Hungry Ghosts

“In the Realm of Hungry Ghosts”:
Dr. Gabor Maté,

Physician at Vancouver Safe-Injection Site, on the Biological
and Socio-Economic Roots of Addiction and ADD

DEMOCRACY NOW

"In the Realm of
Hungry Ghosts" Dr. Gabor Maté

interviewed by Amy Goodman on Democracy Now 1 of 2

"In the Realm of
Hungry Ghosts" Dr. Gabor Maté

interviewed by Amy Goodman on Democracy Now 2 of 2

AMY GOODMAN: The Obama administration’s budget
proposal for the Office of National Drug Control Policy sets
aside nearly twice the amount of funding for law enforcement
and criminalization than for treatment and prevention of drug
addiction. Out of a total of $15.5 billion, some $10 billion
are used for enforcement. National Drug Control Policy Gil
Kerlikowske praised the numbers as reflecting a
“balanced and comprehensive drug strategy.”

Well, just last year, the newly appointed drug czar and
former Seattle police chief had called for an end to the
so-called “war on drugs," raising hopes among
advocates of harm-reduction approaches to curbing drug use.
In an interview with the Wall Street Journal last May,
Kerlikowske said, “People see a war as a war on them.
We’re not at war with people in this country.”

Well, I’m joined right now here in the Democracy
Now! studio by a doctor who has spent the last twelve
years working with one of the densest populations of drug
addicts in the world. Dr. Gabor Maté is the staff physician
at the Portland Hotel, a residence and harm reduction
facility in Vancouver, Canada’s Downtown Eastside. Dr.
Maté also treats addicts at the only safe-injection site in
North America, a center that’s come under fire from
Canada’s Conservative government led by Stephen Harper.

Dr. Gabor Maté is the bestselling author of four books.
His latest, just out in the United States, is called In
the Realm of Hungry Ghosts: Close Encounters with Addiction.

Welcome to Democracy Now!, Dr. Maté.

DR. GABOR MATÉ: Pleasure to be here.

AMY GOODMAN: Now, what do you mean, the only
safe-injection site, the only legal injection site in North
America? People inject heroin there?

DR. GABOR MATÉ: People are allowed to bring their
drugs there. We don’t provide them with their drugs. I
think we should, but we don’t. But they bring it in, and
without fear of being arrested, they’re allowed to
inject, under supervision. And the staff, without being fear
arrested, are allowed to help them inject in a safe way, give
them clean needles, sterile swabs, and resuscitate them if
they overdose. So, everywhere else in Canada or in the
States, of course, these activities would all be illegal.

AMY GOODMAN: Why are they allowed to do this?

DR. GABOR MATÉ: Well, it was conceived in a moment
of political openness, because so many people pass on
infections, like HIV and hepatitis C, to one another through
injection use, sharing needles. They infect themselves with
bacteria from their skin by using dirty water. So it’s a
harm reduction measure that, in many studies, have been shown
to reduce the burden of disease and also the economic costs
attendant to addiction to society.

AMY GOODMAN: And do you find that addicts can
actually heal themselves or perhaps be able to get off heroin
more easily by injecting there?

DR. GABOR MATÉ: Well, the facility is not designed
to treat addiction, per se; it’s designed to
reduce the harm from it. It’s a harm reduction measure.
What we do find, though, is that we have a detox facility on
the second floor, which is where I’ve been working, and
people come from the injection facility to detox, because
they’ve been into— brought into contact with
compassionate caregivers perhaps for the first time in their
lives. These people all had very tough lives. And so, for
them to even contemplate receiving help takes a lot of trust.

AMY GOODMAN: Talk about the people you treat.

DR. GABOR MATÉ: Well, the hardcore drug addicts
that I treat, but according to all studies in the States, as
well, are, without exception, people who have had
extraordinarily difficult lives. And the commonality is
childhood abuse. In other words, these people all enter life
under extremely adverse circumstances. Not only did they not
get what they need for healthy development, they actually got
negative circumstances of neglect. I don’t have a single
female patient in the Downtown Eastside who wasn’t
sexually abused, for example, as were many of the men, or
abused, neglected and abandoned serially, over and over again.

