In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

The mind activity that can physically rewire malfunctioning brain circuits and alter our dysfunctional emotional and cerebral responses is conscious mental effort—what Dr. Schwartz calls mental force. If changing external circumstances can improve brain physiology, so can mental effort. “Intention and attention exert real, physical effects on the brain,” Dr. Schwartz explains.9 Not surprisingly, the brain area activated in studies looking at the effect of self-directed mental effort is the prefrontal cortex, the apex of the brain’s emotional self-regulation system. It’s also an area where, we have learned, the brains of addicts are impaired. The mental activity most critical to the development of emotional self-regulation has been called “dispassionate self-observation” by the authors of an important article on the interface of brain and mind, published in the Philosophical Transactions of the Royal Society (Biological Sciences) in 2005. “The way in which a person directs their attention (i.e., mindfully or unmindfully) will,” they write, “affect both the experiential state of the person and the state of his/her brain.”10 Mindful awareness involves directing our attention not only to the mental content of our thoughts, but also to the emotions and mind-states that inform those thoughts. It is being aware of the processes of our mind even as we work through its materials. Mindful awareness is the key to unlocking the automatic patterns that fetter the addicted brain and mind.

We can distinguish between two kinds of mind function: awareness (the dispassionate observer) and the jumble of automatic processes (conscious, semiconscious, and subconscious) that dictate our emotional states, thoughts, and much of our behavior. One of the first scientists to recognize this distinction was the great Canadian neurosurgeon Wilder Penfield. “Although the content of consciousness depends in large measure on neuronal activity, awareness itself does not,” Penfield wrote. “To me it seems more and more reasonable to suggest that the mind may be a distinct and different essence from the brain.”

The automatic mind, the reactive product of brain circuits, constantly interprets the present in the light of past conditioning. In its psychological responses it has great difficulty telling past from present, especially whenever it is emotionally aroused. A trigger in the present will set off emotions that were programmed perhaps decades ago at a much more vulnerable time in the person’s life. What seems like a reaction to some present circumstance is, in fact, a reliving of past emotional experience.

“Be at least as interested in your reactions as in the person or situation that triggers them,” Eckhart Tolle advises. In a mindful state one can choose to be aware of the ebb and flow of emotions and thought patterns instead of brooding on their content. Not “he did this to me and therefore I’m suffering” but “I notice that feelings of resentment and a desire for vengeance keep flooding my mind.” Although bare attention was developed as a meditative practice, its use is not limited to formal meditation. It is the conscious attending to what occurs in the mind as it takes in physical or emotional stimuli from within and outside the body. “Bare Attention is the clear and single-minded awareness of what actually happens to us and in us at the successive moments of perception,” write the authors of the Philosophical Transactions article. “It is called ‘Bare’ because it attends just to the bare facts of a perception as presented either through the five physical senses or through the mind without reacting to them.”

Bare attention can show her that these moods and feelings have only the meaning and power that she gives them.

Bare attention allows us to take an objective stand outside the ever-moving ebb and flow of thought, reaction, and emotion and to reinforce the part of us that can observe, know, and decide consciously. It allows us to observe the many individual frames, as it were, that make up the self-created movies in our minds.

With bare attention, we move from this automatic identification with our fear or frustration to a vantage point from which the fear or frustration are attended to with the same dispassionate interest as anything else. There is enormous freedom to be gained from such a shift. Instead of running from difficult emotions (or hanging on to enticing ones), the practitioner of bare attention becomes able to contain any reaction: making space for it, but not completely identifying with it. 15

When Rae, my wife, says no to me or behaves in a way that upsets me, my automatic belief is that I’m being rejected or abandoned by the woman whose love I need, and my mechanical reaction is to detach emotionally, to withdraw. This is a common response of young children who experience emotional or physical separation from their parents. Addiction confers invulnerability because it allows us to soothe vulnerable emotions like pain or fear or the aching for love with behaviors, objects, or substances whenever we choose. It’s a way to avoid intimacy. Mindful awareness can bring into consciousness those hidden, past-based perspectives so that they no longer frame our worldview. “Choice begins the moment you disidentify from the mind and its conditioned patterns, the moment you become present,” writes Eckhart Tolle. “Until you reach that point, you are unconscious.” Once I notice my programmed, defensive impulse to withdraw from intimacy and understand its source, I have some choice whether or not to act it out. With even a modicum of sanity, why would I? In present awareness we are liberated from the past.

