The key ideas

In the Realm of Hungry Ghosts: Close Encounters with Addiction

Gabor Maté, 2008

A doctor who spent many years treating people with severe addiction on the poorest street in Vancouver once left a patient in labour to go to a record store. Gabor Maté tells his patients' stories and his own, and offers a contested but powerful view: addiction often grows out of pain. This book is about why the question “why the pain?” may matter more than the question “why the addiction?”

Who it is for

For anyone who wants to understand addiction in themselves or in someone close, and for everyone who wonders why people keep doing what destroys them.

The question is never why the addiction, but why the pain.

About the book

A doctor who spent many years treating people with severe addiction admits that he once left a patient in labour to go and buy a music CD. What does he have in common with the people he treats on the poorest street in Vancouver?

Gabor Maté, a Canadian physician, worked for twelve years in the Downtown Eastside, a neighbourhood where addiction, poverty and illness are packed into a few blocks. His book is made of his patients' stories, his own confession and an attempt to answer where addiction comes from.

First, a word on what this is. The book's central idea, that the root of addiction often lies in early pain and trauma, is the author's position. It is disputed, and it is not an established scientific law. Even where trauma and addiction are linked, trauma is not the only cause. The book helps you understand, but it diagnoses neither you nor the people close to you.

Idea 1. The realm of hungry ghosts

Maté took his title from the Buddhist image of the Wheel of Life. One of its realms is home to hungry ghosts: they have huge empty bellies and tiny mouths on thin necks. They are always hungry, and no food can ever fill them.

In the author's view, this is an exact picture of addiction. A person looks outside for something to ease a hunger inside: a substance, a purchase, work, other people's approval. The relief is brief, and the hunger comes back.

Maté believes that it is not only his patients who enter this realm, but many of us too. The price is just different for each person.

On a bad evening, someone opens their feed “for a minute” and looks up an hour later. They feel no better, yet their hand reaches for the phone again.

In Maté's framework, addiction can begin as an attempt to fill an inner emptiness with something from outside. That is why the object of an addiction sometimes says less about it than the hunger it feeds.

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About the author

Gabor Maté is a Canadian physician. He was born in Budapest in 1944, survived the Holocaust as a child and moved to Canada with his family in 1957. For many years he worked as a family doctor and served as medical coordinator of a palliative care unit, and then spent twelve years treating patients at the Portland Hotel in Vancouver's Downtown Eastside.

All books by this author: Gabor Maté

Terms from the book

  • Attunement
  • Hungry ghosts: An image from the Buddhist Wheel of Life: beings with huge bellies and tiny mouths who can never be satisfied. For Maté it is a metaphor for addiction, not a scientific term.
  • Addiction: In Maté's broad definition, any repeated behaviour, involving a substance or not, that a person keeps up despite the harm. This is the author's definition; medical classifications are stricter.
  • Dislocation: A concept from the psychologist Bruce Alexander that Maté uses: the breakdown of a person's ties to family, community and a settled way of life. In the author's framework, it is the soil addictions grow in.
  • Harm reduction: An approach where help aims to reduce damage to health and life, even if the person has not yet given up the substance. Doctors and politicians still argue about it.
  • Four steps: Jeffrey Schwartz's method for obsessive thoughts, which Maté adapted to addictive behaviour and extended with a fifth step. The author's advice, not a substitute for treatment.

All terms

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