And then it arrived, early October: the long-expected new book by Gabor Maté and his co-author, son Daniel Maté: The Myth of Normal – Trauma, Illness & Healing in a Toxic Culture – what a treat! It is a great tome of 500 pages (excluding notes with references and the index) and provided with 22 recommendations by big names in the field, such as of course Bessel van der Kolk, Daniel Siegel and Richard Schwartz, but also Esther Perel, V (formerly Eve Ensler) and Marianne Williamson.
No tables, no graphs, no colourful images to distract the reader from the content – just two paintings printed in black-and-white (made by Rae Maté, Gabor’s wife), beautiful chapter opening quotes from wise people all over the world, and words, words, words, captivating strains of sentences, endless fascinating overviews and winding roads around the central theme of the book that is phrased as follows:
“I will make the case that much of what passes for normal in our society is neither healthy nor natural, and that to meet modern society’s criteria for normality is, in many ways, to conform to requirements that are profoundly abnormal in regard to our Nature-given needs – which is to say, unhealthy and harmful on the physiological, mental, and even spiritual levels.
If we could begin to see much illness itself not as a cruel twist of fate or some nefarious mystery but rather as an expected and therefore normal consequence of abnormal, unnatural circumstances, it would have revolutionary implications for how we approach everything health related (p.7, 8; author’s italics).”
Quite an assignment to take on, dealing with ‘everything health related’, and the thickness of the book is therefore no miracle. We are halfway through now, but took a curious peak at the acknowledgments in the back to see what the authors had to say about the journey undertaken. After many names, Gabor lastly thanks Rae with his well-known self-reflective self-mockery, explaining how her “much-needed critique and the most honest feedback [were], not always graciously received but eventually almost always, heeded” (p. 500). Daniel speaks frankly, too: “It’s been the opportunity of my lifetime to finally get to put words in your [Dad’s] mouth, and a true joy besides. Proud of you, Pop” (p. 502). He calls the book Gabor’s “magnum-est opus yet”. There is a lot of loving honesty and recognition in both their words, by which they implicitly illustrate the processes they have gone through over the years, processes deeply related to healing within the culture of their own family, families being those very basic units of the collective cultures we all live in.
We can wholeheartedly recommend reading the whole book (Dutch translation expected to be available early December 2022), but for those who won’t, we will try to give a fairly thorough overview of a seminal work that is already a bestseller. This blog will cover Part I, the first seven chapters.
The book has five parts: Our Interconnected Nature; The Distortion of Human Development; Rethinking Abnormal: Afflictions as Adaptations; The Toxicities of Our Cultures; and Pathways to Wholeness, fairly evenly split into 33 chapters dealing with aspects of these themes. In the introduction, Gabor discusses “Why Normal is a Myth”. As he does in many of his lectures and presentations, he emphasises again how the mind cannot be separated from the body, and the individual not from the environment, because it hugely impacts our social-emotional lives and thus either supports or undermines our health and wellbeing. With stress and inequality being so ubiquitous, they are easily misunderstood as being normal, or worse… we do not even recognise them, because, like fish, we cannot be aware of the water we swim in. He describes this state of affairs as a “toxic culture”, defined as “the entire context of social structures, belief systems, assumptions, and values that surround us and necessarily pervade every aspect of our lives” (p. 3), with most people in effect being “acculturated” to the many stressors present. The pathology resulting from this arises from “a web of circumstances, relationships, events, and experiences” (p. 9). How all of these play out in daily life, has a lot to do with the extent to which our basic, “nonnegiotable human needs” are satisfied. If unmet, they lead us into a state of survival that fragments our experience of self and the world around us. It also disconnects us from our body, because truly feeling the pain of unmet needs is often unbearable. Healing, therefore, is about wholeness, feeling your body again, undoing the fragmentation and (re)turning to a deep understanding of the interconnectedness of life’s many aspects.
Chapter 1 lays out a basic picture of what trauma is and does. In Greek, it means ‘wound’ and the wounds that trauma causes, the unsafety we experience, dysregulates our stress regulation system, and undermines immunity. It causes us to fall into very primary survival behaviours that restrict our ability for rational thinking and considered action and keeps us strongly tied to the past and the fear it : “Trauma is not what happens to you but what happens inside you” (p. 20), to use Gabor’s shorthand definition. And because all societal layers and institutions are built from people who have their own life history that often carries trauma within it, trauma is very pervasive. It often subconsciously shapes our personal and professional practices and routines. Once we have learned the world to be a scary place, our approach of her will unfold accordingly.
Chapter 2 discusses the mindbody-unity, that is very concisely summarised in the term “psychoneuroimmunoendocrinology”, a word focussing “on the unity between all our constituent parts: mind, brain, nervous and immune systems, and the hormonal apparatus” (p. 45). In this context, many of our readers may be familiar with the HPA-axis, the pathway from the hippocampus, to the pituitary and then the adrenal glands to activate the body when danger is signalled. These danger signals have a lot to do with our social context and humans are thus often called biopsychosocial creatures: the biological organism is influenced by psychological and social events.
This also means we highly influence those most near to us: we “are affected by all, and affect all”, also called interpersonal (neuro)biology, all that happens to the organism within the relationship, as explained in Chapter 3.
Chapter 4 deals with the by now anachronistic idea that most of who and how we are is determined by genes. Of course, we do have a genetic potential, but how that potential expresses itself, is based on experience. The field that occupies itself with this topic is epigenetics. Many genes even need environmental input, or they will not function at all. The chapter also deals with telomeres, “miniature DNA structures at the end of chromosomes”; the length is influenced by the context and a shorter length due to adversity has a negative influence on longevity (p. 59, 65).
Chapter 5 speaks about the many devastating effects of chronic inflammation and the resulting increase of autoimmune diseases. When there is early childhood trauma, chances increase of inflammation in adulthood. This can happen through the mechanism of suppressing emotions and thus increasing stress in the body; this wears out the immune system, creating an allostatic load. By clearing up these mechanisms, and the role of interpersonal stress in them, we can get a much better idea of the direction we might choose for diagnosing and healing. This, however, constitutes a true paradigm shift that will probably face much resistance, seeing the disruptive character for the medical status quo.
Chapter 6 discusses disease as a process in which often “martial metaphors” are used (p. 87), an external enemy that has to be killed or conquered. But… “[w] if we saw illness as an imbalance in the entire organism, not just as [molecular and cellular] pathology” (p. 89), or put differently, would take a biopsychosocial approach and would see illness as a systemic issue? It can then be seen as an alarm, a cry for help to heal the system as a whole.
Chapter 7 deals with one of Gabor’s favourite topics: the tension between attachment and authenticity. Children need the proximity and physical and emotional care of their primary attachment figures, because without it, they cannot survive. Another core need is authenticity, “being true to oneself, and the capacity to shape one’s own life from a deep knowledge of that self” (p. 106). If attachment is threatened by authenticity (‘If I am myself, my parents will not love me anymore; I have to earn their love’), children will usually compromise on their authenticity. Their character will adjust to the family system’s expectations and where needed they will suppress unwanted emotions. What looks like a character trait, may well be a coping strategy – with all kinds of health consequences related to it.
In the next blog, we will speak on Part II, The Distortion of Human Development.