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

by Gabor Maté

The source of that sense of overweening power soon began to surface. “My parents went through a really hard time when I was eleven,” Caterina recalled. “They would have horrible fights at night . . . and they would scream at each other. My dad would cry to me . . . understandably, because he was going through a lot, and we were really close.” That “closeness,” really an unhealthy lack of boundaries that psychologists call “fusion,” had persisted throughout Caterina’s formative years. Harmful as the dynamic was, in Caterina’s mind it was her moral duty to protect her parents: she wore her inability to hold her family together like a badge of shame, proof of her unworthiness. Absorbing a parent’s sorrow is not the Nature-given responsibility of a child. “The reversal of roles between child, or adolescent, and parent, unless very temporary, is almost always not only a sign of pathology in the parent but a cause of it in the child,” wrote the great pioneer of attachment research and personality development, the British psychiatrist John Bowlby.[19]

What, in our society, are the most widespread emotional triggers for stress? My own observations of self and others have led me to endorse fully what a review of the stress literature concluded, namely that “psychological factors such as uncertainty, conflict, lack of control, and lack of information are considered the most stressful stimuli and strongly activate the HPA axis.”[3] A society that breeds these conditions, as capitalism inevitably does, is a superpowered generator of stressors that tax human health. Capitalism is “far more than just an economic doctrine,” Yuval Noah Harari observes in his influential bestseller Sapiens. “It now encompasses an ethic—a set of teachings about how people should behave, educate their children, and even think. Its principal tenet is that economic growth is the supreme good, or at least a proxy for the supreme good, because justice, freedom, and even happiness all depend on economic growth.”[4] Capitalism’s influence today runs so deep and wide that its values, assumptions, and expectations potently infuse not only culture, politics, and law but also such subsystems as academia, education, science, news, sports, medicine, child-rearing, and popular entertainment. The hegemony of materialist culture is now total, its discontents universal.

As a speaker on stress and trauma I’m often asked what lessons we may derive from the COVID-19 pandemic. Chief among them, surely, is the indispensability of connection—a quality globalized materialism has increasingly drained from modern culture, long before the isolation imposed by the virus reminded us of life’s spiritual impoverishment without it. The health impacts are immeasurable.

A society that fails to value communality—our need to belong, to care for one another, and to feel caring energy flowing toward us—is a society facing away from the essence of what it means to be human.

If a gene or virus were found that caused the same impacts on the population’s well-being as disconnection does, news of it would bellow from front-page headlines. Because it transpires on so many levels and so pervasively, we almost take it for granted; it is the water we swim in. We are steeped in the normalized myth that we are, each of us, mere individuals striving to attain private goals. The more we define ourselves that way, the more estranged we become from vital aspects of who we are and what we need to be healthy.

That loss of meaning, Duhigg says, afflicts “even professionals given to lofty self-images, like those in medicine and law.” Why would this be? the author wondered. The answer: “Oppressive hours, political infighting, increased competition sparked by globalization, an ‘always-on culture’ bred by the internet—but also something that’s hard for these professionals to put their finger on, an underlying sense that their work isn’t worth the grueling effort they’re putting into it.”[5] It’s simple economics, really: artificial inflation (of self-concept, of identity, of material ambition) is bound to lead to a downturn or even a crash when the bubble inevitably bursts.

Corporations are ingenious at exploiting people’s needs without actually meeting them. Naomi Klein, in her book No Logo, made vividly clear how big business began in the 1980s to home in on people’s natural desire to belong to something larger than themselves. Brand-aware companies such as Nike, Lululemon, and the Body Shop are marketing much more than products: they sell meaning, identification, and an almost religious sense of belonging through association with their brand. “That presupposes a kind of emptiness and yearning in people,” I suggested when I interviewed the prolific author and activist. “Yes,” Klein replied. “They tap into a longing and a need for belonging, and they do it by exploiting the insight that just selling running shoes isn’t enough. We humans want to be part of a transcendent project.”

Whatever one might say about the corporate, social, or ecological ethics of firms like Ford or General Motors, the unionized jobs they provided did keep generations of families employed gainfully and, for many, even meaningfully.

