Dr. Gabor Mate (pronounced “Ma-tay”) is a Vancouver based physician, author and speaker. His newest book In the Realm of Hungry Ghosts looks at the roots and ramifications of addiction (and not just to illicit substances). He approaches the subject from multiple angles, showing that addiction originates and plays out in personal feelings and experiences, body chemistry, societal structure and cultural attitudes. And what do you know, these angles quite neatly correspond with the four quadrants Ken Wilber’s mapped out as a major tenet of Integral Philosophy. Specifically:

Individual Subjective (feelings, thoughts, memories - the non-physical interior of the individual) - Mate works as a physician in Vancouver’s Downtown Eastside, Canada’s poorest and most drug addled neighbourhood. He presents first person accounts of his patients’ life stories and looks at the emotional roots of addiction. 

Far more than a quest for pleasure, chronic substance use is the addict’s attempt to escape distress. - pg 33

Addictions always originate in pain, whether felt openly or hidden in the unconscious. They are emotional anaesthetics. Heroin and cocaine, both powerful painkillers, also ease psychological discomfort.  - pg 34

Mate’s observations (always backed up by cited research) are a strong retort to the commonly held notion that addicts indulge out of wanton irresponsibility and hedonism. Seeing through the eyes of society’s outcasts becomes an exercise in understanding and compassion.

The question is never ‘Why the addiction?’ but ‘Why the pain?’. The research literature is unequivocal: most hard-core substance abusers come from abusive homes. The majority of my Skid Row patients suffered severe neglect and maltreatment early in life. Almost all the addicted women inhabiting the Downtown Eastside were sexually assaulted in childhood, as were many of the men. The autobiographical accounts and case files of Portland (Hotel) residents tell stories of pain upon pain: rape, beatings, humiliation, rejection, abandonment, relentless character assassination. - pg 34

Individual Objective (biology, chemistry, the atoms, molecules, cells, fluids and whatnot that you can measure, touch, extract, dissect, amputate, transplant, etc.) - Mate describes the biology that contributes to addiction and supports it, and how addiction continues to reshape the addict’s brain.

...the orbitofrontal cortex, a central part of the brain system that regulates how we process our emotions and how we react to them, participates in substance dependence in a number of ways. First, it emotionally overvalues the drug, making it the chief concern of the addict - and often the only concern. It undervalues other objectives, such as food or health or relationships. By becoming triggered even at the thought of the drug (or activity) of choice, it contributes to craving. And finally, it fails at its task of impulse inhibition. It aids and abets the enemy. - pg 174

Mate’s writings on this subject show the fallacy in the comparison any non-addicted person might make between themselves and an addict: “I can just say no, so why can’t they?”. Chemistry plays a part. Environment and behaviour affect brain chemistry throughout a person’s life.

The next three quotes show the relationship between the first and second quadrants, namely, how emotional experience (individual subjective) affects the physical body (individual objective).

Brain development in the uterus and during childhood is the single most important biological factor in determining whether or not a person will be predisposed to substance dependence and to addictive behaviours of any sort, whether drug-related or not. - pg 180

Happy, attuned emotional interactions with parents stimulate a release of natural opioids in an infant’s brain. This endorphin surge promotes the attachment relationship and the further development of the child’s opioid and dopamine circuitry. On the other hand, stress reduces the numbers of both opiate and dopamine receptors. - pg 188 – 189 

Freedom of choice, understood from the perspective of brain development, is not a universal or fixed attribute but a statistical probability. - pg 290 

Collective Objective (laws, institutions, systems of organization - the various elements of society we can quantify) - Mate looks at the social systems that give rise to addictions and make the problem worse.

