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Book Summary: The Myth of Normal – Trauma, Illness & Healing in a Toxic Culture

The Myth of Normal (2022) unpacks why chronic disease and mental illness are on the rise. Western medicine focuses on individual pathologies, but what if the key actually lies in our culture? Things we consider normal – like stress, adversity, and trauma – are often toxic and breed disease. The pathway back to health rests in identifying and addressing these underlying conditions.

Book Summary: The Myth of Normal - Trauma, Illness & Healing in a Toxic Culture

Content Summary

Introduction: Discover how society’s idea of “normal” is making us sick.
The clash between attachment and authenticity leads to a fractured self.
Stress wreaks havoc on the body, setting the stage for disease.
Our culture generates chronic stress and the conditions for illness.
Trauma often begins in childhood because society undermines our developmental needs.
Your health is an expression of the life you’ve lived and the context surrounding it.
Healing is about finding a pathway to wholeness.
About the author
Table of Contents
Video and Podcast
Read an Excerpt/PDF Preview


Psychology, Mental Health, Nutrition, Post-traumatic Stress Disorder, Popular Psychology Pathologies, Personal Transformation Self-Help

Introduction: Discover how society’s idea of “normal” is making us sick.

In the 1990s, the Cleveland Clinic was witness to a strange phenomenon. Despite having fairly brief contact with patients, the nursing staff could often predict who would develop ALS, a degenerative autoimmune disease that attacks nerve cells in the brain and spine.

They would write comments in each patient’s chart like, “Probably has ALS, she is too nice,” or “No way, he is NOT nice enough.” To the astonishment of the neurologists, these predictions were almost always correct.

In the decades since, research has supported the nurses’ observations. The title of one published article is, Patients with ALS Are Usually Nice Persons. And it’s true for other diseases, too. In 2000, Cancer Nursing looked at the relationship between anger repression and cancer. But how could a personality trait like niceness possibly predict disease?

For world-renowned physician Dr. Gabor Maté, the answer lies in trauma and chronic stress. In fact, these factors often underlie much of what we call disease.

Drawing on his decades of experience as a physician, Dr. Maté has set out to debunk common myths about what makes us sick. In this summary, we’ll explore his powerful critique of how our society fosters illness – and one possible path to healing based on compassion.

In particular, Dr. Maté calls on us to stop seeing disease as an expression of individual pathology. Instead, people with illness are a “living alarm,” calling attention to the fact that what passes as normal in this culture is neither healthy nor natural. And things that are abnormal – addiction, mental health, and illness – are actually a reasonable response to the conditions of trauma and stress that many of us live in.

The clash between attachment and authenticity leads to a fractured self.

At 27, Mee Ok Icaro developed a rare and painful autoimmune disorder called scleroderma, where the connective tissue throughout the body hardens. It left Mee Ok bedridden and unable to move. She felt so much pain and despair that she wanted to end her life.

Mee Ok’s condition vexed doctors, so she began looking to her childhood for answers.

Born in Korea to a single mother, she was given up for adoption at six months. She was then taken in by an evangelical couple in the US, who raised her in a strict environment. For years, she suffered sexual abuse by her adoptive father – memories of which she’d repressed.

As Mee Ok began to confront her past, she realized how much emotional pain she had been stuffing down. To cope, she had learned to channel her energy into being hyperfunctional and indispensable at work, often carrying the pressures of everyone around her.

While Mee Ok’s disease is rare, her story is sadly not. Like the ALS patients at the Cleveland Clinic, these traits of self-sacrifice, suppressing negative emotions (especially anger), and high concern for social acceptance are common in patients with autoimmune diseases.

So what’s going on here? For Dr. Maté, it exemplifies what happens when two fundamental human needs – attachment and authenticity – are put in conflict. Attachment is your core need for emotional proximity and love. But you also need to be the author of your life, guided by a deep knowledge of your authentic self.

In Mee Ok’s case, the trauma of separation and sexual abuse was so painful and alarming that she had to disconnect entirely from her memories and her emotional self. At some point, she learned that working hard and being useful was a safe way to gain acceptance.

This is the split self: there are the parts of you that you believe are acceptable, and there are others you reject. When Mee Ok learned to reconnect with those once rejected parts, she began to heal. Today, she is off all medications and can walk, travel, and even hike again.

Next, we’ll explore how this split self sets the conditions for disease.

Stress wreaks havoc on the body, setting the stage for disease.

So, we’ve seen how the conflict between attachment – our need for connection with others – and authenticity – our need to be true to ourselves – can lead to a fractured self. We suppress certain parts, like our emotions, in order to win approval or affection.

The toll this takes on our health is significant. And the key here is stress. Constantly suppressing our emotions and needs activates the stress response. To better understand this, let’s look at what happens to a body under stress.

An emotional stressor first activates a complex network of connections – think of a major highway system with many interchanges – between the hypothalamus, which is the brain center responsible for keeping your biological systems in equilibrium, and the pituitary and adrenal glands, which release stress hormones like adrenaline and cortisol.

