BY CHARLES M. YOUNG

In Buddhist mythology, the hungry ghosts are exactly what they sound like: wraiths who haunt the Hell Realm, unable to escape because they can’t let go of their cravings. In physical reality, the obvious hungry ghosts – addicts – have their own Hell Realm of scapegoating in the press and relentless persecution from law enforcement.

Staff physician at the Portland Hotel, a residence for the street people of downtown Vancouver, Dr. Gabor Maté has a practice consisting mostly of hungry ghosts who suffer in varying degrees from addiction, mental illness and AIDS. Once a high school English teacher, Maté has become their witness, too. He has written a bestseller in Canada, “In the Realm of Hungry Ghosts” (North Atlantic Books, 2010), that chronicles their traumatic lives with a mindful compassion that is normally reserved in our culture only for celebrities. The book is now making a mark in the U.S. as well, thanks to some compelling interviews on Democracy Now! and several lectures posted on YouTube.

Maté has also written the definitive book on ADD, “Scattered: How Attention Deficit Disorder Originates and What You Can Do About It” (Plume, 2000). Back in the mid-‘90s when attention deficit disorder (ADD) went from unknown to (in the eyes of some) a fad diagnosis, most books on the subject attributed the condition to genetics. In 2000, Maté made the case that ADD was more about early childhood development, that the brain does most of its wiring after birth and this wiring is determined by the child’s emotional environment.

Born in Budapest on January 6, 1944, a couple months before the Nazis rolled into town and started hauling off Jews to the death camps, Maté absorbed plenty of stress from his family in his early years even if he was too young to understand where it was coming from. Decades later in his 50s in Canada, he realized that he was wrecking his life and his family with chaotic workaholism and an odd addiction (buying enormous numbers of classical music CDs). In the course of his professional reading, he figured out that he himself fit the diagnosis for ADD. Continuing his reading in the latest brain science and in his mother’s diary of the war years, he added 2+2 and the answer came out ADD and addiction.

Charles M. Young: What is addiction, what is attention deficit disorder, and why are they related?
Gabor Maté: Addiction is fundamentally a response to severe emotional stress, which is often from the impact of stored childhood trauma. Whether the addiction is to alcohol or heroin or sex or gambling, it is an attempt to change one’s mind state from negative to positive in the short term. People who do that don’t have the capacity to regulate their emotions with healthier methods.

ADD entails a terrific fear of the present moment. The tuning out in ADD is nothing but the brain’s defense against distress, which again goes back to childhood experience. The more severe your childhood trauma, the more severe your addiction. And it’s the same with ADD. We know that environment determines how the child’s brain gets wired, and that stress and trauma cause problems. Addictions and ADD both develop in malfunctioning dopamine circuits, which disrupt normal patterns of incentive, reward and motivation.

The treatment for ADD is stimulant medication such as Ritalin and Dexedrine, which soothe the brain by elevating dopamine levels. All the addictive drugs also elevate dopamine levels. In a significant minority of cases, addiction actually represents an attempt to self-medicate ADD by increasing dopamine. So both conditions are rooted in childhood distress, both involve the dopamine circuits, and both are attempts to escape anxiety.

CY: So we’re talking brain science and not unproven neo-Freudian speculation about the unconscious?
GM: Well, let’s be kind to Freud. Some of his theories now seem arbitrary and retrograde, but his basic understanding that human beings are largely governed by unconscious forces is absolutely correct. What we now know from brain science is which circuits govern which behavior. You can’t separate psychology from the brain.

CY: Alice Miller is hard on Freud because he backed away from his insight that child abuse was a widespread problem. He decided his patients had to be making it up.
GM: Yes, he was scared off. We live in a society of denial. The broad social assumption that addiction is a choice, that people decide to be addicted, is contrary to human experience and scientific fact. So our laws and attitudes are all based on denial. And the more you deny the more likely you are to be a rightwing radio commentator. If you look at them, you can tell by their body language they were all traumatized as children and are now in denial of their own pain. They’re very hard on addicts, because addicts act out the pain that the world has inflicted on them. The political right can’t stand being reminded of its own vulnerability.

CY: One of the least appealing aspects of human beings is that we pick on people we can get away with picking on. We don’t pick on our actual oppressors.
GM: Yes, bullying was going to be the topic of my next book, but I’ve been so busy with the four books I’ve already published that I had to hold off on it. Bullies are people who have been hurt in their own vulnerability, so they attack the most vulnerable among us, who are addicts, people of color, other minorities, and so on. Often the addict is already part of a minority group, because addiction is a response not just to individual trauma but also to group trauma, to social dislocation and the great crimes in history. That’s who the bully wants to attack – at the individual level and through the war on drugs.

I was speaking to the head of the narcotics squad in a big city police department a few months ago, and he told me that the world wide market for illegal drugs is almost $400 billion a year, and maybe 5% of that is affected by law enforcement. So if I had a $400 billion business, wouldn’t I accept a marginal loss like that as normal overhead? You have to conclude that the war on drugs is such a dismal failure that it must serve some other purpose, like providing bigger budgets for law enforcement and permanent targets for the bullies.

CY: You favor the decriminalization of everything?
GM: Personal use of any drug ought not to be a crime. That’s been the policy in Portugal for the past 10 years and they’ve had good results. I’m not saying drugs should be sold at the corner grocery, either. It just shouldn’t be a criminal matter.

CY: Would you put the major addictive drugs under prescription?
GM: I would provide heroin to addicts under supervised conditions. Wherever that’s been done, it’s been a success. But you don’t stop there. You begin there. Particularly with heroin, you show people that the addict is more functional, there’s less crime, there’s more employment, better relationships, less disease. And it’s the end of the drug trade, because drugs are only profitable because of the illegality.

