Monday, April 27, 2015

Squatters on the Walk of Shame

1001 Books To Read Before Your Kindle Battery Dies, Part 48
Gabor Maté, MD, In the Realm of Hungry Ghosts: Close Encounters with Addiction

Doctor Gabor Maté left a thriving private practice to counsel addicts in one of North America’s most brutal neighborhoods, Vancouver’s Downtown Eastside. He has immersed himself in addict subculture, the battles won and the tears shed, and has come to recognize his own addictions, though not to substances. He’s made one important discovery: it’s hard to hate people you know. So he introduces readers to his hard-bitten, suffering clientele.

This book, a thick tome that rewards careful perusal, starts as a form of group autobiography. Not that he claims his patients’ stories as his own. Having worked among Vancouver’s poorest, most despised citizens for a decade, he remains an outsider, returning to his suburban home nightly. Yet he knows these survivors’ stories well enough to write of them: "The misery is extraordinary in the drug gulag, but so is the humanity."

The gulag metaphor isn’t incidental. Not only have Maté’s clients disproportionately suffered incarceration (some, he says, have spent more than half their adult lives in jail), but many face extended imprisonment within their own minds. Most come from backgrounds of abuse and neglect. Many of Maté’s First Nations patients have generational trauma and Reservation Sickness back to the first white encroachments. Drugs cannot explain their behaviors.

Where these people come from, what tragedies and Sisyphean challenges formed their outlooks, proves inextricable from their addictions. Nearly all were broken before they touched drugs: "'I'm not afraid of dying,' a client told me. 'Sometimes I'm more afraid of living.'" This gives Maté his direct line into science. Transitioning from storytelling, Maté becomes an incisive researcher, distilling massively complex science into plain English without losing power.

Dr. Gabor Maté
At some pivotal moment in childhood development, Maté writes, addicts lack the unconditional love children require. It’s actually more difficult than that, but stripped to its rudiments, all people suffering long-term intractable addiction didn’t have loving guidance, as children, to control their emotions. Children, by definition, cannot handle stress independently. Our developing brains outsource self-control to responsible adults; if such adults aren’t around, our brains adapt accordingly.

Not for nothing, Maté observes, to many addicts compare the heroin rush to receiving a warm, lingering hug. The un-nurtured infant brain never develops the ability to guide itself through stress; fundamentally, that squalling child survives, desperate and scared, within every addict’s brain. The deprived infant becomes the terrified adult. "The dominant emotions suffusing all addictive behavior,” Maté writes, “are fear and resentment—an inseparable vaudeville team of unhappiness."

Don’t start feeling self-righteous, though, because you don’t wolf narcotics. Maté describes equitable structures in behavioral addictions, like abusive overeating, philandering, and thrill-seeking. Some of Maté’s most engaging chapters describe his own struggles with workaholism and binge-buying music CDs. "What seems non-adaptive and self-harming in the present was, at some point in our lives, an adaptation to help us endure what we had to go through then."

It’s difficult to read certain chapters without powerful twinges. Many women addicts he counsels, Maté writes, obsessively collect teddy bears among their drug-fueled squalor. Others have lost their children, but cannot bear to be parted from their small furry animals. Remember, he’s describing the poorest, most despised people in Canada, and all they want, amid the burglaries and self-mutilation and prostitution that subsidizes their drug dependency, is something to love.

This makes current approaches to drug prohibition doubly costly. We pay social costs to capture, prosecute, and imprison junkies, yes, and civil libertarians have long protested this lopsidedness. But the trauma of imprisonment compounds the conditions that created addicts’ problems to begin with. Nobody taught these people how to endure being alone with themselves, so what, let’s throw them in solitary? Who does that help?

As Maté describes it, criminal justice approaches become just plain mean. But more: we deny addicts social services, meaningful jobs, and basic medical care. This makes no sense, as Maté writes: "If our guiding principle is that a person who makes his own bed ought to lie in it, we should immediately dismantle much of our health care system." Yet somehow, we accept that further dehumanizing people already stripped of common humanity will help.

Addiction isn’t a story of “those people.” It’s the story of how we construct ourselves, and help construct other people, every day. Maté essentially paraphrases Thomas Aquinas when he writes: "In the final analysis, it's not the activity or object itself that defines an addiction but our relationship to whatever is the external focus of our attention or behavior." This means us.

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