Book review of ‘The Myth of Normal’, Part 4

Last week, we shared the blog about Part III of ‘The Myth of Normal’; this week, we turn to Part IV, called ‘The Toxicities of Our Culture’.

Chapter 19 dives straight into the biopsychosocial aspect of who we are as human beings: we are enormously influenced by our context and suffer more the bigger the inequalities are, as they cause such a lot of stress. We can depoliticise health and make it an individual responsibility, but the fact of the matter is that political decisions have a huge impact on personal life circumstances and thus also on the stresses people have to deal with in relation to income (in)security, lack of control over their own lives, and dependence on jobs that bring no fulfilment only to pay (part of) the bills. Combined with stress physiology, these circumstances go “from society to cell” (p. 278), from public routines and institutions to personal lives and bodies. Capitalism, with all its pollution and unemployment, has arrived at a point “where everything is acceptable and no one is accountable” (p. 283).
The chapter ends with a definition of ‘alienation’ that deserves a full quote, despite its length, as it also has core characteristics of trauma: “It is the cry of men who feel themselves the victims of blind economic forces beyond their control. It’s the frustration of ordinary people excluded from the processes of decision-making. The feeling of despair and hopelessness that pervades people who feel with justification that they have no real say in shaping or determining their own destinies” (p. 285). What if we look at this definition from the perspective of children…?

Chapter 20 is about the impact of social disconnection and the illness that can but ensue because of the loneliness, stress, and immune suppression caused by it: truly “a public health crisis” (p. 293). The “social dislocation”, people finding “themselves cut off from autonomy, relatedness, trust, and meaning (…) is a potent source of mental dysfunction, despair, addictions, and physical illness” (p. 289). Seeing that humans are innately meaning-making creatures, a life with no meaning is bound to cause problems. Competition, as a driving societal force, causes us to strongly rely on how we perform in comparison to others, instead of on our authenticity. Because of our “need for belonging” (p. 292), our sense of feeling seen and heard and valued thus becomes highly conditional and fragile.

Chapter 21, again, contains a lot of societal criticism, this time about “sociopathy as a strategy”, as the chapter’s title calls it. It speaks about the difference between pleasure (‘This feels good, I want more’) and happiness (‘This feels good, I am contented and complete’) and how the yearning for pleasure feeds into addictions and the short-term satisfaction of dopamine rushes. Businesses (ab)use this the search for pleasure through “neuromarketing (…) a deliberate corporate conspiracy to hook people on addictive junk foods, with no regard for health consequences” (p. 299). This is not a theory, the authors state, but realism, primarily aimed at the vulnerable, among whom children. In this context, the term ‘Coca-colonization’ (p. 301) is used, a contemporary capitalist form of preying on certain groups. Many people thus get addicted on all kinds of substances, such as unhealthy foods, alcohol, and nicotine, that are not forbidden in the name of health, but often heavily taxed by the government and then cause illness that is often treated with medication. This is seemingly normal and often not frowned upon. Illness is still seen by many as a matter of ‘bad luck’. The addiction to medication (profiting pharmaceutical companies) concerns much larger numbers, however, than the addiction to opioids and the like. That last form of addiction, however, is most certainly condemned and those falling for it, in their effort to self-medicate, are heavily punished and stigmatised. The chapter then makes a comparison between characteristics of sociopaths and large corporations, arguing that the latter should be given that same label.

Chapter 22 and 23 discuss the dire consequences of the disadvantages certain classes and ‘races’ (some no longer want to use this word; see also p. 314) have to endure. Women are also routinely disadvantaged, their problems being compounded by their female sex added to race and class. This phenomenon can be called “biological embedding, (…) that our social environments and experiences (…) get under the skin early in life, shaping our biology and development” (p. 312). Another concept in this context is that of intersectionality, the idea that it is hard to clearly differentiate between certain factors as causal for hardship, because they are at play simultaneously, with the one often increasing the severity of the other. When you are constantly the target of ‘othering’, being treated as intrinsically different and alien, what may arise is an “assaulted sense of self” (p. 315), being defined by someone else’s negative ideas about you.

All these kinds of stressors and the way they get under the skin, are triggering for “inflammation-promoting genes” (p. 319), leading to a high allostatic load, toxifying the body and wearing it out. Different kinds of discrimination continuously trigger survival defenses, the basis of many diseases. This leads to much shorter life expectancies in the most underprivileged groups. Cited is anthropologist Ashley Montagu, who termed this “sociogenic brain damage”, with more recently a scientist calling poverty a “neurotoxin” (p. 326). All these factors are called social determinants of health (with a whole field of scientific study surrounding it, such as DOHaD, Developmental Origins of Health and Disease). A sobering example is given of how this would translate to healthcare advice. Instead of ‘Stop smoking’, practitioners would have to say ‘Don’t be poor’, ‘Don’t work in a stressful job’ or ‘Don’t live near a polluting factory’.

