• In the Realm of Hungry Ghosts

  • Close Encounters with Addiction
  • By: Gabor Maté
  • Narrated by: Daniel Maté
  • Length: 16 hrs and 18 mins
  • 4.8 out of 5 stars (990 ratings)

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Publisher's Summary

In this timely and profoundly original book, best-selling writer and physician Gabor Maté looks at the epidemic of addictions in our society, tells us why we are so prone to them and what is needed to liberate ourselves from their hold on our emotions and behaviours. 

For over seven years Gabor Maté has been the staff physician at the Portland Hotel, a residence and harm reduction facility in Vancouver’s Downtown Eastside. His patients are challenged by life-threatening drug addictions, mental illness, Hepatitis C or HIV and, in many cases, all four. But if Dr. Maté’s patients are at the far end of the spectrum, there are many others among us who are also struggling with addictions. Drugs, alcohol, tobacco, work, food, sex, gambling, and excessive inappropriate spending: what is amiss with our lives that we seek such self-destructive ways to comfort ourselves? And why is it so difficult to stop these habits, even as they threaten our health, jeopardize our relationships, and corrode our lives? 

Beginning with a dramatically close view of his drug addicted patients, Dr. Maté looks at his own history of compulsive behaviour. He weaves the stories of real people who have struggled with addiction with the latest research on addiction and the brain. Providing a bold synthesis of clinical experience, insight, and cutting-edge scientific findings, Dr. Maté sheds light on this most puzzling of human frailties. He proposes a compassionate approach to helping drug addicts and, for the many behaviour addicts among us, to addressing the void addiction is meant to fill. 

I believe there is one addiction process, whether it manifests in the lethal substance dependencies of my Downtown Eastside patients, the frantic self-soothing of overeaters or shopaholics, the obsessions of gamblers, sexaholics and compulsive internet users, or in the socially acceptable and even admired behaviours of the workaholic. Drug addicts are often dismissed and discounted as unworthy of empathy and respect. In telling their stories my intent is to help their voices to be heard and to shed light on the origins and nature of their ill-fated struggle to overcome suffering through substance use. Both in their flaws and their virtues they share much in common with the society that ostracizes them. If they have chosen a path to nowhere, they still have much to teach the rest of us. In the dark mirror of their lives we can trace outlines of our own.
(from In the Realm of Hungry Ghosts)

©2011 Gabor Maté (P)2018 Vintage Canada

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Gabor should have been the narrator

I am a big fan of Gabor's work and have had the privilege of seeing him speak in a small group setting. I love his voice and am very disappointed that he is not the narrator. It changes everything for me. I'm only on the first hour and debating whether to return it and head to youtube to watch his talks and interviews instead. His son has a fine voice it's just not what I was expecting or wanting. I'm losing interest in listening. Gabor's energy comes through his voice. It calms my nervous system.
I would love Gabor to narrate any future audio books.

42 people found this helpful

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How did they let this narration happen?

Title says it. I agree with the other reviewer that Gabor’s voice is quite enjoyable. In fact the way he delivers his message is very powerful. And the message is so crucial. Daniel’s rendition makes the whole matter feel like a joke. How did the producer let him do impressions and accents when reading quotes? The performance feels completely unprofessional.

23 people found this helpful

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Eye Opening, paradigm shifting

This book is very powerful, and I can only hope the masses digest what he is saying, as well as government leaders too. Gabor brilliantly illuminates the true nature of addiction, and provides keen insight from his personal experience, backed by scientific and spiritual support. This book has solid guidance for those who suffer from addiction just as much as it does for those who don’t.

We should be providing compassionate care for people with drug addictions. If harm reduction sites were in every state, and drugs were decriminalized, I am confident we would see a massive drop in violent crimes, deaths from overdose, and an overall increase in well-being across the board. I am really grateful for Dr. Maté, and for the information he provided in this book. I highly recommend it.

14 people found this helpful

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Did pitiful injustice to a deeply human theme

The reader may be forgiven for thinking that the promising title of this book, alluding to the invisible world of the seeking and wanting human spirit, articulates the central theme that the author develops —it does not; I presume it was the publisher who chose the catchy name. Rather than delving with sensitivity and clarity into the rich and nuanced theme alluded to in the title, Maté writes in a confused conflation of changing and loose definitions, self-aggrandisement and confessional, psychiatric mendacity and category error. And it’s a shame, because his actual central theme, that we all escape psychological pain in ways that can be less-than-optimal, while different from the hunger he cites in the title, would have been a good topic, worth developing deeply and accurately, had he done so.

