An addict named Ralph tells Maté that his job and his money haven’t given him freedom, but an illusion. Ralph views what he does—living on the street—as a greater sort of freedom than going to work all day just to earn a few dollars. Maté says that freedom from pursuits might be his ultimate version of freedom. Ralph then asks, “Why is it that some people, through no merit whatsoever, get to have whatever they think will give them happiness? Others, through no fault of their own, are deprived” (264). Ralph believes that no one can disprove his worldview, because everyone experiences a different, subjective reality.

After their conversation, Maté wonders if Ralph might be correct. Maté sees himself as a more privileged addict than Ralph, but an addict, nevertheless. He wonders if the fact that he feels compelled to defend his own freedom is a sign that he doesn’t actually have it. Whenever he finds himself judging his patients harshly, he realizes that he is seeing something in them that reminds him of himself.

Maté then cites statistics about Americans spending over 15 billion dollars on cosmetic surgery in 2006. A book titled Beauty Junkies posits that Americans are addicted to beauty standards.