Depression, anxiety, and substance abuse also tend to be higher among people who value the aims encouraged by consumer society.” He points to four central principles of what he calls ACC—American corporate capitalism: it “fosters and encourages a set of values based on self-interest, a strong desire for financial success, high levels of consumption, and interpersonal styles based on competition.”[13]

Not all psychopaths are in prison. Some are in the boardroom. —R. D. Hare, Ph.D.

“It’s not what you are eating,” someone cleverly said, “it’s what’s eating you.” Stress induces people to “choose” unhealthy foods and to put on weight in the wrong places, promoting disease. It also depletes the serotonin/contentment circuits, shifting the brain’s functioning toward the short-term, dopamine-fueled pleasure mechanisms.

Historically the idea of race arose from the impulse of European capitalism to enrich itself by subjugating, enslaving, and, if necessary, destroying Indigenous people on other continents, from Africa to Australia to North America. Indeed, the word “race” did not exist in any meaningful way until it was created in the late eighteenth century. Psychologically, on the individual level, the “othering” racism entails is an antidote to self-doubt: if I don’t feel good about myself, at least I can feel superior to somebody and gain a sense of power and status by claiming privilege over them.

“The anti-Semite,” wrote the French philosopher Jean-Paul Sartre, “is a man who is afraid. Not of the Jews, to be sure, but of himself and his own consciousness, of his liberty, of his instincts, of his responsibilities, of solitariness, of change, of society, and of the world . . . The existence of the Jew merely permits the anti-Semite to stifle his anxieties.”

The brilliant writer James Baldwin once said, “What white people have to do is try and find out in their own hearts why it was necessary to have a n—— in the first place. If you, the white people, invented him, then you’ve got to find out why.”

Such loss of self, in Dworkin’s phrase, becomes women’s portion in large part because, in addition to their role in providing for their families’ economic and physical needs, they are the designated emotional caregivers, at their own expense. The task of caring, in fact, falls largely to women in this culture. The contemporary phrase emotional labor does a great job of conveying the joblike nature of this stress-inducing, externally imposed role. Arguably to an even greater degree than housework and childbirth, this is the proverbial “woman’s work” that “is never done.”

Women often serve as the emotional glue—the connective tissue, if you like—that keeps nuclear and extended families and communities together. It is no coincidence they suffer far more than men do from diseases of actual connective tissue, among which lupus, rheumatoid arthritis, scleroderma, fibromyalgia, and their multiple relatives are variants. Thus, these conditions, as most chronic maladies do, reflect social dynamics along the lines we have been investigating throughout, not simply individual physiology gone rogue.

It is no secret that the stress of caregiving enfeebles the immune system. The caretakers of Alzheimer patients, for example—the vast majority of whom are women—have significantly diminished immune function and poorer wound healing, suffer more respiratory illness, and experience much higher rates of depression than well-matched non-caregiving peers.[17] Immunity is not the only function impaired by caregiver stress. Mothers looking after emotionally challenged children were found to have abn...

Our society reinforces men’s sense of being entitled to women’s care in a way that almost escapes being put into words. I refer here to the automatic mothering women provide their male partners, the emotional sustenance that forms the invisible mortar of many heterosexual relationships: a very conventional dynamic that speaks to how tenacious gendered social constructs are, how thoroughly steeped we are in them. Some men are aware of the care they receive only in its absence and experience intense resentment when it is withdrawn; for example, when their female partner is preoccupied elsewhere, as when children are born.

“Girls are given all sorts of overt and covert messages that the way to get along is to go along and seek consensus, make sure everybody else is happy,” she said. “You know, they see their mothers. I definitely saw my mom doing this for my father—making dinner, doing the dishes, doing the laundry. He’s reading the paper after dinner . . . You take on somebody else’s pain.

In Down Girl: The Logic of Misogyny, the contemporary feminist philosopher Kate Manne, associate philosophy professor at Cornell University, gives us a handy way of conceptualizing the expectations held of women and the demands made on them: feminine-coded goods and services—those which are “hers to give.” They include “attention, affection, admiration, sympathy, sex, and children (i.e., social, domestic, reproductive, and emotional labor); . . . safe haven, nurture, security, soothing, and comfort.” These are counterposed with the masculine-coded perks and privileges that are “his for the taking”: for example, “power, prestige . . . rank, reputation, honor . . . hierarchical status, upward mobility, and the status conferred by having a high-ranking woman’s loyalty, love, devotion, etc.”[21] It is not hard to intuit which of these groupings would entail and engender (no pun intended) more self-suppression, sacrifice, and stress. Bear in mind, too, that Manne is depicting here women of relative privilege. So many others, in addition to assigned gender roles, struggle under the heavy freight of poverty, single parenthood, and racial discrimination. We have seen the cost in health these intersectional misfortunes exact.

