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

by Gabor Maté

The second mystery is the highly skewed gender distribution of autoimmune diseases. About 70 to 80 percent of sufferers are women,

Another lamentable feature of Western medical practice—not universal, but all too often seen—is a power hierarchy that casts physicians as the exalted experts and patients as the passive recipients of care. For all doctors’ dedication and goodwill, the imbalance compromises patients’ agency over their own health and healing process.

hyperfunctioning on top of hidden inner distress is a recurring theme among the many autoimmune patients I’ve encountered in my years of practice and teaching.

Microbiologists these days speak of “neurogenic inflammation,” stress-induced inflammation triggered by discharges of the nervous system—a system we now understand to be powerfully influenced by emotions.[12]

As in the other autoimmune conditions, in virtually every case the childhood patterning that led people to be overconscientious, hyper-responsible, and emotionally stoic about their own needs was evident—as were stresses preceding the illness, such as interpersonal conflict, family crisis, loss of a relationship, or added duties at work.

Disease is an outcome of generations of suffering, of social conditions, of cultural conditioning, of childhood trauma, of physiology bearing the brunt of people’s stresses and emotional histories, all interacting with the physical and psychological environment.

The gist of the whole book?

To restate a question essential to our theme: What if we saw illness as an imbalance in the entire organism, not just as a manifestation of molecules, cells, or organs invaded or denatured by pathology?

When we cease to view illness as a concrete, autonomous thing with a predetermined trajectory—and when we have the proper help and a willingness to look both within and without—we can start to exercise agency in the matter. After all, if disease is a manifestation of something in our lives rather than merely their cruel disruptor, we have options: we can pursue new understandings, ask new questions, perhaps make new choices. We can take our rightful place as active participants in the process, rather than remain its victims, helpless but for our reliance on medical miracle workers.

Nobody all of a sudden “gets” an autoimmune disease, or “gets” cancer—though it may, perhaps, make itself known suddenly and with tremendous impact.

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.

It the hypothalamus

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.”[11]

Malignant transformation happens regularly, as an accidental by-product of natural cell division. Under normal conditions the organism’s defenses can eliminate such threats to well-being.

One of the things many diseases have in common is inflammation, acting as kind of a fertilizer for the development of illness.

the suppression group showed heightened activation of their sympathetic, or fight-or-flight, nervous system: in other words, a stress response.[9] There may be certain situations where a person, for perfectly valid reasons, deliberately chooses not to express how he feels; if one does it habitually or under compulsion, the impact is more than likely to be toxic.

by being regarded as admirable strengths rather than potential liabilities. 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,

lifelong repression of one’s feelings—particularly healthy anger—which undermines the immune system and poses a risk for malignancy and other illness. Where does such forsaking of the self come from? “Type C,” Lydia Temoshok pointed out, “is not a personality, but rather a behavior pattern that can be modified.”[10] I completely agree with her view. Precisely because no one is born with such traits ingrained, we can unlearn them. That’s a pathway toward healing—not

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. The fact that we don’t consciously choose such coping mechanisms makes them all the more tenacious. We cannot will them away when they no longer serve us precisely because we have no memory of them not being there, no notion of ourselves without them. Like wallpaper, they blend into the background; they are our “new normal,” our literal second nature, as distinct from our original or authentic nature.

The internal adaptations we make to our own personalities in order to survive adversity early in life carry the same risks as conditions shift, but we are far less wise to the danger. No matter how the weather changes, the protective gear, welded as it is onto the personality, never comes off. 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 imperative to survive overrides everything, and that survival depends on the maintenance of attachment, at whatever cost to authenticity. This is why so many childhoods, particularly in a culture that both breeds stress and feeds on it, are marked by a tense standoff between the two, where the outcome is predictable and the consequences are lifelong.

There is a tendency in this culture, whether with approval or dismay, to see people as inherently aggressive, acquisitive, and ruggedly individualistic.

Experience, therefore, is the decisive influence on how our biology manifests in our lives.

While it is in our nature to adjust to and survive in an almost infinite array of environments—certainly many more than oak trees can—we are not necessarily at our best or our healthiest in all of them. Some of these, whether physical, emotional, or social, will make wellness an uphill battle or a luxury for the lucky, rather than a widely available norm.

our nature, all else being equal, expects or even prefers as its baseline state a condition of caring, relative harmony, and equilibrium, of the kind that obtains when interconnectedness rules the day. It is not that our nature is to be those ways, but that it wants them to be present. When they are, we thrive; when denied, we suffer.

