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

by Gabor Maté

Someone who is not valued or recognized for who she is early in life may develop an outsize appetite for status or wealth. If we are not made to feel important for just who we are, we may seek significance by becoming compulsive helpers—a syndrome I know intimately. And

I am fond of the physician and trauma researcher Vincent Felitti’s astute remark about addiction that “it’s hard to get enough of something that almost works.” Much like the rush an addict experiences immediately after using, the relief we buy with our compensatory pseudo-strengths does not last: we crave more and more, again and again and again.

More than any other factor, it is the environment—the conditions under which development takes place, which either do or don’t meet our multiple needs—that determines which potentials will or will not manifest. This is as true for us as for any other life-form.

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.”

the expression of genes, in themselves inert, depends on the environment. Experience, therefore, is the decisive influence on how our biology manifests in our lives.

What to make, then, of the modern received wisdom that we are fundamentally aggressive, selfish? Where does such an idea come from? Under a capitalist system notions and expressions of human nature will both mirror the individualized, competitive ideal and justify it as being the inevitable status quo.

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.

Our culture too often subordinates felt knowledge to the intellect. This inverted ranking system upends how we raise our children—which, in turn, serves to reinforce the error culturewide. Above all, the singer asserts, “we are feeling creatures.”

If emotion is the ground of cognition, then relationships are the tectonic plates that shape that ground. Of these, a child’s early emotional interactions with their nurturing caregiver(s) exert the primary influence on how the brain is programmed—again, the unconscious comes first, followed later by things like intellect.[5]

Suffice it for now to say that the quality of early caregiving is heavily, even decisively, determined by the societal context in which it takes place. As we will see, children are increasingly set upon by an accumulation of potent influences—social, economic, and cultural—that overwhelm and, in many ways, subjugate their internal emotional apparatus to imperatives that have nothing to do with well-being; that are, in fact, inimical to the healthy growth of the mind. “Such growth is becoming seriously endangered by modern institutions and social patterns,” according to Dr. Greenspan. “There exists a growing disregard for the importance of mind-building emotional experiences in almost every aspect of daily life including childcare, education, and family life.”

“Children must feel an invitation to exist in our presence, exactly the way they are.” With that need in mind, the parents’ primary task, beyond providing for the child’s survival requirements, is to emanate a simple message to the child in word, deed, and (most of all) energetic presence, that he or she is precisely the person they love, welcome, and want. The child doesn’t have to do anything, or be any different, to win that love—in fact, cannot do anything, because this abiding embrace cannot be earned, nor can it be revoked. It doesn’t depend on the child’s behavior or personality; it is just there, whether the child is showing up as “good” or “bad,” “naughty” or “nice.”

A 2010 study from Duke University reported that “early nurturing and warmth have long-lasting positive effects on mental health well into adulthood.”

The neuroscientist Jaak Panksepp termed the cerebral apparatus governing these needs the “PANIC/GRIEF” system because, like a car alarm, these are the emotions that become activated in the absence of secure attachment. The message: we are wired to attach, to connect with one another, which we are able to do by dint of our early bonding with our caregivers. Not only that, but the wiring goes both ways: infants are “born to cry,” in Dr. Panksepp’s words, precisely to activate the nurturing brain structures and affectionate behaviors of the parents—what he called the CARE system.

“When our brains are undercared for,” writes Darcia Narvaez, “they become more stress-reactive and subject to dominance by our survival systems—fear, panic, rage.” Don’t I know it.

2. A sense of attachment security that allows the child to rest from the work of earning his right to be who he is and as he is.

3. Permission to feel one’s emotions, especially grief, anger, sadness, and pain—in other words, the safety to remain vulnerable.

Consider the prescription of psychologist and mega-bestselling author Jordan Peterson: “An angry child should sit by himself until he calms down. Then he should be allowed to return to normal life. That means the child wins—instead of his anger. The rule is ‘Come be with us as soon as you can behave properly.’ This is a very good deal for child, parent and society.”[10] Is it, though?

4. The experience of free play in order to mature. Rather than a frivolous, childish activity to “grow out of,” play is a requirement for the healthy development of all mammalian species.

Intrauterine experiences may not be accessible to conscious recall, but they can live on as a different kind of memory: emotional and neurological imprints embedded in the cells and nervous system of the human organism.

“Environment does not begin at birth; environment begins as soon as you have an environment,” the neuroscientist Robert Sapolsky has said. “As soon as you’re a fetus, you are subject to whatever information is coming through Mom’s circulation, hormone levels, and nutrients.”

