The mandala, the Buddhist Wheel of Life, revolves through six realms. Each realm is populated by characters representing aspects of human existence-our various ways of being. In the Beast Realm we are driven by basic survival instincts and appetites such as physical hunger and sexuality, what Freud called the id. The denizens of the Hell Realm are trapped in states of unbearable rage and anxiety. In the God Realm we transcend our troubles and our egos through sensual, aesthetic or religious experience, but only temporarily and in ignorance of spiritual truth. Even this enviable state is tinged with loss and suffering. The inhabitants of the Hungry Ghost Realm are depicted as creatures with scrawny necks, small mouths, emaciated limbs and large, bloated, empty bellies. This is the domain of addiction, where we constantly seek something outside ourselves to curb an insatiable yearning for relief or fulfillment.
The aching emptiness is perpetual because the substances, objects or pursuits we hope will soothe it are not what we really need. We don''t know what we need, and so long as we stay in the hungry ghost mode, we''ll never know. We haunt our lives without being fully present. Some people dwell much of their lives in one realm or another. Many of us move back and forth between them, perhaps through all of them in the course of a single day. My medical work with drug addicts in Vancouver''s Downtown Eastside has given me a unique opportunity to know human beings who spend almost all their time as hungry ghosts. It''s their attempt, I believe, to escape the Hell Realm of overwhelming fear, rage and despair. The painful longing in their hearts reflects something of the emptiness that may also be experienced by people with apparently happier lives.
Those whom we dismiss as "junkies" are not creatures from a different world, only men and women mired at the extreme end of a continuum on which, here or there, all of us might well locate ourselves. I can personally attest to that. "You slink around your life with a hungry look," someone close once said to me. Facing the harmful compulsions of my patients, I have had to encounter my own. No society can understand itself without looking at its shadow side. I believe there is one addiction process, whether it is manifested in the lethal substance dependencies of my Downtown Eastside patients; the frantic self-soothing of overeaters or shopaholics; the obsessions of gamblers, sexaholics and compulsive Internet users; or the socially acceptable and even admired behaviours of the workaholic. Drug addicts are often dismissed and discounted as unworthy of empathy and respect. In telling their stories my intent is twofold: to help their voices to be heard and to shed light on the origins and nature of their ill-fated struggle to overcome suffering through substance abuse.
They have much in common with the society that ostracizes them. If they seem to have chosen a path to nowhere, they still have much to teach the rest of us. In the dark mirror of their lives, we can trace outlines of our own. There is a host of questions to be considered. Among them: * What are the causes of addictions? * What is the nature of the addiction-prone personality? * What happens physiologically in the brains of addicted people? * How much choice does the addict really have? * Why is the "War on Drugs" a failure and what might be a humane, evidence-based approach to the treatment of severe drug addiction? * What are some of the paths for redeeming addicted minds not dependent on powerful substances-that is, how do we approach the healing of the many behaviour addictions fostered by our culture? The narrative passages in this book are based on my experience as a medical doctor in Vancouver''s drug ghetto and on extensive interviews with my patients-more than I could cite. Many of them volunteered in the generous hope that their life histories might be of assistance to others who struggle with addiction problems or that they could help enlighten society regarding the experience of addiction. I also present information, reflections and insights distilled from many other sources, including my own addictive patterns. And finally, I provide a synthesis of what we can learn from the research literature on addiction and the development of the human brain and personality.
Although the closing chapters offer thoughts and suggestions concerning the healing of the addicted mind, this book is not a prescription. I can say only what I have learned as a person and describe what I have seen and understood as a physician. Not every story has a happy ending, as the reader will find out, but the discoveries of science, the teachings of the heart and the revelations of the soul all assure us that no human being is ever beyond redemption. The possibility of renewal exists so long as life exists. How to support that possibility in others and in ourselves is the ultimate question. I dedicate this work to all my fellow hungry ghosts, be they inner-city street dwellers with HIV, inmates of prisons or their more fortunate counterparts with homes, families, jobs and successful careers. May we all find peace. As I pass through the grated metal door into the sunshine, a setting from a Fellini film reveals itself.