Prolonged or chronic stress leads to an excessive release of these hormones, exhausting the entire system over time. It also wreaks havoc on your nervous system, which you know if you’ve experienced those tense jitters before a big presentation or an exam.

What’s worse, this stress inhibits your body’s natural defense against sickness. When functioning properly, the immune system floods in to attack a foreign substance and then dissipates. But stress suppresses the signals that turn it off, leading to chronic inflammation. When the immune system attacks healthy cells, it’s an autoimmune response – like in ALS or Mee Ok’s scleroderma.

Stress can even affect our DNA. Telomeres are tiny structures that protect chromosomes from fraying – kind of like the little plastic aglets at the end of your shoestrings. These telomeres shorten as we age, but if they become too short, the host cell can become impaired. Scientists have found that stress and adversity significantly shorten telomeres, prematurely aging our cells and making us more prone to illness.

It’s evident that emotional stress is inseparable from the physical state of our bodies. Dr. Maté calls this mind-body unity. But while the stress response evolved to help us survive, modern social conditions are keeping it constantly activated – which is what we’ll explore next.

Our culture generates chronic stress and the conditions for illness.

Think back, for a moment, to high school biology. Remember the petri dish? That shallow, transparent container used for growing bacteria or fungi cultures? A petri dish can create the right environment for organisms to thrive: the perfect balance of light, temperature, and nutrients, along with an absence of toxins. If the environment is off, whatever is being cultured may not survive.

After decades of treating patients, Dr. Maté has come to see that the petri dish we live in – in other words, our culture – isn’t ideal for human flourishing. In fact, it’s toxic. It breeds the chronic stress that forms the basis of our many ailments.

Consider economic insecurity. Most people have had to work harder and more hours than previous generations to keep up financially. This leaves less time for family. For many, their job – a major source of self-esteem and purpose – feels precarious, like they could lose it at any moment.

People living in poverty often have to choose between putting food on the table or paying rent. But even the global middle class hasn’t fared well. According to the Organization for Economic Cooperation and Development, they’ve been under increased pressure since the 1980s.

Groups facing discrimination have far worse health outcomes. A 2020 study by Dr. Brad Greenwood and colleagues found that a Black baby’s risk of death at birth increases twofold if their doctor is not Black. And a Canadian study showed that women have worse outcomes than men after heart surgery because they have to resume their caregiving duties earlier. They simply don’t get the same time to rest and heal as men.

For Dr. Maté, all the stress and disconnection we feel is further exploited by our consumerist culture. Think about all the advertising campaigns that set out to make us feel insecure and insufficient in order to sell us products that promise to fulfill our needs.

What’s worse, the average person has far less influence over our collective destiny than those with financial power. A recent study found that when a large majority are in favor of a particular public policy, it’s rarely implemented if the economic elite are against it.

When we take a step back, it’s no wonder that people are experiencing more stress than ever.

Trauma often begins in childhood because society undermines our developmental needs.

Here’s the thing about a society that causes so much stress: children feel it most. That’s because parental stress easily transfers to the child. Consider a study by Sonia Lupien and colleagues, which found that a child’s stress-hormone levels rise if their mother is under economic stress.

And there’s a good reason for this. A child’s development makes them extremely sensitive to their environment. What happens in these formative years sets the foundations for everything to come – their health, brain development, and future relationships.

The child’s primary developmental need is having secure and reliable attachment to caregivers, coupled with warm, attuned, and consistent interactions. Poor attachment, or stressed and distracted interactions, can lead to shaky emotional and mental development.

Considering this, you might imagine that society would do everything in its power to provide a low-stress environment for childbirth and child-rearing. Yet that couldn’t be further from reality.

First of all, there is the stress of feeling alone and unsupported in raising children – and the economic pressure parents often face today. But alongside this, parents also take cues from a culture that centers child development around the needs of society rather than the needs of the child.

It begins with overly medicalized birthing practices, which often deny women’s agency and lead many to experience obstetric trauma. Then, the integral contact that a child needs with caregivers in the first months of life is undermined by parental leave policies. One quarter of American women, for example, return to work after just two weeks.

There are also parenting guides that subvert parental instincts by encouraging disconnection and punishment. Dr. Benjamin Spock’s influential guide, for example, encourages parents to sleep-train infants by leaving them to “cry it out.” The requirement here is for children to adjust to the demands of society’s work schedules.

A culture that undermines childrens’ need for secure attachment creates the conditions for the sort of embedded, chronic stress that comes with self-fracturing. This is the basis for trauma, an emotional and psychological woundedness that we can carry throughout life.

Your health is an expression of the life you’ve lived and the context surrounding it.

The template for Dr. Maté’s lifelong depression was set in his childhood. He was born into the trauma of Nazi-occupied Hungary, and his Jewish grandparents were killed in Auschwitz. His young mother, fearing for her baby’s health, sent him to live with relatives who found safer hiding conditions. But when the two were reunited later, he would not so much as look at his mother.

