In the Realm of Hungry Ghosts: Close Encounters with Addiction

Reviewed by Jennifer Silverness, MSEd, LPCC, LADC – Founder, Pioneer Recovery Center Gabor Maté’s In the Realm of Hungry Ghosts is one of the most humane and insightful books ever written about addiction. Drawing from his work with people in Vancouver’s Downtown Eastside, Maté dismantles stereotypes and shows addiction for what it truly is—a response to pain, loss, and disconnection. What makes this book so powerful is the combination of medical expertise, personal vulnerability, and deep compassion. Maté doesn’t just talk about the science of addiction; he tells the stories of real people, making it impossible to reduce them to labels or statistics. His insights align closely with what we see at Pioneer Recovery Center: that healing requires safety, empathy, and an understanding of trauma’s role in addiction. Whether you’re a professional, a family member, or someone in recovery yourself, this book offers both understanding and hope. It’s a reminder that behind every addiction is a human being who deserves compassion and connection.

I thought I had, especially as the best book I've read in two or three decades. This is one remarkable, almost entirely unique, (I'll say it now) masterpiece by Gabor Mate. I told him so in an email to him. Few books really ought be required reading, but this is one of them. Mate, not least himself a behavioral addict, understands addictions like no one I've ever read or ever listened to. He gets it. And he gets near to the roots of addiction as anyone ever has. And then he critiques ridiculous public policy stuck in the Middle Ages. The Middle Ages can be excused for lack of access to data, writing materials, etc., etc., while modern nations cannot be excused for such reasons. But nations, led by persons addicted to power and wealth and a hundred other behaviors and substances, insist more on character assassination, placing of self-blame and then punishment I doubt Torquemada ever contemplated on such a vast scale--when 50% or so of America's extremely high prison population consists of addicts (now ex-addicts the hard way if they can't get drugs in prisons) whose violations of law were so minor as to have warranted no more (indeed, no less) than admission to places who think it a better idea to help addicts as opposed to punishing them. But when traditional "values" continue to prevail...outcome is to be expected--draconian at all times pretty much no matter the problem. One wonders just how far backward a society or civilization can move before collapsing of its own gluttony for punishment. Addiction is a sociological problem, not a psychological problem, or at worst a mix of the two. Mate understands this perfectly and has told Canadian officials as much insofar as Mate is Canadian transplanted from Hungary where he was born a Jew about the time WWII got going. I've put it more strongly than Mate does; he's nicer about it, though I doubt he's any more patient. But only a relatively small part of the book is devoted to discussion of public policy. Mostly, the book tells the stories of individual addicts Mate knows or has known (prior to their suicides or murders) on Vancouver's less swank east side. He writes of Native Canadians, who like their American kin, are more prone to addiction, not least for the way they've been regarded by the dominant races and classes. It's not as though they're more prone because native! One reads such crap all the time, however, and so Mate is refreshing as mountain air after years in a stinking city. What he writes was for me as I read utterly familiar, as though he'd taken the words from my mouth. He didn't, but just said it for me and far better than I could ever have said it. Plus, he's an actual physician with access to actual data as well as to other experts on the topics of addiction and psychology, and sociology too. This book is also science at it's best, in relation to the world beyond the theoretical. There's actual evidence, quite a lot of it, in support of Mate's claims, up to and including studies of the human brain, of what endorphins are, of how they are released and taken up in and by the brain, of how not all people really are created equal (politically in the blind eyers of the law perhaps, but not psychologically or physiologically. And not economically either). They're not, as any dope, so to speak, who thought about it for 30 seconds could not help but conclude. Addicts are sufferers in ways many of us can't imagine, while on the other hand lots of us can very well imagine and then indulge for ourselves, whether in substances or repetitive behaviors, either or both in hope of