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

by Gabor Maté

We can certainly fold these two meanings into our discussion, but I am using “toxic culture” to characterize something even broader and more deeply rooted: the entire context of social structures, belief systems, assumptions, and values that surround us and necessarily pervade every aspect of our lives.

For better or worse, we humans have a genius for getting used to things, especially when the changes are incremental. The newfangled verb “to normalize” refers to the mechanism by which something previously aberrant becomes normal enough that it passes beneath our radar. On a societal level, then, “normal” often means “nothing to see here”: all systems are functioning as they should, no further inquiry needed. The truth as I see it is quite different. The late David Foster Wallace, master wordsmith, author, and essayist, once opened a commencement speech with a droll parable that well illustrates the trouble with normality. The story concerns two fish crossing aquatic paths with an elder of their species, who greets them jovially: “‘Morning, boys. How’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, ‘What the hell is water?’” The point Wallace wanted to leave his audience pondering was that “the most obvious, ubiquitous, important realities are often the ones hardest to see and talk about.” On its surface, he allowed, that might sound like “a banal platitude” but “in the day-to-day trenches of adult existence, banal platitudes can have a life-or-death importance.”

If we could begin to see much illness itself not as a cruel twist of fate or some nefarious mystery but rather as an expected and therefore normal consequence of abnormal, unnatural circumstances, it would have revolutionary implications for how we approach everything health related. The ailing bodies and minds among us would no longer be regarded as expressions of individual pathology but as living alarms directing our attention toward where our society has gone askew, and where our prevailing certainties and assumptions around health are, in fact, fictions. Seen clearly, they might also give us clues as to what it would take to reverse course and build a healthier world.

Most of me is in the grips of the distant past, near the beginnings of my life. This kind of physio-emotional time warp, preventing me from inhabiting the present moment, is one of the imprints of trauma, an underlying theme for many people in this culture. In fact, it is so deeply “underlying” that many of us don’t know it’s there. The meaning of the word “trauma,” in its Greek origin, is “wound.” Whether we realize it or not, it is our woundedness, or how we cope with it, that dictates much of our behavior, shapes our social habits, and informs our ways of thinking about the world. It can even determine whether or not we are capable of rational thought at all in matters of the greatest importance to our lives. For many of us, it rears its head in our closest partnerships, causing all kinds of relational mischief.

It may seem counterintuitive, but this reflexive rejection of the loving mother is an adaptation: “I was so hurt when you abandoned me,” says the young child’s mind, “that I will not reconnect with you. I don’t dare open myself to that pain again.” In many children—and I was certainly one—early reactions like these become embedded in the nervous system, mind, and body, playing havoc with future relationships. They show up throughout the lifetime in response to any incident even vaguely resembling the original imprint—often without any recall of the inciting circumstances.

“My problem is that I am married to someone who understands me,” I have often grumbled, only partly in jest. Really, of course, my great blessing is to be married to someone with healthy boundaries, who sees me as I am now and who will no longer bear the brunt of my prolonged and unplanned visits to the distant past.

As I use the word, “trauma” is an inner injury, a lasting rupture or split within the self due to difficult or hurtful events. By this definition, trauma is primarily what happens within someone as a result of the difficult or hurtful events that befall them; it is not the events themselves. “Trauma is not what happens to you but what happens inside you” is how I formulate it. Think of a car accident where someone sustains a concussion: the accident is what happened; the injury is what lasts. Likewise, trauma is a psychic injury, lodged in our nervous system, mind, and body, lasting long past the originating incident(s), triggerable at any moment. It is a constellation of hardships, composed of the wound itself and the residual burdens that our woundedness imposes on our bodies and souls: the unresolved emotions they visit upon us; the coping dynamics they dictate; the tragic or melodramatic or neurotic scripts we unwittingly but inexorably live out; and, not least, the toll these take on our bodies.

Trauma, until we work it through, keeps us stuck in the past, robbing us of the present moment’s riches, limiting who we can be. By impelling us to suppress hurt and unwanted parts of the psyche, it fragments the self. Until seen and acknowledged, it is also a barrier to growth. In many cases, as in mine, it blights a person’s sense of worth, poisons relationships, and undermines appreciation for life itself. Early in childhood it may even interfere with healthy brain development. And, as we will witness, trauma is an antecedent and a contributor to illness of all kinds throughout the lifespan.

