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 In the Realm of Hungry Ghosts: Close Encounters with Addiction
Gabor Mate's latest reveals the unexpected and strangely poetic connections between love, belonging, and dopamine and endorphin receptors

People from all walks of life struggle with addictions to both behaviours and substances, and few people know this better than Vancouver physician Dr. Gabor Mate. Dr. Mate runs a community clinic for the Portland Hotel Society, a non-profit that provides housing and services in Vancouver's Downtown Eastside.

The Portland Hotel Society's projects range from the Portland Hotel itself, which houses people with a "dual-diagnosis" of addiction and mental health issues, to InSite, North America's first supervised injection facility. In addition to his work as a physician, Dr. Mate has authored several books. His newest book, In the Realm of Hungry Ghosts: Close Encounters with Addiction, builds upon ideas explored in several of his earlier works.

Books such as Scattered Minds, Mate's look at Attention Deficit Disorder, and Hold On to Your Kids, his book on parenting, share with In the Realm of Hungry Ghosts investigations into how the environments we exist in during our first few months and years of life strongly influence how our brains will develop and grow. Approaching the topic of addiction from the context of his belief in the importance of early childhood development, Mate has written a book that articulates all aspects of addiction in a way that is honest, warm, approachable, and thoroughly researched.

Part One of In the Realm of Hungry Ghosts, the first quarter of its 400 pages, is entitled "Hellbound Train." This is the section that is devoted to Mate's clients, their stories and life histories. As a reviewer I seriously considered skipping this section, preferring instead to jump to the discussions of brain chemistry and structure, the politics of the "War on Drugs," and possibilities for healing. More than just impulsiveness, by skipping ahead I hoped to avoid the stress and pain that I feared would come from reading about people I have known.

Like Dr. Mate, I also work for the Portland Hotel Society. It has been a pleasure to get to know people that are often regarded as inhuman by much of society, and to see them as whole people. It has also been very difficult at times to accept that, as Portland Hotel Society Director, Liz Evans, says in the book, "I could not rescue people from their pain and sadness. All I could offer was to walk beside them as a fellow human being, a kindred spirit."

I'm glad now that I did choose to read the first part of In the Realm of Hungry Ghosts. I learned how little I understood about the addictions that drive those people I have known for so long, about the connections between their tragic life stories and the development of basic structures in the their brains, and about the unexpected and strangely poetic connections between love, belonging, and dopamine and endorphin receptors. The stories also make the book's later discussions of neurology seem real and grounded rather than abstract.

Part of Dr. Mate's expertise and wisdom on this topic comes from his own addiction, which he talks about frankly throughout the book. His compulsive buying of classical music albums, sometimes spending thousands in a week, seems at first absurd compared to the stories he tells of his illicit-drug addicted patients. The reader is soon convinced, however, of how legitimately harmful Mate's addiction is to himself and others, as he places it on a continuum on which his patients in the Downtown Eastside are at the extreme end.

Mate frequently brings his own experiences into the book, both his own struggles with addiction as well times when he was admittedly too harsh or judgmental of patients. Descriptions of incidents when, out of frustration, he chastised patients for self-destructive and irresponsible behaviour provide points of departure for later reflections on brain chemistry that explain why they could not help but act they way they did.

While In the Realm of Hungry Ghosts focuses heavily on neurological explanations of addiction, with fascinating and accessible discussions of brain chemistry and development, it by no means falls entirely on the "nature" side of the "nature versus nurture" question. In fact, he shows how "[in] the real world there is no nature vs. nurture argument, only an infinitely complex and moment-by-moment interaction between genetic and environmental effects." For Dr. Mate the causes of addiction, as well as the social problems that, superficially, stem from addiction, are best understood as a convergence of neurology, genes, social dislocation, family history and politics.

The neurological origins of addiction explain how certain people are "wired" to be more susceptible than others, but Mate argues that the processes of brain development that cause this "wiring" in the first place are largely social. In particular, he explores how a child's attachment and attunement to her primary caregivers very early in life contribute to the development, or in some cases non-development, of important brain circuits.

Politically, Mate explores the futility of the "War on Drugs" and the harm it actually causes, and discusses more humane and sensible approaches to addiction that support people where they are rather than punishing them for what they cannot help. The last part of In the Realm of Hungry Ghosts, "The Ecology of Healing," explores spirituality and the process of recovery from addictions with wisdom and, importantly, practicality.

As I read those last chapters on the recovery and management of addictions, and the tremendous amount of hard work, persistence, learning, and support involved, I thought of the message that is implicit throughout the book, which is that addictions are preventable. Addictions are signs of our failure to prevent poverty, abuse, dislocation, and exclusion, and of our failure to provide support and understanding, for children and their caregivers.--Lief Eriksen

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