Book Review: In the Realm of Hungry Ghosts: Close Encounters with Addiction, by Gabor Maté, M.D., 2010, North Atlantic Books, Berkeley CA 94712, pps. 493, $17.95

Reviewed by John A. Speyrer

"The fundamental addiction is to the fleeting experience of not being addicted. The addict craves the absence of the craving state. For a brief moment he's liberated from emptiness, from boredom, from lack of meaning, from yearning, from being driven or from pain."
--Gabor Maté M.D In the Realm of Hungry Ghosts, p. 114.

"The prevention of substance abuse needs to begin in the crib -- and even before then....All possible resources should be mobilized to help (the mother) experience a pregnancy that is emotionally, physically, and economically as stress free as possible."
--Gabor Maté M.D. In the Realm of Hungry Ghosts, p. 419.

I first learned of Dr. Maté's book from C-Span's week-end Book TV program. It was fascinating to listen to him expound on all aspects of addictions both chemical and behavorial. His large well-written work covers all phases of the why and the how one gets shackled to and by one's early pain. The first third of his book details the lives of addicts. The author has first hand knowledge of their lives as he is physician to the chemically addicted at the Downtown Eastside in Vancouver, B.C. His book was a #1 Canadian best seller.

One important fact which he soon makes clear is that potential addiction does not reside in the drug being taken, but rather, in the individual drug taker's physical brain. Only "at risk" individuals are susceptible. But you might not know if you are such a person with this possibility. Those who have this vulnerability have different kinds of brains. The number of dopamine receptor sites in their brain are determined before they are born. They were created because they were needed. They were needed because their possessor endured very early stress and trauma.

While the author acknowledges that predisposition to addiction exists, he does not seem to stress genetic factors. Our inutero, infantile and early childhood brain development, according to Maté, are the "most important biological factor in determining whether or not a person will be predisposed to substance dependence and to addictive behaviors of any sort, whether drug-related or not." p. 188

Early traumas are almost a universal association when one speaks of addiction. The Adverse Childhood Experiences (ACE) studies (2003) are well known and show a high positive correlation of trauma with addiction and other mental health and psychophysiological disorders. There are many websites available to those who wish detailed information about the ACE studies conducted by Felitti, et als..

Dr. Drew Pinsky, addiction medical specialist, also feels that trauma is only one of the factors which makes a brain addiction prone. He also believes that if you don't have the "addiction genes" even with trauma, you will not become an addict. Dr. Maté, however, titles Chapter 19, It's Not in the Genes, and is a strong believer that inheritance by epigenetics, the inheritance of acquired characteristics (no, it's not Lamarckism) is an important factor in making an addict. [See two articles on epigenetics and trauma by A. Janov, Ph.D: epigenetics I - epigenetics II]

Gene expression can be determined by a number of factors and "both the prenatal and postnatal period have a profound effect on gene expression and adult patterns of behavior," which the author quotes from the Journal of Neuroscience. Even before birth, predispositions to addiction work to throw a wrench into the developmental process of fetal brain development as even the traumas of the mother can be visited upon the developing fetus. The "quality" and number of receptor sites of the fetal brain for important neurotransmitters are determined in the inutero environment.

In Chapter 22, Poor Substitutes for Love, the author explores why certain behavorial addictions are chosen rather than others. The title of the chapter begins the explanation and is one of the most interesting of Dr. Maté's book. Such non-chemical means of expressing one's addiction are without number. We know the most common, such as, over-gambling, over-shopping, hyper-compulsive sex, over-spending, over-saving, shoplifting for the thrill, over-eating, overuse of pornography and over-exercising. I believe my own behavorial addiction is somewhere in the list above.

However, there are more socially destructive behavorial additions/compulsions as, for example, serial rape, pedophilia. serial torture with murder and spousal beatings. The simplistic answer to the question of choice of addiction, is that those dopamine sites in the brain become flooded with the performance of the addict's favorite behaviorial act out. The ultimate and final explanation is that the particular act out is chosen because it is a symbol of the major emotional deficiencies or traumas experienced during the addict's early life.

Dr. Maté writes about his own behavorial addictions to over-purchasing classical music on compact discs and his over-work addiction, both of which he ties in to his early life. I won't write about mine. In the addictions, the chosen act out is invariably symbolically related to one's very early deprivation and this fact bears repeating as it is the kernel of the truth.