7] These might include bullying by peers, the casual but repeated harsh comments of a well-meaning parent, or even just a lack of sufficient emotional connection with the nurturing adults. Children,

especially highly sensitive children, can be wounded in multiple ways: by bad things happening, yes, but also by good things not happening, such as their emotional needs for attunement not being met, or the experience of not being seen and accepted, even by loving parents. Trauma of this kind does not require overt distress or misfortune of the sort mentioned above and can also lead to the pain of disconnection from the self, occurring as a result of core needs not being satisfied. Such non-events are what the British pediatrician D. W. Winnicott referred to as “nothing happening when something might profitably have happened”—a subject we will return to when we consider human development. “The traumas of everyday life can easily make us feel like a motherless child,” writes the psychiatrist Mark Epstein.[8]

“Trauma is when we are not seen and known.”

What causes such a disconnect? In my case, the answer requires no speculation. As an infant in wartime Hungary, I endured chronic hunger and dysentery, states of acute discomfort threatening and distressing to adults, let alone to a one-year-old. I also absorbed the terrors and unrelenting emotional distress of my mother. In the absence of relief, a young person’s natural response—their only response, really—is to repress and disconnect from the feeling-states associated with suffering. One no longer knows one’s body. Oddly, this self-estrangement can show up later in life in the form of an apparent strength, such as my ability to perform at a high level when hungry or stressed or fatigued, pushing on without awareness of my need for pause, nutrition, or rest. Alternatively, some people’s disconnection from their bodies manifests as not knowing when to stop eating or drinking—the “enough” signal doesn’t get through. In

“We have feelings because they tell us what supports our survival and what detracts from our survival,” the late neuroscientist Jaak Panksepp once said. Emotions, he stressed, emerge not from the thinking brain but from ancient brain structures associated with survival. They are drivers and guarantors of life and development. Intense rage activates the fight response; intense fear mobilizes flight.

I would have thus exhibited what is called response flexibility: the ability to choose how we address life’s inevitable ups and downs, its disappointments, triumphs, and challenges. “Human freedom involves our capacity to pause between stimulus and response and, in that pause, to choose the one response toward which we wish to throw our weight,” wrote the psychologist Rollo May.[12] Trauma robs us of that freedom.

The past hijacks and co-opts the present, again and again.

“Contained in the experience of shame,” writes the psychologist Gershen Kaufman, “is a piercing awareness of ourselves as fundamentally deficient in some vital way as a human being.”[13] People bearing trauma’s scars almost uniformly develop a shame-based view of themselves at the core, a negative self-perception most of them are all too conscious of. Among the most poisonous consequences of shame is the loss of compassion for oneself. The more severe the trauma, the more total that loss.

“Everything has mind in the lead, has mind in the forefront, is made by the mind.” Thus opens the Dhammapada, the Buddha’s timeless collection of sayings.[15] Put another way, the world we believe in becomes the world we live in. If I see the world as a hostile place where only winners thrive, I may well become aggressive, selfish, and grandiose to survive in such a milieu. Later in life I will gravitate to competitive environments and endeavors that can only confirm that view and reinforce its validity. Our beliefs are not only self-fulfilling; they are world-building.

Work pressures, multitasking, social media, news updates, multiplicities of entertainment sources—these all induce us to become lost in thoughts, frantic activities, gadgets, meaningless conversations. We are caught up in pursuits of all kinds that draw us on not because they are necessary or inspiring or uplifting, or because they enrich or add meaning to our lives, but simply because they obliterate the present. In an absurd twist, we save up to buy the latest “time-saving” devices, the better to “kill” time. Awareness of the moment has become something to fear. Late-stage capitalism is expert in catering to this sense of present-moment dread—in fact, much of its success depends on the chasm between us and the present, our greatest gift, getting ever wider, the false products and artificial distractions of consumer culture designed to fill in the gap.

