As promised in my February 3rd, 2016, blog post, I just finished reading In the Realm of Hungry Ghosts: Encounters with Addiction (2008) by Canadian MD Gabor Maté. I read Hungry Ghosts because on the surface it appeared to track the information presented in the 2014 edited volume entitled Addictions from an Attachment Perspective—Do Broken Bonds and Early Trauma Lead to Addictive Behaviours? (which I summarized in an earlier series of blog posts and will refer to as Addictions & Attachment for short).
Also as promised I immediately began writing a post intended to summarize Hungry Ghosts. I wrote several drafts of this post. After I completed each draft, I’d wake up the next day with my inner voice nagging at me: “You’re not addressing the elephant in the room.” I tend to listen to my inner voice but for the life of me, I could not figure out what elephant I was ignoring.  Then it dawned on me: the elephant in the room is mourning. More specifically, the elephant in the room is how other theories tend to hijack Bowlbian attachment theory by effectively, in large part, devaluing or, in some cases, ignoring the process of mourning grief. Now that I think about it, I did have a nagging feeling that the process of mourning grief was being overlooked as I read Hungry Ghosts. And it’s not that Maté does not mention mourning and grief; he does. What’s going on then? I decided to address the elephant in the room before completing my summary post of Hungry Ghosts.
As I have blogged about before, there are many different framings of attachment theory. Here’s the list I presented in a post from September of 2011:
- RAD (reactive attachment disorder)—held by behaviorism
- Neurobiology and attachment—held by reductionism
- Mindfulness—held by Buddhist religion
- Attachment parenting—held by New Ageism
- Self-esteem—held by postmodernism
- Attachment or holding therapy—held by conservative Christian religion
- Bowlbian attachment—held by ethology and naturalistic systems
To this list I would add psychoanalytic framings of attachment.  What the above list tells us is that one cannot simply use the word “attachment” without using some qualifier like “postmodern attachment” or “conservative Christian religion attachment,” or “reactive attachment.” Why are these qualifiers important? To answer this question I will turn to what I am calling the Midgley systems continuum, which I am pulling from Gerald Midgley’s 2000 book entitled Systemic Intervention—Philosophy, Methodology, and Practice. I have invoked the specter of Midgley’s systems continuum many times in earlier posts, to the point of being a broken record. Here’s the Midgley systems continuum:
worldview <==> ideology <==> methodology <==> intervention
I keep bring up the Midgley systems continuum because I feel that it has far-reaching implications as far as guiding thinking and analysis. Simply, if you encounter a worldview, then the interventions that fall from that worldview will be constrained by that same worldview. Conversely, if you encounter an intervention, that intervention is always held by a worldview. Now, postmodernists will argue that their worldview breaks free from the Midgley systems continuum. Postmodernists argue that their worldview is about liberation from the constraints of worldviews. But a worldview of no worldviews or all worldviews is still a worldview and places certain constraints on interventions. Sorry postmodernists but you’re trying to pull yourselves up by your bootstraps.
Why am I mentioning all of this in the context of summarizing Hungry Ghosts? Simply put, Hungry Ghosts uses a brain studies or neurobiology worldview. As a result, methodologies are framed as finding ways to rewire the brain. As it happens, Maté uses the interventions of Buddhist mindfulness, observation, and reflection to effectively rewire the brain. Here’s the Midgley systems continuum I imagine for Maté’s book, along with the one I imagine for Addictions & Attachment as a comparison:
|A Brain Science View of the World
|Organisms possess a brain comprised of a number of brain centers (i.e., hippo-campus and prefrontal cortex)
|Methods designed to encourage the healthy development of brain centers
|Buddhist meditation as one possible way to appropriately (re)wire brain center(s)
|Addictions & Attachment
|An Evolution View of the World
|Organisms possess innate behavioral systems (i.e., attachment and sex)
|Methods designed to encourage the healthy operation and integration of behavioral systems
|12 step program as one possible surrogate attachment figure
I should point out that there appears to be a movement in the direction of linking up brains studies and Buddhist practices. For example, neurobiologist Dan Siegel (who Maté references) presents a similar Midgley systems continuum in his 2007 book entitled The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being. In fact, the West Coast is home to a mindfulness movement within both mental health and education. Whether you agree with the Midgley systems continuums I present above, I recommend that you develop your own and use them to guide your thinking and analysis.