And that’s what sets up the brain biology of
addiction. In other words, the addiction is related both
psychologically, in terms of emotional pain relief, and
neurobiological development to early adversity.

AMY GOODMAN: What does the title of your book mean,
In the Realm of Hungry Ghosts?

DR. GABOR MATÉ: Well, it’s a Buddhist phrase.
In the Buddhists’ psychology, there are a number of
realms that human beings cycle through, all of us. One is the
human realm, which is our ordinary selves. The hell realm is
that of unbearable rage, fear, you know, these emotions that
are difficult to handle. The animal realm is our instincts
and our id and our passions.

Now, the hungry ghost realm, the creatures in it are
depicted as people with large empty bellies, small mouths and
scrawny thin necks. They can never get enough satisfaction.
They can never fill their bellies. They’re always
hungry, always empty, always seeking it from the outside.
That speaks to a part of us that I have and everybody in our
society has, where we want satisfaction from the outside,
where we’re empty, where we want to be soothed by
something in the short term, but we can never feel that or
fulfill that insatiety from the outside. The addicts are in
that realm all the time. Most of us are in that realm some of
the time. And my point really is, is that there’s no
clear distinction between the identified addict and the rest
of us. There’s just a continuum in which we all may be
found. They’re on it, because they’ve suffered a
lot more than most of us.

AMY GOODMAN: Can you talk about the biology of
addiction?

DR. GABOR MATÉ: For sure. You see, if you look at
the brain circuits involved in addiction—and that’s
true whether it’s a shopping addiction like mine or an
addiction to opiates like the heroin addict—we’re
looking for endorphins in our brains. Endorphins are the
brain’s feel good, reward, pleasure and pain relief
chemicals. They also happen to be the love chemicals that
connect us to the universe and to one another.

Now, that circuitry in addicts doesn’t function very
well, as the circuitry of incentive and motivation, which
involves the chemical dopamine, also doesn’t function
very well. Stimulant drugs like cocaine and crystal meth,
nicotine and caffeine, all elevate dopamine levels in the
brain, as does sexual acting out, as does extreme sports, as
does workaholism and so on.

Now, the issue is, why do these circuits not work so well
in some people, because the drugs in themselves are not
surprisingly addictive. And what I mean by that is, is that
most people who try most drugs never become addicted to them.
And so, there has to be susceptibility there. And the
susceptible people are the ones with these impaired brain
circuits, and the impairment is caused by early adversity,
rather than by genetics.

AMY GOODMAN: What do you mean, “early adversity”?

DR. GABOR MATÉ: Well, the human brain, unlike any
other mammal, for the most part develops under the influence
of the environment. And that’s because, from the
evolutionary point of view, we developed these large heads,
large fore-brains, and to walk on two legs we have a narrow
pelvis. That means—large head, narrow pelvis—we
have to be born prematurely. Otherwise, we would never get
born. The head already is the biggest part of the body. Now,
the horse can run on the first day of life. Human beings
aren’t that developed for two years. That means much of
our brain development, that in other animals occurs safely in
the uterus, for us has to occur out there in the environment.
And which circuits develop and which don’t depend very
much on environmental input. When people are mistreated,
stressed or abused, their brains don’t develop the way
they ought to. It’s that simple. And unfortunately, my
profession, the medical profession, puts all the emphasis on
genetics rather than on the environment, which, of course, is
a simple explanation. It also takes everybody off the hook.

AMY GOODMAN: What do you mean, it takes people off the hook?

DR. GABOR MATÉ: Well, if people’s behaviors
and dysfunctions are regulated, controlled and determined by
genes, we don’t have to look at child welfare policies,
we don’t have to look at the kind of support that we
give to pregnant women, we don’t have to look at the
kind of non-support that we give to families, so that, you
know, most children in North America now have to be away from
their parents from an early age on because of economic
considerations. And especially in the States, because of the
welfare laws, women are forced to go find low-paying jobs far
away from home, often single women, and not see their kids
for most of the day. Under those conditions, kids’
brains don’t develop the way they need to.