"More typically in healthy relationships, sex improves with time and shared experiences. Addictive sex, on the other hand, wanes with increased knowledge of the other person because it no longer provides escape from buried feelings."
-- Charlotte D. Kasl, Ph.D. in Women, Sex, and Addiction

It is no surprise to learn that sexual addiction is based on the addict's love deficiency during infancy and early childhood. Although there are many symbols of love, sex is such an obvious one. The particular act out helps to temporarily fill the empty place in one's psyche by the timely release of those wonderous feel good brain neuro-chemicals.

Tiger Wood's sexual addiction has been in the news lately, and it's a good example of a behaviorial addiction. Sexual addiction is a stand-in or substitute for nurturing, for love, - a crucial unmet need from which we can suffer during our very early lives.

Having orgasmic sex floods the receptor sites with good feelings transmitters, but for the sexual addict, the feelings just don't last. Like drinking salt water, the sex does not satisfy and the addict's brain soon needs another fix. Today's NY Daily News (3-22-10), quotes Woods as having said, "Yeah, I tried to stop, and I couldn't stop,...It was just, it was horrific....I've had a lot of low points...Just when I thought they couldn't get lower, they got lower." Thus one also suffers from the effects of behavorial addictions as they can impel behavior which have untoward emotional, psychological and financial effects as the early trauma residuals often demand release in activities which can be detrimental to one's equanimity.

Related to this addiction is "the Casanova syndrome which compels a man to try to show himself that he is lovable by making up in numbers of conquests what is missing in the special quality of love that should have been found in his mother, the kind that assures one of one's existence and one's worth." (Jean Liedloff, in The Continuum Concept)

An unfortunate oftentimes accompanying problem is that in those who suffer severely and compulsively from sexual act outs, pornographic or otherwise, there is often a co-joined dread of real sexual intimacy based on the love deficiency from the sexual addict's infancy. Rather than face the demon of rejection by the mother head on, the severely addicted sex addict is forced to compulsively behave in a serial fashion. The beneficial relief from one fix don't last long. Instead of facing the repressed pain from infancy and before, the addict's unknown unconscious earlier unmet needs force him to go from lover to lover seeking, by definition what he cannot ever find.

He spends an unconscionable amount of time looking for love in all the wrong places and experiences only temporary relief from each encounter. The act out is the scream for the early love which was lacking and the problems he has with intimacy with his spouse are thereby avoided.

Month after month and year after year, the most popular article on my website remains the Madonna/Whore Complex. It explains how, because of early trauma, one's wife can rather become to be psychologically regarded as one's mother, with resultant lack of sexual interest by the husband.

It is not so much the need for an orgasmic release by the sexual addict but instead the futile hope that this time the early needs for love will be met. He can only get those needs met in the present in a symbolic way. Needs of infancy must be met when they needed to be met. In the now, in therapy, the victim can only feel what he did not get. But feeling what pushes the drive to feed this dragon of need can be ultimately curative. The present day act outs do not satisfy the need, but they do reveal the existence of the earlier non-getting to those knowledgable ones in the mental health field. They do reduce anxiety and tension temporarily. Each of the behavorial addictions mentioned above, and many others, have their ultimate origins in the very early life of the addict and are almost always at a deep unconscious level.

Maté writes that "...simplistic pop psychological methods that flourished from the 1950s to at least the 1980s,...did encourage a blaming and even hostile attitude towards parents, especially mothers." p. 248. Ouch! Is he talking about my beloved primal type psychotherapies? Well, that's also what I believed when I read some of Dr. Arthur Janov's works before the self-process began in me. I also was suspicious because it seemed too dramatic, too Hollywoodian. I could not relate to his books as, I figured I had the most loving mother in the world! One has to deeply feel those early traumas to become convinced that that is one of the sources of one's misery. Janov's regressive type therapy works, as does Stan Grof's holotropic breathwork, both, albeit at a slower rate than I had hoped and expected!

Dr. Maté writes on the next page, that when the Toronto Star made the first review of his book, Scattered Minds (2007) , the reviewer wrote, "Maté blames his mother." That was quite a deceptive oversimplification as, in the 12th month of his life in Hungary during WWII, his mother had temporarily given him up in order to ensure his survival. In his current book, the author responds to the reviewer with one sentence, "Blame, like beauty, is in the eye of the beholder." Undoubtedly, he had experienced the not to be denied feeling of abandonment, although through no fault of his mother. Perception can be as damaging as reality.