Both Hungry Ghosts and Addictions & Attachment pull from the same areas: ethology (animal studies), attachment, human development (especially child development), cognitive science, and systems theory. (Actually, all of the frames used to frame attachment listed above tend to pull from these same areas.) What differentiates them is the worldview used to frame all of this information. As the above table suggests, Hungry Ghosts uses a brain studies worldview while Addictions and Attachment uses an evolution worldview. These worldviews funnel information toward restricted intervention strategies. This is not necessarily a bad thing. What’s bad is not making the worldview used, and the various entailments this worldview brings, transparent. Allow me to take a stab at briefly describing the treatment approach that falls first from the brain studies worldview and then the Bowlbian attachment studies worldview.
Brain studies: through using Buddhist practices, the addict is encouraged to take up refuge within the safety of the upper, reflective, observing brain. From this position of safety, the addict can begin healing the brain structures of the feeling mid brain and emotional lower brain centers where addictive urges and motivations have been set up. Through early childhood trauma, brain centers become damaged. Such damage sets up addictive urges and motivations. Through trauma, the “opiod attachment/reward system,” the “dopamine-based incentive-motivation apparatus,” and the “self-regulation areas of the prefrontal cortex” (quoting Maté) become compromised. Buddhist practices have the ability to heal these various brain systems.
Bowlbian attachment studies: through using surrogate attachment figures (such as a 12 step group, sponsor, or therapist), the addict is encouraged to take up refuge within the safety of an attachment relationship. From this position of safety, the addict can begin healing body-mind systems by mourning grief. Mourning grief brings about higher integration and function of all body-mind systems. Through early childhood trauma, these systems have taken on an autonomous character (according to organismic systems theory). For example, through trauma the amygdala (the brain’s main fear center) often acts in a self-contained fashion producing its own fear stories that exist out of the contexts of time and space (such contexts are generally provided by upper brain structures).   Secure attachment relationships have the ability to integrate and harmonize body-mind systems so that they can act as a coherent whole.
I should mention that PTSD is characterized by reliving experiences: reliving traumatic experiences—such as early abuse or war atrocities—as if they were happening today, in the moment. During reliving experiences, upper brain structures are not able to provide middle brain structures with the contexts of time and space.
Back in September of 2011, I wrote about where the brain studies worldview came from by profiling the 2003 edited edition Primate Psychology, to which primatologist Dario Maestripieri contributed a chapter entitled simply Attachment. Maestripieri writes that the meteoric rise of the brain studies worldview can be traced back to two main factors: “[T]he rapid progress of biological disciplines such as genetics, molecular biology, and neuroscience and the growing popularity of scientific reductionism.” Maestripieri gives us this “bottom line”: “[T]he success of neuroscience led to the optimistic view that many important questions about behavior would eventually be answered by studies of brain anatomy and function, thus rendering [naturalistic] behavioral research less necessary.” The above is a good way to frame the information that Maté presents in Hungry Ghosts: questions surrounding addiction could be best “answered by studies of brain anatomy and function” making naturalistic behavior research, such as Bowlbian attachment theory, “less necessary.”
The brain studies worldview is popular right now because, well, it’s popular. By that I mean brain studies are sexy. They’re new. They’re cutting edge. They use very expensive imaging equipment, the cost of which has to be justified. And in 2013 you have President Obama announcing the 100 million dollar BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies). Innate behavioral systems (like attachment, sex and caregiving(receiving)) are passé. As I have blogged about before, critics of the brain studies worldview (who tend to be of a conservative stripe) argue that liberals use the concept of brain plasticity (e.g., the brain’s ability to rewire itself) as a catchall panacea designed to promulgate a liberal worldview. As I mentioned in an earlier post, liberals tend to believe that an overall brain system “retains hidden reserves available at any age to learn new skills or to compensate for damage, so long as the correct behavioral interventions are used” (quoting Michael S. C. Thomas). Conservatives are not as optimistic and tend to believe that brain plasticity is limited.