It is a scene both familiar and outlandish, dreamlike and authentic. On the Hastings Street sidewalk Eva, in her thirties but still waif-like, with dark hair and olive complexion, taps out a bizarre cocaine flamenco. Jutting her hips, torso and pelvis this way and that, bending now at the waist and thrusting one or both arms in the air, she shifts her feet about in a clumsy but concerted pirouette. All the while she tracks me with her large, black eyes. In the Downtown Eastside this piece of crack-driven improvisational ballet is known as "the Hastings shuffle," and it''s a familiar sight. During my medical rounds in the neighbourhood one day, I saw a young woman perform it high above the Hastings traffic. She was balanced on the narrow edge of a neon sign two storeys up. A crowd had gathered to watch, the users among them more amused than horrified.
The ballerina would turn about, her arms horizontal like a tightrope walker''s, or do deep knee bends-an aerial Cossack dancer, one leg kicked in front. Before the top of the firemen''s ladder could reach her cruising altitude, the stoned acrobat had ducked back inside her window. Eva weaves her way among her companions, who crowd around me. Sometimes she disappears behind Randall-a wheelchair-bound, heavy-set, serious-looking fellow, whose unorthodox thought patterns do not mask a profound intelligence. He recites an ode of autistic praise to his indispensable motorized chariot. "Isn''t it amazing, Doc, isn''t it, that Napoleon''s cannon was pulled by horses and oxen in the Russian mud and snow. And now I have this!" With an innocent smile and earnest expression, Randall pours out a recursive stream of facts, historical data, memories, interpretations, loose associations, imaginings, and paranoia that almost sound sane-almost. "That''s the Napoleonic Code, Doc, which altered the transportational mediums of the lower rank and file, you know, in those days when such pleasant smorgasboredom was still well fathomed.
" Poking her head above Randall''s left shoulder, Eva plays peek-a-boo. Beside Randall stands Arlene, her hands on her hips and a reproachful look on her face, clad in skimpy jean shorts and blouse-a sign, down here, of a mode of earning drug money and, more often than not, of having been sexually exploited early in life by male predators. Over the steady murmur of Randall''s oration comes her complaint: "You shouldn''t have reduced my pills." Arlene''s arms bear dozens of horizontal scars, parallel, like railway ties. The older ones white, the more recent red, each mark a souvenir of a razor slash she has inflicted on herself. The pain of self-laceration obliterates, if only momentarily, the pain of a larger hurt deep in the psyche. One of Arlene''s medications controls this compulsive self-wounding, and she''s always afraid I''m reducing her dose. I never do.
Close to us, in the shadow of the Portland Hotel, two cops have Jenkins in handcuffs. Jenkins, a lanky Native man with black, scraggly hair falling to below his shoulders, is quiet and compliant as one of the officers empties his pockets. He arches his back against the wall, not a hint of protest on his face. "They should leave him alone," Arlene opines loudly. "That guy doesn''t deal. They keep grabbing him and never find a thing." At least in the broad daylight of Hastings Street, the cops go about their search with exemplary politeness-not, according to my patients, a consistent police attitude. After a minute or two Jenkins is set free and lopes silently into the hotel with his long stride.
Meanwhile, within the span of a few minutes, the resident poet laureate of absurdity has reviewed European history from the Hundred Years'' War to Bosnia and has pronounced on religion from Moses to Mohammed. "Doc," Randall goes on, "the First World War was supposed to end all wars. If that was true, how come we have the war on cancer or the war on drugs? The Germans had this gun Big Bertha that spoke to the Allies but not in a language the French or the Brits liked. Guns get a bad rap, a bad reputation-a bad raputation, Doc-but they move history forward, if we can speak of history moving forward or moving at all. Do you think history moves, Doc?" Leaning on his crutches, paunchy, one-legged, smiling Matthew-bald, and irrepressibly jovial-interrupts Randall''s discourse. "Poor Dr.