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

by Gabor Maté

There is nothing novel about the notion of the mind and body being intricately linked; if anything, what is new is the belief, tacitly held and overtly enacted by many well-meaning doctors, that they are separable.

Pert coined the term “bodymind” to describe this oneness. The official website dedicated to her work and legacy takes care to note that this expression was “intentionally written without a hyphen in order to emphasize unity of its component parts.”

Women with severe post-traumatic stress disorder (PTSD) were found to have twice the risk of ovarian cancer as women with no known trauma exposure.

“The findings indicate that having higher levels of PTSD symptoms, such as being easily startled by ordinary noises or avoiding reminders of the traumatic experience, can be associated with increased risks of ovarian cancer even decades after women experience a traumatic event.” The more severe the trauma symptoms, the more aggressive the cancer proved to be.

Racism is another risk factor for asthma. In a large cohort of Black American women, experiences of racial discrimination were associated with the adult onset of the disease.[12] And that raises an inescapable question we should all ponder: Is the inflammation and airway constriction of these women a case of individual pathology or the manifestation of a social malaise?

“We found that experiences with racism and discrimination accounted for more than 50% of the black/white difference in the activity of genes that increase inflammation,” wrote the lead author, Dr. April Thames, in an article titled “Racism Shortens Lives and Hurts Health of Blacks by Promoting Genes That Lead to Inflammation and Illness.”[11]

“Genes do not change in such a short period of time,” Virginia Ladd, chief executive of the American Autoimmune Related Diseases Association, told Medical News Today in 2012. “The rapid increase in autoimmune diseases . . . clearly suggests that environmental factors are at play.”[6] In other words, something in our environment—or a combination of somethings—is inflaming our bodies.

In 2007, British scientists found that adults who had been maltreated in childhood had higher blood levels of certain inflammation-signaling substances[*] produced in the liver, independent of personal behaviors and lifestyle considerations. “Childhood maltreatment is a previously undescribed, independent, and preventable risk factor for inflammation in adulthood,” wrote the researchers.[15] “Inflammation may be an important developmental mediator linking adverse experiences in early life to poor adult health,” they added cautiously.

Many years later, a 1965 survey reported the prevalence in rheumatoid arthritis–prone individuals of an array of self-abnegating traits: a

“compulsive and self-sacrificing doing for others, suppression of anger, and excessive concern about social acceptability.”[16]

Blood tests found one of the indicators of rheumatoid arthritis highly elevated, clinching the diagnosis. Her emotional profile aligned with the hyper-responsible, anger-suppressing personae described in the literature, traits she developed in a family of origin

In men, the immune system’s capacity to react to prostate cancer was diminished in those with a tendency to suppress anger.[8] Another prostate study found that social support reduced the risk.[9]

One of the things many diseases have in common is inflammation, acting as kind of a fertilizer for the development of illness. We’ve discovered that when people feel threatened, insecure—especially over an extended period of time—our bodies are programmed to turn on inflammatory genes.”

“Doctors,” she writes, “become masters at stuffing their emotions. We can’t cry when we’re grieving or when someone has hurt our feelings, or when we are sad.”

No one wakes up in the morning and decides, “Today I’ll put the needs of the whole world foremost, disregarding my own,” or “I can’t wait to stuff down my anger and frustration and put on a happy face instead.” Nor is anyone born with such traits: if you’ve ever met a newborn infant, you know they have zero compunction about expressing their feelings, nor do they think twice before crying lest they inconvenience someone else. The reasons these habits of personality, as we might call them, develop and grow to prominence in some people are both fascinating and sobering.

Why these features and their striking prevalence in the personalities of chronically ill people are so often overlooked—or missed entirely—goes to the heart of our theme: they are among the most normalized ways of being in this culture. Normalized how? Largely 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, temperance, conscience,

Authenticity’s only dictate is that we, not externally imposed expectations, be the true author of and authority on our own life. The seed of woe does not lie in our having these two needs, but in the fact that life too often orchestrates a face-off between them. The dilemma is this: What happens if our needs for attachment are imperiled by our authenticity, our connection to what we truly feel? What happens, in other words, when one nonnegotiable need is pitted by circumstance against the other?

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 sources of these scars are most often evident in their shape, so to speak: in many cases, specific traits can be traced to particular kinds of wounding.

If we’re constrained by anything, maybe it’s that very open-endedness; strange as it may sound, our miraculous talent for adaptation could also be a liability. Because our nature is so influenceable, different conditions evoke different versions of us, from benign to disastrous. When we reify—set in stone, mentally speaking—the particular way human behavior shows up in a certain place and time, we commit the fallacy of conflating how we’re being with who we are. This error can keep us from considering other possibilities, even if our current way of operating isn’t good for us. We then replicate conditions that are unfit for our well-being, and the sad saga continues. This is why, in seeking a vision of a healthier world, we had best disabuse ourselves of any fixed, limiting beliefs about what we’re all about, and instead ask, What circumstances evoke which sorts of outcomes?