“Your worst enemy cannot hurt you as much as your own thoughts, when you haven’t mastered them,” said the Buddha. “But once mastered, no one can help you as much—not even your father and your mother.”

I don’t propose meditation and mindfulness as panaceas. It is futile to dream of corralling a group of active cocaine addicts or alcoholics into a meditation class. To pursue such practices, one requires mental resources, a commitment to emotional clarity, an access to teaching, and some mental space in one’s life. They are also difficult, especially at the beginning. But for people whose lives are blighte...

When asked about my view of meditation my stock answer has been, “I have a profound relationship with meditation; I think about it every day.” It’s true. Every day for years I’ve heard the call of contemplative solitude, and nearly every day I’ve turned a deaf ear. I’ve run from mental discipline like Jonah escaping the call of God until he ends up in the putrid belly of the whale. My addiction-prone, ADD brain always wants to look to the outside to get away from itself. As a result, I tend to oscillate between excessive, multitasking busyness and a proclivity for “vegging out” in ways t...

It’s a way of working with the most immediate environment, the internal one. “Mindfulness changes the brain,” psychiatrist and brain researcher Daniel Siegel points out: “Why would the way you pay attention in the present moment change your brain? How we pay attention promotes neural plasticity, the change of neural connections in response to experience.”16

The addict’s behavior or substance use is also meant to calm anxiety—an unease about life itself, or about a sense of insufficient self.

A warning about possible pitfalls. I have a tendency, typical in attention deficit disorder (ADD), of beginning projects with enthusiasm and a sense of commitment, only to abandon them after some lapse or failure. “I’ve tried that,” I’ll then say, “but it doesn’t work for me.” That attitude is also typical of self-recovery practices in addiction, since, by definition, addiction is characterized by relapses. I have to get that there is no “it” to work or not work. “It” doesn’t have to work. I am the one who has to work. And what is commitment? Commitment is sticking with something not because “it works” or because I enjoy it, but because I have an intention that overrides momentary feelings or opinions. So, too, with the four-step program. You don’t have to feel or believe that it’s working for you: you just have to do it and to understand that if you have lapsed, it doesn’t mean that you have failed. It’s an opportunity to begin anew.

I may feel, for example, that I must leave off whatever I’m doing right now and go to the classical music store. The feeling takes on the quality of a need, of an imperative that must immediately be satisfied. Another person will say that she needs to have a chocolate bar immediately or needs to do this or that, depending on the object of the addiction. When we relabel, we give up the language of need. I say to myself, “I don’t need to purchase anything now or to eat anything now; I’m only having an obsessive thought that I have such a need. It’s not a real, objective need but a false belief. I may have a feeling of urgency, but there is actually nothing urgent going on.”

It is conscious intention and attention, not just rote repetition that will result in beneficial changes to brain patterns, thoughts, and behaviors. Be fully aware of the sense of urgency that attends the impulse and keep labeling it as a manifestation of addiction rather than any reality that you must act upon. “In Re-labeling,” writes Dr. Schwartz, “you bring into play the Impartial Spectator, a concept that Adam Smith used as the central feature of his book The Theory of Moral Sentiments. He defined the Impartial Spectator as the capacity to stand outside yourself and watch yourself in action, which is essentially the same mental action as the ancient Buddhist concept of mindful awareness.”2

“In Re-attribute you learn to place the blame squarely on your brain. This is my brain sending me a false message.”4 This step is designed to assign the relabeled addictive urge to its proper source. In step one you recognized that the compulsion to engage in the addictive behavior does not express a real need or anything that “must” happen; it’s only a belief. In step two you state very clearly where that urge originated: in neurological circuits that were programmed into your brain long ago, when you were a child. It represents a dopamine or endorphin “hunger” on the part of brain systems that, early in your life, lacked the necessary conditions for their full development. It also represents emotional needs that went unsatisfied. Reattribution is directly linked with compassionate curiosity toward the self. Instead of blaming yourself for having addictive thoughts or desires, you calmly ask why these desires have exercised such a powerful hold over you. “Because they are deeply ingrained in my brain and because they are easily triggered whenever I’m stressed or fatigued or unhappy or bored.” The addictive compulsion says nothing about you as a person. It is not a moral failure or a character weakness; it is just the effect of circumstances over which you had no control. What you do have some control over is how you respond to the compulsion in the present. You were not responsible for the stressful circumstances that shaped your brain and worldview, but you can take resp...