What is lost is well described by the Polish-born writer[*] Eva Hoffman as “nothing more or less than the experience of experience itself. And what is that? Perhaps something like the capacity to enter into the textures or sensations of the moment; to relax enough so as to give oneself over to the rhythms of an episode or a personal encounter, to follow the thread of feeling or thought without knowing where it leads, or to pause long enough for reflection or contemplation.”[16] Ultimately, what we are distracted from is living.

The news gets better: seeing trauma as an internal dynamic grants us much-needed agency. If we treat trauma as an external event, something that happens to or around us, then it becomes a piece of history we can never dislodge. If, on the other hand, trauma is what took place inside us as a result of what happened, in the sense of wounding or disconnection, then healing and reconnection become tangible possibilities. Trying to keep awareness of trauma at bay hobbles our capacity to know ourselves. Conversely, fashioning from it a rock-hard identity—whether the attitude is defiance, cynicism, or self-pity—is to miss both the point and the opportunity of healing, since by definition trauma represents a distortion and limitation of who we were born to be. Facing it directly without either denial or overidentification becomes a doorway to health and balance.

A 1982 German study presented at the fourth international Symposium on the Prevention and Detection of Cancer in London found certain personality traits to have a strong association with breast cancer. Fifty-six women admitted to hospital for biopsy were evaluated for characteristics such as emotional suppression, rationalization, altruistic behavior, the avoidance of conflict, and the superautonomous self-sufficiency we saw embodied by Caroline. Based on the interview results alone, both the interviewers and “blind” raters who had no direct contact with the women were able to predict the correct diagnosis in up to 94 percent of all cancer patients, and in about 70 percent of the benign cases.

In the Hindu scripture the Bhagavad Gita, the divine avatar Krishna declares, “They live in wisdom who see themselves in all and all in them.” And the early seventeenth-century cleric and poet John Donne famously mused, “No man is an island, entire of itself.”

What we call the personality traits, in addition to reflecting genuine inborn temperaments and qualities, also express the ways that people, as children, had to accommodate their emotional environment. They reflect much that is neither inherent nor immutable about a person, no matter how closely identified he or she is with them. Nor are they character faults; though they may cause us difficulty now, they began as modes of survival.

As far back as 1892 the great Canadian-born Johns Hopkins physician William Osler—later knighted by Queen Victoria for his contributions to British medicine—had already noted “the association of the disease with shock, worry, and grief.” Many years later, a 1965 survey reported the prevalence in rheumatoid arthritis–prone individuals of an array of self-abnegating traits: a “compulsive and self-sacrificing doing for others, suppression of anger, and excessive concern about social acceptability.”[16] An unusually perceptive Canadian specialist in autoimmune disease, Dr. C. E. G. Robinson, wrote in 1957 that his patients with RA “usually tried very hard to please both in professional and personal contacts, and either concealed hostility or expressed it indirectly. Many of them were perfectionistic.” The onset of disease was often preceded by stress. He added, sagely, “Frequently as much time is needed for dealing with the emotional problems of the patient with chronic rheumatoid arthritis as with the joint or systemic disorders . . . I think the emotional and psychological aspect of many rheumatoid patients is of first importance.”[17] Four decades after Dr. Robinson published his comments, American researchers likewise found that the degree of interpersonal stress was correlated with disease severity among a group of women with rheumatoid arthritis.[18]

Cancer is no more a disease of cells than a traffic jam is a disease of cars. A lifetime study of the internal-combustion engine would not help anyone to understand our traffic problems . . . A traffic jam is due to a failure of the normal relationship between driven cars and their environment and can occur whether they themselves are running normally or not.

“A disease is not like a thing. It is energy flow, it’s a current; it is evolution or devolution that occurs when you’re not awake and connected, and trauma is essentially ruling your life. I think it’s such a mistake to identify it as a thing, because that makes it hard matter when it’s in fact a much more psychological, spiritual, emotional condition.” This hard-won perspective raises some unfamiliar, potentially fruitful questions. What if, she writes, “when you got sick, you weren’t a stage [of a disease] but in a process? And cancer, just like having your heart broken, or getting a new job, or going to school, were a teacher? What if, rather than being cast out and defined by some terminal category, you were identified as someone in the middle of a transformation that could deepen your soul, open your heart?”

It may be that these martial metaphors are so appealing because their force matches our feelings of anger and despair; that does not, however, make them helpful.

