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

by Gabor Maté

The personality is an adaptation. What we call the personality is often a jumble of genuine traits and conditioned coping styles, including some that do not reflect our true self at all but rather the loss of it. Each personality takes shape according to how one’s particular temperament reciprocally interacts with family, community, and culture. It may not express our real needs, deepest longings, and truest nature, but rather our attempt to compensate for our estrangement from them. “We suffer from a case of mistaken identity. Our culture has sold us a bill of goods about who we really are,” writes marital/family therapist Dick Schwartz.

What matters in applying the practices below is not so much the letter of the law as the spirit of the endeavor. That spirit is captured in the name of a methodology I have developed: Compassionate Inquiry (CI). Compassionate Inquiry is both a professional training I have taught to thousands of therapists in over eighty countries and a practice of individual self-reflection, as outlined below. To their edification (and sometimes dismay), the professional participants in the CI course spend the first three months working on their own issues, not those of others. Therapist, heal thyself.

openness, patience, and generosity. Think of how you would treat a struggling friend or loved one in their time of need, the leeway you would grant them to be confused, perplexed, frustrated. Being compassionate to yourself is no different, except that it’s often harder to practice.

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?

More generally, ask yourself: 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? You will find this impact lands in three main spheres: the physical, the emotional, and the interpersonal.

Resentment can be seen as the residue of things unsaid, feelings not honored. The word “resent” comes, after all, from the French ressentir, meaning “to feel again.” And again, and again, and again, in our minds and bodies, until we get the memo.

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? The third question reverses the direction of the previous one: here we start with the physical impacts, trusting them to reveal where authenticity has been missing. It requires you to take an inventory of your body—a regular and deliberate scan—for the day or the week.

The idea is to take a regular survey of ongoing symptoms—say, fatigue or a persistent headache or upset stomach or low back pain—and then ask what unsaid “no” these might be signaling.

Question #4: What is the hidden story behind my inability to say no? What feeds our habitual pattern of denying our “no” is what I call the story. By this I mean the narrative, the explanation, the justification, the rationalization that makes these habits seem normal and even necessary. In truth they sprout from limiting core beliefs about ourselves. Most often we are not aware that they are stories. We think and act as if they’re true. When

If you have a hard time spotting the story underlying your behavior, try asking, “What must I believe about myself to deny my own needs this way?”

Some examples of familiar stories: Saying no means I can’t handle something. It’s a sign of weakness. I have to be strong. I have to be “good” to deserve being loved. If I say no, I’m not lovable. I’m responsible for how other people feel and what they experience. I mustn’t disappoint anyone. I’m not worthy unless I’m doing something useful. If people knew how I really felt, they wouldn’t like me. If I turned down my friend/spouse/colleague/parent/neighbor, I would feel deservedly guilty.[*] It’s selfish to say no. It’s not loving to have anger.

Question #5: Where did I learn these stories? No one is imbued at birth with a sense of worthlessness. It is through our interactions with nurturing caregivers that we develop our view of ourselves. If, because of their own trauma, they treat us badly, we take it personally. If, for whatever reason, they are stressed or unhappy, we take that personally, too. Awareness of our parents’ distress, which as young children we could not have alleviated, can lead us to question our own value, even if we were assured verbally that we were loved. That certainly happened to me, as came to my awareness most forcefully on a therapist’s couch—an incident I will describe in chapter 30.

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?

Healing cannot occur if we do not accept our worthiness—that we are worth healing, even if doing so might shake up our view of the world and how we interact with others. —Mario Martinez, Psy.D., The MindBody Code

There are many ways of working with the tall tale of unworthiness. Some teachers suggest positive affirmations. Personally, I have found that such messages seem to evaporate precisely when I most need them. We should not underestimate how entrenched and insidious this conviction of unworthiness is, or how difficult it is to dislodge with words. We were almost literally hypnotized into it. In a neural framework, as the biologist Bruce Lipton explains, it’s a matter of brainwaves. Delta waves, the brain’s lowest frequency, predominate in our first two years, then theta waves ramp up until we are about six. “A child under seven is predominantly in theta,” he told me. “Theta is a hypnotic state, and it’s how you absorb all this stuff for seven years. Just as under the spell of a hypnotist, you believe whatever messages you get.” Only afterward does the state of conscious awareness and logical thinking associated with alpha and beta wave activity come on line. “We download our perceptions and beliefs about life years before we acquire the capacity for critical thinking,” Dr. Lipton writes. “Those perceptions or misperceptions become our truths.”[1] From such truths, we will henceforth generate our concepts about ourselves in the world. More precisely, from such untruths.

