering of injection-drug users into moving case histories and reveals how clearly he himself, as a music collector and workaholic physician, fits his own definition of addiction. Informed by the new research on brain chemistry, he proposes sensible drug laws to replace the War on Drugs. Inspired by the evolving spirituality that underlies his life and work, he outlines practical ways of overcoming addiction. This is not a fix-it book to hurry through, but a deep analysis to reflect upon."
—Dr. Bruce Alexander, Professor Emeritus (Psychology), Simon Fraser University, and author of The Globalization of Addiction

"A harrowingly honest, compassionate, sometimes angry look at addiction and the people whose lives have been disordered by it."
Ottawa Citizen

"Gabor Maté’s latest book is a sprawling but fascinating look at addiction that is part science, part diatribe, part character study, and part confessional.… The writing is powerful.… the book leaves the reader with a profound sense of empathy and understanding for some of society’s most marginalized victims.
Quill & Quire

"[E]xcellent.… One of the book’s strengths is Maté’s detailed and compassionate characterization of the afflicted addicts he treats…a calm, unjudging, compassionate attentiveness to what is happening within."
The Walrus

"Maté’s subjects are the living, breathing embodiment of Canada’s grimmest statistics for HIV/AIDS, hepatitis, homelessness, crime, abuse, neglect, overdose, and death. More than merely poor and disenfranchised, they are truly the lowest of the low, reviled by society and demonized by law enforcement. [In the Realm of Hungry Ghosts] is enormously compelling and Maté is admirably, sometimes inexplicably, empathetic to all who cross his path."
Toronto Star

"I highly recommend Hungry Ghosts to everyone seeking insight into addiction. Gabor Maté’s masterful and impassioned treatment of the topic is a welcome relief from the tired old thinking that has kept us from dealing effectively with it for the last 100 years."
—Gerald Thomas, Centre for Addictions Research, for the Vancouver Sun

"It seems odd to use the word ‘beautiful’ to describe a book that focuses, frequently in graphic, unrelenting detail, on the lives of some of the most hopeless outcasts of our society: the hard-core street addicts with whom Dr. Gabor Maté works. Yet that’s the word that came repeatedly to mind as I read In the Realm of Hungry Ghosts. It’s not only the grace of Maté’s writing, though that’s certainly a great part of it. It’s the sense of compassion that infuses the entire book, the author’s continued faith in and affection for the men and women with whom he works, even when he is the victim of their drug-fueled abuse, racial epithets, and thefts. Maté offers no easy fixes (pun intended), but does offer hope and understanding."
—Hal Goodman, The Record (Kitchener, Cambridge, and Waterloo)

"In the Realm of Hungry Ghosts looks at addictions, how they work, who experiences them and what can be done.… The book is a survey of scientific evidence on addiction, but it is haunted by Maté’s patients who are wrestling with poverty, violence, mental illness, drug addiction, HIV/AIDS, hepatitis, the authorities, their pasts. We read about the depths of addiction, but also the persistence of humanity under the worst of conditions.… That the well-off and the destitute are considered together in this book reminds us that addiction transcends class."
The Gazette (Montreal)

“I highly recommend In the Realm of Hungry Ghosts to anyone interested in deepening his or her understanding of all types of addictive behavior. With Dr. Gabor Maté’s help, the foundation is being made to reexamine how to treat addiction from a new premise that engages and honors the heart and soul of humanity.”

“[Gabor Maté] has sought to draw a map for human understanding of people scorned, neglected and persecuted by society.”

“In Hungry Ghosts, Maté compellingly tells the often desperate and heartbreaking stories of his patients, and calls for a new drug policy paradigm that is grounded in both science and compassion.”
Real Change News

"[In the Realm of Hungry Ghosts] is a taste of a different kind of victory—over our own impulses to leave 'undeserving' souls outside the human circle of affection and good will."

“[In the Realm of Hungry Ghosts] shows an unflinching look at addiction… Dr. Maté makes observations that cut through all the myths and misinterpretations about addicts and how they live… There are many nuggets of wisdom and insight throughout the book. Readers can literally pick up the book and leaf to a...