Today, Dr. Maté understands that his response to the trauma of separation was reasonable and adaptive. His detachment and emotional repression helped protect him against feeling such unbearable pain again, much like Mee Ok’s repressed memories of abuse.

He can also now see the ways in which he absorbed his own mother’s trauma from living through those harrowing events. But still, like with all children who experience trauma, it embedded itself in his nervous system and his mind, influencing his behavior well into adulthood.

When we treat mental illness, like depression, as merely a disease, we miss the opportunity to understand the purpose it once served. Many of the addiction patients Dr. Maté has treated first turned to drugs or alcohol as a way to escape their emotional pain and early trauma.

Understanding the source of suffering – trauma, adversity, and stress – as the social conditions of living in a toxic culture helps put sickness and disease in a different light. Within this new framework, sick bodies and minds are more like a siren: we might look at what disease and mental illness are expressing about the life and social context they emerged from.

We have a tendency to think of illness as something that springs up one day, completely out of the blue. What if, instead, we saw an illness as a process – a journey that may connect back to the earliest days of one’s life, and extend all the way to the present?

What if someone who is sick is in the midst of a transformation, and is being called to look honestly and with an open heart at the wounds they carry?

Healing is about finding a pathway to wholeness.

While detoxifying our culture is beyond the scope of this summary, there is still a lot of cause for hope. That’s because healing is possible.

For Dr. Maté, healing is the natural movement toward wholeness. If the conditions for disease begin with a separation from the self, emotions, and others, then it makes sense that one solution is to reintegrate our fractured parts. This process involves acknowledging our suffering, and the suffering of the world, and learning to confront the wounds that have caused disconnection.

A powerful strategy that you can begin to use in your own life is an exercise called Compassionate Inquiry. Compassion is an attitude that accepts what is, and the person you are. In other words, there is no should. It allows for genuine and open inquiry, where you don’t presume to have all the answers.

This is a practice to try daily, or weekly at first. It involves answering some introspective questions, and it’s best to write your answers out by hand.

The first things to ask yourself are: When do I struggle to say no in the areas of my life that matter, and how does that impact me? When have I denied following my urge to say yes? These questions are about identifying the ways in which you deny your emotions and needs, and prioritize others.

Then you can ask, What bodily signals have I been ignoring? What symptoms could be trying to give me warning? In these questions, you’re focusing on the mind-body connection, identifying where emotional stress is held in your body.

Next, try to identify the hidden story behind your inability to say no. Where did you learn these stories? This is about untangling the narrative, so that you can see how your responses and behaviors once served you.

And that’s it. The goal of this healing work is to learn to hear your authentic, essential self. Once you’ve achieved that, you can free yourself from the automatic responses and adaptations to stress, adversity, and trauma that keep you disconnected.


Born into an environment that centers around the needs of society rather than parents and children, many of us experience small and large traumas of all kinds. To cope, we split from those painful emotions – rejecting parts of ourselves and turning away from loving connection. The source of mental illness, addiction, and disease often traces back to these inner wounds and the stress they lock into our body.

Despite many societal advances, disease and mental illness are on the rise. But the medical system rarely considers the whole life of a patient or their inner emotional world. Instead, it isolates the biology of disease from its social context, trying to cure illness so we can get back to normal. But what is normal? It may just be the very thing that is making us sick in the first place.

About the author

A renowned speaker and bestselling author, Dr. Gabor Maté is highly sought after for his expertise on a range of topics including addiction, stress, and childhood development. Dr. Maté has written several bestselling books, including the award-winning In the Realm of Hungry Ghosts: Close Encounters with Addiction, When the Body Says No: Exploring the Stress-Disease Connection, and Scattered: How Attention Deficit Disorder Originates and What You Can Do About It, and has coauthored Hold On to Your Kids: Why Parents Need to Matter More Than Peers. His works have been published internationally in nearly thirty languages.

Daniel Maté is a Brooklyn-based composer-lyricist who has received the Kleban Prize, Cole Porter Award, and Jonathan Larson Grant. His musicals include The Trouble With Doug and The Longing and the Short of It. Other shows in development include Hansel & Gretl & Heidi & Günter, Middle School Mysteries, and an adaptation of the Russell Banks novel The Sweet Hereafter. He is the host of the YouTube program Lyrics To Go and runs a “mental chiropractic” service called Walk With Daniel.