In the refocus step you buy yourself time. Although the compulsion to open the bag of cookies or turn on the TV or drive to the store or the casino is powerful, its shelf life is not permanent. Being a mind-phantom, it will pass, and you have to give it time to pass. The key principle here, as Dr. Schwartz points out, is this: “It’s not how you feel that counts; it’s what you do.” Rather than engage in the addictive activity, find something else to do. Your initial goal is modest: buy yourself just fifteen minutes. Choose something that you enjoy and that will keep you active: preferably something healthy and creative, but anything that will please you without causing greater harm. Instead of giving in to the siren call of the addiction, go for a walk. If you “need” to drive to the casino, turn on the TV. If you “need” to watch television, put on some music. If you “need” to buy music, get on your exercise bike. Whatever gets you through the night—or at least through the next fifteen minutes. “Early in therapy,” advises Jeffrey Schwartz, “physical activity seems to be especially helpful. But the important thing is that whatever activity you choose, it must be something you enjoy doing.”5 The purpose of refocusing is to teach your brain that it doesn’t have to obey the addictive call. It can exercise the “free won’t.” It can choose something else. Perhaps in the beginning you can’t even hold out for fifteen minutes—fine. Make it five, and record it in a journal as a success...

This step should really be called devalue. Its purpose is to help you drive into your own thick skull just what has been the real impact of the addictive urge in your life: disaster. You know this already, and that is why you are engaged in these four steps. It’s because of the negative impact that you’ve taken yourself by the scruff of the neck and delayed acting on the impulse while you’ve relabeled and reattributed it and while you have refocused on some healthier activity. In this revalue step you will remind yourself why you’ve gone to all this trouble. The more clearly you see how things are, the more liberated you will be. We know that the addicted brain assigns a falsely high value to the addictive object, substance, or behavior, the process called salience attribution. The addicted mind has been fooled into making the object of your addiction the highest priority. Addiction has moved in and taken over your attachment-reward and incentive-motivation circuits. Where love and vitality should be, addiction roosts. The distorted brain circuits, including the orbitofrontal cortex, are making you believe that experiences that can come authentically only from genuine intimacy, creativity, or honest endeavor will be yours for the taking through addiction. In the revalue step you devalue the false gold. You assign to it its proper worth: less than nothing. What has this addictive urge done for me? you will ask. It has caused me to spend money heedlessly or to stuff myself w...

Jesus said, “If you bring forth what is within you, what you have will save you.”

Life, until now, has created you. You’ve been acting according to ingrained mechanisms wired into your brain before you had a choice in the matter, and it’s out of those automatic mechanisms that you’ve created the life you now have. It is time to re-create: to choose a different life. You have values. You have passions. You have intention, talent, capability. In your heart there is love, and you want to connect that with the love in the world, in the universe. As you relabel, reattribute, refocus, and revalue, you are releasing patterns that have held you and that you have held on to. In place of a life blighted by your addictive need for acquisition, self-soothing, admiration, oblivion, and meaningless activity, what is the life you really want? What do you choose to create?

Consider, too, what activities you can engage in to express the universal human need to be creative. Mindfully honoring our creativity helps us transcend the feeling of deficient emptiness that drives addiction. Not to express our creative needs is itself a source of stress.

The more I listened, the louder the message became: I needed to write, to express myself through written language not only so that others might hear me but so that I could hear myself.

The point is to honor the urge. To do so is healing for ourselves and for others; not to do so deadens our bodies and our spirits. When I did not write, I suffocated in silence.

“What is in us must out,” wrote the great Canadian stress researcher Dr. Hans Selye, “otherwise we may explode at the wrong places or become hopelessly hemmed in by frustrations. The great art is to express our vitality through the particular channels and at the particular speed Nature foresaw for us.”

Write down your values and intentions and, one more time, do so with conscious awareness. Envision yourself living with integrity, creative and present, being able to look people in the eye with compassion for them—and for yourself. The road to hell is not paved with good intentions. It is paved with lack of intention. Re-create. Are you afraid you will stumble? Of course ...

Human beings have an ingrained opposition to any sense of being forced, an automatic resistance to coercion that my friend Dr. Gordon Neufeld has called counterwill. It is triggered whenever a person feels controlled or pressured to do someone else’s bidding—and we can generate counterwill even against pressure that we put on ourselves.