Maté’s greatest and most pervasive flaw is his imprecise use of language and definitions; his use of blunt rhetorical instruments in a intricate topic yields results one might expect. Deconstructing his amalgamation of gobbledygook could serve as frustrating yet excellent training in clear-eyed reasoning for someone with a strong stomach. For example, we learn from Maté that addiction is ‘not primarily a disease’. What does this mean? Does he observe that some part is a disease, and another part not? Which? —Or is there an in-between category of partial disease that cannot be separated into parts? He does not explain. But he does let us know that ‘addiction is a spectrum’ and that it ‘flows in where divine knowledge is missing’.

For clarification, we then learn that although ‘addiction is not primarily a disease’, ‘everyone agrees that addiction represents a different state of the brain’ and that the ‘disease model of addiction is useful’. Because, ’in brain diseases the patient’s behaviours function pathologically”. ‘The cure is the brain deciding to change behaviour or to become normal for the very first time’. ‘The brain forces us to become reflections of our personal histories’; ‘any passion can become an addiction’. 'The fundamental addiction is to the fleeting experience of not being addicted'.

What can the reader make of all this? I found myself driven to read on, hating the intellectual morass, contradiction, and sloppy and inexistent definitions all along the way, trying to find my way through it and to pick out actual valuable gems that Maté may have to offer, but was incapable of relating -and I did find a few, like his comment on the significance and effects of an individual’s relative position in the social hierarchy. Yet such a useful insight is lost in a book where the author, a medical doctor, says that ‘In a cerebral vascular accident, or stroke, brain tissue is destroyed, usually due to bleeding’ (not ischaemia); and gets the Harlow wire-mesh surrogate attachment experiment findings backwards, while sprinkling in little gems that leave the reader wondering what he means by, ‘the so-called placebo effect’ and “the patient could be trusted, his addiction could not’ or “lab rats, that, under certain conditions will resist the addictive appeal of drugs” —how does he know that the rats even have such internal conflict?

Maté espouses immorality the viewpoint of the non-aggression principle, and he uses weasel terms to try to obfuscate what he does and proposes. This is particularly dangerous for people who may be looking to him for direction or understanding. After an interaction with a person whom he has the legal power to incarcerate without trial and the legal ability to supply with drugs at other peoples’ expense, he concludes that the persons thanking him was indeed a sincere thank you -as if no other factor were pertinent to understanding the interaction. Maté (CH 10) tells a patient that ‘he doesn’t think for a minute that the man is crazy, but for the way he’s behaving, he’ll have him forcibly committed’ -honest and powerful words about the extra-judicial trial and incarceration that psychiatrists perpetuate in the name of ‘health’. But no comment about it.

In typical 180-degree fashion, he says coercion should not be used, because ‘it always gives the results opposite of what we want’, yet wants taxpayers and medical professionals coerced to provide all manner of things. He then maintains that ‘people need to feel emotionally understood valued and respected, they need love and understanding’, as justification for coercive government programmes in medicine, daycare, and education. —So much for understanding, loving, respecting and emotionally valuing the taxpayers; just use the State to coerce them to pay. This, from a man who had relatives killed by the Nazis. 



But, to him; ‘moral judgments are never about the obvious, they always speak to the underlying similarities between the judge and the condemned’. Whatever, pray tell, that dissolution of victim and aggressor means. Yet also he says we cannot judge anyone, everyone is different, all brains are different. Some people are more free than others’. ‘We cannot know any person‘s individual capacity for freedom’ - Later he asks about a patient ‘how much freedom does he really have?’ No matter, ‘all problems are psychological, but all solutions are spiritual’ he quotes a MD as saying. Finally, what we need is a ‘therapeutic relationship’, with the State-run medical system.

In a particularly poignant scene, ‘a crying toothless woman, who he and his staff have permanently barred from the clinic where they have the state privilege of supplying her with drugs that would be a crime for her to procure, asks for a hug when she sees them on the street, where she ambles around like a overgrown child craving love’, Maté, that deep and sensitive understander of the human soul, explains that this is “because she needs endorphin’. She accuses him of being like the mafia; he informs/threatens her that he can choose between treating her like a mentally ill person or a sane person. And, as a cruel kafkaesque coup de gras, then tells her that ‘her addiction is a choice’, and adds ‘that scientifically, of course, that’s not true’.