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Dr. Gabor Maté

Table of Contents

Introduction Why Normal Is a Myth (And Why That Matters) 1
Part I Our Interconnected Nature
Chapter 1 The Last Place You Want to Be: Facets of Trauma 15
Chapter 2 Living in an Immaterial World: Emotions, Health, and the Body-Mind Unity 37
Chapter 3 You Rattle My Brain: Our Highly Interpersonal Biology 52
Chapter 4 Everything I’m Surrounded By: Dispatches from the New Science 59
Chapter 5 Mutiny on the Body: The Mystery of the Rebellious Immune System 68
Chapter 6 It Ain’t a Thing: Disease as Process 85
Chapter 7 A Traumatic Tension: Attachment vs. Authenticity 96
Part II The Distortion of Human Development
Chapter 8 Who Are We Really? Human Nature, Human Needs 115
Chapter 9 A Sturdy or Fragile Foundation: Children’s Irreducible Needs 123
Chapter 10 Trouble at the Threshold: Before We Come into the World 136
Chapter 11 What Choice Do I Have? Childbirth in a Medicalized Culture 146
Chapter 12 Horticulture on the Moon: Parenting, Undermined 160
Chapter 13 Forcing the Brain in the Wrong Direction: The Sabotage of Childhood 179
Chapter 14 A Template for Distress: How Culture Builds Our Character 197
Part III Rethinking Abnormal: Afflictions as Adaptations
Chapter 15 Just Not to Be You: Debunking the Myths About Addiction 211
Chapter 16 Show of Hands: A New View of Addiction 224
Chapter 17 An Inaccurate Map of Our Pain: What We Get Wrong About Mental Illness 235
Chapter 18 The Mind Can Do Some Amazing Things: From Madness to Meaning 253
Part IV The Toxicities of Our Culture
Chapter 19 From Society to Cell: Uncertainty, Conflict, and Loss of Control 275
Chapter 20 Robbing the Human Spirit: Disconnection and Its Discontents 286
Chapter 21 They Just Don’t Care If It Kills You: Sociopathy as Strategy 297
Chapter 22 The Assaulted Sense of Self: How Race and Class Get Under the Skin 311
Chapter 23 Society’s Shock Absorbers: Why Women Have It Worse 329
Chapter 24 We Feel Their Pain: Our Trauma-Infused Politics 343
Part V Pathways to Wholeness
Chapter 25 Mind in the Lead: The Possibility of Healing 361
Chapter 26 Four A’s and Five Compassions: Some Healing Principles 374
Chapter 27 A Dreadful Gift: Disease as Teacher 390
Chapter 28 Before the Body Says No: First Steps on the Return to Self 408
Chapter 29 Seeing Is Disbelieving: Undoing Self-Limiting Beliefs 422
Chapter 30 Foes to Friends: Working with the Obstacles to Healing 430
Chapter 31 Jesus in the Tipi: Psychedelics and Healing 447
Chapter 32 My Life as a Genuine Thing: Touching Spirit 463
Chapter 33 Unmaking a Mytb: Visioning a Saner Society 481
Acknowledgments 499
Notes 503
Index 546


By the acclaimed author of In the Realm of Hungry Ghosts, a groundbreaking investigation into the causes of illness, a bracing critique of how our society breeds disease, and a pathway to health and healing.

In this revolutionary book, renowned physician Gabor Maté eloquently dissects how in Western countries that pride themselves on their healthcare systems, chronic illness and general ill health are on the rise. Nearly 70 percent of Americans are on at least one prescription drug; more than half take two. In Canada, every fifth person has high blood pressure. In Europe, hypertension is diagnosed in more than 30 percent of the population. And everywhere, adolescent mental illness is on the rise. So what is really “normal” when it comes to health?

Over four decades of clinical experience, Maté has come to recognize the prevailing understanding of “normal” as false, neglecting the roles that trauma and stress, and the pressures of modern-day living, exert on our bodies and our minds at the expense of good health. For all our expertise and technological sophistication, Western medicine often fails to treat the whole person, ignoring how today’s culture stresses the body, burdens the immune system, and undermines emotional balance. Now Maté brings his perspective to the great untangling of common myths about what makes us sick, connects the dots between the maladies of individuals and the declining soundness of society—and offers a compassionate guide for health and healing. Cowritten with his son Daniel, The Myth Of Normal is Maté’s most ambitious and urgent book yet.


“In The Myth of Normal, Gabor Maté takes us on an epic journey of discovery about how our emotional well-being, and our social connectivity (in short: how we live), is intimately intertwined with health, disease and addictions. Chronic mental and physical illnesses may not be separate and distinct diseases, but intricate, multilayered processes that reflect (mal)adaptations to the cultural context that we live in, and the values we live by. This riveting and beautifully written tale has profound implications for all of our lives, including the practice of medicine and mental health.”–Bessel A. van der Kolk MD, President, Trauma Research Foundation, Professor of psychiatry, Boston University School of Medicine, #1 New York Times Bestseller: The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma

“Gabor and Daniel Maté have created a magnificent resource for us all in The Myth of Normal, a powerful, in-depth, science-packed, inspiring story-filled opus that helps us see how stress within our culture shapes our well-being in all its facets. By carefully reviewing medical and mental health through a wide lens of inquiry, they challenge simplistic views of disease and disorder to offer instead a wider perspective on human flourishing that has direct implications for how we live individually, at home, and as a larger human family. A thorough and inspiring work of the heart, this book urges us to question our assumptions and think deeply about who we are and how we can live more fully and freely, harnessing the power of the mind to bring healing and wholeness into our shared lives on Earth.”–Daniel J. Siegel, MD, Clinical Professor, UCLA School of Medicine, Executive Director, Mindsight Institute, New York Times bestselling author of IntraConnected: MWe (Me plus We) as the integration of self, identity, and belonging