A large Swedish survey recently showed that paternal depression in the year from preconception to the end of the second trimester elevated the risk of extreme prematurity (coming between weeks twenty-two and thirty-one of gestation) by nearly 40 percent. This effect was greater, in fact, than that of depression in the mother herself, which raised the risk only of moderate preterm birth (thirty-two weeks or after).[13] “Paternal depression is also known to affect sperm quality, have epigenetic effects on the DNA of the baby, and can also affect placenta function,” one of the researchers pointed out.

social context for procreation in our world assigns women untenably stressful roles in every facet of life, including intimate relationships. Besides being the bearers of children, they’ve generally been expected to assuage the psycho-emotional stresses of the men in their lives. Mothering a child may be a mandate from Nature, but mothering a grown man is both unnatural and impossible. No wonder the father’s stress gets outsourced to the mother, at a cost to children and even to the gestating infant.

According to the best estimates, about 10 to 15 percent of deliveries ought to end with C-sections to ensure healthy outcomes. Here in my home province of British Columbia that rate now approaches 40 percent, as it does in many other parts of the world, with some countries exceeding that mark; worldwide, the number of these surgical deliveries doubled between 2000 and 2015.

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?”

she points out, we invite birth trauma with “the use of steel instruments, bright lights, rubber gloves, the smells of antiseptic and anesthetic, loud voices or the sounds of machinery.”

Amid the stresses generated by our culture, even educated middle-class parents are challenged to provide these needs—if they are even aware of them: Soothing perinatal experience Prompt responsiveness to the needs of the infant and prevention of distress Extensive touch and constant physical presence, including touch with movement (carrying and holding) Frequent, infant-initiated breastfeeding for two to five years, with four as the average weaning age A community of multiple, warm, responsive adult caregivers A climate of positive social support (for mother and infant) Creative free play in Nature with multi-aged mates.[10]

Back in the world of science, the American Academy of Pediatrics, having reviewed nearly one hundred studies, issued a statement in 2018 that aligns with ancestral wisdom. It called for the end of spanking and of harsh verbal punishment of children and adolescents. Such treatment, the organization of sixty-seven thousand pediatric specialists pointed out, only increases aggression in the long term and undermines the development of self-control and responsibility. By elevating stress hormone levels, it may cause harm to healthy brain development and lead to mental health problems.[15] More recently, a Harvard study showed that the damage wrought by spanking to the child’s nervous system and psyche may be as severe as that caused by more intense violence.[16] The good news is that the tide is turning, with young parents less and less likely to employ corporal disciplining—a welcome instance, perhaps, of the future leading us back to the past.

In 2006 I wrote a newspaper article titled “Why I No Longer Believe Babies Should Cry Themselves to Sleep,” pointing out that leaving small infants alone stresses their brains, with potential negative effects. It also hurts a mother’s heart. I quoted my late mother-in-law, Monica, who had a painful memory of being a young mom in the late 1940s and early ’50s and following medical counsel to ignore her infants’ cries. “It was torture for me to do it,” she told me. “It went against all my motherly emotions.”

One in four American women returns to work within two weeks of giving birth, a mere third of the length of postpartum maternal leave suggested by the American College of Obstetricians and Gynecologists. Even that paltry recommendation by the ACOG seems intended only to allow the maternal body to heal and recover from the travails of labor—given especially how many births these days involve surgical intervention. Such a brief postpartum absence from work leaves the needs of the child entirely out of consideration.

“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.”

However noble our intentions, our ability to carry them out is heavily influenced by our own early experiences and unresolved traumas, by the social expectations we are charged with transmitting to our children, and by the stresses of life.

Children, like the young of many species, must attach to someone in their lives: their neurophysiology demands it. Absent a reliable attachment figure, they experience fear and disorientation. Their brain wiring will go, well, haywire. In effect, essential brain circuits having to do with capacities such as learning, healthy social interaction, or emotional regulation will not develop appropriately.

“We used to think that schools built brains,” Gordon Neufeld said in Brussels. “Now we know that it is play that builds the brains that school can then use . . . It’s where growth most happens.”

Developmental psychologists agree that praising a child’s effort is helpful and promotes self-esteem, while valuing the achievement only programs kids to keep seeking external approval—not for who they are but for what they do, for what others demand of them. It’s yet another barrier to the emergence of a healthy self.

My own workaholism as a physician earned me much respect, gratitude, remuneration, and status in the world, even as it undermined my mental health and my family’s emotional balance. And why was I a workaholic? Because, stemming from my early experiences, I needed to be needed, wanted, and admired as a substitute for love. I never consciously decided to be driven that way, and yet it “worked” all too well for me in the social and professional realms.

Prevailing views about addiction have progressed somewhat in the past decade, in the direction of more compassion, science, and sense. For all that, deceptive and dangerous myths about addiction’s provenance and its very nature still reign in many circles, from medical treatment to criminal justice and policy. Even the well-meaning world of rehabilitation and recovery has its blind spots. Given the evident shortcomings and even ruinous harm wrought by our standard approaches, many voices are finally calling for a fresh view.

