Excerpt: In the Realm of Hungry Ghosts

Posted by – May 24, 2019
Categories: Excerpt Health & Healing Psychology & Personal Growth Society & Politics

For Mental Health Awareness Month, we’re sharing an exclusive excerpt from one of our best-selling and most beloved books ever, In the Realm of Hungry Ghosts by Dr. Gabor Maté.

Based on Maté’s decades of experience as a medical doctor and his groundbreaking work with addicted populations in Vancouver, In the Realm of Hungry Ghosts: Close Encounters with Addiction is a radical re-envisioning of trauma, addiction, mental health, and the social systems that can support—or often inhibit—healing and growth. With a holistic lens, Dr. Maté explores the complex interplay of personal history, emotional development, behavior, and brain chemistry to promote compassionate self-understanding as a critical component of emotional healing.

As Dr. Maté says, 
My book, in short, is an attempt to bring light to core issues shrouded in darkness.

We hope you enjoy the excerpt below.

The Ecology of Healing: The Power of Compassionate Curiosity

When I’m reasonably balanced in my personal and spiritual life, I don’t have difficulty finding compassion for my addicted patients. I’m curious about their life histories and self-perceptions, and for the most part I’m able to avoid imposing judgments on them. As with [my patient] Clarissa, my aim is to open their eyes to the possibility of a nonjudgmental, compassionate curiosity toward themselves.

Things are very different when it comes to my own self in the midst of an addicted phase. Suffused with corrosive shame, I attempt to hide the self-loathing from my own sight with feigned joviality or self-justifying combativeness, neither of which do the job near adequately. As with my drug-dependent, fellow hungry ghosts, this slush of pitiless, negative self-judgment only intensifies the desire for escape and oblivion. The spiral of addiction-shame-addiction keeps swirling on.

As Dr. Bruce Perry said about drug addicts, “we need to be very loving, very accepting, and very patient with people who have these problems.” We also need to extend that same loving, accepting, and patient attitude toward ourselves. And, as Dr. Jaak Panksepp has suggested, to deal successfully with addictions we have to bring emotions back into healthy balance; we have to give ourselves “a chance to think about it.” When we’re awash in a poisonous soup of self-recrimination and shame,
we cannot think creatively.

Among the necessary initial moves toward sobriety is the directing of compassionate curiosity at oneself. Many teachings, from spiritual writings to psychological works, tell us that we need to look at ourselves this way. “In cultivating loving-kindness, we learn first to be honest, loving, and compassionate towards ourselves,” writes the American Buddhist nun Pema Chödrön. “Rather than nurturing self-denigration, we begin to cultivate a clear-seeing kindness.” Chödrön also suggests it’s a good idea to lighten up:

Being able to lighten up is the key to feeling at home with your body, mind, and emotions, to feeling worthy of living on this planet. . . . In addition to a sense of humor, a basic support for a joyful mind is curiosity, paying attention. . . . Happiness is not required, but being curious without a heavy judgmental attitude helps. If you are judgmental, you can even be curious about that.

Posed in a tone of compassionate curiosity, “Why?” is transformed from rigid accusation to an open-minded, even scientific question. Instead of hurling an accusatory brick at your own head (e.g., “I’m so stupid; when will I ever learn?” etc.), the question “Why did I do this again, knowing full well the negative consequences?” can become the subject of a fruitful inquiry, a gentle investigation. Taking off the starched uniform of the interrogator, who is determined to try, convict, and punish, we adopt toward ourselves the attitude of the empathic friend, who simply wants to know what’s going on with us. The acronym COAL has been proposed for this attitude of compassionate curiosity: curiosity, openness, acceptance, and love: “Hmm. I wonder what drove me to do this again.”

The purpose is not to justify or rationalize but to understand. Justification is another form of judgment every bit as debilitating as condemnation. When we justify, we hope to win the judge’s favor or to hoodwink her. Justification connives to absolve the self of responsibility; understanding helps us assume responsibility. When we don’t have to defend ourselves against others or, what’s more, against ourselves, we are open to seeing how things are. I become free to acknowledge the addiction the moment the fact of having behaved along addictive patterns no longer means that I’m a failure as a person, unworthy of respect, shallow and valueless. I can own it and see the many ways it sabotages my real goals in life.

Being cut off from our own natural self-compassion is one of the greatest impairments we can suffer. Along with our ability to feel our own pain go our best hopes for healing, dignity, and love. What seems nonadaptive and self-harming in the present was, at some point in our lives, an adaptation to help us endure what we had to go through then. If people are addicted to self-soothing behaviors, it’s only because in their formative years they did not receive the soothing they needed. Such understanding helps delete toxic self-judgment on the past and supports responsibility for the now.
Hence the need for compassionate self-inquiry.

If I examine my addictive behaviors without judgment and ask “Why?” in the spirit of compassionate curiosity, what do I find? More to the point, whom do I find? What is the full truth of me? Is it that I’m a respected thirty-year veteran of medical practice, spouse and parent, counselor, public speaker, activist, and author? What about the anxious, insecure man who has often felt empty and incomplete and has looked to the outside to allay some insatiable hunger? As fellow addict and author Stephen Reid said during our conversation in the cafeteria of the William Head penitentiary: “. . .makes my teeth hurt, the work of pulling back from all those outside things and looking inside myself.” In my case, the unconscious tension literally made my teeth hurt—so forcefully have I ground my teeth at night since childhood that by the end of my fifth decade most of them were whittled stubs with the pulp exposed.

