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

by Gabor Maté

Such a view threatens to keep the sufferer largely in the position of passively receiving treatment, his symptoms ameliorated by medications to be ingested, in many cases, for a lifetime.

The gospel of genetic causation shields us from having to confront our hurts, leaving us all the more at their mercy.

There are no measurable physical markers of mental illness other than the subjective (a person’s description of their own mood, say) and the behavioral (sleep patterns, appetite, etc.).

Diagnoses are abstractions, or summaries: sometimes helpful, always incomplete. They are professional shorthand for describing constellations of symptoms a person may report, or of other people’s observations of someone’s behavior patterns, thoughts, and emotions.

we have to avoid the fallacy of inferring from medication’s (in some cases) observable benefits that the proven origin of mental illness rests in the biochemistry of the brain, let alone that physiological disturbances are genetically caused.

It’s all in the genes’: an explanation for the way things are that does not threaten the way things are.

repressing the rejected emotion is the surest way of escaping overwhelming levels of vulnerability, of avoiding a too-painful rift between oneself and the ambient world. There is a catch, however: we cannot select which emotions to force below consciousness, nor willfully reverse the mechanism even after it has outlived its usefulness.

Thus the repression of emotion, while adaptive in one circumstance, can become a state of chronic disconnect, a withdrawal from life. It becomes programmed into the brain, embedded in the personality.

depression appears as a coping mechanism to alleviate grief and rage and to inhibit behaviors that would invite danger.

Those are either ‘I want someone to know I’m in distress,’ or ‘When I start patching this arm up, running and finding the Band-Aid, and cleaning myself up, I have a crisis, but it’s manageable, and the one in my head was not.’”

Nailed it

Again, what is being transmitted, if anything, is sensitivity and not disease.

What we call a disorder is revealed to be an ingenious means for an assaulted psyche to absent itself from agony.

A chronic, reflexive tuning out is one of the hallmarks of attention deficit hyperactivity disorder (ADHD),[*] now being diagnosed worldwide with increasing and alarming frequency. This is not dissociation-level “out of body”–ness, but it does disconnect one from oneself, from one’s activities, and from other people in ways that disrupt functioning and are, as I personally attest, often highly frustrating. ADHD’s features include poor attention span, distractibility and low boredom threshold, poor impulse control, and (mostly in males) difficulty being still.

Tuning out is dissociation’s less extreme cousin, part of the same family of escapist adaptations. It is invoked by the organism when the circumstances are stressful and there is no other recourse for relief, when one can neither change the situation nor escape it.

It’s true that we are seeing more troubled children these days, but blaming a child’s behavior on her brain makes no sense—nor does blaming the parents. As we have seen with other conditions, when a syndrome rises sharply in frequency over a short period of time, genetics cannot possibly be the cause.

Just as depression is “explained” by the biologically minded as resulting from a lack of the neurotransmitter serotonin, ADHD is chalked up to an insufficiency of dopamine, the brain’s incentive-motivation molecule. So we prescribe dopamine-enhancing stimulants, such as Ritalin or Adderall. While dopamine certainly seems to be implicated, here, too, medical practice ignores the interaction of physiology and environment. Today, voluminous research has linked the symptoms of ADHD to trauma or early stress, and has shown that both can impact the dopamine circuits of the brain and that adversity can interfere with a child’s subsequent capacity to focus and to organize tasks.[15]

children were in every case the proverbial canaries in the coal mine. Sensitive to the nth degree, their “symptoms” expressed the unresolved travails of the entire family system, itself often overwhelmed by the pressures exerted by a culture increasingly unfriendly to development.

“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,”

My problem with the usual approach is not that doctors give medication; only, too often, that’s all they do.”

From behavioral problems to full-blown mental illness, it’s not anyone’s fault—nor, as we’ve seen, the fault of their brains or their genes. It is an expression of untended wounds, and it is meaningful.

“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.

higher levels of stress, harbored “lower hope for the future,” and suffered “significantly more widespread symptoms of depression and anxiety,” as well as, ominously, lower cortisol levels.[11] The latter is a marker of long-term stress: a sign that people’s healthy, protective stress-response mechanism was burning out. It often augurs future disease.[*]

Thus on the very terrain in which capitalism stakes its greatest claims to success—economic achievement—we find many people in a state of chronic uncertainty and loss of control, subject to stress-inducing fears that translate into disturbances of the hormonal apparatus, of the immune system, and of the entire organism.

“capitalism is failing to produce what was promised, but is delivering on what was not promised—inequality, pollution, unemployment, and most important of all, the degradation of values to the point where everything is acceptable and no one is accountable.”[23]

What if, I would put to them, the system is not failing at all but succeeding magnificently? To suppose that its demonstrated harms represent a “failure” is to ignore that for some people—who also happen to be the class gaining most of the wealth and wielding the most power—the system is functioning smoothly indeed.

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.

The rapid deindustrialization of the working class in North America has led to a loss not only of income security but also of meaning, exacerbating the dislocation epidemic. The proliferation of service jobs and Amazon warehouse gigs hasn’t replaced the sense of belonging these company jobs fostered in many communities.