“Wise, sophisticated, rigorous and creative: an intellectual and compassionate investigation of who we are and who we may become. Essential reading for anyone with a past and a future.”–Tara Westover, New York Times bestselling author, Educated

“Gabor and Daniel Maté have delivered a book in which readers can seek refuge and solace during moments of profound personal and social crisis. The Myth of Normal is an essential compass during disorienting times.”– Esther Perel, Psychotherapist, Author and Host of Where Should We Begin

“Gabor Maté articulates bluntly, brilliantly and passionately what all of us instinctively know but none of us really want to face: the entire social construct of the world we’re living in is deeply flawed, with toxicities on every level. Yet though the book makes clear what’s so terribly wrong, it also points to how we can make it right. Maté is a guide through the dangerous forest of our minds and our society, not letting us ignore the darkness but ultimately showing us the light. The Myth of Normal is exactly what we need.”–Marianne Williamson, New York Times bestselling author, A Return To Love

“The Myth of Normal is an astonishing achievement, epic in scope and yet profoundly down to earth and practical. I believe it will open the gates to a new time where we come to understand that our emotions, culture, bodies and spirits are not separate and wellness can only come about if we treat the whole being. I will read this book again and again.”–V (formerly Eve Ensler), author of The Vagina Monologues and The Apology

“The Myth of Normal may forever change the way you view your life experiences, and how they can shape your biology. But more importantly, Gabor Maté points us to a path of desperately needed communal healing.”–Elissa Epel, PhD, Professor, UCSF, co-author of best seller The Telomere Effect

“In this brilliant, compelling and groundbreaking book, Gabor Maté unveils the societal trance that has blinded us to the death-grip of pervasive trauma in our world. He shows that this is not our ‘personal’ trauma. It is sourced in a culture that undermines meeting our basic needs for connection, authenticity and meaning. Drawing on his decades of pioneering clinical work, fascinating contemporary science and contemplative wisdom, Maté offers us a way to bring clear seeing and a greatness of heart to the crisis of our times.”–Tara Brach, author of Radical Acceptance and Radical Compassion

“Gabor and Daniel Maté offer a powerful and surprising redemptive path out of the toxic illusion of ‘normalcy.’ This remarkable and revolutionary book will profoundly impact the wellbeing of self, society, and our earth at a time when wisdom and compassion are essential for our common survival.”–Rev. Joan Jiko Halifax, Abbot, Upaya Zen Center

“At a time so many of us are struggling physically and psychically, Gabor Maté’s The Myth of Normal is a godsend, providing wisdom and realistic hope. Maté is a revolutionary thinker and gifted writer whose work has always inspired me. The Myth of Normal is no exception. It’s no exaggeration to say that this groundbreaking book can help us heal as individuals, families and a society.”–David Sheff, author of NYT #1 bestseller, Beautiful Boy

“As if Gabor Maté hasn’t done enough already by depathologizing addiction, autoimmune diseases, and ADHD; now, in this magnum opus, he challenges us to expand our minds even further. In The Myth of Normal, he asserts that those problems, and the many other social ills that plague us, are not only related to the traumas we suffered but are also symptoms of the toxic nature of our materialistic, isolating, patriarchal, and racist culture. What’s remarkable about this beautifully written book is not just that he makes that bold contention, but how well he backs it up with an amazing amount of scientific research, compelling stories of his patients, and moving disclosures from his own life. Our culture is, indeed, very sick and I don’t know of a better diagnostician of and physician for it than Gabor Mate. This book contains a prescription that, if we have the courage to follow, will heal us all.”–Richard Schwartz, PhD creator of the Internal Family Systems Model

“The Myth of Normal is a book literally everyone will be enriched by – a wise, profound and healing work that is the culmination of Dr, Maté’s many years of deep and painfully accumulated wisdom.”–Johann Hari, New York Times bestselling author of Stolen Focus

“This gripping book builds upon two key truths for our time, that everything is connected, including psychic wounds and physical illnesses, and that these are not anomalies but ordinary, even epidemic, in the society we’ve built. The Myth of Normal is a powerful call for change in how we live with, love, understand, treat, and think about each other, by someone ideally situated to map the terrain and to give us some valuable tools with which to navigate it.”—Rebecca Solnit, author of Men Explain Things to Me

“In this wide-ranging and beautifully written book, Gabor Maté and his co-writer son Daniel offer an acute diagnosis of what ails our culture and a blueprint for personal healing, while pointing the way to what is required to create a more hospitable, human-friendly world for ourselves and our children.”–Dr. Shefali, New York Times bestselling author and clinical psychologist

“Gabor Maté’s latest book is a guide to self-awareness, social insight and healing that is deeply personal and utterly transparent. It merits becoming this generation’s The Road Less Traveled. Written with fluid, crystalline prose, profound wisdom, great humor and hard-won humility, in my two-word summation The Myth of Normal is Fiercely Tender.”–William M. Watson, S.J., D.Min., President & Founder, Sacred Story Institute