While Dr. Schwartz originally developed these steps for healing obsessive-compulsive disorder, they readily lend themselves to reprogramming other kinds of thought loops as well. After all, negative thinking has a more-than-obsessive quality: we are compelled to it, over and over, despite deriving no pleasure from it. The idea is to retrain the brain, to strengthen through conscious effort the prefrontal cortex’s capacity to break out of a past-based trance and repatriate us to the present. Any repetitively self-deprecating thought pattern can be worked with in this way. The method is an experiential one, requiring commitment and mindfulness. It needs to be not only done but fully experienced. Only when attention is present can the mind rewire the brain. “Conscious attention must be paid,” Jeffrey Schwartz insists. “Therein lies the key. Physical changes in the brain depend for their creation on a mental state in the mind—the state called attention. Paying attention matters.”

Find a place to sit and write, preferably a quiet place. With this exercise, too, you’ll want to keep a handwritten journal. Step 1: Relabel The first step is to call the self-limiting thought what it is: a thought, a belief, not the truth. For example, “I seem to believe that I’m responsible for everyone’s feelings.” Or, “I’m having the thought that I have to be strong.” Or, “I’m acting as if I think I’m only worthy when I’m being helpful.”

Step 2: Reattribute In this step you learn to assign the relabeled belief to its proper source: “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.

Step 3: Refocus This one is all about buying yourself a little time. Being mind phantoms, your negative self-beliefs will pass—if you give them time. The key principle, Jeffrey Schwartz points out, is this: “It’s not how you feel; it’s what you do that counts.”

Your initial goal is modest: buy yourself a quarter of an hour. Choose something that you enjoy and will keep you active, preferably something healthy and creative, but really anything that will please you without causing greater harm. Instead of helplessly sinking into the familiar despair of negative self-belief, go for a walk, turn on some music, do a crossword puzzle—whatever can get you through the next fifteen little minutes. “Physical activity seems to be especially helpful,” Schwartz suggests. “But the important thing is that whatever activity you choose, it must be something you enjoy doing.”

Step 4: Revalue Here’s where you take stock and get real. Up until now, the self-rejecting belief has ruled the roost, overshadowing whatever else you may consciously believe about yourself. Let’s say you’ve told yourself, “I deserve love in my life,” but all the while your mind is assigning greater value to the currency of “I’m worthless.” It’s that second one that tips the scales at least nine times out of ten. You can think of this step, then, as a kind of audit, an investigation into the objective costs of the beliefs your mind has invested so much time and energy in. What has this belief actually done for me? you ask. Possible answers: It has left me feeling ashamed and isolated. It has produced bitterness. It has stopped me from pursuing dreams, from taking risks, from experiencing intimate love. It has incurred physical illness or symptoms. To recognize its impact, allow your answers to go beyond the conceptual. Feel your own body state as you consider the space the belief has occupied in your mind. The impacts live right there, in your physiology, as surely as they do in your actions and relationships.

A complete revaluation also takes into account any payoffs or dividends you have derived from this belief. Has it kept you safe from harm, even in the short term? Has it protected you from criticism or rejection? Include these, too: the more thorough the audit, the better.

Step 5: Re-create What has determined your identity up until now? You’ve been acting out mechanisms wired into your brain before you had a choice in the matter, and from those automatic mechanisms and long-ago programmed beliefs you have fashioned a life. It is time to re-create: to imagine a different life, one truly worth choosing. You have values. You have passions. You have intention, talent, capability, a desire to contribute, perhaps a latent sense of purpose or calling. In your heart there is love, and you want to connect that with the love in the universe. As you relabel, reattribute, refocus, and revalue, you are releasing patterns that have held you and that you have held on to.