Not only does our individual and societal sanity depend on connection; so does our physical health. Because we are biopsychosocial creatures, the rising loneliness epidemic in Western culture is much more than just a psychological phenomenon: it is a public health crisis.

Social isolation inhibits the immune system, promotes inflammation, agitates the stress apparatus, and increases the risk of death from heart disease and strokes.[10]

the more insecure people feel, the more they focus on material things. As materialism promises satisfaction but, instead, yields hollow dissatisfaction, it creates more craving. This massive and self-perpetuating addictive spiral is one of the mechanisms by which consumer society preserves itself by exploiting the very insecurities it generates.

While similar in some ways, pleasure and happiness run on different neurochemical fuels: pleasure employs dopamine and opiates, both of which operate in short-term bursts, while contentment is based on the more steady, slow-release serotonin apparatus.

Not all food- or tobacco-related ill health can be ascribed directly to the commercialized “hacking” of the public mind, any more than the epidemic of prescription drug deaths is due exclusively to corporate manipulation. It is truer to say that the manipulation is made possible by the very stresses, disconnections, and dislocations of life entrenched by globalized capitalism.

There are many aspects of life that drive people to follow unhealthy diets and engage in self-harming habits, the main culprits being emotional pain, stress, and social dislocation.

“many corporations meet the criteria of ‘sociopaths,’ acting without a conscience: not caring about what happens to other people as a consequence of their actions, having no compulsion to comply with social or legal norms, not feeling guilt or remorse.”

“Narcissism and sociopathy describe corporate America,” he told me. “But it’s flat-out wrong to think in twenty-first-century America that narcissism and sociopathy are illnesses. In today’s America, narcissism and sociopathy are strategies. And they’re very successful strategies, especially in business and politics and entertainment.”

Humanity faces no challenge of more gravity and consequence than the climate crisis that, as of this writing, is devastating many areas of the world and threatens planetary life itself. To my mind, no issue illustrates more vividly the sociopathic behavior of those in corporate and government spheres who had plenty of advance warning but for decades minimized or denied the menace for the sake of profit or power.

For young children, being subordinated in their social milieu—whether family or classroom—leads to heightened cardiovascular, nervous system, and hormonal responses to stress and higher risks of chronic medical conditions. That remains true for adults as well. The suppression of individual authenticity plays havoc with biology, breeding illness; even greater mayhem will ensue for bodies belonging to groups whose self-suppression has been systemically imposed, often with great violence.

it is “racism, not race itself, that threatens the lives of African American women and infants,” a recent review of multiple studies concluded.[13]

We have seen how emotional stressors, among which racism ranks as a frontrunner, get “under the skin”: the triggering of inflammation-promoting genes, the premature aging of chromosomes and cells, tissue damage, elevation of blood sugar, the narrowing of airways.

“Medicine is a social science, and politics nothing else but medicine on a large scale.”

Both inequality and poverty stir the by now familiar brew of disturbed genetic function, inflammation, chromosomal and cellular aging, physiological wear and tear, hormonal disturbances, cardiovascular effects, and immune debility, all of which combine to bring illness, disability, and death.

research shows that, at most, only about 25 percent of population health is attributable to health care. A full 50 percent is determined by social and economic environments.[20]

Recall from chapters 5 and 7 this array of self-abnegating traits that predispose to disease: a compulsive and self-sacrificing doing for others, suppression of anger, and an excessive concern about social acceptability. These personality features, found across all autoimmune conditions, are precisely the ones inculcated into women in a patriarchal culture.

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.”

If disease is the individual body’s way of alerting us to something out of joint, something contrary to what our nature intends for us, then surely social maladies like addiction and global catastrophes like climate change are all signs of something amiss in the body politic. So, too, is the mood of resignation and cynicism that surrounds politics in general, and the sometimes ludicrous levels of suspicion and venom that infuse public discussions of everything from elections to abortion to how we should handle health pandemics.

The subliminal beliefs leaders hold about human nature, the world, and their position in it, and the unconscious impulses that motivate their actions, are of great consequence for their politics—which is to say, for our lives and our world. The worldview they developed early in life under the impact of misfortunes they did not choose and could not control imbues how they feel about, interact with, and act upon the universe and their fellow beings decades later.

she is a paragon of poise, grace, empathy, hard work, and reason. What almost never gets asked is, Where do such relentless ambition and “tenacity” come from, and at what cost? Ought we really to celebrate it, or is it in its own way also an unhealthy norm,

“Hillary Clinton and Donald Trump,” the conservative columnist David Brooks wrote discerningly in 2016, “. . . both ultimately hew to a distrustful, stark, combative, zero-sum view of life—the idea that making it in this world is an unforgiving slog and that, given other people’s selfish natures, vulnerability is dangerous.”[14]

Abetted and amplified by the profit-driven media machine, political culture plays on our deepest longings for surety, security, and even supremacy, targeting our damaged “inner children” with force and precision. In fact, much of politics is a lot more coherent if we see how people, many millions of them at once, unconsciously look to their leaders to fulfill their own unmet childhood needs.

Less appreciated is the way pop culture grooms us for a particular sort of passive, spectator-like engagement with politics. The hero worship and emotional projection driving modern showbiz run on superfuel distilled in large part from trauma.