Gabor Maté’s “In The Realm of Hungry Ghosts: Close Encounters with Addiction” is a look at addiction and drug policy based on the author’s experience as a doctor working with addicts in the impoverished downtown eastside neighborhood of Vancouver, B.C. The Downtown Eastside has lately been subjected to intensified police repression as Vancouver prepares to host the 2010 Winter Olympics. In “Hungry Ghosts,” Maté compellingly tells the often desperate and heartbreaking stories of his patients, and calls for a new drug policy paradigm that is grounded in both science and compassion. He recently spoke at Seattle’s Town Hall to promote the U.S. publication of this influential Canadian bestseller.
Tim Harris: Your book describes current drug policy as driven largely by ideology and politics and disconnected from the scientific research. Where is the hope for shifting that to a more rational and results-based conversation?
Gabor Mate: Well, there are some encouraging signs in the U.S. right now. The recent lift of the ban on needle exchange, for example, and some movement toward recognizing the value of medical marijuana: These are signs that the rigidity is lifting a bit. That’s the result of the growing public awareness that what we’ve been doing for a long time doesn’t work. But there is, as you say, a fundamental disconnect. What it will take, and of course these initiatives don’t come from politicians very often, is more public awareness of what addiction and mental illness are all about in general, and how these rigid fundamentalist and ideologically driven solutions are no solution at all.
T.H.: Your book, as it says on the cover, is a “#1 National Bestseller” in Canada. What’s your sense of the impact on the policy debate?
G.M.: I can tell you that I was invited to speak to the Canadian Senate committee just a few weeks ago in Ottawa. Unfortunately, the Harper government, the current conservative government in Canada, is at the ideological level of the Bush administration in the States. Just when you guys are letting people out of jail and realizing the bankruptcy of that legal approach, in Canada they’re toughening up sentencing laws, putting up mandatory sentencing, and getting rid of all kinds of provisions, and hence they’re building more jails. That’s happening out here. No book by itself will of course override the ideological imperatives that drive those policies, but it’s certainly made a contribution to the debate. Hardly anyone involved in addiction in Canada is not familiar with the book.
T.H.: What’s the status of the InSITE safe injection center in Vancouver? Obviously, that is a critically important program not just in terms of its direct impact, but also as a harbinger of future policy and how the model might be expanded. Where your book leaves off, there was an outcry at the end of the three-year test period, and the program was provisionally allowed to continue for another year and a half. Is there an update?
G.M.: It’s worse than that. The Harper government tried to withdraw the authorization, and were stopped from doing so only because of a supreme court decision which determined it was a necessary medical service, and therefore the federal government does not have the right to withdraw permission. The federal government, in its wisdom, decided to appeal that ruling, so it’s open but in legal limbo at the moment. In the meanwhile, even though people elsewhere want to open safe injection facilities, they can’t. The government isn’t granting them permission. So at this point, it’s pretty much up in the air. It’s functioning, but threatened, and no other similar projects are allowed to go up anywhere else.
If you want to see a great documentary about it, by the way, the CBC has a wonderful documentary on it called “Staying Alive” and you can Google “staying alive,” “CBC,” and “Fix the State,” and watch the whole program online.
T.H.: I was very struck by the similarity between the debates on drugs and incarceration. We see the same dehumanization and willingness to throw people away with both issues, and the same sort of projection and fear-based politics. We’re starting to see in the U.S. that we’ve reached a tipping point to some extent, where the costs of incarceration are coming up against budget realities. California, for example, has started releasing inmates.
G.M.: It’s been one of the worst states. The prison guards’ union is bigger than the teachers’ union there. The question is, can change be driven just by the economics?
T.H.: I wish I could be more optimistic. I’m glad to see that the financial realities are driving some of these points home, but that’s not where the shift is going to happen. The shift has to happen on the level of understanding and compassion; not on the level of “We don’t have the money to jail these people.”
G.M.: The U.S., as you know, is the most jailed country in the world. You guys make up 5 percent of the world’s population and 25 percent of the world’s jail population. So the other failure of the war on drugs has been driven home all too clearly. Your former police chief, Norm Stamper, gets this, and is an advocate of legalization, and Gil Kerlikowske, the current White House drug czar and another former police chief of Seattle, is speaking at least in a much more humane way about this issue.
Basically, the people who are the most addicted are the most abused in their lives. But the change that will happen will not be because of money. All that will happen there is that they might let more people out of jail. But that doesn’t mean there’s going to be a more humane policy toward drug addicts.
T.H.: It sounds like what you’re saying is that the realities of dehumanization and fear and everything that follows from that trumps rational policy discussion, and until we deal with the psycho-social level of what’s driving drug policy, we won’t see much progress.
G.M.: That’s exactly right, and given that the States, particularly, has such an addicted culture in every way, this is really a fear of looking at one’s self. It really is a fear of getting at the very root of wholeness and happiness. It’s all based on the external and the “I’m going to be happy if I make so much money,” and this sort of thing. Until people deal with the essence of addiction in their own lives, they’re going to have a hard time looking at the addict compassionately.