The precursor to addiction is dislocation... the loss of psychological, social and  economic integration into family and culture; a sense of exclusion, isolation and powerlessness. - pg 261

With the rise of industrial societies came dislocation: the destruction of traditional relationships, extended family, clan, tribe and village. Vast economic and social changes tore asunder the ties that formerly connected people to those closest to them and to their communities. They displaced people from their homes and shredded the value systems that secured people’s sense of belonging in the moral and spiritual universe. - pg 261

In both of the preceding quotes we’ve got one quadrant affecting another. Modern society’s move towards progress and wealth has often resulted in groups of people splitting apart and staying apart (collective objective). And there have been emotional repercussions from this (individual subjetive). How does a person assuage feelings of loss and isolation brought on by the abrupt removal of their support network? In many cases, addiction.

The same process is happening around the world as a result of globalization. China is a prime example... The pressures of urbanization are cutting millions of people adrift from their connections with land, tradition and community. The social and psychological results of massive dislocation are not only predicable, they’re already obvious. China has had to set up a massive needle exchange program in an attempt to prevent the spread of HIV and other infectious diseases among its rapidly burgeoning addict population. According to the Ministry of Health in Beijing, nearly half of China’s estimated 650 000 people living with HIV/AIDS are drug users who contracted the disease by sharing needles. - pg 261 – 262

This next quote shows the error in a single perspective point of view: if you look at widespread drug addiction only from the collective objective, you get one social system (law enforcement) attacking another (the vast network of drug distribution), as if that encompasses the entire problem.

The War on Drugs fails, and is doomed to perpetual failure, because it is directed not against the root causes of drug addiction and of the international black market in drugs, but only against some drug producers, traffickers and users. - pg 283 

Collective Subjective (the feelings, opinions and attitudes of a population, everything usually summed up in the word "culture") - Mate details the ways our shared beliefs contribute to the problem. Which addictions are good? Which are bad?

Addiction cuts large swaths across our culture. Many of us are burdened with compulsive behaviours that harm us and others, behaviours whose toxicity we fail to acknowledge or feel powerless to stop. Many people are addicted to accumulating wealth; for others the compulsive pull is power. Men and women become addicted to consumerism, status, shopping or fetishized relationships, not to mention the obvious and widespread addictions such a gambling, sex, junk food and the cult of the “young” body image. - pg 254 

How is our culture afraid of facing its shadow?

One of the greatest difficulties we human beings seem to have is to relinquish long-held ideas. Many of us are addicted to being right, even if facts do not support us. One fixed image we cling to, as iconic in today’s culture as the devil was in previous ages, is that of the addict as an unsavoury and shadowy character, given to criminal activity. What we don’t see is how we’ve contributed to making him a criminal. - pg 305

Which elements that our culture lacks create the void that addiction rushes in to fill?

It is not a coincidence that addictions arise mostly in cultures that subjugate communal goals, time-honoured tradition and individual creativity to mass production and the accumulation of wealth. - pg 391

As grounded as Mate is in scientific and sociological research, he doesn’t hesitate to bring spirituality into the discussion.

The object, form and severity of addictions are shaped by many influences - social, political and economic status, personal and family history, physiological and genetic predispositions - but at the core of all addictions there lies a spiritual void. - pg 79 

Spiritual awakening is no more and no less than a human being claiming his or her own full humanity. People who find themselves have no need to turn to addiction, or to stay with it. Armed with compassion, we recognize that addiction was the answer - the best answer we could find at one time in our lives - to the problem of isolation from our true selves and from the rest of creation. It’s also what keeps us gloomy, sad and angry. - pg 396 

Mate’s books are best-sellers in Canada, though not everyone agrees with his conclusions (I have yet to read or hear of a refutation of his work that provides contrary evidence). He regularly speaks to sold out houses across the country. I’m glad he’s doing what he does. He gives us an example of the depth and complexity that come across when all four quadrants are included the discussion (he’s yet to refer to the four quadrants, or any work of Integral Philosophy in any of his books, by the way - this is just me sorting some of his ideas into this framework). I hope In the Realm of Hungry Ghosts makes an impact in the US, where it was released this past January. I hope we get to the point where people read his books and marvel that his ideas were ever thought controversial and revolutionary.

All citations from Mate, Gabor. In the Realm of Hungry Ghosts. Toronto: Vintage Canada, 2008