In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

As to morality, duty, and responsibility, if they have abandoned their children, I have also abandoned mine—by not being present for them and by placing a higher value on my perceived needs than on their real ones. If my patients have lied and manipulated, so have I. If they have obsessed about their next hit, so have I. If they persist long after the negative consequences strike them, so have I. If they repeatedly make promises and resolutions only to relapse, it’s nothing I haven’t done.

There is no such thing as a good addiction.

No human being is empty or deficient at the core, but many live as if they were and experience themselves primarily that way. Attempting to obliterate the sense of deficiency and emptiness that is a core state of any addict is like laboring to fill in a canyon with shovelfuls of dust.

People are susceptible to the addiction process if they have a constant need to fill their minds or bodies with external sources of comfort, whether physical or emotional. That need expresses a failure of self-regulation—an inability to maintain a reasonably stable internal emotional atmosphere.

characterizing the addiction-prone personality is the absence of differentiation.3 Differentiation is defined as “the ability to be in emotional contact with others yet still autonomous in one’s emotional functioning.” It’s the capacity to hold on to ourselves while interacting with others. The poorly differentiated person is easily overwhelmed by his emotions; he “absorbs anxiety from others and generates considerable anxiety within himself.”

The better differentiated she becomes, the more she is able to mix with others without losing her sense of self. The individuated, well-differentiated person can respond from an open acceptance of his own emotions, which are not tailored either to match someone else’s expectations or to resist them. He neither suppresses his emotions nor acts them out impulsively.

functional differentiation and basic differentiation, which, from the perspective of health and stress, are worlds apart. Functional differentiation refers to a person’s ability to function based on external factors. The less basic differentiation a person has attained, the more prone he is to rely on relationships to maintain his emotional balance. When relationships fail to sustain such people, they may turn to addiction as the emotional crutch.

These, then, are the traits that most often underlie the addiction process: poor self-regulation, lack of basic differentiation, lack of a healthy sense of self, a sense of deficient emptiness, and impaired impulse control.

When, owing to internal demons arising from their own childhoods or to external stressors in their lives, parents are unable to regulate—that is, keep within a tolerable range—the emotional milieu of the infant, the child’s brain has to adapt: by tuning out, by emotional shutting down, and by learning to find ways to self-soothe through rocking, thumb-sucking, eating, sleeping, or constantly looking to external sources of comfort. This is the ever-agitated, ever-yawning emptiness that lies at the heart of addiction.

I’ve had a lifelong resistance to receiving love—not to being loved or even to knowing intellectually that I am loved, but to accepting love vulnerably and openly on a visceral, emotional level. People who cannot find or receive love need to find substitutes—and that’s where addictions come in.

The sources of my work addiction are clear to me. No matter how much she loves him in her heart—and my mother loved me with all of hers—a child with a depressed mother feels constant deprivation and deep distress.

I learned that preaching at people about behaviors, even self-destructive ones, did little good when I didn’t or couldn’t help them with the emotional dynamics driving those behaviors.

As with all addictions, sex addiction is a stand-in for nurturing the person was deprived of. The dopamine and endorphin rewards that love is meant to provide are obtained by having sex—but, as with all addictions, only temporarily. The craving for contact is, perversely, accompanied by a terror of real intimacy because of the painful instability of early relationships.

Before we do, however, a few words on the touchy subject of “blaming the parent,” a charge easily leveled at anyone who points to the crucial importance of the early rearing environment. The vigilance around parent blaming arises from people’s natural defensiveness about anything that leaves them feeling accused of not loving their children or not doing their best.

As I’ve remarked before, even for my addicted patients, their greatest shame and regret is their failure to parent their own children, a sorrow that rarely fails to bring tears to their eyes. The point is that, as in the parenting my children received, our best is circumscribed by our own issues and limitations. In most cases, those issues and limitations originated in our childhoods—and so on down the generations. That parenting styles are passed on from one generation to the next is known both from human studies and animal experiments. In the latter, it has been shown that parental nurturing practices can be biologically inherited, not through genes but through molecular mechanisms.

D. W. Winnicott. Stressed parents have difficulty offering their children a specific quality required for the development of the brain’s self-regulation circuits: the quality of attunement. Attunement is, literally, being “in tune” with someone else’s emotional states. It’s not a question of parental love but of the parent’s ability to be present emotionally in such a way that the infant or child feels understood, accepted, and mirrored. Attunement is the real language of love, the conduit by which a preverbal child can realize that she is loved.

Children in poorly attuned relationships may feel loved, or be aware that love is there, but on a deeper and essential level they do not experience themselves as seen or appreciated for who they really are.