The road to hell is not paved with good intentions; it is paved with lack of intention. The more you relabel, reattribute, refocus, and revalue, the freer you will be to re-create. Are you afraid you will stumble? Guess what: you will. That’s called being a human being. —

My life has not been about fixing what is broken. It has been about engaging in a loving and tender archaeological dig back to my true self. —Jewel, Never Broken: Songs Are Only Half the Story

Their reason for being, mind you, is anything but stupid. Although they cause us pain now, they first came along to save us. Their presence is in fact an unmistakable sign of the deep intelligence of the human bodymind. And fortunately, healing does not require their disappearance, only their realignment—or perhaps their reassignment. What matters is that we, rather than they, are in the lead.

What possible role could this debilitating, self-shaming stance have played in preserving our safety? Think of it as harm reduction. When the adult world requires, even if inadvertently, that an infant or child suppress parts of her true self—her own desires, feelings, and preferences—she cannot risk noncompliance lest the indispensable attachment relationship be compromised or threatened. She must develop within herself some sturdy enforcement mechanisms to preempt the anxiety of disappointing, or being cut off from, the caregiver. Guilt is one of the most reliable of these inner invigilators. The child’s self-expression is curtailed, yes, but above all the relationship with the parent is preserved. For survival, attachment trumps authenticity, as at that age it must.

Less obvious is that this belief, too, has a protective function. When a young person’s universe is in turmoil—when things fall apart and the center cannot hold, to channel Yeats[*]—there are two working theories the child could adopt. One is that her little world is terribly awry and misshapen, her parents incapable or unwilling to love and care. In other words, she is unsafe. The other, which wins out virtually every time, is that she—the child—is flawed. Helen Knott depicts this process in her eloquent account of intergenerational trauma, sexual violence, and addiction:[*] “I was so convinced that I was to blame, and because of that, I remained silent.” She could not have been convinced otherwise: acknowledging that those on whom one depends are incapable of meeting one’s needs would be a devastating blow to a young person. Thus self-blame, like guilt, is an unflagging protector. Believing that the deficiency is ours gives us at least a modicum of agency and hope: maybe, if we just work hard enough, we can earn the love and care we need.

As we have said, the trauma is not what happened to us, but what happened inside us as a result. Peter Levine reminds us that “trauma is about broken connection. Broken connection to the body, broken connection to our vitality, to reality, and to others.” That being the case, it’s impossible to overstate that so long as we are alive and of sound mind, reconnection remains possible.

it isn’t true that we don’t remember. Our memories show up every day in our relationship to ourselves and others, if we only know how to recognize them. Every time we are triggered—which is to say, caught up suddenly in an unwanted, puzzlingly overwrought emotional reaction—that is the past showing up: an echo of our childhood as we actually experienced it, if not how we consciously recall it. There are ways to retrieve such encoded memories by using present-moment emotions and body experiences to find their origins.[*] The word “trigger” is itself a major clue. It has become something of a rhetorical cannonball, hurled back and forth by opposite sides in many a debate or confrontation, rarely deepening conversations and often ending them. Yet, on closer examination, it has much to teach us about ourselves. Consider: How big a part of a weapon is the trigger? Minuscule, really; perhaps the smallest visible component. The weapon also bears ammunition, explosive material, often a guidance system, and mechanisms for delivering the payload to its target with the desired force. If, when triggered, we focus our ire only on the external stimuli that set us off, we miss a golden opportunity to examine what ammunition and explosive charges we ourselves have been packing since childhood.

