why the pain

all quotes from in the realm of hungry ghosts by gabor mate

"some people are attracted to painful places because they hope to resolve their own pain there. others offer themselves because their compassionate hearts know that here is where love is most needed. yet others come out of professional interest: this work is ever challenging. those with low self-esteem may be attracted because it feeds their egos to work with such powerless individuals. some are lured by the magnetic force of addictions because they haven't resolved, or even recognized, their own addictive tendencies. my guess is that most of us physicians, nurses, and other professional helpers who work in the downtown eastside are impelled by some mixture of these motives. . .

there's another factor in the equation. many people who've worked in the downtown eastside have noticed it: a sense of authenticity, a loss of the usual social games, the surrender of pretense -- the reality of people who cannot declare themselves to be anything other than what they are.

yes, they lie, cheat, and manipulate -- but don't we all, in our own way? unlike the rest of us, they can't pretend not to be cheaters and manipulators. they're straight up about their refusal to take responsibility, their rejection of social expectation, their acceptance of having lost everything for the sake of their addiction. that isn't much by the straight world's standards, but there's a paradoxical core of honesty wrapped in the compulsive deceit any addiction imposes. . . perhaps there's a fascination in that element of outrageous, unapologetic pseudoauthenticity. in our secret fantasies, who among us wouldn't like to be as carelessly brazen about our flaws?"

"people jeopardize their lives for the sake of making the moment livable. nothing sways them from the habit -- not illness, not the sacrifice of love and relationship, not the loss of all earthly goods, not the crushing of their dignity, not the fear of dying. the drive is that relentless."

"like patterns in a tapestry, recurring themes emerge in my interviews with addicts: the drug as emotional anesthetic; as an antidote to a frightening feeling of emptiness; as a tonic against fatigue, boredom, alienation, and a sense of personal inadequacy; as stress reliever and social lubricant."

"addictions always originate in pain, whether felt openly or hidden in the unconscious. . . the very same brain centers that interpret and 'feel' physical pain also become activated during the experience of emotional rejection. . . when people speak of feeling 'hurt' or of having emotional 'pain', they are not being abstract or poetic but scientifically quite precise."

"the question is never 'why the addiction?' but 'why the pain?'"

"the addict's reliance on the drug to reawaken her dulled feelings is no adolescent caprice. the dullness is itself a consequence of an emotional malfunction not of her making: the internal shutdown of vulnerability.

from the latin word vulnerare, 'to wound', vulnerability is our susceptibility to be wounded. this fragility is part of our nature and cannot be escaped. the best the brain can do is to shut down conscious awareness of it when pain becomes so vast or unbearable that it threatens to overwhelm our capacity to function. the automatic repression of painful emotion is a helpless child's prime defense mechanism and can enable the child to endure trauma that would otherwise be catastrophic. the unfortunate consequence is a wholesale dulling of emotional awareness. 'everybody knows there is no fineness or accuracy of suppression,' wrote the american novelist saul bellow in the adventures of augie march; 'if you hold down one thing you hold down the adjoining.'

intuitively, we all know that it's better to feel than not to feel. beyond their energizing subjective charge, emotions have crucial survival value. they orient us, interpret the world for us, and offer us vital information. they tell us what is dangerous and what is benign, what threatens our existence and what will nurture our growth. . . our emotions are an indispensable part of our sensory apparatus and an essential part of who we are. they make life worthwhile, exciting, challenging, beautiful, and meaningful.

when we flee our vulnerability, we lose our full capacity for feeling emotion. we may even become emotional amnesiacs, not remembering ever having felt truly elated or truly sad. a nagging void opens, and we experience it as alienation, as profound ennui, as the sense of deficient emptiness described earlier.

the wondrous power of a drug is to offer the addict protection from pain while at the same time enabling her to engage the world with excitement and meaning."

"many addicts report similar improvements in their social abilities under the influence, in contrast to the intolerable aloneness they experience when sober. . . we shouldn't underestimate how desperate a chronically lonely person is to escape the prison of solitude. it's not a matter here of common shyness but of a deep psychological sense of isolation experienced from early childhood by people who felt rejected by everyone, beginning with their caregivers."

"another powerful dynamic perpetuates addiction despite the abundance of disastrous consequences: the addict sees no other possible existence for himself. his outlook on the future is restricted by his entrenched self-image as an addict. no matter how much he many acknowledge the costs of his addiction, he fears a loss of self if it were absent from his life."

"i've often been struck by the childlike insouciance of my addicted patients when they lie to me. a naive manipulation like the one serena attempted is simply part of the game, and being caught is no more shameful than being found while playing hide-and-seek."

"imprinted in the developing brain circuitry of the child subjected to abuse or neglect is fear and distrust of powerful people, especially of caregivers. in time this ingrained wariness is reinforced by negative experiences with authority figures such as teachers, foster parents, and members of the legal system or the medical profession. whenever i adopt a sharp tone with one of my clients, display indifference, or attempt some well-meant coercion for her benefit, i unwittingly take on the features of the powerful ones who first wounded and frightened her decades ago. whatever my intentions, i end up invoking pain and fear."