In the Realm of Hungry Ghosts

Part 4 examines the roles that brain development, biological changes arising from stress and abuse, and genetics play in addiction. Mate’s stance is straightforward in these chapters: He states unequivocally that environmental factors—causing inordinate stress, such as a lack of parental nurturing, or the presence of abuse—beyond a child’s control will all but guarantee struggles with addiction later. Thematically, these chapters are an extension of his question about whether Claire is copping out by blaming her addiction for her unacceptable behavior. What if the brain of an addict truly does not get to make a choice?

Criticism of Maté’s approach to addiction often focuses on his insistence that childhood stress—and brain development in childhood, or even in the womb—leads to increased susceptibility to addiction. Opponents of the view that childhood stressors as influencers on later addictions view Maté’s claims as myopic to the point of being dangerous. There is persuasive evidence showing that most victims of abuse, for instance, do not become drug addicts.

Maté writes that, “The three environmental conditions absolutely essential to human brain development are nutrition, physical security, and consistent emotional nurturing” (193). Few addiction specialists are inclined to disagree with him. However, his critics argue that, while a lack of these three environmental conditions may very well lead to childhood stresses, it is reductive to claim that their lack is the root cause of addiction later in life. Rather, focusing on one, inarguable, absolute cause for addiction—in the most heinous cases, child abuse—can actually limit the understanding of addiction. If physicians are predisposed to look to childhood trauma or neglect as the primary sources of addiction, they may overlook or ignore other possible causes, limiting their avenues for treatment. In Chapter 18, Maté begins a sentence with: “Hard-core drug addicts, whose lives invariably began under conditions of severe stress […]” (207). But, not all specialists agree this is invariable or inevitable.

Maté quotes a great deal of scientific literature throughout Part 4, but the conclusions he draws from the studies do not have consensus in the scientific world.

In Chapter 18 he writes that “stress has everything to do with addiction” (205). He considers even mild disruptions in the childhood experience as cues that the child will suffer from behavioral addiction as an adult. The U.S. National Institute of Health defined stress, in 1992, as “a state of disharmony or threatened homeostasis” (205). Maté goes on to explain that all stressors have something in common: the loss of something required for survival, or the threat of its loss. Again, while few specialists would disagree, Maté’s challengers can also argue the question: If stress changes the biochemistry of the brain, and those brain changes invariably lead to addiction or obsessive behavioral anomalies, it would be reasonable to assume that people without addictions or compulsions actually managed to avoid childhood stress in its entirety, despite the improbability of such a claim.

In Chapter 19, Maté attempts to dispel the notions that genes are responsible for addiction. He quotes addiction specialist Lance Dodes, who says, “The most important finding of research into a genetic role for alcoholism is that there is no such thing as a gene for alcoholism. Nor can you directly inherit alcoholism” (212). However, Maté says that the current medical consensus is that marijuana use can be up to 80 percent heritable, and that alcoholism is about 50 percent heritable (213). He believes that these mistaken numbers indicate an exaggerated belief in the power that genes play in determining someone’s choices and proclivities.

Maté writes that “genes are controlled by their environment, and without environmental signals they could not function” (214). The idea that genes switch on and off by environmental factors—factors that cause childhood stresses—supports Maté’s arguments in favor of harm reduction and the importance of controlling whatever one can control to alleviate childhood stress. The text appears to present a pessimistic tone in Part 4, given Maté’s suggestion that someone never had a choice to avoid becoming high-risk for addiction. However, he concludes Chapter 19 by saying that if he is correct in his conclusions, and if genes do not absolutely dictate behaviors and predispositions, then “there is much we can do” (220).

Maté has now laid the scientific foundation for the discussions of self-awareness and self-compassion that begin in Part 5 and will comprise the rest of the book.