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

by Gabor Maté

Health and wellness have become a modern fixation. Multibillion-dollar industries bank on people’s ongoing investment—mental and emotional, not to mention financial—in endless quests to eat better, look younger, live longer, or feel livelier, or simply to suffer fewer symptoms.

How are we to understand that in our modern world, at the pinnacle of medical ingenuity and sophistication, we are seeing more and more chronic physical disease as well as afflictions such as mental illness and addiction?

I have come to believe that behind the entire epidemic of chronic afflictions, mental and physical, that beset our current moment, something is amiss in our culture itself, generating both the rash of ailments we are suffering and, crucially, the ideological blind spots that keep us from seeing our predicament clearly, the better to do something about it.

We could also understand “toxic” in its more contemporary, pop-psychological sense, as in the spread of negativity, distrust, hostility, and polarization that, no question, typify the present sociopolitical moment.

It is my contention that by its very nature our social and economic culture generates chronic stressors that undermine well-being in the most serious of ways, as they have done with increasing force over the past several decades.

If the same organisms begin showing pathologies at unprecedented rates, or fail to thrive, it’s either because the culture has become contaminated or because it was the wrong mixture in the first place. Whichever the case, we could rightly call this a toxic culture—unsuitable for the creatures it is meant to support.

From a wellness perspective, our current culture, viewed as a laboratory experiment, is an ever-more globalized demonstration of what can go awry.

ours is a toxic culture. Worse yet, we have become accustomed—or perhaps better to say acculturated—to so much of what plagues us. It has become, for lack of a better word, normal.

Indeed, the lives, and the deaths, of individual human beings—their quality and in many cases their duration—are intimately bound up with the aspects of modern society that are “hardest to see and talk about”; phenomena that are, like water to fish, both too vast and too near to be appreciated. In other words, those features of daily life that appear to us now as normal are the ones crying out the loudest for our scrutiny.

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.

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.

Trauma pervades our culture, from personal functioning through social relationships, parenting, education, popular culture, economics, and politics.

“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 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.

“capital-T trauma.” It underlies much of what gets labeled as mental illness. It also creates a predisposition to physical illness by driving inflammation, elevating physiological stress, and impairing the healthy functioning of genes,

capital-T trauma occurs when things happen to vulnerable people that should not have happened,

There is another form of trauma—and this is the kind I am calling nearly universal in our culture—that has sometimes been termed “small-t trauma.”

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.

An event is traumatizing, or retraumatizing, only if it renders one diminished, which is to say psychically (or physically) more limited than before in a way that persists.

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.

Oh.

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.

response flexibility: the ability to choose how we address life’s inevitable ups and downs, its disappointments, triumphs, and challenges.

It is a marker of our culture’s insanity that certain individuals who flee from shame into a shameless narcissism may even achieve great social, economic, and political status and success.

Our beliefs are not only self-fulfilling; they are world-building.

If trauma entails a disconnection from the self, then it makes sense to say that we are being collectively flooded with influences that both exploit and reinforce trauma. 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.

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.

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.

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,

In a study of men with prostate cancer, anger suppression was associated with a diminished effectiveness of natural killer (NK) cells—a frontline immune system defense against malignancy and foreign invaders. These cells play a key role in tumor resistance.[7] In previous research, NK cell activity was reduced in healthy young people in response to even relatively minor stresses—especially for those who were emotionally isolated, a significant source of chronic stress.

It’s not only events as such but also our emotional responses and how we process them that affect our physiology.)

stress may disable our immune systems’ capacity to control and eliminate malignancy.

A (relatively) new science, psychoneuroimmunology maps the myriad pathways of the bodymind unity; its field of study includes the connections between emotions and our nervous and immune systems, and how stress might instigate disease.

The renowned American stress researcher Bruce McEwen[*] popularized the word “allostasis” to capture the body’s attempt to maintain inner equilibrium in the face of changing circumstances.

“staying the same amid change.” We cannot do without it, and so our bodies will go to great lengths to maintain it—even to the point of long-term wear and tear if stresses do not abate. Such strain on our body’s regulatory mechanisms, which McEwen dubs “allostatic load,” leads to an excessive and prolonged release of the stress hormones adrenaline and cortisol, nervous tension, immune dysfunction,

The interrelatedness of seemingly isolated organisms has now been discovered even in the lives of trees that form living networks, communicating through electrical impulses akin to animal and human nervous systems, hormones, chemical signals, and scents.

Although modern medicine’s focus on the individual organism and its internal processes isn’t wrong as such, it misses something vital: the pivotal influence of the mental, emotional, social, and natural environments in which we live. Our biology itself is interpersonal.

our bodies influence our brains and minds and, necessarily, the brains, minds, and bodies of others.

factors such as poverty, racism, and urban blight can directly impact our genetic and molecular functioning.

Like all building blocks, genes help make up the language of existence, but it is through the workings of epigenetics that they are activated, accented, or quieted. The mechanisms of epigenetics include, among myriad others, adding certain molecules to DNA sequences so as to change gene function, modifying the numbers of receptors for certain messenger chemicals, and influencing the interactions between genes.[*]

Experience, in other words, determines how our genetic potential expresses itself in the end.

It isn’t that genes don’t matter—they certainly do—only that they cannot dictate even the simplest behaviors, let alone account for most illnesses or address possible cures for them. Far from being the autonomous arbiters of our destinies, genes answer to their environment; without environmental signals, they could not function. In fact, life for us would be impossible if not for the epigenetic mechanisms that “turn” genes “on” or “off” in response to signals from within and from outside the body.[*]

Epigenetics doesn’t deny evolution. Epigenetics is part of evolution, but it demands a new look at how evolution works.” The new biology improves upon the standard Darwinian view of spontaneous mutations and random selection as the motors of species adaptations; it demonstrates that circumstances themselves can shape how genes adjust to the environment.

In humans, paternal stress early in a child’s life can also have long-term effects, into adolescence at the least.

telomeres manifest the vagaries of fate and history, class and race, stress and trauma. How? At birth, telomeres have many “units”—the DNA base pairs of which they are constituted—and by old age, far fewer. “We start out with about ten thousand when we’re a baby, and we get down to four thousand when we die,” Elissa Epel told me. Every time a cell in our body divides, telomeres shorten; when they get too short, their host cell dies or may deteriorate and become dysfunctional. As they shrink, immune function is impaired, inflammation rises, and we fall more prone to illness.

Telomeres have been called “cellular clocks,” in that they are a measure of biological rather than chronological age.

shortened telomeres and impaired immunity, reinforcing the idea that “chronic psychological stress has a negative impact on immune cell function and may accelerate their aging.”[14] In other words, stress ages our chromosomes, and therefore ages us.

Black women were found, on average, to be over seven years more biologically aged than their white counterparts, consistent with higher rates of poverty, stress, hypertension, obesity, and related health conditions.[16]

Fortunately, the door of environmental effects swings both ways: it turns out that experiences that build stress resilience can lengthen our telomeres, even in the face of illness or adversity.

Autoimmune diseases are among the great unsolved mysteries of the medical profession. Most are considered “idiopathic” in nature, which simply means “of unknown origin.”

“In the last half-century, the prevalence of autoimmune disease . . . has increased sharply in the developed world,”