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

by Gabor Maté

What is happening? 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? Moreover, how is it that we’re not more alarmed, if we notice at all? And how are we to find our way to preventing and healing the many ailments that assail us, even putting aside acute catastrophes such as the COVID-19 pandemic?

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.

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.

“the most obvious, ubiquitous, important realities are often the ones hardest to see and talk about.”

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.

health and illness are not random states in a particular body or body part. They are, in fact, an expression of an entire life lived, one that cannot, in turn, be understood in isolation: it is influenced by—or better yet, it arises from—a web of circumstances, relationships, events, and experiences.

It is hard to imagine the scope of an individual life without envisioning some kind of trauma, and it is hard for most people to know what to do about it.

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 is not what happens to you but what happens inside you” is how I formulate it.

“Trauma is when we are not seen and known.”

trauma “is about a loss of connection—to ourselves, our families, and the world around us. This loss is hard to recognize, because it happens slowly, over time.

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.

“Human freedom involves our capacity to pause between stimulus and response and, in that pause, to choose the one response toward which we wish to throw our weight,”

Among the most poisonous consequences of shame is the loss of compassion for oneself. The more severe the trauma, the more total that loss.

In a previous British study at King’s College Hospital in London, it had also been shown that women with cancerous breast lumps characteristically exhibited “extreme suppression of anger and of other feelings” in “a significantly higher proportion” than the control group, which was made up of women admitted for biopsy at the same time but found to have benign breast tumors.[3]

Finnish researchers, writing in the British Journal of Psychiatry in 2005, found, quite remarkably, that people undergoing “life events”—relatively ordinary stresses and emotional losses such as relationship issues and work problems that would not qualify them for a formal diagnosis—suffered more PTSD-like symptoms such as bad dreams or emotional numbing than more obviously traumatized people who had endured war or disaster.[12]

The more stress someone perceives or experiences, the higher the resting activity of the amygdala and the greater the risk of heart ailments.

“The one contains the many and the many contains the one. Without the one, there cannot be the many. Without the many, there cannot be the one.”

Married people have lower rates of mortality than their age-matched single contemporaries, whether the latter were separated, divorced, widowed, or had never married.[6]

Tellingly, those who had been treated for their stress-related mental conditions with SSRI-type medication—the most widely prescribed class of antidepressants,[*] of which Prozac is probably the most famous—had lower risk for autoimmunity: a clear indication of the bodymind, to use Dr. Candace Pert’s phrasing for the interflow of psychology and physiology in humans, and of the role of emotions in illness.

In other words, early development sets the ground—whether strong or shaky—for all the learning, behavior, and health (or lack of it) that will come later.

Though it no doubt runs diametrically counter to most parents’ intentions, a child whose cries are not responded to, who is not fed, not held close to a parent’s warm body when in distress, learns a clear if wordless lesson: that his needs will not be met, that he must constantly strive to find rest and peace, that he is not lovable as he is.

“Mental health needs to be on the curriculum as soon as a woman gets pregnant—just as there are prenatal classes for the physical birth, so there should be for the emotional birth. The woman’s focus must be on the baby, and not on the husband or even the job; the husband’s focus—everyone’s focus—must be on supporting the woman. Parents need to know that their job is mutual, that while the wife is pregnant, the husband is also pregnant. Society needs to protect pregnant women because everybody is creating this child. It takes a world to make a baby.”

We’ve all lost our children . . . Just look at them, for God’s sake—violent in the streets, comatose in the malls, narcotized in front of the TV. In my lifetime something terrible happened that took our children away from us. —Russell Banks, The Sweet Hereafter

The interpersonal-biological math is elementary: the more stressed the adult, the more stressed the child.

There can be no keener revelation of a society’s soul than the way it treats its children. —Nelson Mandela

“[Recent] studies have shown that repeated drug use leads to long-lasting changes in the brain that undermine voluntary control.”[3] Translation: when it comes to addiction, “free will” is in many ways a neurobiological non sequitur.

“I don’t want you to call what you have a mental illness. You have been injured.”

In her Touched with Fire, an equally poignant book, Jamison puts it more explicitly, asserting that “the genetic basis for manic-depressive illness is especially compelling, indeed almost incontrovertible.”

After all, unlike in cancer or rheumatoid arthritis, no physical findings, blood tests, biopsies, radiographs, or scans can either support or rule out psychiatric diagnoses. That statement may surprise many readers, so it bears repeating. 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.).

Elizabeth Wurtzel would depict in her 1994 personal account Prozac Nation. “One morning I woke up and really did want to live,” she wrote. “It was as if the miasma of depression had lifted off me, in the same way that the fog in San Francisco rises as the day wears on. Was it the Prozac? No doubt.”

Perhaps the line between sanity and madness must be drawn relative to the place where we stand. Perhaps it is possible to be, at the same time, mad when viewed from one perspective and sane when viewed from another. —Richard Bentall, Madness Explained: Psychosis and Human Nature

The notion that capitalism is meant to provide equality and opportunity for all must be taken on faith, since history and material reality provide no evidence for it.

As a medical study in 2020 found, the “presence [of] and search for meaning in life are important for health and well-being.”

6] Simply put, the more meaningful you find your life, the better your measures of mental and physical health are likely to be.

“Imagine,” they wrote, “a condition that makes a person irritable, depressed, and self-centered, and is associated with a 26% increase in the risk of premature mortality. Imagine too that in industrialized countries around a third of people are affected by this condition, with one person in 12 affected severely, and that these proportions are increasing. Income, education, sex, and ethnicity are not protective, and the condition is contagious. The effects of the condition are not attributable to some peculiarity of the character of a subset of individuals, they are a result of the condition affecting ordinary people. Such a condition exists—loneliness.”

A report published in the Lancet found that eleven million deaths worldwide in 2017 could be attributed to diets deficient in vegetables, seeds, and nuts but laden with salt, fat, and sugar.[3] According to another study presented to the American Heart Association, sugary drinks alone may be responsible for up to 180,000 deaths around the world.[4] Coca-colonization, this has been called.

“We could not get out. The ground we walked on was trip-wired. The air we breathed was toxic. The water stunted our growth. We could not get out . . . Not being violent enough could cost me my body. Being too violent could cost me my body. We could not get out.”[6]

the compassion of recognition, which allows us to perceive and appreciate that we are all in the same boat, roiled by similar tribulations and contradictions.

What I really needed was just the space to experience all of my emotions, with no pretense—no pretense, for the first time. I needed to feel the hurt of it all.”

Question #1: In my life’s important areas, what am I not saying no to?

With whom and in what situations do I find it most difficult to say no? Even if I say it, do I do so reluctantly, apologetically, or with guilt? Do I beat myself up about it afterward?

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

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?

Question #6: Where have I ignored or denied the “yes” that wanted to be said?

“This is my brain sending me an old, familiar message.”

“I was so convinced that I was to blame, and because of that, I remained silent.”