And so, if it’s all caused by genetics, we don’t
have to look at those social policies; we don’t have to
look at our politics that disadvantage certain minority
groups, so cause them more stress, cause them more pain, in
other words, more predisposition for addictions; we
don’t have to look at economic inequalities. If
it’s all genes, it’s all—we’re all
innocent, and society doesn’t have to take a hard look
at its own attitudes and policies.

AMY GOODMAN: Can you talk about this whole approach
of criminalization versus harm reduction, how you think
addicts should be treated, and how they are, in the United
States and Canada?

DR. GABOR MATÉ: Well, the first point to get there
is that if people who become severe addicts, as shown by all
the studies, were for the most part abused children, then we
realize that the war on drugs is actually waged against
people that were abused from the moment they were born, or
from an early age on. In other words, we’re punishing
people for having been abused. That’s the first point.

The second point is, is that the research clearly shows
that the biggest driver of addictive relapse and addictive
behavior is actually stress. In North America right now,
because of the economic crisis, a lot of people are eating
junk food, because junk foods release endorphins and dopamine
in the brain. So that stress drives addiction.

Now imagine a situation where we’re trying to figure
out how to help addicts. Would we come up with a system that
stresses them to the max? Who would design a system that
ostracizes, marginalizes, impoverishes and ensures the
disease of the addict, and hope, through that system, to
rehabilitate large numbers? It can’t be done. In other
words, the so-called “war on drugs,” which, as the
new drug czar points out, is a war on people, actually
entrenches addiction deeply. Furthermore, it
institutionalizes people in facilities where the care is
very—there’s no care. We call it a
“correctional” system, but it doesn’t correct
anything. It’s a punitive system. So people suffer more,
and then they come out, and of course they’re more
entrenched in their addiction than they were when they went in.

And by the way, according to many studies, the easiest
place to get drugs is in prisons—and in schools, by the
way. These are the two areas where you can get drugs in North
America: the schools and the prisons. So that it makes no
sense from any point of view. It serves some people, perhaps,
with entrenched interests, but it does not serve the addict,
nor does it serve society.

And I could tell you something else about that. A patient
of mine with a $50 cocaine habit a day, which is not
excessive, how does he raise money to be able to afford those
drugs? By shoplifting. To reach $50 a day, he has to shoplift
$500 worth of goods. Who pays for that? The social cost is
way beyond the cost of law enforcement.

AMY GOODMAN: Wasn’t there an attempt to shut
down the clinic that you have in Vancouver by the federal
government in Canada?

DR. GABOR MATÉ: Well, the federal government we
have in Canada right now, the Harper government, is—got
its stuck head very much in the sands of Bush-era attitudes.
And they never liked the idea of a supervised injection site,
and they’ve tried to shut it down, and twice now, in the
Supreme Court of British Columbia and in appeal court. Their
attempt has been defeated, because the courts have ruled that
this is a necessary medical service which the government does
not have the right to withdraw. And, of course, twenty-four
international studies have attested to that, but the
government ignores the medical information.

AMY GOODMAN: You’re headed back to Vancouver,
where the Olympics are beginning next week.

DR. GABOR MATÉ: Yes.

AMY GOODMAN: What is the effect of the Olympics on
the community, especially when it comes to social services?

DR. GABOR MATÉ: Well, in the Downtown Eastside,
there’s a real fear, because the last time there was a
big international event in Vancouver, which was Expo, the
police simply took street people off the streets and shipped
them out of Vancouver. They put them on buses. Now,
nobody’s clear that that’s going to happen this
time, and probably not, because the political organization
amongst people in the Downtown Eastside is much stronger now.

But certainly, I live in an area of the world where
we’re building highways now so that rich people can see
skiing events, whereas social services are being cut.
There’s a danger of teachers being let go because of the
typical North America-wide economic squeeze. And drug
programs in northern British Columbia that serve aboriginal
youth have been cut now because of budgetary constraints. At
the same time, we’re building skating rinks. So
it’s usually the people at the very bottom who pay the
price for the people who are well-to-do to have a good time.

AMY GOODMAN: I’m curious about your own
history, Gabor Maté.

