Addiction is usually thought of in terms of substances: alcohol, cocaine, opioids. But according to Dr. Gabor Maté, author of In The Realm of Hungry Ghosts: Close Encounters with Addiction, it can take less obvious—and more socially condoned—forms, like work, wealth and status.
To Maté, addiction has its roots in childhood trauma. Speaking at last weekend’s Summit conference in Los Angeles, he was careful to note that trauma is something that happens inside. Rather than a specific incidence of abuse or toxic dynamics within a family, trauma is the loss of some essential part of you, like a sense of peace, vitality or presence.
He would know: now 73 years old, Maté was an infant when the Nazis invaded Hungary, and his family’s flight from Budapest took what he considers to be a lifelong toll on him. In the light of the Holocaust, his mother couldn’t exactly be the nurturing, supportive, attuned presence that children need in order to grow up with a secure sense of self. “When a mother is unhappy, the child takes it personally,” Maté explained to the crowd. “If you’re not wanted, you make yourself needed. If you want to be needed, go to medical school.”
Which is precisely what Maté did in his adopted home of Vancouver, Canada. He went on to have a 20-year family practice as well as 12 years treating substance abusers in the city’s gritty Downtown Eastside neighborhood, the stories of which populate In The Realm of Hungry Ghosts.
Practicing medicine, he writes, was the perfect venue for proving his usefulness and indispensability. For the longest time, it was impossible for him to turn down work: “The drug of being wanted was far too powerful to refuse, and in any case I needed the flame of constant preoccupation to ward off the anxiety of depression or ennui that always lurked at the edges of my psyche.” Indeed, to not be working threw him into disarray. Like “an addict in withdrawal,” he shared onstage, not having to go into work on the weekends left him feeling empty and irritabile.
But the thing about addiction—workaholism included—is that it’s never quite satisfied. Even if people needed him when they were being born, or dying, or sick or injured, there was still the nagging question of whether they’d still want him if he wasn’t wearing a lab coat. “It doesn’t matter how many patients I see, there’s that nagging feeling that they don’t want me for who I am,” he said. “The success addict needs constant validation.” (Though he’s no longer practicing medicine, Maté says that a similar intensity animates his approach to speaking tours.)
Like any problematic repetitive behavior, being addicted to work, validation, or success is an issue with lots of factors and possible treatments. In Hungry Ghosts, Maté distinguishes between contingent and genuine self esteem. The bigger the void that people feel, the greater the urge to get themselves noticed, and the greater the compulsion to acquire status. Genuine self-esteem, on the other hand, “needs nothing from the outside”—it’s a sense of feeling worthwhile, regardless of your accomplishments. “Self-esteem is now that the individual consciously thinks about himself; it’s the quality of self-respect manifested in his emotional life and behaviors.” Cultivating that may very well be the work of a lifetime, and likely requires the long, slow process of deliberately befriending yourself.