Book review of ‘The Myth of Normal’, Part 3

Last week, we discussed Part II of ‘The Myth of Normal’; this week, we will look at Part III, called ‘Rethinking Abnormal: Afflictions as Adaptations’.

Chapter 15 and 16 deal with the way addictions are still often viewed, “either the product of ‘bad choices’ or else a ‘disease’ ” (p. 213). Fact of the matter is that they are almost always “rooted in coping mechanisms” (p. 216), an effort to survive through what feels hard or impossible to endure or even life-threatening. Any addiction, be it a substance or a behaviour, is a way for someone to find inner peace and quiet, a sense of safety instead of feeling abnormal, unworthy, and deficient.

My first encounter with Gabor Maté was through watching the film ‘The House I Live in’, on and off freely available online (but not right now, as it seems). This impressive and somehow heartbreaking film deals with the addiction issues of relatives of the former nanny of film-maker Eugene Jarecki and the embeddedness of their problems in the political forces and social structure in the United States. Somewhere in, Gabor says: “When people are in pain, they want to soothe their pain, so the question is not ‘why the addiction’, but ‘why the pain?’ ” That question is revisited in these chapters and it is explained that the central theme of addiction is pain and how addiction is an effort at self-medication of that pain.

The definition of addiction that is a red thread through all Gabor’s work is this one:
“Addiction is a complex psychological, emotional, physiological, neurobiological, social, and spiritual process. It manifests through any behavior in which a person finds temporary relief or pleasure and therefore craves, but that in the long term causes them or others negative consequences, and yet the person refuses or is unable to give it up” (p. 224, 225).

This definition is, as can be seen, not about disease or moral weakness, but about survival. It is also not restricted to drugs. It is about any behaviour that helps one “from intolerable feeling incurred through adversity and never processed, and into a state of temporary freedom, even if illusory” (p. 229).

Related to adversity is of course the ACE-study by Robert Anda and Vincent Felitti from 1998, dealing with Adverse Childhood Experiences (ACE’s) and the multiplying effect they have on one another. In this context, the term ‘syndemics’ comes to mind, a concept “introduced recently by medical anthropologists to label the synergistic interaction of two or more coexistent diseases and resultant excess burden of disease” (Singer 2016). With healthy development and healthy brain systems, based on early closeness to emotionally attuned parents, we will have less need for ‘dope’, a term for drugs that interestingly seems very close to the longed-for dopamine they provide (p. 232).

Chapter 17 states that what is often termed ‘mental illness’, when viewed from a different angle, is actually an injury to the peoples’ nervous systems by way of ACE’s or other traumatic experiences. What is called ‘mental illness’ is in most cases a dysfunction based on life events, not on genetics, but: “The gospel of genetic causation shields us from having to confront our hurts, leaving us all the more at their mercy” (p. 239). The authors point out that in some cultures, people with the behaviours or qualities that are related to ‘mental illness’ are seen as the sage ones, the ones who bring wisdom to their tribes, the bearers of hidden knowledge and insights. In fact, the theory of ‘chemical imbalance’ as the cause of mental illness has never been proven, nor have biomarkers been found. When asked, researchers had to admit: “Well, we didn’t really find that. It’s a metaphor” (p. 241). The chapter also takes up the topic of the way the DSM-5 comes to certain diagnoses and how dubious those are. It quotes Bruce Perry, who feels “playing the DSM game is completely wrong” and we should diagnose our communities and societies instead (p. 244). Even if there are ACE’s, however, Perry feels that it is important to look at the present connectedness in relationships, that can have a very healing effect on previous sequelae of adversity.

Nevertheless, we should not be casual about ACE’s, seeing that some people are “exquisitely sensitive to their environment, making them especially vulnerable under conditions of adversity but unusually vital, creative, and successful within supportive, nurturing environments”, the so-called ‘orchids’, as opposed to dandelions, who have an easier time thriving in all kinds of habitats (p. 250).
Again, all of this is not meant to blame anyone, just point out where we might look for causes and solutions by taking responsibility: “It is entirely possible to embrace responsibility without taking on the useless baggage of guilt or blame” (p. 252).

Part III ends with Chapter 18, which explains how certain behaviours have an adaptive function, “the surest way of escaping overwhelming levels of vulnerability” by distancing oneself “from emotions that are unbearable at a time in life when to experience them is to court greater calamity” (p. 255, 254). What happens in case of ‘mental illness’ or ‘brain disorders’ should thus be seen as a reflection of life experiences. Once children have to habitually suppress their emotions, it becomes increasingly hard to “discern between major and minor threats – or no threat at all” (p. 259). The dissociation this might lead to, is a form of self-defense against the pain that might result from maintained vulnerability. This is one side of what Gabor calls ‘the wisdom of trauma’, the wisdom of the body, the organism as a whole, to find ways to survive the unbearable.

An extensive discussion on ADHD has a plea for creating less stressful environments for children. They are “canaries in the coal mine”, where the coal mine stands for the societies we create and that hinder healthy brain development and plasticity, and biopsychosocial wellbeing. To keep a population healthy, to not inflict wounds and to be able to attend to them if they exist, is not merely an individual task, but an assignment for cultures as a whole.

Next week, we will discuss Part IV, ‘The Toxicities of Our Culture’.

Posted in Book and movie reviews.