I’ve made so many promises in the past that it’s meaningless to make another one. So, more practically: On Monday I’ll be there at 9:30. I’ll be bringing ten signed, undated checks for $100.00 each, made out to the Portland Hotel Society. Any day I’m even one minute past 9:30, you date the check and deposit it. Should those ten run out, I’ll bring in another ten. Thanks again. I deeply regret the hassle and frustration I’ve caused you and the inconvenience to our clients. That e-mail exchange took place in late September. As of May 2007, Susan has had to cash nine of the checks. The atmosphere in the clinic has been transformed. I’ve had the pleasure of facing my clients without shame clouding my eyes and of working alongside colleagues who no longer have to compensate for my tardiness and disguise their resentment. Sweet are the rewards of sobriety. The prewritten checks are not a form of self-punishment, but a way of building a structure that helps keep me sober. They would not be necessary if I possessed sufficient self-regulation; I would just show up on time. They serve me as the sponsor serves the twelve-step novice: when in the morning an urge arises to stay writing by my computer or to keep pedaling on my exercise bike, the thought of the lost income reminds me of my responsibilities and helps to regulate my insufficiently active prefrontal impulse-control brain circuits. Creating such structures is part of establishing an external environment that supports mental ...

But anyone who has successfully achieved sobriety knows that no evanescent pleasure can be compared with the peace that comes from living in integrity. Many people think of commitment as a limitation of possibilities. Rather than a limitation, it is a source of joy. When you are true to your word, you are in charge. Governing your life are your values and your intentions, not some mechanical compulsion arising from the past. That emancipation means much more than the illusory freedom of obeying any impulse that arises in the moment.

• The most potent stressors are loss of control and uncertainty in important areas of life, whether personal or professional, economic or psychological.

In Isabella’s case, as in most, the stressors were not simply objective circumstances but a rash of attitudes and perceptions that both evoked and magnified the stresses of her situation. Consider, for example, her inhibitions in dealing with her emotions of fear and resentment toward her husband. Where she believed he was “controlling,” she had never asserted her desire for financial equality and partnership in the marriage. Where she doubted his sexual orientation, she had kept her concerns secret for fear of rocking the boat. Where she craved freedom to pursue her art, she allowed herself to be held back by her fear that he would disapprove.

As the famed stress researcher Dr. Bruce McEwen has pointed out, a key determining factor triggering the stress response is the way a person perceives a situation.3 We ourselves give events their meaning, depending on our personal histories, temperament, physical condition, and state of mind at the moment we experience them. Thus the degree to which we’re stressed may depend less on external circumstances than on how well we are able to take care of ourselves physically and emotionally. We may also take on chronic stresses because of ingrained beliefs of how we “ought” to be. Some people, for example, may find themselves unable to say no to work demands or the emotional expectations of their spouse, adult children, or family of origin. Something has to give—and what gives, if not our physical health, is our mood or peace of mind. Addiction comes along as an “antidote.”

In our culture, the suppression of emotion is a major source of stress and therefore a major source of addictions. Science tells us that not even in rodents can the link between emotions and mental organization be ignored. In her Berkeley laboratory Dr. Marian Diamond found improvements in the problem-solving abilities of rats treated with tender, loving care, and this corresponded with the growth of richer connections in their cortex. “Thus,” Dr. Diamond has written, “it is important to stimulate the portion of the brain that initiates emotional expression. Satisfying [one’s] emotional needs is essential at any age.”

Sometimes a person remains with an addicted partner for fear of the guilt they might experience otherwise. A therapist once said to me, “When it comes to a choice between feeling guilt or resentment, choose the guilt every time.” It is wisdom I have passed on to many others since. If refusal to take on responsibility for another person’s behaviors burdens you with guilt, while consenting to it leaves you eaten by resentment, opt for the guilt. Resentment is soul suicide.

What if, on the other hand, the wife said to her husband, ‘I’m feeling good today, honey. I only obsessed about your drinking once today. I’m really making progress on my addiction to self-righteousness. How are you feeling?’ Wouldn’t that be a loving way to approach each other rather than one person trying to control another’s addiction? After all, if the developmental roots of the addiction process lie in insufficient attachment, recovery includes forming attachments. As with good parenting, real attachment relationships are based on truth. The truth is, a wife who thinks she does not have plenty of her own spiritual or psychological work to do—that is, one for whom another’s behavior becomes the central determinant of her own emotional/spiritual condition—is not in touch with the truth.”

Whether I am a soothing presence or one that generates tension depends not on the situation but on my own state of mind. I am responsible.