CY: The first hundred pages of “Hungry Ghosts” are all profiles of the street addicts you have as patients in Vancouver. I don’t remember reading anything quite like it; these closely drawn portraits of people couldn’t be less like celebrities.
GM: We have a tendency to define people by their most observable behavior but not to get inside and see what’s been going on for them. So that first section of the book is to get inside these people and see what’s happening internally. They all suffered terrible trauma as children, but that doesn’t mean they’re always sympathetic. I can get quite angry with them, about lying and petty theft. My reactions are about me, though, not about them. People say that I’ve humanized the addict, which is an interesting way of putting it. How can you humanize something that is already human? Perhaps I succeeded in detecting the humanity in these people, which is, unfortunately, unusual. I humanized the demonized.

CY: In the culture of AA, there is a school of thought that you shouldn’t take antidepressants and/or stimulants for ADD, because that means you aren’t sober. Do you think that pharmaceuticals are cheating?
GM: That’s unfortunate. I think the 12-step process is essential for the healing process, but at the same time AA can be dogmatic and theological on some issues, which maybe has something to do with AA’s roots in almost fundamentalist Christianity. It’s quite true that an alcoholic can’t consume just a little bit of alcohol, so you need the abstention model for the 12 steps and alcoholism. But because of rigidity when it comes to other substances they miss the boat. Alcohol is often self-medication for anxiety and depression, which are genuine medical conditions that have to be addressed. If you help someone with their depression, you are helping them with their alcoholism. Similarly with heroin addiction, if you put somebody on methadone, it’s true that they’re still addicted, but they’re functioning. They can hold a job, keep their family together, which they couldn’t do on heroin. So I wish there was more flexibility in 12-step programs. I don’t think they’ve looked at the issue compassionately enough.

The other critique I would offer is that the AA disease model doesn’t take into account where the disease comes from, so they don’t talk much about the childhood stresses and traumas that actually potentiate addiction. People need a chance to heal from that in any 12-step program.

CY: Dr. Lance Dodes has argued in “The Heart of Addiction” that addiction is displacement, a compulsive action to assuage a feeling of powerlessness or shame that substitutes for addressing the underlying cause. As a compulsion, it’s basically the same thing as obsessive-compulsive disorder.
GM: Yes, Dodes is one of the guys who gets it. I quote him in my book. It’s astonishing how much addiction literature there is, and how few people understand what addiction is. Regarding obsessive-compulsive disorder (OCD), the first thing you have to do is get rid of the idea that these are all discreet diseases. Mental health is a continuum, starting with people who are functioning normally and extending to people who are trapped in repetitive patterns, like the addict or person with OCD, who have a lot in common. Both of them are engaged in a compulsive behavior with negative consequences that they can’t give up. And it’s the same brain circuits. The difference is that the person with OCD does not crave washing his hands. He hates it. He finds no pleasure in it. If I repeat an addictive behavior, I get pleasure from it in the short term. So there is a huge difference that way. But the compulsion and the repetition are very much the same. Therefore it makes sense that some of the approaches with ADD and OCD would work with addiction. In “Hungry Ghosts” I adapt for addiction the OCD treatment of Jeffrey Schwartz (“Brain Lock”; “The Mind and the Brain”) at UCLA.

CY: Are eating disorders any different?
GM: The obesity epidemic in North America is a massive public health issue, but it’s got nothing to do with high fructose corn syrup and fast foods and immobility. Well, they pertain to it. But what it has to do with is people’s alienation from themselves, their emotional distress and their need to self-soothe with food. And all of that goes back to early childhood experience. That’s not my theory, individually. Large-scale studies have shown that more stress in childhood is associated with greater risk of obesity later in life.

CY: What if someone wasn’t beaten or molested as a child? If he gets an addiction, is it just spontaneous?
GM: The great British psychiatrist D. W. Winnicott said that two things can go wrong in childhood: that which shouldn’t happen but does happen, and that which should happen but doesn’t happen. It’s much easier to study people who remember specific trauma that shouldn’t have happened, but what did not happen that should have is equally important. What did not happen but should have for many addicts is the non-stressed, emotionally available, nurturing, consistently present, parenting adult in their childhood. When people think of trauma, it’s usually some specific bad event, not the absence of a parent who was attuned to your needs. Attunement is what allows the child’s brain circuits to develop without chronic anxiety and fear.

CY: When I read the news, it seems like we have a culture hell-bent on inflicting more stress on families, which will create even more addiction and other mental health problems in the next generation. Do you think America’s political class is a bunch of power junkies?
GM: It is a matter of addiction. Politicians are addicted to power. Wall Street is addicted to profit. To feed those addictions, they don’t care who suffers. If you look at the family histories of recent American presidents, Clinton was an abused child. Bush was traumatized in his family. You didn’t even need to read his biography. There was trauma all through his body language. And Obama is a mask. You have no idea what’s behind it. Why does someone want to develop a mask? Because they’re hiding from something. Reagan’s father was alcoholic, and Reagan was in lifelong denial. He made a career of denial. It is often the most extraordinarily dysfunctional people who reach positions of power.

CY: The other day I was standing on the subway platform, and I saw a young woman with a four-month old baby strapped to her chest. They were gazing into each other’s eyes and had these rapturous expressions. It was so beautiful I almost cried.
GM: Yes, attunement. When I talk about something that should happen for the child but doesn’t, it’s usually attunement that is missing. That’s when two people are sharing an emotional space and fully communicating. The loss of it is hurtful because we all need it to become fully ourselves. And when it is absent, we are not fully ourselves. We have addictions. So, yeah, there’s nothing more beautiful and moving than attunement. Whenever I see it, I think, “What a lucky baby!”

Charles M. Young is a journalist who has written for Rolling Stone, Men’s Journal and Musician magazine.