This is such an astoundingly and often grotesquely confused and confusing book, that it could be worth reading as practice in critical thought, backdropped against the internally-consistent reason and crisp definitions of a clear thinker —someone like TS Szasz.

After reading the entire book, I still did not know what Maté actual and concise definition of addiction was; there were many, often contradictory or mutually-exclusive definitions. However, in operational terms, in became clear that addiction is a vague and malleable term that Maté uses to 'spend $8000 on music in a week', have an identity as a spiritual, medical, and intellectual leader, exercise power over others and get taxpayers' money, publish books and gain social prestige, all while being and not being addicted.

Maté reveals his 
intellectual integrity with respect to exploring the meanings of peoples' actions in his comment about the analytical and intellectual field of psychotherapy, when he affirms that ‘ayahuasca may achieve in a few sittings what many years of psychotherapy can only aspire to’ —and this is precisely the type of analysis and intellect you will find in this book, ‘produced and directed by Post-Hypnotic Press’.

10 people found this helpful

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So enlightening

Thank you for this great work. Greatest approach to addiction I've learned and I'm on my way to recovery.

7 people found this helpful

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Like a compass

Filled with so much insight, no chapter went without its revelations.
The content is highly technical, but manages to be accessible to laypersons seeking answers about their inner mechanics.
I have recommended it several times already.

7 people found this helpful

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Great Testimony of human condition

Adiction is usually caused by great trauma and distress which is many times inherited in family over generations (and thats why aboriginal and other exploited populations have much more adiction rates). Lost faith in humanity, lost human connection and emotions, which both gives us meaning creates void - we try to fill this void with addictions (not just substances, but not ending flood of information from our electronic devices, which works similar to our dopaminergic system for example->atention economy). Seeing adicts as wounded people actually works much better then repression (in most cases people can be persuaded much better and faster with kindness, not pressure, unconditional acceptance is good starting point for encounter with anyone and hardest is usually unconditionally accepting ourselves). Criminal behavior dont follow drug use, criminalization of drug use is followed by criminal behavior. So these thoughts above resonated with me most. Adiction is a dark side of passion, where passion creates, addiction steals (its sort of that mythos of holy and fallen world, Satan has all the virtues but love). In all types of addction the addict is actually addicted to the moment of liberation from the emptiness/void, for that brief moment when he is whole. Addiction is ussually some personal parts and evolution systems (of reward and habit forming) blown out of proportion. Passion creates meaning, addiction has meaning only in that brief moment of wholess -> it have no meaning itself. Obsessive passion is an addiction - from outside it can look differently (alcoholic vs workoholic), but inside is always emptiness. ❓Are u addicted?: Is the individual or behavior in control? Given the hurt you doing to yourself and others are you willing to stop? Or You are not able to admit it? -> You are addicted. Addiction consumes the individual and others too over time. Its same as with any escape behavior - depression, psychosis etc. (its obviously complex and there is no perfect person...). Moseses burning bush wasnt consumed by the fire -> passion, addiction would consume ove time. Usefull tool/self-development can become addiction gradually when it shifts from being a tool/way to end in itself (obsession). DaVinci style. Personality of addict can usually easily shift from one addiction to another (addict is primed by less dopamin neurons which can be a predisposition, cause could be trauma/not enough emotional nurturing during childhood or substance use itself). In the case of addictive behaviors (hazard, shopping, internet) people are hooked on their own brain chemicals (dopamin, endorfins) which substance drugs mimics.

6 people found this helpful

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A deeeeep dive into addiction

this is an amazing resource for anybody who's working in a field where addiction is a factor. The audiobook, was no easier to get through then the print version. It's long, but full of amazing information.

6 people found this helpful

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Anyone in the helping field must read

This book is Is great for anyone in the helping field it’s a must read if you are working with addictions or in the emergency room or anywhere. Dr Gabor puts a true face on any addictions.

6 people found this helpful

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A must read if you want to understand addiction

I have a much greater understanding of addiction after listening this book. I will listen to more of Matè's work after this.

4 people found this helpful