The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture

by Gabor Maté

Within the myth of normal, of course, this kind of nuance is barely comprehensible: you’re either “sick” or you’re “well,” and it should be obvious which camp you’re in. But really, there are no clear dividing lines between illness and health.

The telltale hallmarks of the disease process are there: the prolonged course; the professional befuddlement at the lack of specific markers on physical examination, blood tests, or imaging studies; and the sudden interpersonal stress that finally brings on the full-blown manifestations of illness.

the hypothalamus is the hub of the body’s and brain’s stress apparatus, a key modulator of immune activity, and the apex of the autonomic nervous system. It is the transducer into physiological data of our emotional functioning and, therefore, of our interpersonal relationships and of our relationship to ourselves. It translates fear, loss, grief, and stress into responses in our bloodstream, organs, cells, nerves, lymph nodes, messenger chemicals, and molecules throughout the entire organism.

stress per se does not cause cancer; however, clinical and experimental data indicate that stress and other factors such as mood, coping mechanisms, and social support can significantly influence the underlying cellular and molecular processes that facilitate malignant cell growth.”

Stress cannot “cause” cancer, for the simple reason that our bodies naturally harbor potentially malignant cells at all times.

What drives the progression of these cells into clinical illness? What keeps the immune system from successfully confronting the internal menace? This is where stress plays its incendiary role: for example, through the release of inflammatory proteins into the circulation—proteins that can instigate damage to DNA and impede DNA repair in the face of malignant transformation.

To assert that emotions contribute to disease was, for her, to promote “punitive or sentimental fantasies,” to traffic in “lurid metaphors” and their “trappings.” She found this view especially distasteful because she perceived it as a way of blaming the patient. “I decided that I was not going to be culpabilized.”

Asserting that features of the personality contribute to the onset of illness, and more generally perceiving connections between traits, emotions, developmental histories, and disease is not to lay blame. It is to understand the bigger picture

Time after time it was the “nice” people, the ones who compulsively put other’s expectations and needs ahead of their own and who repressed their so-called negative emotions, who showed up with chronic illness in my family practice,

I have distilled my own list of the personality features most often present in people with chronic illness, as observed by myself and many others. They may remind you of some of the personal stories I’ve included thus far. Whether a person exhibits one, a few, or every one of these features, they all, each in their own way, speak to self-suppression and/or repression. I have found them not only present but prominent among people with all manner of chronic illnesses, from cancer to autoimmune disease to persistent skin conditions, through a gamut of maladies including migraine headaches,

fibromyalgia, endometriosis, myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome, and many others. In no particular order, these traits are – an automatic and compulsive concern for the emotional needs of others, while ignoring one’s own; – rigid identification with social role, duty, and responsibility (which is closely related to the next point); – overdriven, externally focused multitasking hyper-responsibility, based on the conviction that one must justify one’s existence by doing and giving; – repression of healthy, self-protective aggression and anger; and – harboring and compulsively acting out two beliefs: “I am responsible for how other people feel” and “I must never disappoint anyone.”

Why these features and their striking prevalence in the personalities of chronically ill people are so often overlooked—or missed entirely—goes to the heart of our theme: they are among the most normalized ways of being in this culture.

These dangerously self-denying traits tend to fly under our radar because they are easily conflated with their healthy analogues: compassion, honor, diligence, loving kindness, generosity, temperance, conscience, and so forth. Note that the qualities on the latter list, while perhaps superficially resembling those of the first, do not imply or require that a person overstep, ignore, or suppress who they are and what they feel and need.

Precisely because no one is born with such traits ingrained, we can unlearn them.

authenticity. Definitions vary, but here’s one that I think applies best to this discussion: the quality of being true to oneself, and the capacity to shape one’s own life from a deep knowledge of that self.

A healthy sense of self does not preclude caring for others, or being affected or influenced by them.

Authenticity’s only dictate is that we, not externally imposed expectations, be the true author of and authority on our own life.

Thus our real selves are leveraged bit by bit in a tragic transaction where we secure our physical or emotional survival by relinquishing who we are and how we feel.

Inauthenticity is thereafter misidentified with survival because the two were synonymous during the formative years—or, at least, seemed so to our young selves.

And just as an opiate like heroin does not satiate, so the temporary endorphin hit of valuation or appreciation or approval or success cannot possibly resolve the ache in the soul.

For most of us it may require a crisis of some kind before we question the veracity and solidity of the self-concept we act from, before it even occurs to us that it might conceal something truer about us.

it is not only necessary to leave blame and guilt behind on the road to healing, to move from self-accusation to curiosity, from shame to “response ability”—it is also and always possible.

The relative health of any life-form is a function of its essential needs being met, or not met.

There is a tendency in this culture, whether with approval or dismay, to see people as inherently aggressive, acquisitive, and ruggedly individualistic. We might cherish kindness, charity, and community-mindedness—our “better natures,” so to speak—but these are often spoken of wistfully, as exceptions to a hardwired rule.