DR. GABOR MATÉ: Yeah.

AMY GOODMAN: You’ve written a number of
bestselling books. We won’t get to talk about them all.
I’m very interested in your one on how attention deficit
disorder originates and what you can do about it. But about
your own history, you were born in Nazi-occupied Hungary?

DR. GABOR MATÉ: Well, ADD has a lot to do with
that. I have attention deficit disorder myself. And again,
most people see it as a genetic problem. I don’t. It
actually has to do with those factors of brain development,
which in my case occurred as a Jewish infant under Nazi
occupation in the ghetto of Budapest. And the day after the
pediatrician—sorry, the day after the Nazis marched into
Budapest in March of 1944, my mother called the pediatrician
and says, “Would you please come and see my son, because
he’s crying all the time?” And the pediatrician
says, “Of course I’ll come. But I should tell you,
all my Jewish babies are crying.” Now infants don’t
know anything about Nazis and genocide or war or Hitler.
They’re picking up on the stresses of their parents.
And, of course, my mother was an intensely stressed person,
her husband being away in forced labor, her parents shortly
thereafter being departed and killed in Auschwitz. Under
those conditions, I don’t have the kind of conditions
that I need for the proper development of my brain circuits.
And particularly, how does an infant deal with that much
stress? By tuning it out. That’s the only way the brain
can deal with it. And when you do that, that becomes
programmed into the brain.

And so, if you look at the preponderance of ADD in North
America now and the three millions of kids in the States that
are on stimulant medication and the half-a-million who are on
anti-psychotics, what they’re really exhibiting is the
effects of extreme stress, increasing stress in our society,
on the parenting environment. Not bad parenting. Extremely
stressed parenting, because of social and economic
conditions. And that’s why we’re seeing such a preponderance.

So, in my case, that also set up this sense of never being
soothed, of never having enough, because I was a starving
infant. And that means, all my life, I have this propensity
to soothe myself. How do I do that? Well, one way is to work
a lot and to gets lots of admiration and lots of respect and
people wanting me. If you get the impression early in life
that the world doesn’t want you, then you’re going
to make yourself wanted and indispensable. And people do that
through work. I did it through being a medical doctor. I also
have this propensity to soothe myself through shopping,
especially when I’m stressed, and I happen to shop for
classical compact music. But it goes back to this insatiable
need of the infant who is not soothed, and they have to
develop, or their brain develop, these self-soothing strategies.

AMY GOODMAN: How do you think kids with ADD, with
attention deficit disorder, should be treated?

DR. GABOR MATÉ: Well, if we recognize that
it’s not a disease and it’s not genetic, but
it’s a problem of brain development, and knowing the
good news, fortunately—and this is also true for
addicts—that the brain, the human brain, can develop new
circuits even later on in life—and that’s called
neuroplasticity, the capacity of the brain to be molded by
new experience later in life—then the question becomes
not of how to regulate and control symptoms, but how do you
promote development. And that has to do with providing kids
with the kind of environment and nurturing that they need so
that those circuits can develop later on.

That’s also, by the way, what the addict needs. So
instead of a punitive approach, we need to have a much more
compassionate, caring approach that would allow these people
to develop, because the development is stuck at a very early age.

AMY GOODMAN: You began your talk last night at
Columbia, which I went to hear, at the law school, with a
quote, and I’d like you to end our conversation with that quote.

DR. GABOR MATÉ: Would that be the quote that only
in the presence of compassion will people allow themselves—

AMY GOODMAN: Mahfouz.

DR. GABOR MATÉ: Oh, oh, no, yeah, Naguib Mahfouz,
the great Egyptian writer. He said that "Nothing records
the effects of a sad life” so completely as the human
body—“so graphically as the human body.” And
you see that sad life in the faces and bodies of my patients.

AMY GOODMAN: Well, Dr. Gabor Maté, I want to thank
you very much for being with us. His latest book is called In
the Realm of Hungry Ghosts. Before that, Scattered:
How Attention Deficit Disorder Originates and What You Can Do
About It and When the Body Says No: Understanding the
Stress-Disease Connection.

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