Beyond the declarations of war, there is another, even more popular class of misapprehensions that cloud our view of disease: “I have cancer.” “She has MS.” “My nephew has ADD.” Embedded in each phrase is the unexamined assumption that there is an I (or a someone) distinct and independent from the thing called disease, which the “I” has—as in the statement “I have a flat-screen TV.” Here is my life, and over there is the disease that has encroached upon it. Seen this way, disease is something external with its own nature, existing independently of the person in whom it shows up. Given where that perspective has gotten us, it is time to consider a new one.

One of the things many diseases have in common is inflammation, acting as kind of a fertilizer for the development of illness. We’ve discovered that when people feel threatened, insecure—especially over an extended period of time—our bodies are programmed to turn on inflammatory genes.”

“I had been a stereotypical good girl, overachiever, top of my class, always pushing to develop my talent and intellect, not to satisfy me but to be accepted by others,” she told me. That relentless pressure, she learned, manifested in her medical conditions. She had to let it go.

As Lissa Rankin realized, much good can come from an open-minded engagement with the process that disease represents. It may not be the guest we ever desire to see, but a modicum of hospitality—welcoming the unwelcome, so to speak—costs us nothing. It may even lead to an opportunity to find out why this particular visitor has come to call, and what it might tell us about our lives.

But there is such a thing as a lust for life, and then there is being driven to derive one’s sense of self from constant activity, even to the point of not being able to pause for self-care when disaster strikes.

It is sobering to realize that many of the personality traits we have come to believe are us, and perhaps even take pride in, actually bear the scars of where we lost connection to ourselves, way back when. The sources of these scars are most often evident in their shape, so to speak: in many cases, specific traits can be traced to particular kinds of wounding. For example, if we don’t receive the agenda-free, unconditional attention we all require, one way to guard against that deprivation is to become concerned with physical attractiveness or other attention-getting attributes or accomplishments. A child who does not experience himself as consistently and unconditionally lovable may well grow to be preternaturally likable or charming, as with many a politician or media personality. Someone who is not valued or recognized for who she is early in life may develop an outsize appetite for status or wealth. If we are not made to feel important for just who we are, we may seek significance by becoming compulsive helpers—a syndrome I know intimately. And here’s the final part of the disappearing act: as mentioned, in our culture, many of these compensations for what we lost are seen as not only normal but even admirable. Valued as “strong suits,” they too often encase and wall off the authentic self by assuming its guise.

Every society makes assumptions about human nature, and ours is no exception. “It’s human nature,” we say, shrugging our shoulders at someone’s—often our own—manipulative, self-serving behavior. “Interestingly,” notes the educator Alfie Kohn, “the characteristics we explain away in this fashion are almost always unsavory; an act of generosity is rarely dismissed on the grounds that it is ‘just human nature.’”[1] 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.

Neufeld sums up eloquently what all young ones, whatever their temperament, need first and foremost: “Children must feel an invitation to exist in our presence, exactly the way they are.” With that need in mind, 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. The child doesn’t have to do anything, or be any different, to win that love—in fact, cannot do anything, because 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, even if it elicits momentary anger or requires correction. Operating from this attitude may even allow us to see the child’s “misbehavior” in a broader, more forgiving frame—perhaps it expresses a need frustrated, a communication unheard, an emotion unprocessed. We understand and respond to the needs an...

Though it no doubt runs diametrically counter to most parents’ intentions, a child whose cries are not responded to, who is not fed, not held close to a parent’s warm body when in distress, learns a clear if wordless lesson: that his needs will not be met, that he must constantly strive to find rest and peace, that he is not lovable as he is. By taxing my brain’s PANIC/GRIEF system, my poor mother’s non-responsiveness also helped wire my brain for those chronic tendencies of mine that express the overactivation of that system: anxiety and depression. “When our brains are undercared for,” writes Darcia Narvaez, “they become more stress-reactive and subject to dominance by our survival systems—fear, panic, rage.” Don’t I know it.