What’s also passé? Mourning. Addictions & Attachment specifically frames interventions using the process of mourning; Hungry Ghosts does not. Again, Hungry Ghosts mentions grief and mourning, but at no point does Dr. Maté frame addiction as a form of locked mourning. Further, he does not frame interventions as being about unlocking mourning so it can take a natural course. But in fairness to Dr. Maté, mourning in general seems to be passé. Social critics such as mythologist Robert Bly  have been writing about how Western society does not place a value on collective mourning. This has been carried to an extreme. In the recent edition of the DSM (DSM-5—Diagnostic and Statistical Manual of Mental Disorders) normal mourning has been pathologized. For more on this topic, see the Psychology Today article entitled DSM-5 Controversy Rages On in the Bereavement Community.
There’s something else profound that complicates issues surrounding mourning. As Professor Robert Solomon asks in a lecture he gave entitled A Death in the Family—The Logic of Grief, “What is the desire in grief?” Professor Solomon answers thus: “It would seem that what you want in grief is the utterly impossible. What you would like is for the person who has died to come back to life.” Professor Solomon goes on to suggest that grief may be that first social emotion that motivated us to approach the world in a conscious way. Using prehistoric Neanderthal burial sites as a backdrop, Solomon reveals that “Neanderthals must have thought, in whatever language or concepts they thought with, about death and what happened after death.” Solomon continues, “There is a sense in which death is something that is so basic that all other concepts of religion, philosophy, and astronomy are just clouded by contrast.”
As you read Dr. Maté’s descriptions of persons struggling with addiction, you do get this sense that they are trying to bring about the impossible, to bring back to life the mother (or caregiver) who was not there, who was effectively emotionally dead. I feel a sense of loss as existential crises such as these are reduced to ill-developed brain wiring. Mourning is about making the impossible, possible; to bring back the person lost through our memories of that person. Clearly mourning becomes exceedingly difficult if a person does not wish to have any memories of a childhood abuser or a war enemy. Sadly, not wishing to have any memories of a childhood abuser characterizes many of the persons struggling with addiction portrayed in Maté’s book. In fairness to Buddhist practices, maybe there are situations where giving up certain worldly attachments is not such a bad idea. 
So, using very wide brushstrokes, Maté’s book Hungry Ghosts is made up of four major sections:
- CASE STUDIES: Stories and vignettes concerning person’s battling addiction
- SCIENTIFIC DATA: Information mainly from the areas of human development and brain research concerning addiction
- POLICY & POLITICS: Dominant policies and politics used to frame the addictive process and addiction treatment
- ALTERNATIVE WORLDVIEW: Using Buddhist mindfulness and meditation to frame the addictive process and addiction treatment 
I would say that it is fair to use these same four categories to broadly group the topics covered in Addictions & Attachment (although Addictions & Attachment does not focus in on Buddhist practices). Using these four broad categories as a background, in my next post I’ll look at how these two books on addiction dovetail or part ways. With respect to the last section—ALTERNATIVE WORLDVIEW— the two books part greatly (as sketched out above). Whereas Addictions & Attachment principally frames addiction as locked mourning, Hungry Ghosts principally frames addiction as faulty brain wiring. As examples, in Addictions & Attachment we hear: “Recovery from problem gambling is experienced as a deep grief, a sense of bereavement, a broken heart at the loss of a lover.” Addictions & Attachment gives us this sense that the addict relates to the object of addiction as if it was an attachment figure. Within this frame, all recovery from addiction will inevitably result in yet another loss (a loss that could activate all earlier losses): loss of the addictive object as the person’s only true attachment figure. In Hungry Ghosts, Maté writes:
We know that the majority of chronically hard-core substance-dependent adults lived, as infants and children, under conditions of severe adversity that left an indelible stamp on their development. Their predisposition to addiction was programmed [my emphasis] in their early years. Their brains never had a chance.
Addictions & Attachment frames addiction as seeking out and attaching to an object, process, or substance as a stand in for a primary attachment figure. Hungry Ghosts frames addiction as fundamentally arising from faulty brain wiring. Simply two different views of the world. Even though the two books part ways on the last section, there is considerable agreement on the first three sections. It’s this common ground, which I will cover in my next post, that may be of central interest to readers. Stay tuned.