It also has to happen on a level of just getting it. The research is not even controversial anymore. You treat people a certain way when they’re children, their brains are going to be affected. The evidence is overwhelming now. You can see it on brain scans. Their brains are different as adults. So both on level of insight and on the level of science the evidence is clear.
T.M.: There is a divide in terms of advocacy tactics, where we argue on the one hand around cost-benefit analyses and on the other to the deeper causes within a broken and dehumanizing system. Those who argue that the problems are systemic and so must be the solutions are sometimes dismissed as impractical and waiting for a revolution that will never come. How do you address that?
G.M.: Well, I’m quite happy to have the argument on the level of costs and benefits, as long as we’re looking at all the costs and all the benefits. I’ll point out to them that the billions of dollars you are spending on incarceration and punishment is not doing any good and that same money could be spent on rehabilitation in a humane way, which would do a lot of good based on dividends.
But, as long as the argument is ideologically driven — where the person hates the addict or thinks the addict is someone who made a choice and needs to be punished for it — there is no debating them. The people who argue that way are not coming from evidence; they’re coming from their own psychological positions. It can be debated on any level as long as there is an open argument. The problem is the people who take those positions argue them from an ideological rigidity.
T.H.: When the fundamental problem is simply one of hate. Socially embedded hate.
G.M.: Yeah, or shame.
T.H.: One of the things you talk about in your book is the redemptive power of relationships, and how anybody who is addicted has this strong need for identity and purpose if they’re going to successfully overcome that. Where are the models that are very hopeful for that?
G.M.: Well, look, a human being is both social and a distinct individual; that’s what we are. We are very powerfully connected to one another and don’t live or develop without that connection. Our brains are wired to connect, and our brains are also wired to have empathy. That’s just how we were built as human beings. Rather than being selfish and individualistic and competitive, hostile aggressive creatures — the capitalist myth — we’re actually just the opposite. We’re connected to love and to be loved; we’re wired that way.
And when that is denied us, when we are deprived of that, we suffer. From an actual scientific point of view, all addiction and all mental illness comes down to a problem in early relationships, where the attachment and relationships were impaired. That means that the healing has to happen in the context of relationships. That’s a scientific fact. We’re wired that way.
I’m sure that in your work with the homeless, and with many other people I’ve spoken to where there are successes, it’s always because someone has been able to build a context for relationship with the client. Whether it be the mentally ill, or prisoners, drug addicted people or whoever they are, it’s always based on relationship. The so called “primitive societies” have always known that. If you look at tribal traditions throughout the world, including in North America, it’s always based on relationship and community. So the models are many, and the examples are numerous. It’s not a question of how you do it. It’s a question of if you get the importance of doing it and being able to do it.
Here’s what I do think: So long as you can embody what we’re talking about here, then we can move things. I happen to be in a position where a lot of people want to hear what I have to say, but why do people want to hear this? Because it’s intuitive; they get it. They’re tired of the restrictive paradigms that have been driving our policies for so long. So it’s actually happening, it’s happening on a level of people’s perspective and consciousness. The power of the message is in relationship and love and connection, and that that’s what’s missing in our social intercourse. People are thirsty for it because that’s human reality, and I’m very optimistic about that.
T.H.: There’s this saying from Gandhi that “We need to be the change we want to see in the world.” If I were to sum up the message of your book it comes to almost that. It’s this invitation for us to look at ourselves, at how we’re not so different from those who are near universally despised. And that we have a self-interest in developing compassion based on that.
G.M.: Well, that’s totally right. It’s not even a question of developing compassion so much, because compassion is inside all of us. It’s a question of what’s blocking it. And what’s blocking are these false ideas of ourselves and others. Once you get the universality of the human condition, you know we’re all in the same boat, and once you get that, a lot of our respectable citizens are no different from a drug addict except that the drug addict is more unfortunate. They’ve suffered more and have had to endure more, so their response has been more dramatic and less functional, but fundamentally there is a universality about it all. Once we get all that, we’re actually liberated people. It means we can drop our hateful and judgmental images of ourselves.
When it comes to anything having to do with human nature and human spirit in the long term, far more is possible than in any human-created structures. Historically, no human structure, no empire, no matter how powerful or aggressive or murderous, has lasted forever. They can’t. But the teachings that inspire people — the Buddha and Jesus, and many others — they endure and people keep turning to them.
That’s why these structures eventually are doomed to fall. They’re not based on reality. They’re held together by fear and shame rather than by what is essential about people, which is connectedness and love. That’s why in the long term I’m optimistic. That doesn’t mean I’m optimistic for tomorrow or next year, but I’m certainly optimistic in the long term.
By Tim Harris
Photo: Ken Hawkins
Reprinted from Real Change Newspaper, Seattle, Wash. © Street News Service: http://www.street-papers.org.