Long before we had brain scans, blood tests, ultrasounds, and fetal heart monitors, ancient peoples intuitively understood the sanctity of the intrauterine environment. I spoke once about addiction to a First Nations group here in British Columbia, quoting studies on prenatal development such as cited above. A young man came up to me afterward. “You know,” he said, “in our clan, tradition was that if you were angry or upset, you weren’t even allowed to go near a pregnant woman. We didn’t want you to inflict your troubles on her baby.” In some African tribal societies, infants were greeted by rituals while still in the mother’s belly, including with songs that would later welcome them into the world.[18] Imagine hearing your own melody and lyrics, already familiar to you, as you are ceremonially ushered into your new home, the outside world. Such collective traditions have mostly been lost to colonialism and atomization, but we can still learn from them and apply their lessons.

Support. If we want to build a world that provides it, we could start by asking its would-be recipients what the word means to them. I recently asked Rae—if I could do it over again, I would have done so long before now—what would have supported her back then. I can’t improve upon the wisdom, nor the accuracy, of her answer: “It would have helped if I had had a community in place. If there existed a larger consensus in our culture of what is required to gestate a baby. It would have helped if I had had a doctor or a social worker or family member who could have stood up for me. If the doctor had asked me, even once, how I was faring emotionally . . . If anyone had phoned my husband: ‘Are you aware you are hurting your baby? Whatever problems you have with your wife, your role now is to be protective of her and of the infant she is carrying.’ We all need to realize that entering a pregnancy should be like entering a shrine, a sacred place and time: a baby is being built. “Mental health needs to be on the curriculum as soon as a woman gets pregnant—just as there are prenatal classes for the physical birth, so there should be for the emotional birth. The woman’s focus must be on the baby, and not on the husband or even the job; the husband’s focus—everyone’s focus—must be on supporting the woman. Parents need to know that their job is mutual, that while the wife is pregnant, the husband is also pregnant. Society needs to protect pregnant women because everybody is creating th...

Parental stress expresses itself in less overt ways, too, such as distraction and emotional absence. Many parents, though loving, are frequently preoccupied by genuine concerns about relationship issues or economic troubles or personal problems and, as a result, just aren’t as attentive or “present.” This affects

Making matters more stressful is the alienation imposed by financial hardship. “The relentlessness of modern-day parenting has a powerful motivation: economic anxiety,” the New York Times reported in 2018. “For the first time, it’s as likely as not that American children will be less prosperous than their parents. For parents, giving children the best start in life has come to mean doing everything they can to ensure that their children can climb to a higher class, or at least not fall out of the one they were born into.”[20] The unintended impact of such fearful, status-driven child-rearing is that the child’s irreducible emotional needs fall secondary to the desperation of parents striving to ensure the academic and financial success of their offspring. Recently I was told, by a close eyewitness, of a middle-class mother yelling at her five-year-old son who balked at doing his homework: “You’re not thinking of your academic future!” the poor mom shouted at the preschooler. If only the youngster could have retorted, “Yeah? Well, you’re not thinking of my psycho-emotional future!”

Mothers, whose need for connection is an especially high-stakes matter, are among the hardest hit by these shifts. Adrienne Rich notes that during the relative affluence of the mid-twentieth century, “the move to the suburbs, to the smaller, then the larger, private house, the isolation of ‘the home’ from other homes . . . The working-class mothers in their new flats and the academic wives in their new affluence all lost something: they became, to a more extreme degree, house-bound, isolated women.”[27] Such tendencies are exerting themselves internationally and with growing force under the sway of globalized capitalism.

All young mammals play, and for critical reasons. As the neuroscientist Jaak Panksepp identified, we have a designated “PLAY” system in our brains in common with other mammals. Play is a primary engine of brain development and is also essential to the emotional maturation process. “As a species, we have evolved culturally in a large part because of our playfulness and all that it produces by way of intelligence and productivity,” James Garbarino writes.[15] And true play, Gordon Neufeld insists, is not outcome-based: the fun is in the activity, not the end result. Free play is one of the “irreducible needs” of childhood, and it’s being sacrificed to both consumerism and the digital culture. “The culture is not respecting normal developmental tasks,” the neuroscientist Stephen Porges told me. “Normal developmental tasks are to play with another person, not with an Xbox. Not to talk on a cell phone or text, but to make face-to-face interactions. All these things are neural exercises that provide resilience, creating an ability for an individual to regulate their internal emotional states.”