Chapter 23, on women as ‘shock absorbers’, adds another layer to all of this, namely patriarchy, bringing about toxic power dynamics. One effect is that women often resort to “self-silencing (…), the tendency to silence one’s thoughts and feelings to maintain safe relationships, particularly intimate relationships” (p. 333, 334). Anger building up inside, as expression would risk income or family security, in the long term leads to illness due to the never subsiding stress it causes. Women are often “the designated emotional caregivers” (p. 337), but they pay a price: it weakens their immune systems. There is still a huge male-oriented bias in many aspects of social life (wages, medicine, job positions). Men often feel very entitled, even to women’s care, which can have implications for children who may lose out on maternal attention. Women often decide to go along to get along, to “make sure everybody else is happy” (p. 340). This result of “toxic masculinity”, the authors say, such societal suppression of the feminine, is lethal, and in fact shows “male fragility” (p. 341, 342).
In this chapter, Gabor once again does not spare his own role within his marriage and family – a very brave way of showing the much needed vulnerability and accountability he advocates.

Chapter 24, the last of this part, deals with the way all of this seeps into our politics, with “the wounded electing the wounded, the traumatized leading the traumatized and inexorably, implementing policies that entrench traumatizing social conditions” (p. 344). The earlier described ‘social character’, a character that is very common and thus considered ‘normal’, is represented by politicians. The way they operate, maintaining established power patterns, leads to “toxic myths becom[ing] normalized truths” (p. 345). The authors refer to the way we build our worldview in the early years and how a closer examination of ‘troubled’ politicians shows that usually they did indeed have very troubled, traumatic childhoods, where harshness was not a stranger to the family dynamics. Once in power, these people often do not have much issue with creating their own reality: “there are plenty of congenial liars, but no congenital ones” (p. 350). This once again points to the fact that much of what we become later in life, is a consequence of how we were raised, whether in the early years our needs were met or not, and how we then may try to meet them after all, even if we will never succeed to obtain what we missed out on in the first place. Celebrating and encouraging such leaders and these leaders celebrating their own stern childhoods, the chapter says, is “a public celebration of trauma” (p. 352). These processes can also be recognised in the way other celebrities are pictured in the media and how they often portray themselves: “a fan base is the closest they can come to filling a life-long void of homegrown esteem” (p. 356). It can be hard to recognise this void as such, because we so want believe in the magic of their fame.

Next week, the final part of the book will be the topic of our blog. This Part V is called ‘Pathways to Wholeness’.

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’.

Book review ‘The Myth of Normal’, Part 2

The Myth of Normal, Part 2

Last week, we discussed Part I of ‘The Myth of Normal’, the new book by Gabor Maté and his son Daniel Maté. This week we turn to Part II, ‘The Distortion of Human Development. In this part, the authors deal with the core aspects of human development, from the basic infant needs, via the way we are born and developments around parenting, to their influence on childhood and the impact of the culture we live in on all of this.

Chapter 8 poses the question what human nature is, what we need for good health. Good health and full unfolding of potential will only result if basic needs are being met; this is true for any life-form – think of a tree lacking the right nutrients or enough light. Genes play a role, for sure, but: “We are freer from genetics than any other species on earth” (p. 118). For many people, this is still a fairly new idea, sometimes understandably confronting. It means that our environment really, really matters and this has huge implications for how we organise society. It also means that interpersonal relationships are of great relevance. We have an innate need for reciprocity and being attuned with others, a “neural expectancy”, as worded by neuroscientist and researcher Stephen Porges, who coined the Polyvagal Theory: “” (p. 120). Other have described this as humans being ‘wired for connection’. To understand human relationships and human behaviour, it is well worth looking into his theory, that we will discuss in a different review.

Chapter 9 explains children’s irreducible needs. What is emphasised is that we are feeling creatures, before we are thinking creatures. What we feel in our earliest stages and the emotional knowledge and wisdom we thus develop, has a huge impact on how we think once the intellectual knowledge comes online: “If emotion is the ground of cognition, then relationships are the tectonic plates that shape that ground” (p. 125). For the foundation to be sturdy, a welcoming caregiving environment is necessary, where the child can be authentic. What is often called ‘misbehaviour’ can then be seen as “a need frustrated, a communication unheard, an emotion unprocessed” (p. 127), in short: security not provided. The chapter then discusses some of the seven major brain systems as discerned by Dr. Jaak Panksepp in his work on affective neuroscience: SEEKING, CARE, PLAY and LUST, besides FEAR, RAGE and PANIC/GRIEF. Gordon Neufeldt is quoted for his four irreducible needs: 1. the attachment relationship, 2. attachment security, 3. permission to feel one’s emotions, and 4. the experience of free play. All these needs and systems have to do with that crucial need for connection and security.

