On the 10th anniversary of the publication of his groundbreaking book, In the Realm of Hungry Ghosts, The CJN sat down with Dr. Gabor Maté to discuss his views on drug addiction and its treatment. Dr. Maté is a child survivor of the Holocaust who left Hungary for Canada in 1957 and studied medicine at the University of British Columbia before working in family practice for 28 years. From 1990 until 2011 he focused on those addicted to substances in Vancouver’s Downtown Eastside.
In the Realm of Hungry Ghosts: 10th Anniversary Edition has just been published by Vintage Canada and features new content on the opioid crisis. It blends first-person accounts, riveting case studies, cutting-edge research and passionate argument, and takes a panoramic yet highly intimate look at the widespread and perplexing human ailment of addiction.
What led you from family practice to the Downtown Eastside?
My first work in Vancouver was in the Downtown Eastside and I always knew I’d go back there. After years in family practice and in palliative care, I was looking for a new challenge. When the Portland Hotel Society contacted me and let me know they were looking for an open-minded physician to work with a difficult population, I accepted immediately. As an infant survivor of the genocide I’ve always been aware that a lot of people suffer because of prejudice, through no fault of their own, and because of the indifference of people. This was an opportunity to practise medicine in a population that really needs good care and compassion and rarely gets it.
What changes have you witnessed in the treatment of drug addiction since your book was first published?
I’ve seen two major changes. First, there’s much more acceptance of harm reduction concepts, which means working with the patient to reduce the harm of the addiction to them instead of demanding abstinence. Today supervised injection sites are opening across the country, driven by need. The second change is the availability of suboxone, an innovative medication that’s come into much broader use and is a really good substitution product for a lot of people.
What hasn’t changed is that most medical professionals are still not informed that addiction is always a response to trauma, and unless you deal with the trauma you’re always dealing with its consequence. The average medical student doesn’t learn about how the brain and the circuits involved in addiction develop in interaction with the emotional environment of a child. Epidemiological data clearly shows the correlation between childhood adversity and addiction.
The reality of the Downtown Eastside is that it’s a traumatized, ostracized population. Sometimes the best you can do for this population is listening, treating them with dignity and implementing harm reduction, without any expectation of reducing their drug use. We have a non-system to treating addiction – it’s a random, haphazard, unsupervised, unstandardized method. It’s poorly informed, and the poor results we get reflect the shortcomings of the system.
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How has being Jewish has influenced your decision to be a doctor?
Firstly, the trauma I endured as an infant under the Nazis made me acutely aware of human pain, because I experienced it myself. It resulted in a burning desire to alleviate pain, and medical work is a natural outlet for that impulse. Secondly, my grandfather, who was killed in Auschwitz when I was five months old, was a powerful influence. He was a physician and a writer and I grew up with the refraction of his image through my mother’s eyes. Thirdly, in Jewish tradition there’s the perspective of a just, kind world that honours everyone’s humanity, especially that of the downtrodden, and it’s inspired me to work towards that kind of a world. And finally there’s the fact that an intellectual profession such as medical work is highly portable, so the insecurity of the east European Jew is alleviated by having knowledge that’s not place-specific.
You wrote about your own addiction to shopping for classical music and to being a workaholic. How do you manage that today?
I’m still purchasing classical music but I’m no longer addicted. I got to a point of fatigue with the habit and what it was doing to my life, my relationships, my time management and my self-esteem. My other addiction, work, has been tougher to curtail and it takes constant work to keep it in balance. I get a lot of invitations to speak internationally on the subjects I’ve written about. It’s very satisfying work, and having your sense of worth validated by other people is very addictive. It took quite a bit to get the work addiction under control. I had to examine what I really value, – my own peace of mind, or the work? The only difference between a drug addiction and my addictions is that mine were socially acceptable.
What are some of the least recognized addictions today, in your opinion?
The circuits in the brain that drive addictive behaviour are the same no matter what the addiction – sex, pornography, gambling, gaming, Facebook, drugs or shopping. Today the Internet has become a hugely addictive outlet in the hands of people who are emotionally empty, lacking meaning in their lives and needing to be occupied with something. But there’s social acceptance and social support for it, just as there is for work addiction. If I’m a workaholic I get nothing but reward from the world: more money, more praise, more respect. It’s only that my inner life becomes emptier, less spiritual, and my relationships become more arid and unsatisfactory. But the world doesn’t see that.
How do you hope Hungry Ghosts will instigate change? What would you like to see happen?
On all issues, I just wish people would wake up and be willing to look at the whole picture, at all sides, particularly when it comes to trying to understand people who are very different from how they are. We think we’re looking at reality but we’re looking it from a very particular, conditioned perspective. In the medical view of things it’s conditioned by the western separation of mind and body. We don’t see the interrelationship of the emotional, psychological and the physiological. With virtually any medical condition there’s a huge interaction of the mind and body, and of stress, especially unconscious stress. There’s always a purpose behind addiction – to escape reality, stress, to numb oneself. It’s a poor way to resolve distress, but to resolve the addiction we have to understand the distress and resolve that. We have to look at causes, not just manifestations, symptoms. We have to find solutions that relate to primary cause.
What does the future hold for you?
I’m working on two books: Hello Again: A fresh start for adult children and their parents, about adult-children relationships. The second book is called The Myth of Normal: Illness and Health in an Insane Culture. The premise is that in this society normality is a myth. What we consider to be normal is actually abnormal in terms of human needs. It’s how we live our lives that’s insane.
This interview has been edited and condensed for style and clarity