Gabor Maté - In the Realm of Hungry Ghosts - Close Encounters with Addiction

At first sight, the task of a troubled mind transforming itself may seem hopelessly daunting. “What an abyss of uncertainty,” wrote the novelist Marcel Proust, “whenever the mind feels overtaken by itself, when it, the seeker, is at the same time the dark region through which it must go seeking.” Or, as a patient in Dr. Jeffrey Schwartz’s obsessive-compulsive disorder clinic in Los Angeles said, “What we are looking for is what we are looking with.” As these observations suggest, it would be impossible to recover from addiction if a person’s mental life were determined purely by automatic brain functions and underground emotional dynamics. Powerful as those are—and decisive as they can be for many people in many circumstances—they are not the only actors on the scene. Fortunately for human beings, the mind is more than the workings of our automatic brain mechanisms and, it turns out, the brain itself can develop throughout a lifetime.

Not only in childhood, but for our entire lives our brains remain use-dependent. For example, a part of the hippocampus—a brain structure important for memory—has been shown to be much larger than average in London cabbies. The size increase was correlated with the number of years they’d spent navigating through the dense traffic of the British capital. 1In the words of neurologist and brain researcher Antonio Damasio, “the design of brain circuits continues to change. The circuits are not only receptive to the results of first experience, but [are] repeatedly pliable and modifiable by continued experience.” 2

So there are two ways of promoting healthy brain development, and both are essential to the healing of addiction: by changing the external environment and by modifying the internal one. “The mammalian brain appears to have the capacity to remain responsive to environmental enrichment well into advanced age,” asserted Dr. Marian Diamond, a renowned brain researcher at the Department of Anatomy-Physiology at Berkeley. 3In her laboratory, newborn to elderly rats were kept in varying degrees of social isolation, stimulation, and environmental and nutritional enrichment. Autopsies showed that the layers of the cortex in the brains of the environmentally favoured rats were thicker, their nerve cells larger, their branching more elaborate and their blood supply richer. Privileged rats well past midlife could still grow connecting branches almost twice as long as their “standard” cousins, after only thirty days of differential treatment. Dr. Diamond reported these results in her book Enriching Heredity: The Impact of the Environment on the Anatomy of the Brain. *31“At any age studied,” she wrote, “we have shown anatomical effects due to enrichment or impoverishment.” 4

Most encouraging were Dr. Diamond’s findings that even the brains of animals deprived before birth or damaged in infancy were able to compensate through structural changes in response to enriched living conditions. “Thus,” she wrote, “we must not give up on people who begin life under unfavourable conditions. Environmental enrichment has the potential to enhance their brain development too, depending on the degree or severity of the insult.” 5Since Marian Diamond’s pioneering studies the power of an enriched environment to induce positive brain development has been demonstrated repeatedly. For example, rats in a superior housing situation gained new brain connections and as much as a 20 per cent increase in the size of the cortex. In the words of the researchers, “an extraordinary change!” 6

In humans, too, we can expect the adult brain to be beneficially influenced by the environment. The same has long been known to be true for almost any other organ or part of the body. Unused muscles atrophy, but if well exercised they grow in size and strength; blood supply to the heart is improved by exercise and healthy diet; our lung capacity increases with aerobic training. Elderly people who remain physically and intellectually active suffer much less decline in their mental functioning than their more passive contemporaries. “Contrary to dogma, the human brain does produce new nerve cells in adulthood,” reported two neurobiologists in Scientific American in 1999. 7

Early in life the responsiveness of the human brain to changing conditions, known as neuroplasticity, is so great that infants who suffer damage to one side of their brain around the time of birth, even if they lose an entire hemisphere, may compensate for the deficit. The other half develops so that these children grow up to have nearly symmetrical facial movements and only a mild or moderate limp. With age, plasticity declines, but it is never completely lost. Neurological adaptability in adulthood may be seen in the recovery many people make from a stroke. In a cerebrovascular accident, or stroke, brain tissue is destroyed, usually due to bleeding. Although nerve cells that have died will not come back to life, often the patient will once more be able to use a limb that was paralyzed by the stroke. New circuits have taken over and new connections have been made. In fact, this process has recently been harnessed in the rehabilitation of stroke victims, leading to remarkable advances.

The work of Dr. Jeffrey Schwartz and his colleagues at UCLA has shown that in the brains of people with obsessive-compulsive disorder, new circuitry can be successfully established that overrides the ill-functioning circuits. Dr. Schwartz suggests—and I completely agree—that methods used at UCLA can be adapted to the healing of addictive compulsions. We will take a close look at them in the next chapter. “Now there is no question,” Dr. Schwartz writes, “that the brain remodels itself throughout life, and that it retains the capacity to change itself as the result not only of passively experienced factors such as enriched environments, but also of changes in the ways we behave and the ways we think…Nor is there any question that every treatment that exploits the power of the mind to change the brain involves arduous effort—by patients afflicted by stroke or depression, by Tourette or OCD—to improve both their functional capacity and their brain function.” 8Arduous effort is also required on the part of any addict—all the more since her compulsions entice her to behaviours that, contrary to other distressing conditions, promise pleasure and reward.

The mind activity that can physically rewire malfunctioning brain circuits and alter our dysfunctional emotional and cerebral responses is conscious mental effort—what Dr. Schwartz calls mental force. If changing external circumstances can improve brain physiology, so can mental effort. “Intention and attention exert real, physical effects on the brain,” Dr. Schwartz explains. 9Not surprisingly, the brain area activated in studies looking at the effect of self-directed mental effort is the prefrontal cortex, the apex of the brain’s emotional self-regulation system. It’s also an area where, we have learned, the brains of addicts are impaired. The mental activity most critical to the development of emotional self-regulation has been called “dispassionate self-observation” by the authors of an important article on the interface of brain and mind, published in the Philosophical Transactions of the Royal Society ( Biological Sciences ) in 2005. “The way in which a person directs their attention (i.e. mindfully or unmindfully) will,” they write, “affect both the experiential state of the person and the state of his/her brain.” 10

Mindful awareness involves directing our attention not only to the mental content of our thoughts, but also to the emotions and mind-states that inform those thoughts. It is being aware of the processes of our mind even as we work through its materials. Mindful awareness is the key to unlocking the automatic patterns that fetter the addicted brain and mind.