Self-regulation does not refer to “good behavior” but to the capacity of an individual to maintain a reasonably even internal emotional environment. A person with good self-regulation will not experience rapidly shifting extremes of emotional highs and lows in the face of life’s challenges, difficulties, disappointments, and satisfactions. She does not depend on other people’s responses or external activities or substances in order to feel okay. The person with poor self-regulation is more likely to look outside herself for emotional soothing, which is why the lack of attunement in infancy increases addiction risk. It’s what Stephen Reid meant when he said, “I’ve spent too much time on external things, bouncing off other people.”

The lack of an emotionally attuned and consistently available parenting figure is a major source of stress for the child. Such a lack can occur when the parent is physically present but emotionally distracted—a situation that has been called proximate separation. Proximate separation happens when attuned contact between parent and child is interrupted due to stresses that draw the parent away from the interaction. The levels of physiological stress experienced by the child during proximate separation approach the levels experienced during physical separation.7 The development of the brain’s neurotransmitter and self-regulating systems and, in particular, the stress-control circuits is then disrupted, and once entrenched, these physiological dysfunctions increase the risk for addictions.

The void is not in the parent’s love or commitment, but in the child’s perception of being seen, understood, empathized with, and “gotten” on the emotional level.

While it’s true that overt episodes of hostility between the parents may damage the child, so may repressed anger and unhappiness. As a rule, whatever we don’t deal with in our lives, we pass on to our children. Our unfinished emotional business becomes theirs.

The addict is never satisfied. His spiritual and emotional condition is one of impoverishment, no matter how much he achieves, acquires, or possesses. In the hungry-ghost mode, we can never be satiated. Scruples vanish in the face of the addictive “need”—hence the ruthlessness. Loyalty, integrity, and honor lose meaning.

Addicts respond with rage toward anyone who tries to deprive them of their drug, and that rage is fueled by intense frustration.

It’s what psychologist Gordon Neufeld calls conditional or contingent self-esteem: it depends on circumstances. The greater the void within, the more urgent the drive to be noticed and to be “important,” and the more compulsive the need for status. By contrast, genuine self-esteem needs nothing from the outside. It doesn’t say, “I’m worthwhile because I’ve done this, that, or the other.” It says, “I’m worthwhile whether or not I’ve done this, that, or the other. I don’t need to be right or to wield power, to amass wealth or achievements.”

Addiction is always a poor substitute for love.

How can we compare the misdemeanors of my patients—petty dealers thrown against the wall and frisked by police in the back alleys of the Downtown Eastside—with those of their respectable counterparts in corporate boardrooms? In May 2007, Purdue Pharma, a giant drug manufacturer, pleaded guilty to criminal charges that the firm had “misled doctors and patients” in claiming that their product, OxyContin, was less addictive than other opiate medications.

The constant, intrusive, and meaningless mind-whirl that characterizes the way so many of us experience our silent moments is, itself, a form of addiction—and it serves the same purpose. “One of the main tasks of the mind is to fight or remove the emotional pain, which is one of the reasons for its incessant activity, but all it can ever achieve is to cover it up temporarily. In fact, the harder the mind struggles to get rid of the pain, the greater the pain.”14 So writes Eckhart Tolle. Even our 24/7 self-exposure to noise, e-mails, cell phones, TV, Internet chats, media outlets, music downloads, videogames, and nonstop internal and external chatter cannot succeed in drowning out the fearful voices within.

The precursor to addiction is dislocation, according to Bruce Alexander, professor emeritus of psychology at Simon Fraser University. By dislocation he means the loss of psychological, social, and economic integration into family and culture—a sense of exclusion, isolation, and powerlessness. “Only chronically and severely dislocated people are vulnerable to addiction,”

The question is not why the War on Drugs is being lost, but why it continues to be waged in the face of all the evidence against it. Many factors are in play, some psychological, some broadly political, others economic, and yet others driven by the natural if unfortunate moralizing tendencies we human beings share.

Once more, freedom is relative. I believe I have much more freedom than do the hard-core drug users. Both the obsessive-compulsive and the addict experience overwhelming tension until they succumb to their compulsive drive. When they finally do, they gain an immense, if momentary, sense of relief. Given this absence of psychic freedom, the addict might as well be an obsessive-compulsive—with one essential difference. Unlike the addict, the person with OCD does not anticipate his compulsive activity with any pleasure. Far from craving it as the addict does, she regards it as unpleasant and distressing.

One person’s pain cannot be compared with anyone else’s; nor can we compare any two people’s capacity to endure suffering. In addition to the visible factors, there are also many subtle, invisible ones that may positively influence our psychic strength and our capacity for choice: a kind word spoken long ago, a fortuitous circumstance, a new relationship, a flash of insight, a memory of love, a sudden opening to faith.