Actually, the self-disconnect had occurred long before then, in her “very happy, blessed childhood,” as revealed by my next question. It’s one I regularly pose to clients and participants, and I’ll now put it to you, the reader. Anyone whose conscious recall is of a happy childhood—a category that may range from innocuous to idyllic—and yet is confronting chronic illness, emotional distress, addiction, or struggles to be authentic, is particularly invited to engage with it: When I felt sad, unhappy, angry, confused, bewildered, lonely, bullied, who did I speak to? Who did I tell? Who could I confide in? Notice your answer, and also your feelings around it. If, as in Erica’s case, the answer is “No one” or indicates anything other than the presence of a consistently available adult “someone,” an early disconnect was surely at play. (A loving older sibling can in some ways stand in for a parent, but it is unlikely they can fully replace a parent. And even then it signals a disconnect from the adult caregiver.) No infant refrains from emoting to the parents precisely what he feels or from signaling when she requires help. The failure to do so later in childhood is a developmentally abnormal adaptation—for some a truly devastating one, which undergirds the woundings that follow.

Though you may be justifiably grateful for your lot, the fact that others have suffered “more than” you does not diminish by one iota your own pain, nor erase its traces in your psyche. Levels of trauma are not to be evaluated, much less graded on a bell curve. You may, for example, have reassured yourself along the same lines as Erica did: “We were well off financially, I had a ton of friends, and so I wasn’t bullied—I didn’t have any of those big life circumstances.” “And fortunate you were,” I customarily interject. “But just imagine for a moment your little niece or nephew sobbing to you, ‘I feel so sad and alone and confused and I’m afraid to tell Mommy or Daddy about it.’ Would you, if you wished to be supportive, dismiss this little one with ‘Come on, what’s the problem here? Think of all the children who are having big life circumstances, like hunger or abuse or bullying. By contrast, you have nothing to complain about.’ Is that what you’d say to them if you wanted them to know their feelings were safe to feel, that they were lovable no matter what?” I have yet to hear anyone respond in the affirmative: when I put it to them that plainly, they’re finally able to hear in it the absurd double standard enforced against the self.

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.”

Sigmund Freud once said that dreams are the royal road to the unconscious. Psychedelics may be said to be an even more direct route.

of Indigenous practices, he wasn’t interested in religion but in spirituality. “The white man goes into his church and talks about Jesus,” he once said, “but the Indian goes into his tipi and talks to Jesus.”

Life in its wisdom had put me in a position where I had no control. My only choice was to let go and trust—trust others, trust myself, and, most of all, trust the direction my life had suddenly taken—or not. Making the affirmative choice, which may not have been my selection in earlier moments, opened up the possibility of a powerful healing experience, a touch of grace. I won’t say my letting go caused the healing—that’s not how grace works, as far as I can tell—but it was a prerequisite. I just happened to finally be ready, at age seventy-five, to do so.

“We live in a world that is split,” the Buddhist meditation teacher Jack Kornfield told me, “and so our psyche is split. We make money by going to work, and we take care of our bodies in the gym, and we maybe take care of our psyche a little bit in therapy, and we do the arts when we go to a concert, and we do the sacred by going to church or synagogue or mosque or something like that. They’re all in compartments, as if the sacred was somehow separate from the work that we do, or the music that we make.”

My colleague the physician Will Cooke, who in his work with addicted people in the Appalachian-adjacent region of Southern Indiana has seen his share of spiritual openings, described to me “this spark inside of everyone, that shimmering self waiting to be revealed, that’s just cluttered and stacked with all this stuff that life has stuck to them, and they can’t shine. But if we pull that away a little bit at a time and reveal who they are, it’s always something beautiful.”

Ashley Judd has forged her own unique path to healing. One of the first women to call out the film mogul Harvey Weinstein for his inveterate sexual predations, Judd had long carried the early imprints of life in a family rife with alcoholism and unprocessed grief. For her, the grace that allowed her to surrender to a God she “didn’t believe in” arose in part from an intimate encounter with the natural world. “I was sitting in a creek in the Great Smoky Mountains National Park,” she recalled when we talked, “and all the butterflies were coming down the creek, and the sun was glinting off the water, and I just knew that everything was okay. It was one of those epiphanic moments where time was suspended and I was okay, and I was alone, and I might always be alone, but everything was all right.” Even when old stuff arises, Judd says the memory of that moment remains alive for her in a way that fortifies her dedication to the healing path, and can even lighten the proceedings. “There can be some humor,” she said, chuckling. “I kicked its ass before. I’ll be okay.”