relief, not least from societal judgment. The stories are, well...cliche because like most cliche's so true...heartbreaking. Some terrible, terrible things go on all around us, a lot of it happening to children who will grow up to become addicts. (Then we'll play the blame game; namely, blame them for having made poor choices in life. What nonsense. Such game-playing ought be called what it really is, a cop out, a refusal to take responsibility for the world in which we all dwell. Easier to blame the victim for his or her plight. Poof, gone, what problem? Oh him? He deserves whatever happens, as does everyone. "One gets what one really wants." There's no end to such ""common wisdom" that dispense with reality giving nary a thought, let alone another idea. Such are customs and traditions born of ideologies.) Mate would change our systems of beliefs, as would all who tell us the truth refusing to allow us to continue to hide behind curtains consisting of myths. Obviously, I couldn't possibly recommend this book more as absolutely essential reading and on a topic slightly wider than the one advertised. Yes, it's about addicts and their various addictions, but deeper down it's a commentary on the state of our collective being. We've been pretty bad and don't seem much interested in being better, I might add. Instead we're building more prisons and fewer schools, clinics, hospitals or half-way houses liberals don't want in their backyards. We're becoming yet more hypocritical, not less so. Mate exposes us as much as the addicted, perhaps more so. I won't misstate him: He's firmly against addiction, spends much of his life trying to help people out of their addictions as he's helped himself out of his own. He doesn't dismiss personal responsibility, not in the least. Millions of addicts wouldn't make for much in the way of a functioning civilization either. Mate is tough on his patients, sometimes overly so, as he writes. But my favorite part, if you will, is when he writes of "authenticity," specifically of that he's discovered in that east side community, where addicts and hangers on, and other of society's outcasts speak and act with an authenticity unknown in society at large. I suppose that when you've hit bottom there's nothing more to be frightened of, even if fear is often at the root of or the cause of mental illnesses, whether or not addictions are regarded as mental illnesses. (I personally think so.) But there is no room, space or time for pretense among those for whom he cares enough to devote so much of his time and effort. Could we EVER use some of that authenticity in our daily dealings, in our politicians claiming to be "leaders," especially in business gone global, and most especially in foolish media where myths go to be nourished and enriched. Addicts have a lot of important things to say, far more worth listening to than some glorified, media-hyped pol, movie star, whatnot otherwise idiot. I mean the hardcore addict of whom Mate writes and treats as best he can and in more ways than as physician. When he writes of their authenticity I can just feel what he means. I KNOW what he means, also in part for the lack of it I discover or rediscover every day in my own dealings with others and in listening to media, to those who speak through media, who have ready access to media and who are looking out for their own desperate neediness first and foremost. The hardcore addict is far more honest, far more in touch with just being human, which is to be weak at the knees for all time while never ever allowed just to say so. Gabor Mate is philosopher too, one who will make you think, including about what is right and what is wrong, about authentic values, as opposed to those "family" ones always on the lips of politicians and so many of their backers, all of them clueless as to the actual nature of morality, never mind answers. It's not a self-help book though it does help a self whether or not a self asks for help, and it's not cure-all book, in the event anyone still imagines there could ever be such a thing. Mate, like a few others, Erickson, Chomsky, Marcuse, et al. and just to name some of the more recent, has a firm grip on what really matters, and so this book is about more than some junkies and their personal problems along with his own problems or even just all of our problems. It's about all those things, but by its tone--which is NEVER patronizing--and by its insight and revelation the book is also speculative philosophy in an at least one very fine tradition of non-tradition as practiced by those just mentioned and a few others, all of whom ought be essential reading for any who claims to be a citizen of the world.