"What seems like a reaction to some present circumstance is, in fact, a reliving of past emotional experience."
--Gabor Maté M.D., In the Realm of Hungry Ghosts., p. 366

This automatic reaction to the feeling component of an early trauma means that we are powerless to defend against feeling the uncomfortable feeling. It's the synchronous buried hurt in the past which causes our overreaction. Dr. Maté touts various therapy methods which seem to me, to have as their objective the strengthening of our defenses against past emotional experiences rather than the experiencing of our early pain.

Discussing both the eastern tradition of mindfulness and the various well known "steps" of AA, the author does not offer their methodologies as solutions to the problems of addiction. Like all therapies for combating chemical and behavorial addictions, the statistics of positive results are not very good. Perhaps, the hope of a cure being around the corner and the comradeship of fellow addicts offers solace for the time spent in following and discussing the twelve steps programs.

For the behavorial addictions, like gambling, etc. the author has found the Four Step self treatment method program promising. Developed by Dr. Jeffery Schwartz of the Univ. of Cal. at L.A., they are offered to the reader as an adjunct or extension to the traditional twelve step program. Maté adds a fifth step which he feels might be helpful.

Sylvia Cary, author of Jolted Sober (1989), is not happy with the results of such programs: "Some say four out of five fall by the wayside. Others say its more like nine out of ten. From my own experience I'd say its nine out of ten." The trick to getting sober and staying sober, she writes, is having a "jolt recovery." (p. xiv) Some call it having a spiritual or God experience.

Dr. Maté, in common with many who suffered from the Nazi persecution, even as an infant, writes about his earlier God-rage, which in actuality occurred at the beginning of his progress towards enlightenment. But religion, he writes, is not bound with spirituality as "(i)t is no accident that in all major religions the most rigidly fundamentalist elements take the harshest, most punitive line against addicted people." Maté, Ibid., p. 414.

"I don't believe in God", a Narcotics Anonymous member told me, "but at least with step two
I've accepted that I'm not Her."

-- Gabor Maté M.D., In the Realm of Hungry Ghosts, p. 412

The quotation above followed a discussion in Dr. Maté's book of the negative view of the image of God held by many, but not all, addicts. I read somewhere that some of the concentration camp survivors of WWII had completely lost their faith, while others' faith was renewed. Perhaps, it was those who were fortunate enough to have had a loving infancy and childhood who retained their trust and faith in a deity.

In the article, The Origins of Our Image of God, I quote:

"One had to be a witness to this outrage (the Holocaust) in the course of which the only choice that remained, was to hate or love the God who permitted all these things. This was the cause for me to revise my religious views, and I resisted loving a creator that martyred people and would even gas children and would let people be guilty as happened here. If the order of the world was determined through death, then it was perhaps better for God not to believe in Him and, instead, to struggle against death with all one's strength, without lifting one's eyes to Heaven, where God was silent. If on earth there should only be "Scourgers and Victims," then it is an obligation to stand, not on the side of the castigator, but to espouse the cause of the victims." -- Major Plagge
-- The Seach for Major Plagge: The Nazi Who Saved Jews, by Michael Good, p. 223-224

If there is one theme the readers of, In the Realm of Hungry Ghosts, will take away with them is the persuasive argument the author presents that the present-day "war on drugs" is both a war on victims and a flawed social policy. It is without merit and will fail. Governments and especially in the U.S. have gained nothing in this exercise of futility except garnering a higher percentage of incarcerated individuals than any country of the world.

Four short appendices complete Dr. Maté's best seller.

  • Fallacies of Adoption and Twin Studies,
  • Attention Deficit Disorder and Addiction,
  • The Prevention of Addiction, and
  • Twelve Steps.
It was a good read. Recommended with enthusiasm.

Listen and watch a 1:45 presentation by Dr. Gabor Maté on Book TV.

"Imagine a drug so powerful it can destroy a family
simply by distorting a man’s perception of his wife...."
(continued in, National Review , - March 31, 2010)

Return to the Primal Psychotherapy Page Index
Return to the Book Index
Return to the Index of Addiction Articles on the Primal Psychotherapy Page