When I speak of patriarchy, I mean not the conscious will nor, often, even the conscious awareness of individual men, but a system of power. Although patriarchy is ancient, having arisen with the dawn of civilization, capitalism has comfortably adapted it to its needs—we see that played out in economics, in politics, in all institutions of this society, as in the home. Men pay a price, too, even as they reap the dubious “benefits” of the system that privileges them. When I reduce my wife to an object whose purpose is to keep me satisfied, what role am I casting myself in? An impotent, dependent child whose emotional welfare hinges on Mommy’s willingness to comply with my perceived needs. This child, in an adult body, struts, remonstrates, sulks, and makes demands on his caregiver. He is never sated, never satisfied. Both partners, in their own ways, are powerless.

Men’s suffering, too, is part of the patriarchal cycle, in the mix as both effect and cause. The taboo against vulnerability, in particular, is deeply harmful to men as well as to women. Anger may be more permissible among men, but sadness, grief, or “weakness”—which really just means acknowledging one’s limits—are not.

Friedrich Nietzsche wrote somewhere that people lie their way out of reality when they have been hurt by reality, and this is eminently true of Donald Trump’s origin story. Lying, automatic or deliberate, first insulated him from devastating rejection in childhood, and later served him in the realm of political power.

asked Daniel Siegel what draws people to follow leaders who exude hostility and an authoritarian streak, such as a Donald Trump. “People may actually feel excitement that someone in the public eye is expressing aggression or assertion, the opposite of impotence,” the psychiatrist and mind researcher said, noting how such traits can feel empowering to those in whom a sense of real power is wanting. “It’s like a child wanting to be with a parent that will protect them. There is a sense of ‘I’m going to be safe and everything is going to be okay.’” What Dan describes is also a sense memory, an indelible and usually unexplored imprint from childhood, a longing stored in the bodymind and activated by present-day insecurities projected into the political realm. On the liberal side, idealizing leaders as kind, supportive, caring, and inclusive can be another form of displaced longing for attuned parenting. One prominent Democratic-supporting celebrity, the song parodist known as Randy Rainbow, tweeted out a photo of a smiling Joe Biden with Kamala Harris the night she was announced as Biden’s running mate. His caption read “G’night, Mom and Dad. See you in the morning.”[16] People under the sway of such childlike idealizations, even in half jest, are liable to ignore discomfiting counterevidence.

A change of worldview can change the world viewed. —Joseph Chilton Pearce, The Crack in the Cosmic Egg: New Constructs of Mind and Reality

When I speak of healing, I am referring to nothing more or less than a natural movement toward wholeness. Notice that I do not define it as the end state of being completely whole, or “enlightened,” or any similar psychospiritual ideal. It is a direction, not a destination; a line on a map, not a dot. Nor is healing synonymous with self-improvement. Closer to the mark would be to say it is self-retrieval.

The lack of authenticity makes itself known through tension or anxiety, irritability or regret, depression or fatigue. When any of these disturbances surface, we can inquire of ourselves: Is there an inner guidance I am defying, resisting, ignoring, or avoiding? Are there truths I’m withholding from expression or even contemplation, out of fear of losing security or belonging? In a recent encounter with others, is there some way I abandoned myself, my needs, my values? What fears, rationalizations, or familiar narratives kept me from being myself? Do I even know what my own values are? The growing capacity to admit to oneself, “Ouch, that hurts,” or “You know, I didn’t really mean what I just said,” or “I’m really scared to be myself in this situation” is the impulse toward authenticity becoming stronger. After enough noticing, actual opportunities for choice begin to appear before we betray our true wants and needs.

People often ask me to define "healthy anger." Here’s what it’s not: blind rage, bluster, resentment, spite, venom, or bile. All of these stem from an unhealthy buildup of unexpressed or unintegrated emotions that need to be experienced and understood rather than acted out.