The “bad choices” view of addiction—which, if we’re honest, amounts to little more than “It’s Your Own Damn Fault”—is not only disastrously ineffective; it is utterly blind. I have never met anyone who, in any meaningful sense of the word, ever “chose” to become addicted, least of all my Downtown Eastside patients whose lives slowly ebbed away or were rapidly extinguished in the streets, hotel rooms, and back alleys of Vancouver’s drug ghetto.

If a socially conservative dissenter were to protest, “Didn’t they choose to stay hooked?” I would offer this quote by Dr. Nora Volkow, head of the U.S. National Institute on Drug Abuse: “[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. In fact, I would take it much further: most addicted people had little choice even before their habits took hold. Their brains arrived on the scene already impaired by life experience, especially susceptible to the effects of their drug “of choice” (another dubious expression). Actually, that’s true whether the target is a substance or a behavior. In short, the choice model ignores the question of what would drive a person toward addiction in the first place.

We err, however, when we focus on drugs alone: it does not take a substance addiction to bring about changes in brain chemistry. Scans have shown similar deleterious changes in the brains of nonsubstance addicts as well, such as inveterate internet gamers.[4] The compulsive intake of foods that trigger the brain’s reward apparatus can also produce such effects.[5] For all that, the equation of addiction with a largely genetically programmed, treatable disease[*][6] is, as mentioned, scientifically and humanely a step forward from the shaming “bad choices” model.

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. Two

As a quest for self-escape, the internal logic of addiction is inescapable. Where I am is intolerable. Get me out of here.

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.

this definition is not restricted to drugs. The same drive that often devotes itself to substances can activate any number of behaviors, from compulsive sexual roving to pornography; from inveterate shopping to the internet (both of which habits I know well); from gaming to gambling; from any sort of binge eating or drinking to purging; from work to extreme sports; from relentless exercising to compulsive relationship-seeking; from psychedelics to meditation. The issue is never the external target but one’s internal relationship to it. Are you craving and partaking of something that affords you temporary relief or pleasure, inviting or incurring negative consequences but not giving it up? Welcome to the meeting. Free coffee in the back.

It is not uncommon for people to tell themselves they enjoyed a “happy childhood.” As long as life is going reasonably well, we may lack any reason to question this narrative. When addiction is present in oneself or a loved one, some inquiry is definitely in order.[*] Looking inward with compassion, most people will be able to locate themselves somewhere on the trauma/psychological-injury spectrum.

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.

San Diego internal medicine specialist Dr. Vincent Felitti was one of the lead investigators of the now famous (though not famous enough) Adverse Childhood Experiences (ACE) Study. The study emerged after Felitti decided to listen to the life histories of patients at an obesity clinic who all reported childhood traumas. Carried out in the 1990s in California’s Kaiser Permanente health care network, the research showed that among a cohort of over seventeen thousand mostly Caucasian, middle-class persons, the more adversity a child had been exposed to, the greater the risk of addictions, mental health issues, and other medical problems they faced in adulthood.[1] Adversity was categorized under three general headings: abuse (psychological, physical, sexual); neglect (physical, emotional); household dysfunction (alcoholism or drug use in the home, divorce or loss of a biological parent, depression or mental illness in the home, mother treated violently, imprisoned household member). The impacts of such experiences did not merely add up; they multiplied each other. An adult reporting an ACE score of 6 had a risk of intravenous drug use forty-six-fold greater than a child with none of the adversities named.

Addiction has relatively little to do with the supposed addictive properties of certain substances, other than their all providing a desirable psychoactive relief . . . In other words, this is an understandable attempt at self-treatment with something that almost works, thus creating a drive for further doses.”

What’s true of physical illness is just as true of addiction: genes are turned on and off by the environment, and we now know that early adversity affects genetic activity in ways that create a template for future dysfunction. Human and animal studies have both confirmed that any genetic risks for substance abuse can be offset by being reared in a nurturing environment.

Sex addiction, for example, has nothing to do with a “high sex drive” and everything to do with dopamine. New York social worker and former Fordham and Rutgers Universities adjunct professor Zachary Alti specializes in sex therapy and behavioral addictions, particularly addiction to porn. “Studies are suggesting,” he told me, “that when viewing a pornographic image, we get a dopamine spike in our brain. When viewing images after images, we get spike after spike after spike. 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. Especially in pornography addiction, these dopamine spikes happen over and over and over again.” As with smartphone and app companies, pornographers are well aware that their profits rest on the hijacking of their consumers’ brains. The

Work has been the main, but not only, addiction of singer-songwriter Alanis Morissette. In endorphin-friendly terms, she now speaks of it as a compensation. “There’s an attachment-craving in being famous,” she said when we spoke. “If you think about it, eyeballs are on you. Everyone’s hyper-responsive. Everyone’s paying attention to you . . . You keep chasing that sense of being loved and adored and stared at.” Morissette was seeking to attain through her fame that state of infant bliss so many miss out on or experience all too briefly.