This was the first book I read that gave me a more scientific and sensical approach to addiction. Since reading this book, I have read many more journal articles that support Gabor Mate's explanation of addiction. Contrary to many of the pop-culture views that addiction is either a moral failing, an effect of character defects, a spiritual disease, a lack of discipline, or laziness and stupidity, Gabor Mate's book and research points to a simple and empirically supported explanation: Addiction is a maladaptive attempt to self-regulate emotions. Emotional regulation is a physiological necessity for a human organism - and it is a necessity that those who can successfully do take for granted completely. For people who had safe and secure upbringings, by nurturing caregivers in safe environments, their brains and bodies learn how to self-regulate stress. Stress is a normal physiological occurrence, and people fortunate enough to grow up in safe and nurturing environments have a body and brain that can regulate these stress levels. But if you are among the unlucky and large minority of people who grew up with abusive, neglectful, or unpredictable or unsafe environments throughout childhood, then your brain and body most likely did not learn how to effectively regulate physiological stress. Because childhood is the time period wherein humans learn the survival skill of self-regulation, if we go through our childhoods endangered, constantly scared, repeatedly alone, or consistently harmed, then our systems do not learn how to self-regulate. And this is where addiction comes into play. Because for a dysregulated system, it is perfectly natural to seek regulation outside of the system. If our brains and bodies cannot self-regulate successfully on their own, then our brains and bodies will seek out that necessary regulation from outside of ourselves. In the case of substance use addiction, we find it in a drug. Gabor Mate's book explains this simply and effectively, and, best of all, this explanation removes the bulls*** that has long since been used to stigmatize addiction and its sufferers. The whole "character defects cause addiction" and "addicts are criminals and undisciplined idiots" mentality has, for far too long, permeated our culture and stigmatized those of us who cannot self-regulate emotional feeling states, due to our earlier environments that occurred when we were children and had no control to learn differently. My only criticism of Gabor Mate's work, which I hope does not dissuade people in reading his research because it is still contains the clearest and most accessible explanations for addiction that I have found to date, is that he supports the 12-step god-programs of Alcoholics Anonymous for recovery. I personally found the 12-steps of AA to run directly counter to my recovery from trauma. The 12 steps of AA actively undermined and harmed my recovery from trauma, for so many reasons and in so many ways I don't have space or time to elaborate here. And with everything Gabor Mate understands about trauma and its relationship with addiction, I don't see how he could support a program's use for recovery from addiction, when that very same program directly undermines, or even contradicts, recovery from the underlying trauma that prompts and perpetuates the addiction.

My reading of this book concurs with nearly everything I've seen in the other five star reviews; so in the interest of not being repetitive, mine will be short and limited to comments and impressions not prominent in other reviews. Two such impressions stick out - one regarding the neurology of addiction; and the second, related to the first, is with respect to early brain development. My interest in this book was piqued when Stefan Molyneux recommended it in one of his podcasts. I expected that the book would do more than merely introduce the reader to the latest findings in the science of addiction; that it would also shed light on some of the larger pathological brain conditions that we don't normally think of as "addiction" per se - those conditions that lead to behaviors that we actually admire and respect. I was not disappointed one bit. In particular, in Chapter 22, Poor Substitutes for Love: Behavior Addictions and Their Origins, the author deftly describes how addictive prone brain circuitry can drive an individual to obsessions with accomplishments (pride), wealth (greed), admiration (vanity), power (lust), etc. Mate explains that the cascade of neurological events that lead to these addictions are identical to those that lead to the lesser respected ones (such as gambling, sex, food) as well as the most stigmatized, criminalized addictions (illegal drug use). Only the trigger differs. The brain conditions underneath the compulsions are the same. The author does a good job explaining the neuro-mechanisms, but does not go into very much detail, which is understandable since the book is already pretty long. A good compliment in this area would be The Compass of Pleasure by David Linden. How do we address and/or correct these brain conditions? The author's answer is on the mark. In early chapters, the author lays the foundation. First and foremost, the addiction-prone brain (genetics aside, since we cannot control our genes) results from insufficient feel-good hormones and neurotransmitters, and too many of the stress induced chemicals very early on in our lives. The latest research in epigenetics and perinatal care point directly to the nurturing environment from conception through the first year of life as the crucial period of brain development. This period will ultimately determine whether or not we later in life feel the pull toward compulsive behaviors/drugs to compensate for the dearth of "love", neurologically/physiologically speaking, we experienced in the womb and in infancy. Again, since the book is already long, Gabor Mate does not have the luxury of going into a deep description of the latest research. As a companion piece for this purpose, one could consider Neurobiology and the Development of Human Morality by Darcia Narvaez. (By the way, I commend the both Gabor Mate and Darcia Narvaez for bravely making this sound and objective analysis of the topic, as it would certainly be regarded as somewhat offensive to those - I'm thinking of the popular Sheryl Sandberg "Lean In" sentiments as an example - who resist putting perinatal care at the very top of our list of cultural priorities.) The hallmark of a good book for me is one which I find enlightening and enjoyable AS I'm reading it, as well as how much I keep thinking about the contents AFTER I read it. This book did both, in addition to inspiring me to learn more about brain science, epigenetics, and moral development.

