In the Realm of Hungry Ghosts: Close Encounters with Addiction 
by 

Gabor Maté

 

Why Do We Do It ?

Addiction is a purposeful activity, not a disease or even a condition to be cured. The purpose of addiction is to compensate for trauma, often experienced in childhood, that has produced an emotional deficit and real physical and psychic pain. Addiction succeeds in compensating for this deficit and in reducing the pain involved. Addiction also has undesirable physical side effects which are amplified by social stigmas and legal prohibitions. 

This, I think , is a fair summary of Maté’s medical philosophy. I agree with it. But it is precisely that - a philosophy, that is, a way of looking at the world which verifies itself. There is no way to ‘prove’ that Maté’s philosophy is correct. One either accepts it or does not based on what one considers as ‘rational.’ Historically there have been two forms of rationality that have dominated human thought - and the social policies resulting from it: causality and teleology. 

We habitually use the rationality of cause and effect when talking about inanimate objects and human beings whom we don’t hold responsible for their actions - children, victims of natural disasters, and those with diseases. Implicitly, we presume that these people are victims of their condition. They are either guilelessly ignorant, physically or mentally unable to respond to conditions, or simply too overwhelmed to do anything about their fate. Causality is simultaneously condescending and non-judgmental: ‘How sad, too bad, never mind.’

On the other hand, teleological rationality, that is the ascription of intent, is the mode we tend to employ when we want to blame someone (or take credit for something ourselves - an interesting asymmetry). Teleology is the realm of responsibility rather than accident. Whatever state people find themselves in, they have actively participated in creating it - or so we presume. Our judgment kicks in: ‘They should have known better,’ indicating not just ignorance but error. ‘They had options but didn’t take them,’ suggesting a certain personal incompetence. ‘They are just self-indulgent,’ pointing toward a more profound moral defect. Teleology, when applied to others, is smug and uncompromising.

Neither rationality works very well when it comes to addiction. We flip back and forth between them in public debates and in personal efforts to deal with addiction - in ourselves, our families, and our friends. The fact that the two rationales give entirely opposite implications for dealing with the problem of addiction creates as much stress as the condition itself. Should we ban the stuff that people use, thus eliminating a cause? Or should we counsel people who are addicted in order to create alternative motivations strong enough to overcome physical dependency? The choice is unpleasant; so we do both. With little positive result.

Addiction, it seems, has its own rationality according to Maté. It involves unconscious psychic and obvious physical causality with equally unconscious purposeful intent. In this sense addiction may be considered a total physical commitment of body and mind. As such it is difficult to imagine any legal strictures or any therapy with a significant chance to mitigate it. The logic of commitment, as in marriage, religious vows, or even sexual identity - doesn’t allow half-measures. One is either in or out of commitment. Getting in is relatively easy, as many find in marriage; getting out is far more awkward, also as many find in marriage.

As Maté is keen to point out with many examples, the logic of addiction as destructive commitment is relational. The object of that which is in relationship with an addict can be almost anything - other people, reputation, food, power, and, of course, a range of substances which affect body chemistry, mood, and feelings of ‘wholeness.’ The important point is that it is the relationship rather than the object of the relation which is the focus of the commitment and therefore the addiction (My own dominant feeling twenty years ago when I quit smoking 2 packs of Marlboroughs daily was one of loosing my best friend).

Committed relationships are always networks. This is why they are so difficult to unravel. Addiction is in a sense a nexus of people, places, group behaviours, and symbolic objects, as well as whatever chemicals might be around. The programme in which Maté practiced in British Columbia didn’t even attempt to penetrate these networks. Its mission was to make addicts as safe as possible not cure them or ease them back into ‘normal’ society. This, I think, is an implicit recognition of both the causal complexity and the committed solidity of addiction. No therapy keyed on substance-abuse has a hope in hell of ‘fixing’ anyone.

The clear implication of Maté’s experiences is that addiction is an issue of the society in which it occurs. Addiction is neither a choice nor a disease. It is a rational adaptation to that society by members who have been traumatised by circumstances. Such traumatisation is much more widespread than among those involved in illegal drugs. Addiction to sex, consumption, popularity, religion, politics, computer games, and power are much more common, and could easily involve most of the human population of industrialised countries. None of these are less destructive than substance abuse; although each has their own form of damage.

All these addictions have the same ultimate source, and the same prognosis: None will be overcome without an almost mystical self-revelation about the commitments one has made simultaneously with the removal of causal ‘triggers.’ Maté is straightforward about the solution, which is just as mystical as the condition: “Addictions arise from thwarted love, from our thwarted ability to love children the way they need to be loved, from our thwarted ability to love ourselves and one another in the ways we all need.” 

I’m not sure if this leads to hope or to despair. But it is at least worth considering.