We can be noble and narcissistic, generous and genocidal, brilliant in our ingenuity and buffoonish in our stupidity. We are, it seems, all of the above. So where to begin? Rather than trying to adjudicate between the many competing visions of what a human being is, we could instead see our nature as a range of possible outcomes.

More than any other factor, it is the environment—the conditions under which development takes place, which either do or don’t meet our multiple needs—that determines which potentials will or will not manifest.

No hominin species could have survived long enough to evolve had its members seen themselves as atomized individuals, pitted by Nature against their fellow beings.

materialistic cultures generate notions—myths, in effect—of selfish, aggressive striving and dominance as behavioral baselines,

today’s culture hastens human development along unhealthy lines from conception onward, leading to a “normal” that, from the perspective of the needs and evolutionary history of our species, is utterly aberrant. And that, to state the obvious, is a life-size health hazard.

In the words of the renowned developmental psychiatrist Stanley Greenspan and colleagues, “Emotional rather than intellectual interaction serves as the mind’s primary architect.”6

children’s sense of security, trust in the world, interrelationships with others, and, above all, connection to their authentic emotions hinge on the consistent availability of attuned, non-stressed, and emotionally reliable caregivers.

“Children must feel an invitation to exist in our presence, exactly the way they are.”

the parents’ primary task, beyond providing for the child’s survival requirements, is to emanate a simple message to the child in word, deed, and (most of all) energetic presence, that he or she is precisely the person they love, welcome, and want.

this abiding embrace cannot be earned, nor can it be revoked. It doesn’t depend on the child’s behavior or personality; it is just there, whether the child is showing up as “good” or “bad,” “naughty” or “nice.”

Do we then ignore dangerous or unacceptable behavior? No, that wouldn’t be the loving thing to do either, since children’s needs also include guidance and orientation, which include setting boundaries. Rather, we do our best to monitor and curtail undesirable actions from an unconditionally loving place: a way of being wherein children understand that nothing they might do can threaten the relationship,

“We are indeed born for love,” assert the science writer Maia Szalavitz and the child psychiatrist and neuroscientist Bruce Perry, “[but] the gifts of our biology are a potential, not a guarantee.”

Despite all our love for our three children, Rae and I did not know how to provide the stable milieu they required, having lacked some essential aspects of nurturing in our own early years.

For a long time, it was assumed that infants are impelled to bond with caregivers only out of their helpless dependency on food, warmth, and shelter. We now know that social and emotional needs are just as much encoded in our neural circuitry by evolution, and that our optimal development requires that they be met.

“It is true maturation, not schooling, learning or genetics that is key to becoming fully human and humane.”

We have instilled in her the anxiety of being rejected if her emotional self were to surface. This exacts a heavy toll on both physical and mental health. While the expression of an emotion can be inhibited, or even its conscious experience blocked, the emotion itself is energy that cannot be obliterated. By banishing feelings from awareness, we merely send them underground, a locked cellar of emotions that will continue to haunt many lives.

If the overall goal of development is to foster in children a felt sense of being alive in a nurturing world—“how it feels to be human,” in Raffi’s wonderful phrase—then we have utterly lost the plot.

We are all doing our best. My contention—really, the thrust of this whole book—is that our best deserves to be better, and can be if we incorporate the growing body of knowledge now available to us.

We need to consider to what extent our culture, including employment and the health care and insurance systems, supports or undermines women’s capacity to hold their unborn infants’ needs as a high social priority.

Remember telomeres, the chromosomal markers of health and aging? These structures were shown to be shorter—that is, more prematurely aged—in twenty-five-year-old adults whose mothers had undergone major stress during pregnancy.

Though a mother’s emotional stress exerts a direct influence on the child’s development and future health, it is not an isolated factor: interpersonal biology holds sway once again. As was the case with Rae and me, there is a complex interplay between a woman’s psychological states and those of the father.

“We know prenatal depression and stress and anxiety can predict behavior problems in the child,” Professor Letourneau told me. “We can try to fix those behaviors in the kid years later, or we can medicate the child, or we can give pregnant women the support they need in the first place.”

Reducing women to passive recipients of medical care during perhaps the most momentous passage of their lives is dehumanizing, and not only figuratively: it disrupts physiological, hormonal, and psychological processes that have evolved in our species over millions of years to ensure the necessary bonding of mother and baby and the healthy development of our young.

“Cesarean section use has increased over the past 30 years in excess of the 10–15% of births considered optimal, and without significant maternal or perinatal benefits,” noted the Lancet report.

“The women who report the most positive birth experiences,” she observes, “are those who feel they understood all the decisions made and had a say in the decision-making

The biological bottom line is this: Mammalian labor is more than a process of expelling an infant from a womb. It is preparation for life. Labor, as Nature designed it, promotes the release of hormones such as estrogen, oxytocin, and prolactin that activate a host of neural systems governing the emotions and behaviors, ensuring the baby’s well-being in the short and long terms: warmth, nurturing, bonding, protection, and so on. In other words, birth prepares the template for the mother-infant relationship, which itself is the central locus of the child’s early development.