The fact—and some people may need to actively remind themselves of this—is that we are talking about a valid, natural feeling that does not in itself intend anyone any harm. Anger in its pure form has no moral content, right or wrong—it just is, its only “desire” a noble one: to maintain integrity and equilibrium.

We can also observe how our inability to say no fuels chronic resentment that leaves us prone to harmful combustions.

Anger’s core message is a concise and potent no, said as forcefully as the moment demands. Wherever we find ourselves tolerating or explaining away situations that persistently stress us, insisting that “it’s not so bad” or “I can handle it” or “I don’t want to make a fuss about it,” there is likely an opportunity to practice giving anger some space to emerge. Even the plainspoken admission that “I don’t like this” or “I don’t want this” can be a step forward.

Acceptance also means accepting how downright difficult it can be to accept. It may seem paradoxical, but true acceptance denies or excludes no aspect of how it is, not even our impulse to reject how it is. Anger, sadness, trepidation, resistance, even hatred—within an accepting attitude, these all have room to say their piece. Sometimes accepting ourselves starts with facing that we don’t know how we feel, or that our feelings are mixed. Rejection of any part of our experience is an unnatural self-rejection, one that nonetheless feels normal to many of us. You’ve made some serious mistakes? You find yourself filled with hatred, or resentment, or confusion? These, too, are candidates for acceptance; underneath them there is always pain. In fact, hatred, resentment, and even confusion can be the psyche’s attempts not to feel pain or sadness. Healthy grief—the jewel so often hidden within ossified grievance—frequently waits on the other side of accepting how things are and have been. That, too, can be hard to embrace, but when we forestall the energy of mourning that wants to move through us, we only cause it to build up. As Gordon Neufeld puts it, “We shall be saved in an ocean of tears.”

A distinction must be made between accepting and tolerating. Being with something and putting up with something have precious little to do with each other. Acceptance is vitalizing because it makes room for the other three A’s—it grants admission to anger if such is present, increases our sense of free agency, and makes room for whatever our authentic experience might be. Tolerating the intolerable, on the other hand, is deadening. For example, resigning oneself bleakly to conditions such as abuse or neglect involves rejecting crucial parts of one’s self, needs, and values that deserve to be respected and integrity that needs to be safeguarded. That is far from true acceptance.

The acclaimed neurosurgeon James Doty[*] heads Stanford University’s Center for Compassion and Altruism Research and Education. “There is a subset of people who believe that compassion is soft, that it’s not worthy of scientific study,” he told me during a public conversation we held at the California retreat center 1440 Multiversity.[*] “Yet, I assure you, the science we have today demonstrates these practices of mindfulness, self-compassion, and compassion are some of the most powerful that exist to change your physiology and to benefit you in your own health, mental and physical, and in terms of your longevity.” Compassion, as both salve and salvation, is not limited to the realm of the individual. If we are to dream of a healthier, less fractured world, we will have to harness and amplify compassion’s healing power.

The word “compassion” comes from the Latin, meaning “to suffer with.” Whether or not we experience another’s pain so vividly, entry-level compassion does mean the ability to be with suffering. It also means being moved by the awareness that someone is struggling; it does not register as a neutral fact.

When we notice such an empathy gap in ourselves, instead of self-judgment—itself a lack of compassion—we could well ask what pain we have not yet fully felt and metabolized. We can learn a lot about our own emotional-injury history by observing in what situations, and toward whom, our naturally open and supple hearts tend to harden and shut down.

The second compassion takes as its first principle that everything exists for a reason, and that the reason matters. We ask, without judgment, why a person or group—any person, any group—would end up being the way they are and act the way they do, even or especially when we are vexed or perplexed by it. We might also call this the compassion of context. However sincere our desire to help ourselves or someone else, we cannot do so without beholding the suffering being experienced, including knowing its source as best we can.

Until we recognize our commonality, we create more woe for ourselves and others: for ourselves, because we increase our distance from our humanity and get caught up in the tense physiological states of judgment and resistance; for others, because we trigger their shame and further their isolation. If you are not sure what I mean, the next time you feel intense judgment toward anyone, check in with your body states—the sensations in your chest, belly, throat. Does it feel pleasant? Unlikely; nor is it healthy for you.