 Maybe I was watching too many ads for the new animated movie Zootopia that depict the elephant in the room being properly addressed.
 The 2014 book that I summarized in a series of blog posts—The Origins of Attachment co-written by Beatrice Beebe and Frank Lachmann—would be an example here. I should also point out that evolutionary psychologists are in the process of creating a new framing of Bowlbian attachment. For an example, see University of New Mexico researcher Marco Del Giudice’s 2009 article entitled Sex, Attachment, and the Development of Reproductive Strategies (Behavioral and Brain Sciences, vol. 32, p. 1-21).
 This information came to me by way of a workshop put on by neurobiologist Louis Cozolino up in Santa Fe back in October, 2006. In my opinion, Cozolino tends to take a more organismic systems theory approach to brain studies.
 The AAI (adult attachment interview) looks for linguistic structures that reveal that a narrative, either in part or in whole, lacks the contexts of time and space. As an example, when an interviewee is asked to talk about his/her early attachment relationship with his/her primary attachment figure (typically the mother), he/she may provide an answer as if the early attachment relationship was happening right now, right here. An example response might be: “My mother? I’ll tell you about my mother. She leaves me all the time. You forget about me over and over again. I really hate when you do that. Why do you treat me that way?” Notice the use of the present tense to describe events that occurred in the past. In essence, the AAI has the ability to assess for how well upper brain structures are able to provide the contexts of time and space to mid brain structures.
 In his 1996 book entitled The Sibling Society, Bly talks about how Demeter engaged in “inconsolable weeping when Persephone [daughter of Zeus and Demeter] disappeared into the underworld, carried off by Pluto.” Bly continues, “Greek women in ancient times repeated this ritual each year, acting out their grief in a private and yet communal way, walking in groups along the river.” Mythologists like Bly and Joseph Campbell point out that these “death and resurrection” stories are centrally about allowing a community of people to mourn loss. This is certainly true in the Christian faith (as we approach Easter). But what these same commentators point out is that “mourning stories” are losing their ability to help us process grief. After the 9/11 terrorist attacks, President Bush suggested that we simply go about our daily lives and strengthen the economy by buying consumer goods. As critics pointed out, President Bush missed a prime opportunity to lead our country through a much needed process of collectively mourning grief and loss.
 Dan Siegel in his book The Mindful Brain frames Buddhist detachment as essentially dropping below the level of cognitive models where such things as cultural norms and cultural biases exist. I interpreted this as dropping below the level of Bowlby’s Inner Working Models, which are also cognitive models or schemas. Believing in and advocating for the philosophy espoused by a particular political party would be an example of how we use cognitive models to navigate our social worlds. As Bowlby (and other cognitive scientists) points out, once Inner Working Models are set up, they are exceedingly hard to change. Looked at from a Bowlbian persepctive, healing from insecure attachment is centrally about changing and updating Inner Working Models. I think Siegel is aware of this fact. As a result, rather than changing Inner Working Models, Siegel suggests just dropping below them, detaching from them. As a colleague reminds me periodically, Buddhist detachment works because an entire country believes in such forms of detachment. This in part may explain why there is a movement here in the US to push Buddhist practices into the areas of mental health and education.
 In her recent article entitled Why This Doctor Believes Addictions Start In Childhood, Carolyn Gregoire mentions that Maté’s approach to treating addiction is a bit controversial: he uses ayahuasca—“a hallucinogenic brew made from the bark of an Amazonian rain forest tree, which early research has shown could hold promise for treating addiction, depression, and post-traumatic stress disorder” (quoting Gregoire). So, it appears that Maté no longer uses Buddhist practices exclusively. For more on Maté’s thoughts concerning the use of hallucinogenic substances to treat addiction, see Gregoire’s article. Now, I’d be remiss if I did not mention that from my graduate studies in counseling I recall that Alexander Shulgin—developer of MDMA (methylenedioxy-methamphetamine) in 1976, also known as Ecstacy—used MDMA in a therapeutic fashion. Apparently MDMA (at therapeutic doses) gives the user a warm and comforting feeling. Shulgin used MDMA as a way of giving his patients an experience of what it feels like to be in a safe and secure attachment relationship. I’m guessing but maybe Maté is taking a similar approach by using hallucinogenics with addicts.