Before exploring this dynamic, we need to once again dispense with the prevalent myth that genetic traits account for human behavior. They do not. While we have a certain biological makeup, we are not genetically programmed to feel or believe or act in any particular manner. As Robert Sapolsky put it when we spoke, “We are freer from genetics than any other species on earth.” Owing to our adaptability and capacity for invention, we can inhabit a much broader range of environments, for example, than any other large mammal. Further, as we have seen in our discussion of epigenetics, the expression of genes, in themselves inert, depends on the environment.

She is not to be accepted for who she is, only for how she is. Here’s the problem: even if the parent wins the behavior-modification game, the child loses. We have instilled in her the anxiety of being rejected if her emotional self were to surface. This exacts a heavy toll on both physical and mental health. While the expression of an emotion can be inhibited, or even its conscious experience blocked, the emotion itself is energy that cannot be obliterated.

Having been out of the baby-catching game for some decades, I was caught off guard by a phrase Stanger-Ross used when we spoke: “obstetrical trauma.” “That has become a term,” she said. “Unfortunately, a lot of women feel that their birthing experience was one of trauma, which, of course, is going to

have impacts on the parent-child relationship. If the birth was traumatizing, then how does that translate when now you have a newborn in your arms?”

“There is no such thing as a baby,” the British pediatrician D. W. Winnicott once said, explaining, “If you show me a baby, you certainly show me someone else who is caring for the baby . . . One sees a ‘nursing couple’ . . . The unit is not the individual, the unit is the individual-environment set-up.”[5]

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.

“The average child in the United States watches 30,000 television advertisements a year—most of which pitch products directly to them . . . and all conveying a series of subtle, and corrosive, messages: that they will find happiness through their relationships with products—with things, not people; that to be cool and accepted by peers, they need to buy certain products; that fast food and toy companies, not parents and teachers, know what is best for them; that corporate brands are the true bases of their social worth and identities.”[9] These trends have only accelerated since then with the further spread of social media and digital advertising.

You see it all over the place. The phone is so attractive to that young brain.” What gets displaced is the neurobiology of attachment, the release

of bonding and mood-regulating brain chemicals like oxytocin, serotonin, and endorphins, present in the cerebral circuits of both parent and baby when they lock eyes in attuned, responsive connection—chemicals, Dr. Kang points out, that are known to be “the key to long-term happiness and success.” The unintended but wounding message to the child is, again, “You don’t matter.”

And true play, Gordon Neufeld insists, is not outcome-based: the fun is in the activity, not the end result. Free play is one of the “irreducible needs” of childhood, and it’s being sacrificed to both consumerism

“There are nursing mothers taking Botox,” Peter told me. “They are not able to communicate their emotions with their babies, or even pick up the babies’ emotions. They lose that kind of contact.” In many other spheres, including social media, we too often present an artificial, “Botoxed” version of ourselves: an image not of who we are but of how we would like to be perceived by others.

Why would the self need to be escaped? We long for escape when we are imprisoned, when we are suffering. Addiction calls to us when waking life amounts to being trapped in inner turmoil, doubt, loss of meaning, isolation, unworthiness; feeling cold in our belly, devoid of hope; lacking faith in the possibility of liberation, missing succor; unable to endure external challenges or the inner chaos or emptiness; incapable of regulating our distressing mind conditions, finding our emotions unendurable; and most of all, desperate to soothe the pain all these states represent.

Here we arrive at the second cornerstone query regarding addiction, one that has become something of a mantra with me: Ask not why the addiction, but why the pain. This is the question neither the prevailing disease-based medical paradigm nor popular prejudice can possibly answer or would even think to raise. Yet without it, we can have no clue as to why this affliction of mind, body, and spirit is so rampant.

An inquiry into “Why the pain?” has to leave space for the kinds of emotional injuries that may elude conscious recall or, much more often, seem unremarkable to the person doing the remembering.

When addiction is present in oneself or a loved one, some inquiry is definitely in order.

It has been my experience that even people with the most insistent “happy childhood” narrative will, if asked the right questions, very quickly come to realize that their autobiography has been riddled with blind spots.

There had been no big-T trauma in this family, no child abuse or dire adversity. Perplexed, Sheff was forced to ask himself uncomfortable questions to understand what had impelled his talented, vivacious, highly sensitive eldest child into a life-threatening addiction. Looking back, Sheff saw that Nick’s pain must have originated early on, in the crucible of a dysfunctional parental relationship.

Whatever the degree of injury, all addiction is a kind of refugee story: from intolerable feelings incurred through adversity and never processed, and into a state of temporary freedom, even if illusory. Again, try saying no to that.

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.

To the extent that we cling to genetic fundamentalism to avoid the discomforts of personal responsibility or societal reckoning, we radically—and unnecessarily—disempower ourselves from dealing either actively or proactively with suffering of all kinds. It is entirely possible to embrace responsibility without taking on the useless baggage of guilt or blame.

In other words, far from expressing inherited pathology, depression appears as a coping mechanism to alleviate grief and rage and to inhibit behaviors that would invite danger. It is not that neurotransmitters are not involved in depression—only that their abnormalities reflect

experiences, rather than being the primary cause of them.

This is no surprise: a refusal to recognize broad economic and political conditions as relevant to individual health and happiness is a core feature of materialistic ideology. No one inclined to connect those dots would ever be entrusted with the keys to the kingdom.