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  1. Khajeei, Dahlia PhD Candidate, MPH, BSc

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In the Realm of Hungry Ghosts explores the political, social, economic, and personal predispositions underlying substance abuse. This book explains how people are influenced by economic instability, food insecurity, and access to education, housing, and health care services. Dr. Mate claims human beings, similar to ghosts, haunt their lives without being present, and parallels this with his own experiences with addictive behaviors. In the Realm of Hungry Ghosts is intended for nurses, specialists, clinicians, and academics who are interested in the study of addictions using sociological imagination to bring awareness to the connection between self and wider society. Ultimately, a sense of oneness is created between the addict, criminal, bulimic, gambler, obsessive compulsive, blogger, and physician through Dr. Mates use of juxtaposition.


According to Dr. Mate, the key to mindfulness is awareness of one's problem and the creation of a healing space for self and others. He believes the similarities between himself and the patient are as obvious as the blatant, outwardly differences. Dr. Mate does not blame, ostracize, or judge the characters in his novel but uses them as parallels for our own daily lives to raise awareness that we are all struggling with some form of addictive behavior. On altruism, Mate believes the root of empathy is naturally ingrained in man-kind through social connectivity. In doing so, Dr. Mate mocks the division between the "underprivileged" addict and the "privileged" everyday-citizen. In a way, we see how the innate human tendency for social bonds are experienced by all people, through the entire lifespan, regardless of sickness or trauma. Ultimately, emotional intelligence is beneficial to human welfare and sustains social development through techniques that are accepting and aware of individual differences. For physicians, this means a heightened sensitivity to the feelings of rejection people with substance abuse may experience.


Dr. Mate acknowledges the feelings of disempowerment experienced by people seeking medical care. He writes how addiction services should aim to accept patients how they are and not based on their dysfunctional or troublesome narratives-to suspend judgment through awareness. Using narrative stories as evidence, he convinces the reader feelings of rejection are a common barrier in seeking medical treatment evidenced by health professionals who misunderstand their patients. Dr. Mate suggests interventions which enhance social cohesion to reduce economic strain long-term. Crisis counseling and community support groups may assist in breaking the control of the addictive substance over the person. A patient-centered approach will consider how a person presents given the social determinants of health and hereditary factors, to create tailored interventions. Ultimately, service delivery should be mindful of the identity, challenges, and power dynamics faced by patients while remaining culturally competent.


Dr. Mate uses sociological imagination to relay the desire of a user of substances to be needed, heard, and acknowledged similar to each person participating in a community. Dr. Mate is clear in illustrating that he does not save lives or cure his patients, but strengthens the argument for the allocation of greater monetary investment in social programs, which can propel disenfranchised children to be proactive members in their community. Social programs are supportive safety nets for at-risk children and youth. Currently, the Canadian health care system pigeonholes substance users, but political action has been taken in the opening of harm reduction clinics, such as Insite, in Downtown Eastside Vancouver. The style and organization of the book are appropriately creative, leaving room for the reader's own interpretation-particularly, in context of the title. Criticisms include the absence of an opposing view, perhaps to illustrate the impact to the communities where harm reduction clinics are located or to explore the challenges of law enforcement in supporting this marginalized population (see Table 1).

Table 1 - Click to enlarge in new windowTABLE 1 Key Excerpts From



Mate G. (2009). In the realm of hungry ghosts: Close encounters with addiction. Toronto, Ontario, Canada: Vintage Canada. [Context Link]