“The Myth of Normal is a detailed and wide-ranging look at what we all need to know–but all too often fail to live into–when it comes to human health, sanity, maturation, and happiness. It’s also a clear-eyed examination of the benefits, triumphs, limitations, and blind spots of our health and mental health care system.”–Resmaa Menakem, bestselling author of My Grandmother’s Hands, The Quaking of America, and Monsters in Love

“The Myth of Normal is a tour de force journey into the dissonant experience of being human in our aberrant and toxic modern culture. The journey is both heart-rending and exalted in its underlying purpose—to heal the rift from our authentic selves and the collective trauma that stifles our natural expression and joy. If you are ready to do the brave and life-shaking work of examining the truth of your life and the culture that we are literally in the death grips of—this is your read.”–Rachel Carlton Abrams, MD, MHS, ABoIM

“The Myth of Normal presents a unique perspective in viewing what we see as ‘normal” and opens up a way to wake up to what is real and authentic in our lives. Gabor and Daniel Maté have written a compelling book which will challenge your views and help lift the veil of illusion to what is truly happening in your mind and in your body.”–Sharon Salzberg, author of Lovingkindness and Real Happiness

“With rigorous research and painstaking detail, this book by esteemed physician Gabor Maté is a tour de force manifesto of how trauma impacts not just our individual bodies and psyches but our whole society. The Myth of Normal plants seeds for revitalizing what we consider ‘normal’ and giving ourselves permission to say no to what is making us unnecessarily sick.”–Lissa Rankin, MD, New York Times bestselling author or Mind Over Medicine and Sacred Medicine

“This, Gabor Maté’s magnum opus, is essential reading for us all. A genius writer, he gives it to us straight: From the mindbody to the body politic, we learn how loss of authenticity takes its toll psychologically, physically, spiritually, and socially.”–Julie Holland, MD, author, Good Chemistry: The Science of Connection, From Soul to Psychedelics

“Every once in a rare while a book comes along creating a new vision of the world, illuminating for us that which until now has been invisible, yet as vital to our health and well-being as water is to fish, oxygen is for our bodies, and love is for our souls. This work is such a tour de force, a humbling and brilliantly written exposition of what deeper healing requires.”–Jeffrey D. Rediger, MD, MDiv, Assistant Professor, Harvard Medical School, Author, CURED: Strengthen Your Immune System and Heal Your Life.

“Gabor Maté is brilliant and passionate, tender and fierce, writing with an urgent honesty. His analysis is comprehensive and penetrating, combining deep scholarship, hard-earned clinical wisdom, personal trauma, and practical suggestions. This is a masterwork that reads like an intelligent thriller, highlighting our challenges with dramatic clarity while showing the way to their solutions. A must-have book for anyone interested in their own mind, in how our world got so crazy, and in the better future we can forge together.”–Rick Hanson, Ph.D., author of Resilient: How to Grow an Unshakable Core of Calm, Strength, and Happiness

“In The Myth of Normal, Gabor Maté exposes what happens when society becomes the addict, and how can we heal as a society. This is a book for our times–no, rather it is the book for our times. An illumination to therapists and healers, it is much more than that…Read and discover.”–Peter A Levine, author of Waking the Tiger and In an Unspoken Voice

“A sweeping analysis of the relationship between illness, trauma, and capitalism…Maté marshals an impressive amount of research to outline an original and persuasive vision of health focused on environmental influences and the interplay between the mind and body.”–Publishers Weekly

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Book Summary: The Myth of Normal

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Chapter 1

The Last Place You Want to Be: Facets of Trauma

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.

-Mark Epstein, The Trauma of Everyday Life

Picture this: At the tender age of seventy-one, six years before this writing, your author arrives back in Vancouver from a speaking jaunt to Philadelphia. The talk was successful, the audience enthusiastic, my message about addiction and trauma’s impact on people’s lives warmly received. I have traveled in unexpected comfort, having been upgraded to the business-class cabin, thanks to a courtesy from Air Canada. Descending over Vancouver’s pristine sea-to-sky panorama, I am a regular Little Jack Horner in my corner of the plane, suffused with a “What a good boy am I” glow. As we touch down and begin to taxi to the gate, the text from my wife, Rae, lights up the tiny screen: “Sorry. I haven’t left home yet. Do you still want me to come?” I stiffen, satisfaction displaced by rage. “Never mind,” I dictate tersely into the phone. Embittered, I disembark, clear customs, and take a taxi home, all of a twenty-minute ride door-to-door. (I trust the reader is already gripping the pages in empathetic outrage at the indignity suffered by your author.) Seeing Rae, I growl a hello that is more accusation than greeting, and scarcely look at her. In fact, I barely make eye contact for the next twenty-four hours. When addressed, I utter little more than brief, monotone grunts. My gaze is averted, the upper part of my face tense and rigid, and my jaw in a perma-clench.

