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

by Gabor Maté

chronic illness—mental or physical—is to a large extent a function or feature of the way things are and not a glitch; a consequence of how we live, not a mysterious aberration.

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.

“Trauma is not what happens to you but what happens inside you”

When a wound doesn’t mend on its own, one of two things will happen: it can either remain raw or, more commonly, be replaced by a thick layer of scar tissue. As an open sore, it is an ongoing source of pain and a place where we can be hurt over and over again by even the slightest stimulus. It compels us to be ever vigilant—always nursing our wounds, as it were—and leaves us limited in our capacity to move flexibly and act confidently lest we be harmed again. The scar is preferable, providing protection and holding tissues together, but it has its drawbacks: it is tight, hard, inflexible, unable to grow, a zone of numbness. The original healthy, alive flesh is not regenerated.

Here we see the perilous downside of our much-vaunted and wondrous capacity to adapt to diverse and challenging circumstances. After all, most adaptations are meant for specific situations, not as eternally applicable responses in every possible case. Here’s an analogy plucked from the headlines: At the time of this writing, freezing weather has enveloped Texas.[*] People are adapting by wearing extra clothing, heating their homes when power is available, wrapping themselves in warm blankets—all necessary strategies for surviving inclement winter conditions. Those same adaptations, meant to be temporary, would jeopardize health and life if not discarded by the time of summer’s blazing heat. 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.

If our society were truly to appreciate the significance of children’s emotional ties throughout the first years of life, it would no longer tolerate children growing up, or parents having to struggle, in situations that cannot possibly nourish healthy growth. —Stanley Greenspan, M.D., The Growth of the Mind[*]

“My doctor did not respect my decisions,” she said, “and I don’t think he respected me as an autonomous human being. I believe he thought he knew better than me. I can’t think of one single instance where a man is told what he can and can’t do with his body, but women are told this every day.”

On imaging studies, a baby’s smile will light up the same reward areas in the mom’s brain activated by junk foods or addictive drugs, releasing the same pleasure chemicals and triggering the same high.[8] Nature, that unscrupulous drug-pusher.[*]

“You can’t say that parents are incredibly important in the lives of their children, yet if there’s a problem it has nothing to do with the parents. But the truth is, parents don’t raise their children in isolation from society.”

Our emotions are not a luxury but an essential aspect of our makeup. We have them not just for the pleasure of feeling but because they have crucial survival value. They orient us, interpret the world for us, give us vital information without which we cannot thrive. They tell us what is dangerous and what is benign, what threatens our existence and what will nurture our growth. Imagine how disabled we would be if we could not see or hear or taste or sense heat or cold or physical pain. To shut down emotions is to lose an indispensable part of our sensory apparatus and, beyond that, an indispensable part of who we are. Emotions are what make life worthwhile, exciting, challenging, and meaningful. They drive our explorations of the world, motivate our discoveries, and fuel our growth. Down to the very cellular level, human beings are either in defensive mode or in growth mode, but they cannot be in both at the same time. When children become invulnerable, they cease to relate to life as infinite possibility, to themselves as boundless potential, and to the world as a welcoming and nurturing arena for their self-expression. The invulnerability imposed by peer orientation imprisons children in their limitations and fears. No wonder so many of them these days are being treated for depression, anxiety, and other disorders.

I have absolutely no pleasure in the stimulants in which I sometimes so madly indulge. It has not been in the pursuit of pleasure that I have periled life and reputation and reason. It has been in the desperate attempt to escape from torturing memories. —Edgar Allan Poe

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.

Ask not why the addiction, but why the pain.

Yes, the medication was helping me, at least in the short term. And yes, I have witnessed other cases where psychiatric drugs were life-enhancing and even lifesaving. But 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. That a medication has a certain positive effect reveals nothing about the genesis of a symptom. If aspirin eases a headache, can the headache be explained by an inherited brain deficiency of acetylsalicylic acid, the pill’s active ingredient? If a shot of bourbon relaxes you, is your tense nervous system suffering from a DNA-dictated whiskey shortage?

if phenomena like addiction or mental distress are determined mostly by biological heredity, we are spared from having to look at how our social environment supports, or does not support, the parents of young children, and at how social attitudes, prejudices, and policies burden, stress, and exclude certain segments of the population,

“Increasingly, we look after people who don’t get better,” Dr. Lustig replied. “It’s like we’re ladling water out of the proverbial leaky boat with a teaspoon while it keeps pouring in through a gaping hole at the bottom.”

how it feels working in our shitty for profit healthcare system

“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.”

imagine if all the energy now expended on analyzing the private lives of celebrities or the detailed intricacies of sporting events were, instead, devoted to mobilizing populations to collectively tackle the great issues of our age.