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 a recent Wayne State University study that examined a low-resource, high-stress U.S. urban setting, abnormalities in brain connectivity were identified in scans of yet-unborn infants of mothers who reported elevated levels of depression, anxiety, worry, and stress during the last three months.[14] Needless to say, physical factors such as nutrition and air quality interact with socioeconomic status, predisposing children to such problems as depression, anxiety, and ADHD.[15]

Suppression of innate knowledge is one of medicine’s unfortunate tendencies.

What if the angst parents feel speaks not to a lack of information or figures but to a long-brewing, culturally induced alienation from their own deepest instincts? Quite like the genes in which they are coded, instincts do not assert themselves in an automatic or autonomous way. Rather, they have to be evoked by the proper environment, or else we are liable to lose touch with them.

Parental stress expresses itself in less overt ways, too, such as distraction and emotional absence.

“The relentlessness of modern-day parenting has a powerful motivation: economic anxiety,”

a decline in cohesion and community support is discernible, and lamentable.

the destabilization begins with stress transmitted to infants still in the womb, with the mechanization of birth, the attenuation of the parenting instinct, and the denial of the child’s developmental needs. It continues with the increasingly intolerable economic and social pressures on parents these days and the erosion of community ties, and magnifies with the disinformation parents receive on how to rear their young. Reinforced by educational systems that too often stress students with pressures to compete, the process culminates in the exploitation of children and youth for the glory of the consumer market.

Nothing in Nature “becomes itself” without being vulnerable: the mightiest tree’s growth requires soft and supple shoots, just as the hardest-shelled crustacean must first molt and become soft. The same goes for us: no emotional vulnerability, no growth.

very concerned about the impacts of relentless screen exposure on brain development: “Less ability to focus on the normal, the baseline, including states of observation, contemplation, and transitions from which ideas spark—what many under the age of twenty now consider a void, proclaiming boredom . . . On a biological as well as a cultural level, such brain state changes affect learning, socialization, recreation, partnering, parenting, and creativity—in essence all factors that make a society and a culture. The neurophysiological processes that regulate mood and behavior are deregulating.”[13]

The pleasures and boons of online connectivity can neither keep pace with the burgeoning crises of disconnection nor allay concerns about what the digital world is encoding into our kids’ cognitive and emotional operating systems.

A colony typically contains ants that carry out radically different roles and have markedly different body structures and behaviors.” Genetically identical siblings will become differentiated into biologically variable adults based purely on signals from the physical and social environment.

the context of all contexts is hypermaterialist, consumerist capitalism and its globalized expressions worldwide.

Just as we are conditioned to fit into the family, even if that means a departure from our true selves, so we are prepped—one might even say groomed—to fulfill our expected social roles and take on the characteristics necessary to do so, no matter the cumulative cost to our well-being.

what is considered normal and natural are established not by what is good for people, but by what is expected of them, which traits and attitudes serve the maintenance of the culture. These are then enshrined as “human nature,”

Among the great achievements of mass-consumption culture has been to convince us that what we have been conditioned to fervently want is also what we need.

Driven by a culturally fueled conviction of insufficiency, we become addicted to consumption.

Self-abandonment programmed into the social character makes us passive even in the face of threats to our existence as a species.

until we reckon squarely with how things are today: it is we who are made in the image of our distorted, disordered, denatured world—the better to keep it running, even as it runs us into the ground.

The fact is, personal and social life events, filtered through the mind, shape the brain throughout the lifetime. You cannot, scientifically, cleave biology from biography, especially when it comes to a process as psychologically layered as addiction.

Addictions of any kind are not abnormal ailments, willfully self-inflicted maladies, brain disorders, or genetic short straws. Properly understood, they are not even that puzzling. As with other ostensibly mysterious conditions named in this book, they are rooted in coping mechanisms.

Addictions represent, in their onset, the defenses of an organism against suffering it does not know how to endure. In other words, we are looking at a natural response to unnatural circumstances, an attempt to soothe the pain of injuries incurred in childhood and stresses sustained in adulthood.

When it comes down to it, all addiction’s incentives can be summed up as an escape from the confines of the self, by which I mean the mundane, lived-in experience of being uncomfortable and isolated in one’s own skin.

Addiction is a complex psychological, emotional, physiological, neurobiological, social, and spiritual process. It manifests through any behavior in which a person finds temporary relief or pleasure and therefore craves, but that in the long term causes them or others negative consequences, and yet the person refuses or is unable to give it up.

Addiction begins as an attempt to induce feelings that we were biologically programmed to generate innately, and would have—if unhealthy development hadn’t got in the way.

Whereas with substance addictions you typically get one or a few spikes just before use, with behavioral addictions dopamine itself is the substance, the primary component.

While mental ailments certainly exhibit some features of illness—the brain seeming to function like a disordered organ—mainstream psychiatry takes the biological emphasis too far, reducing everything mostly to an imbalance of DNA-dictated brain chemicals.