What is happening with me? Is this the response of a mature adult in his eighth decade? Only superficially. At times like this, there is very little grown-up Gabor in the mix. Most of me is in the grips of the distant past, near the beginnings of my life. This kind of physio-emotional time warp, preventing me from inhabiting the present moment, is one of the imprints of trauma, an underlying theme for many people in this culture. In fact, it is so deeply “underlying” that many of us don’t know it’s there.

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. It can even determine whether or not we are capable of rational thought at all in matters of the greatest importance to our lives. For many of us, it rears its head in our closest partnerships, causing all kinds of relational mischief.

It was in 1889 that the pioneering French psychologist Pierre Janet first depicted traumatic memory as being held in “automatic actions and reactions, sensations and attitudes . . . replayed and reenacted in visceral sensations.” In the present century, the leading trauma psychologist and healer Peter Levine has written that certain shocks to the organism “can alter a person’s biological, psychological, and social equilibrium to such a degree that the memory of one particular event comes to taint, and dominate, all other experiences, spoiling an appreciation of the present moment.” Levine calls this “the tyranny of the past.”

In my case, the template for my hostility to Rae’s message is to be found in the diary my mother kept, in a nearly illegible scrawl and only intermittently, during my first years in wartime and post-World War II Budapest. The following, translated by me from the Hungarian, is her entry on April 8, 1945, when I was fourteen months old:

My dear little man, only after many long months do I take in hand again the pen, so that I may briefly sketch for you the unspeakable horrors of those times, the details of which I do not wish you to know . . . It was on December 12 that the Crossed-Arrows forced us into the fenced-in Budapest ghetto, from which, with extreme difficulty, we found refuge in a Swiss-protected house. From there, after two days, I sent you by a complete stranger to your Aunt Viola’s because I saw that your little organism could not possibly endure the living conditions in that building. Now began the most dreadful five or six weeks of my life, when I couldn’t see you.

I survived, thanks to the kindness and courage of the unknown Christian woman to whom my mother entrusted me in the street and who conveyed me to relatives living in hiding under relatively safer circumstances. Reunited with my mother after the Soviet army had put the Germans to flight, I did not so much as look at her for several days.

The great twentieth-century British psychiatrist and psychologist John Bowlby was familiar with such behavior: he called it detachment. At his clinic he observed ten small children who had to endure prolonged separation from their parents due to uncontrollable circumstances. “On meeting mother for the first time after days or weeks away every one of the children showed some degree of detachment,” Bowlby observed. “Two seemed not to recognize mother. The other eight turned away or even walked away from her. Most of them either cried or came close to tears; a number alternated between a tearful and expressionless face.” It may seem counterintuitive, but this reflexive rejection of the loving mother is an adaptation: “I was so hurt when you abandoned me,” says the young child’s mind, “that I will not reconnect with you. I don’t dare open myself to that pain again.” In many children-and I was certainly one-early reactions like these become embedded in the nervous system, mind, and body, playing havoc with future relationships. They show up throughout the lifetime in response to any incident even vaguely resembling the original imprint-often without any recall of the inciting circumstances. My petulant and defensive reaction to Rae signaled that old, deep-brain emotional circuits, programmed in infancy, had taken over while the rational, calming, self-regulating parts of my brain went offline.

“All trauma is preverbal,” the psychiatrist Bessel van der Kolk has written. His statement is true in two senses. First, the psychic wounds we sustain are often inflicted upon us before our brain is capable of formulating any kind of a verbal narrative, as in my case. Second, even after we become language-endowed, some wounds are imprinted on regions of our nervous systems having nothing to do with language or concepts; this includes brain areas, of course, but the rest of the body, too. They are stored in parts of us that words and thoughts cannot directly access-we might even call this level of traumatic encoding “subverbal.” As Peter Levine explains, “Conscious, explicit memory is only the proverbial tip of a very deep and mighty iceberg. It barely hints at the submerged strata of primal implicit experience that moves us in ways the conscious mind can only begin to imagine.”

To her credit, my wife will not allow me to get away with pinning the entire blame for my arrivals-gate hissy fit on Nazis and fascists and infant trauma. Yes, the backstory merits compassion and understanding-and she has given me an abundance of both-but there comes a point when “Hitler made me do it” won’t fly. Responsibility can and must be taken. After twenty-four hours of the silent treatment, Rae had had enough. “Oh, knock it off already,” she said. And so I did-a measure of progress and relative maturation on my part. In times past, it would have taken me days or longer to “knock it off”: to drop my resentment, and for my core to unfreeze, my face to relax, my voice to soften, and my head to turn willingly and with love toward my life partner.

“My problem is that I am married to someone who understands me,” I have often grumbled, only partly in jest. Really, of course, my great blessing is to be married to someone with healthy boundaries, who sees me as I am now and who will no longer bear the brunt of my prolonged and unplanned visits to the distant past.

What Trauma Is and What It Does

Trauma’s imprint is more endemic than we realize. That may seem a puzzling statement, as “trauma” has become something of a catchword in our society. To boot, the word has taken on a number of colloquial valences that confuse and dilute its meaning. A clear and comprehensive reckoning is warranted, especially in the field of health-and, since everything is connected, in virtually all other societal domains as well.