How much actual freedom to choose does any one human being possess? There’s only one answer: We cannot know. We may have our particular beliefs, spiritual or otherwise, about this aspect of human nature—about how it is or how it should be. These beliefs may strengthen our commitment to helping others find freedom, or they may become harmful dogma. Either way, in the end we all have to humble ourselves and admit to a degree of uncertainty. There is no way we can peer into a brain to measure a person’s capacity for awareness and rational choice or to estimate how the relative balance of these brain-mind systems will operate when that person is stressed. There is no gauging the burden of emotional suffering weighing down one person’s psyche against another’s, and there is no way to know what hidden life-enhancing experiences one person may have enjoyed that another has been denied.

If we cherish the human potential for transformation, the real issue becomes how to encourage and support the addict’s motivation and capacity to choose freedom despite damaging beginnings and a lifelong history of painful events—how, in other words, to promote healthy brain development later in life when the conditions for it have been lacking from earliest childhood onward.

Many people have watched themselves helplessly as they began to do something they knew would be unhelpful or self-defeating. That’s the experience of brain lock: the clutch is stuck, so nothing can be done to stop the motor of “doing” from engaging.

Preattentive analysis is the unconscious evaluation of what goals the brain circuits judge to be essential or irrelevant, valuable or worthless, desirable or unwanted. The cortex is primed to select actions that will achieve the goals set by this preattentive process.

The system we have doesn’t work—not for the addict and not for society. This system cannot be improved; it needs to be transformed.

The findings of stress research suggest that the issue is not control over others, but whether one is free to exercise control in one’s own life.

It’s important to note that decriminalization does not mean legalization. Legalization would make manufacturing and selling drugs legal, acceptable commercial activities. Decriminalization refers only to removing from the penal code the possession of drugs for personal use. It would create the possibility of medically supervised dispensing when necessary. The fear that easier access to drugs would fuel addiction is unfounded: drugs, we have seen, are not the cause of addiction. Despite the fact that cannabis is openly available in the Netherlands, for instance, Dutch per-capita use of marijuana is half that in the United States. And no one is advocating the open availability of hard drugs.

Harm reduction is as much an attitude and way of being as it is a set of policies and methods. Dr. Bruce Perry’s words are worth recalling here: “We need to be very loving, very accepting, and very patient with people who have these problems. And if we are, they will have a much higher probability of getting better.”

Triumph and defeat: these are still metaphors of war. If, as the research shows, addictions arise near our emotional core, to defeat them we would have to wage a war against ourselves. And a war against parts of the self—even against nonadaptive, dysfunctional parts, can lead only to inner discord and more distress.

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.

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?

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.

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.

“We admitted we were powerless over alcohol; that our lives had become unmanageable” is the classic AA formulation. Mindful of the fundamental similarity of all addictions, one can broaden that to say, “I admit I am powerless over my addiction process.” That is, “I fully acknowledge that my cravings and behaviors have been out of control and that my inability to regulate them has led to dysfunction and chaos in important areas of my life. I no longer deny their impact on myself or my coworkers or my loved ones, and I admit my failure to confront them honestly and consistently.” (A friend of mine, Anne, who is a longtime member of AA, cautions against my reformulation of the “we admitted” to “I admit.” “The first word is plural for a reason,” she says. “If I’m an addict and if I’m left alone to my own resources, then I’m pretty much lost.”)

I have been reluctant to take this step until recently, despite the fact that I’ve not had a problem admitting and describing my addictive tendencies either in private or in public. The difficulty has been threefold. First, since I pride myself on a strong intellect, I’ve resisted accepting that I’m powerless over any mental process. On the contrary, it is in the nature of the ego to turn anything to its advantage. Even the public disclosure of my addictive patterns has served to reassure me of my sincerity and honesty and “courage.” Audiences greet such self-disclosure with nods, appreciative smiles, and applause. But real courage does not lie in speaking about addiction; it resides in actively doing something about it—and that, until very recently, I have not been prepared to take on.

Second, in focusing on the most visible compulsive behaviors, such as CD shopping, book bingeing, or workaholism, I could still permit myself to ignore how addictive patterns have permeated much of my functioning. Narrowing it down to a few “problematic” issues has allowed me to deny that the addiction process shows up in numerous aspects of my daily existence. There are many things I do well and many tasks I accomplish, I could assure myself, so there is no cause for me to admit a loss of control. In other words, I have not wanted to accept that, at ...

Finally, whenever I have felt wooden or alienated in the intimate areas of life, I’ve seen myself as deprived, rather than owning the reality that I c...

In an ecological framework recovery from addiction does not mean a “cure” for a disease but the creation of new resources, internal and external, that can support different, healthy ways of satisfying one’s genuine needs. It also involves developing new brain circuits that can facilitate more adaptive responses and behaviors.