Saturday, 1 December 2012

Gabor Mate, "In the Realm of Hungry Ghosts" (2008)

Subtitled, "Close Encounters with Addiction." Winner of the 2009 Hubert Evans Non-Fiction Prize.

Mate is the child of Jewish, East European immigrants, who works as a doctor for street-people, addicts, and other marginalized persons living in Vancouver's notorious East Side. The Realm of Hungry Ghosts differs from other books of its kind for two reasons: 1) Mate's professional experience as a doctor is compelling, but 2) his experience as an addict has given him unique insights into the struggles of his patients.

His book lays out a challenging, compelling, and clearly-written thesis regarding the causes of addiction, and thus offers a new understanding of how addiction works and thus what types of treatment addicts might best respond to. Essentially, Mate suggests that addiction stems in large part from thinking patterns developed in our very young, formative years, and that these thinking patterns significantly help shape the ways our brains come to process information.

Part of Mate's book outlines the physiology of the brain - how serotonin and similar chemicals are used in the brain to convey information and trigger responses - and how experiences and drugs can change this physiology. The other part discusses how personal factors such as life experiences, particularly in childhood, can affect brain chemistry and brain functioning. The combination of these two factors leads Mate to explore concepts such as neural plasticity, and to recommend treatment paths such as cognitive behaviour therapy (although he doesn't actually name this approach, and his programmatic recommendations differ somewhat from the CBT practices I've read about).

For addicts, one of the most useful sections of Mate's book will be a chapter entitled "The Four Steps, Plus One" (pgs. 353-361 of the paperback edition). Mate is not a twelve-stepper. While he has positive things to say about this approach, he has not worked one of those programs (such as AA, etc.) himself. He offers, however, a program developed by Dr. Jeffrey Schwartz, at UCLA's School of Medicine, for helping addicts interrupt what Schwartz refers to as "brain lock"; those unthinking responses and actions that help to maintain addictive habits.

For the sake of you, my reader, the four steps are briefly summarized here:
1) Re-label:
Recognize that what seems to be an imperative, desperate 'need', is actually a temporary, false feeling. This step might be understood as 'apply conscious awareness'.

2) Re-attribute:
Recognize that the message you identified in Step One is a flawed, or false product produced by an addicted mind in situations when that addiction is triggered. It is, in short, a symptom of an illness, and should not be mistaken as - or given the power of - anything more.

3) Re-focus:
Recognize that the message sent by the addicted mind is a temporary phenomenon. It will pass, and is more likely to pass without being acted on if the addict can work to put some time between recognizing the message and choosing to act on it. The key here is to "teach your brain," as Mate says, "that it doesn't have to obey the addictive call." (359).

4) Re-value:
This step involves recognizing the cost and reward of acting on the ideas produced by the addicted mind. Addicts have come to associate false value/reward to seeking and achieving the substance of their addiction. The key here is not to establish some kind of blame or guilt, it is to attempt - as realistically and critically as possible - a sense of what the addictive impulse is actually generating in terms of rewards and benefits, and what the costs of trying to achieve the rewards and benefits the addictive impulse actually result in (NOT the ones the addict believes they might produce).

5) Re-create:
The fifth step is one introduced by Mate. It is a particularly useful and intriguing one. After the 'corrective' steps in understanding identified above, Mate suggests the addicted person undertake to identify what their goals are, what rewards and benefits they seek in their life, and consider alternate methods and activities to pursue them. If, for instance, taking hard drugs does not stop painful memories of childhood abuse, perhaps writing or drawing might help to put these memories in a more manageable perspective. This step offers the addict not only negative or 'corrective' actions, but the ability to envision an 'escape hatch' that offers hope for the future.

More about the book can be found on Dr. Mate's website. There you can also read the 'Introduction' and 'Chapter One - The Only Home He's Ever Had.'