The usual conception of trauma conjures up notions of catastrophic events: hurricanes, abuse, egregious neglect, and war. This has the unintended and misleading effect of relegating trauma to the realm of the abnormal, the unusual, the exceptional. If there exists a class of people we call “traumatized,” that must mean that most of us are not. Here we miss the mark by a wide margin. Trauma pervades our culture, from personal functioning through social relationships, parenting, education, popular culture, economics, and politics. In fact, someone without the marks of trauma would be an outlier in our society. We are closer to the truth when we ask: Where do we each fit on the broad and surprisingly inclusive trauma spectrum? Which of its many marks has each of us carried all (or most) of our lives, and what have the impacts been? And what possibilities would open up were we to become more familiar, even intimate, with them?

A more basic question comes first: What is trauma? As I use the word, “trauma” is an inner injury, a lasting rupture or split within the self due to difficult or hurtful events. By this definition, trauma is primarily what happens within someone as a result of the difficult or hurtful events that befall them; it is not the events themselves. “Trauma is not what happens to you but what happens inside you” is how I formulate it. Think of a car accident where someone sustains a concussion: the accident is what happened; the injury is what lasts. Likewise, trauma is a psychic injury, lodged in our nervous system, mind, and body, lasting long past the originating incident(s), triggerable at any moment. It is a constellation of hardships, composed of the wound itself and the residual burdens that our woundedness imposes on our bodies and souls: the unresolved emotions they visit upon us; the coping dynamics they dictate; the tragic or melodramatic or neurotic scripts we unwittingly but inexorably live out; and, not least, the toll these take on our bodies.

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.

Raw wound or scar, unresolved trauma is a constriction of the self, both physical and psychological. It constrains our inborn capacities and generates an enduring distortion of our view of the world and of other people. Trauma, until we work it through, keeps us stuck in the past, robbing us of the present moment’s riches, limiting who we can be. By impelling us to suppress hurt and unwanted parts of the psyche, it fragments the self. Until seen and acknowledged, it is also a barrier to growth. In many cases, as in mine, it blights a person’s sense of worth, poisons relationships, and undermines appreciation for life itself. Early in childhood it may even interfere with healthy brain development. And, as we will witness, trauma is an antecedent and a contributor to illness of all kinds throughout the lifespan.

Taken together, these impacts constitute a major and foundational impediment to flourishing for many, many people. To quote Peter Levine once more, “Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering.”

Two Types of Trauma

Before we go on, let’s distinguish two forms of trauma. The first-the sense in which clinicians and teachers like Levine and van der Kolk usually employ the word-involves automatic responses and mind-body adaptations to specific, identifiable hurtful and overwhelming events, whether in childhood or later. As my medical work taught me and as research has amply shown, painful things happen to many children, from outright abuse or severe neglect in the family of origin to the poverty or racism or oppression that are daily features of many societies. The consequences can be terrible. Far more common than usually acknowledged, such traumas give rise to multiple symptoms and syndromes and to conditions diagnosed as pathology, physical or mental-a linkage that remains almost invisible to the eyes of mainstream medicine and psychiatry, except in specific “diseases” like post-traumatic stress disorder. This kind of injury has been called by some “capital-T trauma.” It underlies much of what gets labeled as mental illness. It also creates a predisposition to physical illness by driving inflammation, elevating physiological stress, and impairing the healthy functioning of genes, among many other mechanisms. To sum up, then, capital-T trauma occurs when things happen to vulnerable people that should not have happened, as, for example, a child being abused, or violence in the family, or a rancorous divorce, or the loss of a parent. All these are among the criteria for childhood affliction in the well-known adverse childhood experiences (ACE) studies. Once again, the traumatic events themselves are not identical to the trauma-the injury to self-that occurs in their immediate wake within the person.

There is another form of trauma-and this is the kind I am calling nearly universal in our culture-that has sometimes been termed “small-t trauma.” I have often witnessed what long-lasting marks seemingly ordinary events-what a seminal researcher poignantly called the “less memorable but hurtful and far more prevalent misfortunes of childhood”-can leave on the psyches of children. These might include bullying by peers, the casual but repeated harsh comments of a well-meaning parent, or even just a lack of sufficient emotional connection with the nurturing adults.

Children, especially highly sensitive children, can be wounded in multiple ways: by bad things happening, yes, but also by good things not happening, such as their emotional needs for attunement not being met, or the experience of not being seen and accepted, even by loving parents. Trauma of this kind does not require overt distress or misfortune of the sort mentioned above and can also lead to the pain of disconnection from the self, occurring as a result of core needs not being satisfied. Such non-events are what the British pediatrician D. W. Winnicott referred to as “nothing happening when something might profitably have happened”-a subject we will return to when we consider human development. “The traumas of everyday life can easily make us feel like a motherless child,” writes the psychiatrist Mark Epstein.