Along with my positive qualities—intellectual confidence, strengths, passions, and commitments—there has always lurked near the very core of me a churning, inchoate anxiety. Had I been able to be honest with myself and had I been prepared to accept vulnerability, I would have declared at many stages of my life, as Clarissa did, “I’m scared. I’m so very scared.” My anxiety clothes itself in concerns about body image or financial security, doubts regarding lovability or the ability to love, self-disparagement and existential pessimism about life’s meaning and purpose—or, on the other hand, it manifests itself as grandiosity, the need to be admired, to be seen as special. At bottom it is nameless and formless.

I feel sure it was forged in my chest cavity somewhere between my lungs and heart long before I knew the names of things. Do I have reasons to be anxious? By its very nature, chronic anxiety has nothing to do with “reasons.” First it springs into being and much later, once we develop the ability to think, it recruits thoughts and explanations to serve it. In contrast to healthy anxiety (for which a better word is fear) felt in the face of danger—like the fear a gazelle might experience in the presence of a hungry lion or that a small child might feel when his parents are not in sight, chronic anxiety is not rooted in the experience of the moment. It precedes thought. We may believe we’re anxious about this or that—body image, the state of the world, relationship issues, the weather—but no matter what story we weave around it, the anxiety just is. Like addiction itself, anxiety will always find a target but exists independently of its targets. Only when we become aware of it does it wrap itself in identifiable colors. More often we repress it, bury it under ideas, identifications, deeds, beliefs, and relationships.

We build above it a mound of activities and attributes that we mistake for our true selves. We then expend our energies trying to convince the world that our self-made fiction is reality. As genuine as our strengths and achievements may be, they cannot but feel hollow until we acknowledge the anxiety they cover up.

Incompleteness is the baseline state of the addict. The addict believes—either with full awareness or unconsciously—that he is “not enough.” As he is, he is inadequate to face life’s demands or to present an acceptable face to the world. He is unable to tolerate his own emotions without artificial supports. He must escape the painful experience of the void within through any activity that fills his mind with even temporary purpose, be it work, gambling, shopping, eating, or sexual seeking. In my first book, Scattered Minds, I depicted this perennial psychic hunger:

The British psychiatrist R. D. Laing wrote somewhere that there are three things human beings are afraid of: death, other people, and their own minds. Terrified of my mind, I had always dreaded to spend a moment alone with it. There always had to be a book in my pocket as an emergency kit in case I was ever trapped waiting anywhere, even for one minute, be it a bank lineup or supermarket checkout counter. I was forever throwing my mind scraps to feed on, as to a ferocious and malevolent beast that would devour me the moment it was not chewing on something else.

At that time I ascribed that state of perpetual dissatisfaction to attention deficit disorder (ADD). Although a salient mental feature of ADD, the drive to escape the moment is a common, nearly universal human characteristic. In the addicted brain it is magnified to the point of desperation. It becomes the overriding force in directing choices and behavior.

“But I don’t feel any desperation,” some may say. “I just love whatever I’m doing so much that I never want to stop.” Workaholics are prone to think that way, and I used to. “Where is all this pain and grief I’m supposed to feel in order to heal,” I once challenged a therapist. “Try as I may, I can’t force myself to feel anything. Feelings either come or they don’t.” I was so busy stimulating and soothing myself with ceaseless activity, working overtime to keep my brain spinning and gorging it with mind candy, that I didn’t leave even a small gap for any feeling to seep through.

My workaholism and compact disc shopping have been only the most consistent forms of escape my mind chooses when it’s uncomfortable. There have been other behaviors just as compulsive and just as impulsive.

I see now that the underlying anxiety and sense of emptiness have been pervasive. Emotionally they take the shape of chronic, low-grade depression and irritability. On the thought level, they manifest as cynicism—the negative side of the healthy skepticism and independent thinking I’ve always valued. Behaviorally they mask themselves as hypomanic energy or as lethargy, as the constant hankering for activity or for oblivion.

When the ordinary, everyday escape mechanisms fail to satisfy, I plunge into my overtly addictive patterns. If I had greater pain and fewer resources, if I had been less fortunate in the circumstances of my nurturing environment, I might well have been impelled to turn to drugs.

Compassionate curiosity directed toward the self leads to the truth of things. Once I see my anxiety and recognize it for what it is, the need to escape dwindles. It is clear to me that the sense of threat and fear of abandonment that make up anxiety were, in my case, programmed in the Budapest ghetto in 1944. Why attempt to escape some old brain pattern laid down when I was a frightened infant during a terrible time in history? It’s there, and the circuits in which its wordless stories are embedded are indelibly a part of my brain. It doesn’t need to go away—indeed, it won’t go away, not completely. But I can transform my relationship to it, become more intimately related to it. I can even gain some mastery over it, which means noticing it without allowing it to control my moods or behaviors. Similarly, I don’t have to take on the impossible task of erasing the addictive impulses that arose from early acquired brain patterns—but I can transform my relationship to them, as well. Essential to any such transformations is a letting go of judgment and self-condemnation.

Psychiatrist and psychoanalyst Anthony Storr has written about the value of allowing buried emotions to emerge without fear: When a person is encouraged to get in touch with and express his deepest feelings in the secure knowledge that he will not be rejected, criticized, nor expected to be different, some kind of rearrangement or sorting-out process often occurs within the mind which brings with it a sense of peace; a sense that the depths of the well of truth have really been reached.

About the Author

Bevin is the associate comms director at North Atlantic Books.