Product Details

  • Paperback: 520 pages
  • Publisher: North Atlantic Books; 1 edition (January 5, 2010)
  • Language: English
  • ISBN-10: 155643880X
  • ISBN-13: 978-1556438806
  • Product Dimensions: 2.4 x 3.5 x 0.5 inches
  • Shipping Weight: 1.8 pounds (View shipping rates and policies)
  • Average Customer Review: 4.7 out of 5 stars  See all reviews (164 customer reviews)
  • Amazon Best Sellers Rank: #4,781 in Books (See Top 100 in Books)

More About the Author

Gabor Maté, MD, is a physician, author, seminar leader, and acclaimed public speaker. His bestselling books include Scattered, When the Body Says No, and Hold onto Your Kids. A former medical columnist for The Vancouver Sun and The Globe and Mail, he lives in Vancouver, BC.

Customer Reviews

Most Helpful Customer Reviews
224 of 229 people found the following review helpful
5.0 out of 5 stars Changed Me! December 30, 2009
Format:Paperback|Vine Customer Review of Free Product (What's this?)
In all innocence I picked up Gabor Mate's book and in no time I was stunned to find that I was reading about myself. No, I am neither a drug addict nor alcoholic, but I have several other addictions I have been ashamed of my whole life. By the time I finished reading this insightful, compassionate, detailed book, I knew finally who I was, how I got that way and what I could do about it.

I honestly have no idea how anyone could read this book and give less than 5 stars. First of all, the 3-star reviewer totally missed several important points concerning Mate's actions at home and on the job. Money was given to his staff, not as a bribe, but as an incentive for him to stop being late and to give himself a little spiritual humbling. As for Mate's own addictions, I feel so much safer to be in the hands of a man who is frank and transparent with me and says, "Let's try this," rather than one who is distantly perfect and ultimately unknowable, who is given to uttering commands and pronouncements. I know who I would trust more.

Mate may suffer from ADD (which I also do) but let me assure you that his prose is every bit as fluid, clear and inspired as the prose you are presently reading. More, his writing is a joy to read. The book itself is very well presented, almost like a mystery story with as happy an ending as one can expect after several murders have been committed in the beginning! The book starts with the stories, the life histories and personality details of his patients. It goes on to then give the medical and psychological and political facts about addictive behavior, and the last chapters are devoted to help, healing and hope. It could not be more beautifully structured!
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60 of 63 people found the following review helpful
4.0 out of 5 stars Not the Reader's Digest take on Addiction!! August 15, 2009
Those who are looking for a brief look at addiction ought to look elsewhere; whatever else can be said about Gabor Mate's In the Realm of Hungry Ghosts, it represents a lengthy, multi-faceted look at the reality of addiction.

Mate is a Canadian physician who practices medicine in one of Canada's poorest and most socially challenged neighbourhoods: Vancouver's Downtown Eastside. Drawing upon his years of experience working with addicts, as well as his expertise in the fields of stress management and attention deficit disorder, Mate has produced a book that capably examines addiction from a wide variety of vantage points.

That having been said, it is only fair to acknowledge that I, for one, was not equally enamoured of the book's every section. Mate is at his strongest as a narrator; I was truly gripped by the lengthy sections of the book in which Mate is content simply to share the experiences--the oftentimes harrowing experiences--of the clients with whom he works. I was equally impressed with his refreshingly accessible account of the implications of new discoveries in the field of brain science, as scientists try to explain the processes that create and perpetuate addiction.. In addition, the book's final section--on "the ecology of healing"-- contained some genuinely fresh insights and some genuinely practical suggestions. These sections most certainly justify the book's purchase.

I found other sections of the book less satisfactory. Although I share Mate's antipathy toward the "war on drugs", I found his own policy prescriptions less than fully convincing. (Then again, I'm glad to have had an opportunity to grapple with his recommendations).
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28 of 29 people found the following review helpful
5.0 out of 5 stars Hopeful and Helpful About a Hopeless Problem January 9, 2010
Format:Paperback|Vine Customer Review of Free Product (What's this?)
Dr. Mate's book is interesting and complete as he discusses the horrible problem of drug addiction. The book has sections about the life stories of addicts, the brain chemistry of addiction, the addictive process, the war on drugs, and the possibilities for overcoming addiction. Despite the very grim nature of the subject matter, the book is both hopeful and helpful.