“You cannot force nature / only nurture it.”

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. If and when it does morph into a toxic version of itself, we can address the unhelpful stories and interpretations, the self-righteous or self-flagellating thought patterns that keep stoking it, without invalidating the emotion.

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.

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 be inauthentic, the seemingly altruistic impulse arising from our discomfort with our own woundedness.

would never tell anyone that they should be compassionate with themselves. Compassion brooks no “should.” In any case, our defended, walled-off parts do not respond positively to such demands—why would they? It is far kinder and more effective to bring attention to the lack of self-compassion, to notice it and be curious about how it presents in one’s life. Once seen, it softens, allowing one to investigate its long-ago origins and present-day impacts.

believing their content. Everything is a candidate for inquiry, even intensely negative experiences like self-loathing.[*] Rather than admonishing ourselves for hating ourselves, we can be curious as to why self-hatred arrived on the scene in the first place.

Question #1: In my life’s important areas, what am I not saying no to? In other words, where did I, today or this week, sense a “no” within me that wanted to be expressed, but I stifled it, conveying a “yes” (or a silence) where a “no” wanted to be heard?

Question #2: How does my inability to say no impact my life?

“What do I miss out on in life as a result of my inability to assert myself?”

Question #3: What bodily signals have I been overlooking? What symptoms have I been ignoring that could be warning signs, were I to pay conscious attention?

Question #4: What is the hidden story behind my inability to say no?

I’m not worthy unless I’m doing something useful. If people knew how I really felt, they wouldn’t like me.

The intention in looking at the past is not to dwell on it but to let go of it. “The moment you know how your suffering came to be, you are already on the path of release from it,” the Buddha said.[3]

Question #6: Where have I ignored or denied the “yes” that wanted to be said? If stifling a “no” can make us ill, so can withholding an authentic “yes.” What have you wanted to do, manifest, create, or say that you have forsaken in the name of perceived duty or out of fear? What desire to play or explore have you ignored? What joys have you denied yourself out of a belief that you don’t deserve them, or out of a conditioned fear that they’ll be snatched away?

“What is in us must out; otherwise we may explode at the wrong places or become hopelessly hemmed in by frustrations,”

“This is my brain sending me an old, familiar message.” Rather than blaming yourself or anyone else, you are ascribing cause to its proper place: neural circuits programmed into your brain when you were a child. It represents a time, early in life, when you lacked the necessary conditions for your emotional circuitry’s healthy development. You’re not pushing the thought away, but you’re also making clear that you didn’t ask for it, nor have you ever deserved it.

What has this belief actually done for me?

Everything within us, no matter how distressing, exists for a purpose; there is nothing that shouldn’t be there, troublesome and even debilitating though it may be. The question thus shifts from “How do I get rid of this?” to “What is this for? Why is this here?”

The temple had hosted many Europeans and North Americans, but never a group of medical workers, and the Shipibo healers reported afterward that, to their own surprise, they had never worked with such a “heavy bunch.” “As healers ourselves,” they said, “we must face all the pains and traumas people bring to us, but we take care of ourselves: we regularly clear those energies out of our bodies and souls, so they do not accumulate and burden us. We expected you médicos to have done the same for yourselves. But no, we found, you came here weighed down by the griefs and heavy energies you have all been absorbing for years and years.”

not shocked by this at all

“The first thing that comes to my heart,” she told me, “is that we have a commitment to Earth. It’s not just a commitment, though—it’s a mad love affair with this Earth. And we have a capacity and a role in helping Her and all the rest of the life to thrive. It’s not part of the modern world paradigm. Everything is so individualistic, individual achievement, and even anthropocentric, right? Totally self-oriented. When you are part of that larger community, Earth, and you are accountable to this mad romance with birds and fish and trees and mountains and sky, you have more to compel you, to guide you.”

“There is only one common rule valid in finding your special truth. It is to learn to listen patiently to yourself, to give yourself a chance to find your own way which is yours and nobody else’s,” wrote the psychologist and visionary Wilhelm Reich.[3]