An excellent read. Would highly recommend.

I highly recommend Dr. Gabor Mate's in-depth and insightful account of his work as a doctor specializing in treating individuals with serious substance addiction. This is the first book that I have read by this author and I am inclined to purchase his other books that tackle related but separate subjects. Dr. Mate does an excellent job of describing addiction as a process that is the result of environmental circumstances that infants and children endure. The author goes into a significant amount of detail describing the impact that these environmental circumstances have on brain chemistry and functioning, and how these early traumas evolve over time into full blown substance and behavioral addictions. Mate shares a generous number of case histories of his patients (in some cases the patients insisted on their real names being used instead of aliases) as a means to further illustrate the addiction process in action. Dr. Mate goes to great lengths to describe how the addiction process is responsible for every kind of addiction;,whether it be the serious substance abuse that his mostly indigent patients are struggling with as well as behavioral addictions, such as gambling addiction, sex addiction, shopping addiction, workaholism, and the many varieties of behavioral addictions that we've come to recognize. Dr. Mate opens up to describe how the addiction process unfolded in his own life, resulting in overachievement hunger, workaholism and an addiction to classical music CDs. The book is a comprehensive survey of the addiction process, including his critique of the "War on Drugs" and suggestions for more enlightened and evidence-based strategies for treatment. Even though the book contains a great deal of technical information, particularly in its excellent explanation of the brain chemistry and psychological features of the addiction process, Dr. Mate's prose style is very engaging and quite readable. For anyone seeking an up-to-date survey of recent research findings about the addiction process and/or a compassionate and honest overview of the individual and collective challenges presented by all kinds of addictions, this book is an excellent resource.

Eye-Opening and Compassionate Mate, a doctor who's battled his own behavioral addiction, dives deep into the world of addiction. He gets it, man. He truly understands the addicts he treats, many of them from Vancouver's rough Eastside. Unlike some experts who toss around statistics, Mate tells their stories. Heartbreaking stories, of lives ravaged by addiction, often rooted in childhood trauma. Not a Blame Game This book isn't about pointing fingers. Mate argues that addiction is a sociological and psychological problem, not a moral failing. We, as a society, are quick to demonize addicts and throw them in prison, a system Mate sees as draconian and ineffective. He advocates for treatment and compassion, not punishment. Science and Authenticity Mate backs up his arguments with science, studies of the brain and how addiction hijacks it. But this book is more than just facts and figures. It's about the human experience. Mate talks about the authenticity he finds in the addict community, a stark contrast to the phoniness of media and some politicians. A Call to Action "In the Realm of Hungry Ghosts" isn't just about addicts, it's about all of us. It challenges us to be more genuine, to look at the root causes of problems, and to build a more compassionate society. It's a wake-up call, and frankly, we could all use a good jolt sometimes. The book isn't without flaws. Some parts are a bit repetitive, and the focus on the hardcore addicts can feel overwhelming at times. But those are minor quibbles. This book is a must-read for anyone who wants to understand addiction, including those struggling with it themselves. It's not a self-help book in the traditional sense, but it offers a powerful and insightful look at the human condition.