“The message that competition is appropriate, desirable, required, and even unavoidable is drummed into us from nursery school to graduate school; it is the subtext of every lesson,” writes educational consultant Alfie Kohn in his excellent book No Contest: The Case Against Competition: Why We Lose in Our Race to Win, which documents the negative impact of competition on genuine learning, and how competition, praise, grades, rewards, and sanctions imposed on recalcitrant children destroy intrinsic motivation and undermine emotional security.[18] “Does praise motivate kids? Sure it does,” Kohn sarcastically remarks. “It motivates kids to get praise.”

As Thomas Merton noted dolefully in 1948, “We live in a society whose whole policy is to excite every nerve in the human body and keep it at the highest pitch of artificial tension, to strain every human desire to the limit and create as many new desires and synthetic passions as possible, in order to cater to them with the products of our factories and printing presses and movie studios and all the rest.”[7] Constantly living at that “highest pitch of artificial tension” leaves many people dissatisfied, on edge, anxious—utterly captured by an addictive process that alienates them from real needs, real emotions, real concerns, real life.

Over my decades of medical practice and thousands of conversations, I have learned that the first question to ask is not what is wrong with an addiction, but what is “right” about it. What benefit is the person deriving from their habit? What does it do for them? What are they getting that they otherwise can’t access? This inquiry is key to understanding any addiction, whether to substances like alcohol, opiates, cocaine, crystal meth, sniffed glue, or junk food, or to behaviors such as gambling, compulsive sexual roving, pornography, or binge eating and purging. Or to power and profit, for that matter—here, of course, we begin to shade toward addictions that go well beyond individual habits into the realm of collective fixations.

Richard Bentall, a clinical psychologist, academic, and Fellow of the British Academy, summed up the science a few years ago: “The evidence of a link between childhood misfortune and future psychiatric disorder is about as strong statistically as the link between smoking and lung cancer,” he wrote. “There is also now strong evidence that these kinds of experiences affect brain structure, explaining many of the abnormal neuro-imaging findings that have been reported for psychiatric patients.”[12]

“Genes affect how sensitive one is to environment, and environment affects how relevant one’s genetic differences may be,” the leading geneticist R. C. Lewontin has said. “When an environment changes, all bets are off.”[14] Some people will feel more pain and will therefore have greater need to escape into the adaptations that mental illness, or addiction, represent. They will have more need to tune out, to dissociate, to split into parts, to develop fantasies to account for realities they are unable to endure. But that’s a far cry from saying that they have a heritable neurobiological disease. These are the children that Tom Boyce, a professor of pediatrics and psychiatry at the University of California, San Francisco, describes as orchids, “exquisitely sensitive to their environment, making them especially vulnerable under conditions of adversity but unusually vital, creative, and successful within supportive, nurturing environments.”[15] The same “sensitivity” genes that in a stressed environment can help potentiate mental suffering may, under positive circumstances, help promote stronger mental resilience and therefore happiness.[16] Sensitive people have the potential to be more aware, insightful, inventive, artistic, and empathic, if their sensitivity is not crushed by maltreatment or disdain. The most sensitive of our kind have made some of the most lasting cultural contributions; many of these have also suffered the most intense pains during their lives. Sensitivit...

“The child can . . . feel the tension, rigidity and pain in the body of the mother or of anyone else he is with,” writes the psychological thinker and spiritual teacher A. H. Almaas. “If the mother is suffering, the baby suffers too. The pain never gets discharged.”[1] I could not have endured such emotional torment if I had felt it fully—no infant could. Nor was there room for my own sorrow and rage at the separation from my mother at less than one year of age.

The capacity to recognize safety or threat will evolve in a healthy way under conditions of safety but be disrupted by prolonged early insecurity. Possible outcomes include feeling besieged when there is no threat, or conversely, remaining oblivious to danger when it is present.

Even the nomenclature should give us pause: the Greek origin of “schizophrenia” means “split mind.” The question follows naturally: Why would a mind need to split itself? Self-fragmentation is one of the defenses evoked when the experience of how things are cannot be endured. Only those who know real life to be an insufferable bane are impelled to check out from it.