“In the Lakota idea,” Mehl-Madrona told me when we met to discuss this book and the possibility of collaborating in some healing events, “we need to celebrate and support people who are ill because they’re the canaries in the mine. They’re the ones who are showing us that our society is out of balance, and we need to thank them for taking that on and doing it for the rest of us. All of us need to participate in their healing, because if not for them, where would we be? We’re all responsible for whatever ails them. We have the responsibility to contribute to their healing for everybody’s benefit.” What a bracing old/new thought: a society in which all have responsibility for the health of all, where the illness is seen as the manifestation of shared experience. A culture like ours has much to learn from ones that take our biopsychosocial nature as a given.

Some of the gentlest people I’ve met have been lifers in Canadian or American prisons who have courageously confronted their past. Many others working with such people have shared with me that same heartfelt impression. Thanks to my work in addiction, I have been invited to speak to incarcerated populations—in other words, to the most traumatized and marginalized in our culture.

Until very recently, myth was seen as a fount of knowledge, a portal to spirit, and one of the fundaments of any healthy culture. It may well be that this original notion of myth can serve as a gateway into the world of healing, reconnecting us with eons of human wisdom and fostering a mindset where nothing is isolated happenstance and where meaning can be made from any of life’s raw materials. It is a potent antidote to the dualistic thinking that fantasizes mind and body to be separable. In the world of myth, everything is connected: one of many real-world truths that mythic thinking can help us face. Myth is a collective expression of one of the most uniquely human qualities: imagination. Far from magical thinking or denialism, imaginative thinking allows us to see beyond appearances and tap into core insights into what wholeness and wellness mean. “When we lose myth,” the American storyteller, author, and Living Myth Podcast host Michael Meade told me, “we know less. We know less about ourselves, we know less about illness, and thus we know less about healing.”

What I can say with confidence, as a physician and healer, is that for our society to right itself and chart a course toward maximum health, certain conditions will have to be met. And it will take some key changes or shifts to create those conditions. They all derive from the core principles of this book: biopsychosocial medicine, disease as teacher, the primacy of both attachment and authenticity, and, above all, fearless self-inquiry, here on a social scale. None of these shifts is sufficient in itself, but as far as I can tell, they are all necessary. They may not fully come to pass without significant social-political transformation, but they are easy to grasp, and it is well within our power to work toward them.

Are we seeing things creatively or reactively? Automatic reactions are, after all, the specialty of the traumatized personality, which is the ultimate hammer that only sees nails. Creativity, meanwhile, is about something more fundamental: it starts with seeing that we can create, and then has a feel for what wants to be created. It is a facet of authenticity, a close cousin of authorship.

We have to welcome being disillusioned—perhaps even, as Alanis Morissette does in the chorus of one of her hit singles, thank it.

A trauma-informed medical system, for starters, could help heal and prevent suffering on a scale and in ways inspiring to envision. Such a system would revamp how health care is delivered, aligning itself with the latest scientific findings.

Pediatrician Nadine Burke Harris, a well-known trauma awareness advocate and now the surgeon general of California, is introducing screening for adverse childhood experiences into public health programs in her state. In an interview held before her appointment to the post, she expressed an optimism that mirrors Bessel van der Kolk’s. “Believe it or not,” she told me, “it’s going better than I’d hoped. I think we are looking at incremental milestones that need to happen over thirty or forty years’ time, but a lot of groundwork is taking place.” For his part, Will Van Derveer has initiated a popular trauma-focused training for fellow psychiatrists, subscribed to by colleagues from around the world. And Pam Wible has pioneered a community-based approach that respects the bodymind unity and helps empower people to be active agents in their health care. “Medicine,” she told me, “is a calling and it’s a soul’s purpose.” She has now created a way to follow that call.

A trauma-informed legal system would not justify or excuse harmful behavior. Rather, it would replace nakedly punitive measures with programs designed to rehabilitate people and not to further traumatize them.

Trauma Awareness: Education Because trauma affects kids’ ability to learn, a trauma-informed educational system would train teachers to be well versed in the science of development. Education in such a system would encourage an atmosphere where emotional intelligence is valued as highly as intellectual achievement.