The lesson is not that you shouldn’t judge, since it’s not you that’s doing it but rather your automatic mind. To judge yourself for judging is itself to keep the wheel of shame spinning. The opportunity is to inquire into your judgmental mind and body state with compassionate curiosity. Healing flows when we are able to view this hurting world as a mirror for our own pain, and to allow others to see themselves reflected in us as well—recognition paving the way for reconnection. 4.

We may believe it an act of kindness to protect people from experiencing pain. While this is so when it comes to pain that is unnecessary and preventable, there is nothing compassionate about shielding people from the inevitable hurts, disappointments, and setbacks life doles out to all of us, from childhood onward. Such a mission is not only futile, it is counterproductive—and may even ...

Healing, in a sense, is about unlearning the notion that we need to protect ourselves from our own pain. In this way, compassion is a gateway to another essential quality: courage.

The compassion of truth also recognizes that truth may lead, in the short term, to further pain.

There is more to each of us than the conditioned personalities we present to the world, the suppressed or untrammeled emotions we act out, and the behaviors we exhibit. Understanding this allows for what I call the compassion of possibility.

Possibility is connected to many of humanity’s greatest gifts: wonder, awe, mystery, and imagination—the qualities that allow us to remain connected to that which we can’t necessarily prove. It’s up to us to nurture this connection, because the day-to-day world will not always provide us with reassuring evidence. This deepest aspect of compassion recognizes that the seemingly impossible only seems so, and that whatever we most need and long for can actualize at any moment.

Staying open to possibility doesn’t require instant results. It means knowing that there is more to all of us, in the most positive sense, than meets the eye. The same applies to whatever seems the most real, solid, or intractable in us or others. In a famous story, the Buddha saw the universal potential for the humane self to emerge in a notorious criminal who accosted him with murderous intent; the man became his humblest and most gentle follower.

“What happens in these conversations with your rheumatoid arthritis?” I asked Julia, who, since adding therapy, meditation, and other forms of self-work to her low dose of a single drug, has experienced few flare-ups, with no progress of her disease for over a decade and significant improvement in her blood work. “When it speaks to me,” she replied, “rather than seeing it as something I’ve got to push through or go into a big drama about, I literally just feel it. I sit with it, get curious about what’s been happening in my life, what I might be suppressing.”

In contravention of all cultural mores, Julia expressed gratitude for her rheumatoid arthritis. “It saved me,” she said. “It was my body’s way of saying, ‘Wake up, wake up. You’re not helping yourself holding this much anger and rage deep down inside.’ Anger and rage are not feelings I want to hold on to, but I do see them as guides that let me know that something in my life is out of balance. I get [rheumatoid] flare-ups maybe once a year now. When one shows up, I just accept that it’s here and there is something I can do about it, something more to learn from it.” This is a profound testament to the twin power of acceptance and agency—two of the core universal principles of healing we looked at in the last chapter.

Disease’s role as teacher rests in how it leads people to question everything they had thought and felt about themselves, and to retain only what serves their wholeness.

He cannot know how it will go for him, and yet, as the title of his book asserts, he insists the disease has been a blessing. The diagnosis, he told me, served as a wake-up call. “What did it wake you up to?” I asked. “The finite nature of this life, for one thing. It brought the truth of my mortality into a more felt, easier-to-grasp dimension. While we all know it intellectually, psychologically we function with an avoidance or disregard for the reality of death. After the diagnosis, I’d be having conversations with people in the awareness that this might be the last conversation I ever had with that person. And that creates an extraordinary degree of shared presence, listening, care. So yes, total transformation. Day to day when I get out of bed, there is a practice of fully recognizing the gift of this moment, of this day, of this body, of this breathing happening now.” Ours is a culture wholly averse to death and even aging; think of how many products are geared toward erasing or “reversing” the signs of oncoming infirmity, the physical reminders of life’s finitude. Here, then, is another sense in which healing is an upstream journey: it necessarily involves the full-hearted acceptance of the inevitability of our passing and the determination to experience all the days and moments that lead us to our earthly exit.

I’ll say it again: disease is not the authenticity instructor I would wish for any of us. Major calamities of body and mind are only the latest and loudest summons from essential parts of ourselves we have lost touch with. To make such drastic signals less necessary, we can get better at hearing and heeding the more subtle alerts our lives unfailingly send our way, before they become a clamor.