We have seen that addicts lack differentiation—the capacity to maintain emotional separateness from others. They absorb and take personally the emotional states of other people. Their diminished capacity for self-regulation leaves them easily overwhelmed by their automatic emotional mechanisms. They are prone to experience themselves as demeaned and abandoned by authority figures and caregivers, for reasons we have explored. When a busy physician or overworked nurse is short tempered and impatient with them, they interpret it as personal rejection. They react instinctively to the least tension or condescension on the part of caregivers. At the same time, it’s only natural that health care workers are especially prone to be stressed and impatient in the harried environments of overfull emergency departments and understaffed hospital wards. Irritability begets defensive hostility, and hostility sets off more reactive anxiety and rage. Two human beings—one who is seeking help and another who is committed to helping—are soon at loggerheads, quite contrary to their own intentions. There would be much less confrontation and more effective care, I am convinced, if medical and allied staff all took some mindfulness training and if we practiced observing, with awareness and curiosity, our mind-states and our reactions to these unconventional people. We would spare ourselves a lot of tension and stress, and protect our patients from further psychological trauma, if we learned to tak...

Our material culture tries to explain even unselfishness as arising from selfish motives. It is often asserted, cynically, that people who act in kindly ways, without any benefit to themselves, are doing so only to feel good. Neuroscience does not support that view: the brain area that lights up as a person performs an altruistic act is not the circuitry activated by pleasure or by the anticipation of reward. According to a recent study, a key contributor to humane behavior is the posterior superior temporal cortex (pSTC), a region at the back of the brain whose function includes awareness of other people’s emotional states.4 It seems that we are wired to be in tune with one another’s needs, which is one of the roots of empathy. “Perhaps altruism did not grow out of a warm-glow feeling of doing good for others, but out of the simple recognition that that thing over there is a person that has intentions and goals. And therefore, I might want to treat them like I might want them to treat myself,” said one of the researchers—Scott Huettel, associate professor of psychology at Duke University Medical Center in Durham, North Carolina. The golden rule may be inscribed in our brain circuits, not as a commandment but as an essential part of who we are.

We have seen that addiction arises out of dislocation. The absence of meaning is yet another dislocation that we human beings, spiritual creatures that we are, cannot well endure. Meaning has to be defined and found in a personal way by each of us, but as one of Dr. Frankl’s Viennese colleagues, Dr. Alfried Längle, said in a recent Vancouver talk, “meaning arises only out of a dialogue with the world.” By her daily acts of kindness, Judy keeps herself in a dialogue that helps her transcend addiction.

all these things that are here … were here before you. And they’re going to be here when I’m gone. So I’m not bringing nothing new to the table. The only thing new to the table is myself. I’m actually the learner. I’m the last in line to learn—to learn to live, to coexist with everything, to adapt to a bigger thing, to the landscape of my life.”

The hero is the human being who dares descend into the darkest depths of the unconscious—to the very source of our creative power—and there confronts the monsters thrown up by the fright-stricken infant psyche. As the hero pursues the journey, the phantoms and dragons all vanish or lose power or even become allies.

I may have the equivalent of several Mount Everests left to scale, or perhaps I have only to reach out with my little finger to rend the veil of illusion between my soul and the most sacred realities. I cannot know, and it’s useless to speculate. Being on the path is what’s important, and we each need to tread a path on our own, no matter how many may have walked it before us. “Be a lamp onto yourselves,” the Buddha advised his followers, just as Jesus taught his disciples to seek the Kingdom of God within. I have found a way that feels right to me, and I look to the teaching wherever I recognize it. The world has never lacked great spiritual guides, precepts, and practices, but surely it has had a shortage of people willing to learn.

Spiritual awakening is no more and no less than a human being claiming his or her own full humanity.

We may not be responsible for the world that created our minds, but we can take responsibility for the mind with which we create our world.

The addicted mind can project only a universe of grasping and alienation. “I just knew my little world and what I wanted was what I revolved around,” the newly abstinent cocaine user Judy once said. Many of us conduct our lives just in that way. It’s for us to choose consciously what world and what future we wish to live in.

Once a student’s eyes are open, instructors appear everywhere. Everything can teach us. Our most painful emotions point to our greatest possibilities, to where our authentic nature is hidden. People whom we judge are our mirrors. People who judge us call forth our courage to respect our own truth. Compassion for ourselves supports our compassion for others. As we op...