There is a wide continuum of addiction from consumerism, to sugar, to tobacco, to alcohol, to narcotics. As I read the book, it become clear that many of us have at least some degree of unwanted behavior in response to the chemical promptings of our brains. Hardcore drug addicts are not so very different from the rest of us. Given this context, Dr. Mate's critique of the war on drugs is very compelling. I found his arguments for decriminalizing (but not legalizing) drugs to be very persuasive.

Near the end of the book he offers a four (or five) part approach to treating addiction that seems very helpful in part because it promises no magical overnight results, but instead calls for lots of mindful work repeated many times. "Hungry ghosts" is a metaphorical image from Buddhism for those with appetites that can't be met; the idea that mindfulness, often cultivated by meditation, is the best way to treat these appetites helps bring the book full circle.
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28 of 32 people found the following review helpful
4.0 out of 5 stars All over the map, but worth it December 15, 2009
Format:Paperback|Vine Customer Review of Free Product (What's this?)
It is hard for me to review this book. Dr. Mate says he has ADD, and it shows. Where was the editor for this book? It is all over the map; overlong, with chapters that proceed each other without any continuity, some more than excellent and others downright unreadable.

Yet, in parts it excels greatly, and for this I recommend it. I wish Dr. Mate would have dispensed with his discussion of his classical music CD buying "addiction", his forays into the 12-step rooms, and a chapter on one addicted woman's pregnancy "journal."

Otherwise, this is an excellent in-depth look at addiction and the our absurd "war on drugs." When Mate writes about true drug addiction (and not about himself), with clarity and compassion, he is at his best. As one who has struggled with addiction, I know from my gut-level reaction to (parts of) this book that it speaks the truth. Read it, skip the chapters an editor should have cut, or enjoy them as some people have. Regardless of its large flaws, this is an important book.
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Most Recent Customer Reviews
5.0 out of 5 stars great book
I work in the addictions field and this book should be required reading - it gives great insight into the addict and their ways
Published 1 day ago by chuck
5.0 out of 5 stars Practical and grounded
I found this book truly helpful. I work with people who are using and with some in recovery so am regularly looking for helpful perspectives on addiction. Read more
Published 4 days ago by Alan Muia
5.0 out of 5 stars The most astute and compassionate perspective on addiction
This guy gets it! Mate knows why people use, how to care for them, and how to decouple the addiction from the person. There is no better source for such knowledge.
Published 7 days ago by Charles Hayes
5.0 out of 5 stars Addictions revealed
Having an addiction and working with addictions, one becomes frustrated until one csn look objectively at the source. Read more
Published 8 days ago by Mark Doebel
4.0 out of 5 stars Recommended book
I just started reading it but, so far so good. It's very informative and real. I suggested it to other social workers I graduated with last year. Read more
Published 22 days ago by Heather
5.0 out of 5 stars Required reading for individuals and loved ones afflicted with...
A unique thought process and approach to addiction. Dr. Mate's research and clinical experience are compelling and if we as a country are truely serious about addressing the issue... Read more
Published 25 days ago by James Carroll
5.0 out of 5 stars Read it whether you know an addict or not
This is probably one of the few books about addicts that portrays them as human beings deserving of compassion. Read more
Published 1 month ago by Smiley
5.0 out of 5 stars Compassion is the Key with treating the Addictive Person
Gabor Mate is such a compassionate person. He really understands that just punishing someone that is already punishing themselves is not the answer. He is way ahead of his time. Read more
Published 1 month ago by N. J. Black
5.0 out of 5 stars Try to put it down!
If you want to understand the disease of addiction, this is the book for you. Mate shows the individuals who have this disease without judgement.
Published 1 month ago by Codylady
5.0 out of 5 stars By far, the BEST book I've ever read!!!
I've read this book three times and continue to refer to it. I have also highlighted more than half of the book. Read more
Published 1 month ago by jackithepi
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