Born in Hungary, Mate' is a survivor of the Nazi genocide who emigrated to Canada in 1957. He is currently the staff physician at the Portland Hotel, a residence and resource center in Vancouver's Downtown Eastside. Many of his patients suffer from mental illness, drug addiction and HIV, or all three. In the Realm of Hungry Ghosts opens with stories about some of these patients. Reading about the tragic lives of the patients he treats is very difficult to get through. Nevertheless, to Mate' these stories offer "the fresh air of truth, even if it's the stripped, frayed truth of desperation" and "they hold up a mirror in which we all, as individual human beings and collectively as a society, may recognize ourselves." The reader soon becomes clear that most hard-core substance abusers come from abusive homes and the assaults suffered by these folks in childhood are heartbreaking. Key to Mate's work, and its biggest challenge, is to simply demonstrate care and acceptance for these folks, just as they are. On the nature of addiction, Mate' notes that essential to optimal human brain development are nutrition, physical security, and consistent emotional nurturing, all of which are too often missing. Mate' tells the story of his own addictive habit, not to drugs, fortunately, but to purchasing classical music CDs. It sounds minor, but his habit has involved secrecy from his wife, buying binges ($2000 in 6 weeks for CDs he doesn't even have time to hear), hours spent compulsively reading music review, and making lists of discs he wants to buy. The gift of his addiction is, he says, that it takes one to know one. He understands the compulsions of his patients. Finally, Mate' addresses the need for social change. He proposes new approaches to treating addiction based on understanding its biological and socio-economic roots. He argues that the "war on drugs" actually punishes people for having been abused and entrenches addiction more deeply. He says a system that marginalizes, ostracizes and institutionalizes people in facilities with no care and easy access to drugs only worsens the problem. He argues the need for better support for families overall, as most children in North America are now away from their parents from an early age due to economic conditions. Mate' is a fearless social revolutionary whose prodigious heart and mind deserve to be listened to and supported.

Gabor Maté é um médico que trabalhou com diversos dependentes químicos no seu hospital em Vancouver e associou traumas de infância com o uso de drogas proibitivas. As informações contidas no livro são baseadas em 3 fontes: seu conhecimento próprio, suas entrevistas com pacientes e, principalmente, publicações e pesquisas referenciadas ao longo da obra. Porém o livro não quer solucionar o problema dos dependentes de drogas, mas sim explicar que a origem de qualquer vício – seja de drogas, jogos, apostas, bebidas, cigarro, sexo, compras, etc – tem uma dor e um trauma associados. O que diferencia os tipos de vícios entre si está na gravidade do trauma e nas alternativas do indivíduo. Então o que ele ousa fazer (e que faz sentido) é aproximar pessoas de todos os vícios com uma mesma explicação. Uma leitura útil para qualquer pessoa que tenho curiosidade no assunto, ou que tenha algum conhecido que passe por alguma dificuldade maior. O livro contém principalmente 3 tópicos: • Efeitos fisiológicos do vício: sistemas de recompensas do cérebro, hormônios, sintomas de "craving" • Políticas de Guerra às Drogas: como são as políticas na maioria dos países sobre esse assunto tão delicado, e como essas políticas podem sem revisadas • Como combater o vício: ajuda especializada, apoio da família e amigos, auto-conhecimento, meditação. E vale mencionar que, depois do autor definir o vício, temos um parágrafo que explica a diferença entre um vício e uma paixão: "Vício é centrífugo: drena energia de você, criando um vácuo de inércia. A paixão energiza você e enriquece os seus relacionamentos. Concede força aos outros, enquanto traz poder para você. Enquanto a paixão cria, o vício consome."

Went and saw Gabor Mate live in Sydney and such an interesting knowledgeable man. I bought this for my daughter who lost her husband suddenly in July 2023

薬物を始めとした依存症 闇は深く出口の見えないトンネルの様 それを治そうと言うよりは、治っても治らなくても 支えるというスタイルがいいのかもしれないが、 医療者としては疲弊しそう

Nicht leicht zu lesen aber sehr informativ

The cover of the book had some stains and looks used