Chapter 10 discusses the matter of stress before birth. The whole chapter is about pre- and perinatal psychology, the importance of intrauterine environment for the developing child and how “emotional and neurological imprints [are] embedded in the cells and nervous system of the human organism” (p. 139). It is very touching to read how Gabor is well aware of how he influenced the birth environment his wife Rae could (not) provide, due to his own unhealed trauma and the “interpersonal biology” through which we (dis- or co-)regulate one another. He actively writes himself into the story and takes ownership of his role, making visible something of the path he has walked with his family, a path that has now resulted in a book that he wrote together with his son.

It is crucial to be aware, however, that this environment is not merely an individual issue, but something taking shape in a social context, or, as Gabor often says: “Before our minds can create the world, the world creates our minds” (see also p. 366) – and, thus, a preverbal memory of what the world is like. The social context can either support or undermine these environments through all kinds of stressors, increasing the likelihood of all possible kinds of disease. Therefore, the book advocates that the womb and “ a pregnancy should be like entering a shrine, a sacred place and time” (p. 145) and like ancient peoples, we should learn to understand (or ‘innerstand’, as some say) “the sanctity of the intrauterine environment” (p. 144).

Chapter 11 deals with the medicalisation of birth and the fact that “obstetrical practice ignores the genuine and natural needs of mothers and babies – in fact, it often runs roughshod over them” (p. 148). Birthing is not a matter of “pushing and pulling and cutting and catching”, but in cultures still heavily leaning on patriarchy, it is difficult to return from obstetrics back to midwifery and regain trust in natural processes. That is a true loss, as the hormonal cascades involved foster “warmth, nurturing, bonding, protection, and so on”, preparing “the template for the mother-infant relationship” (p. 155). The increase of the number of C-sections is for that and several other reasons a cause for concern, as is obstetric violence. The chapter makes a plea for humility on the side of healthcare providers, encouraging a knitting midwife as a quiet companion for the labouring woman going through that sacred life passage.

Chapter 12 dives into aspects of parenting and how often “the governing principle is what the parent prefers, not what the child needs” (p. 161). We have touched on this very topic before in the blog series on Adult Supremacy. This, again, is very much related to the way culture deals with developmental needs of children. The chapter explains how parenting advice through the centuries has focussed on how the child can be moulded into conforming to society’s expectations. In a contact-starved society it is hard to stay close to what Darcia Narvaez calls the “evolved nest”, an environment with a lot of soothing, responsiveness, touch, several years of breastfeeding, communal caregiving, positive social support, and creative free play. This is what humans as hunter-gatherers have seen as normal for ages and the lack of it is called “unnestedness” by Narvaez (p. 166,167). Narvaez, as well as Jean Liedloff, makes a plea for treating babies with dignity as the best way to foster both health and social competence. With parents much of the time being stressed or worried, there is a lot of “proximate separation”, to use Allan Schore’s description: physically being there, but not emotionally present. With so much sociocultural pressure, parents are regularly “fish out of water” (p. 177), lacking social structures to support them, which in turn creates “a breeding ground for personal and societal malaise” (p. 178).

Chapter 13 strongly emphasises the fact that there is no justification for simplistic ‘parent-blaming’, seeing that parents have to operate in a “socially toxic environment” with a lot of alienation and a “flight from vulnerability” (p. 185). The stress this causes, leads to a defensive state, which does not allow for healthy growth and development. The “persuasive design” of all kinds of products and programmes only adds fuel to the fire and creates brains that become addicted to short-term dopamine rushes to create instant gratification instead of more long-term ‘rewards’ from inspiring relationships and experiences, leading to higher oxytocin and serotonin levels. All of this harms both cognitive and social skills.

Chapter 14 discusses the influence of culture on who and how we are: “How we function as individuals cannot be understood outside of our relationship to the larger group” (p. 198). It leads to a ‘social character’, “the core character common to most members of a culture” (p. 201). What is considered ‘normal’, is thus highly dependent on what is expected of people, even if routines or habits or convictions are in themselves hardly understandable or defensible. Social acceptability thus becomes a driving force for behaviour, even if it is to a serious extent socially constructed by corporate entities trying to make a profit from the human insecurities of never having and never being enough.

Next week, we will blog on Part III of the book, ‘Rethinking Abnormal: Afflictions as Adaptations’.

Book review ‘The Myth of Normal – Trauma, Illness & Healing in a Toxic Culture’ door Gabor Maté en Daniel Maté, Part 1

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.

Book review of ‘The soiled nest. Transgenerational trauma’ by José Al

“When silence and ‘enduring’ have become a survival mechanism and the psyche and emotions can no longer go anywhere, then the body breaks the silence.”
“When you grow up in trauma, chronic pain becomes a wallpaper that you are so used to that it is barely noticeable.”

Body and mind as separate, independently functioning parts of a person… Already decades ago, scientific research showed that we are not made that way. Body and mind are one whole; in very nuanced ways, influences from within and without are constantly impacting how we are doing. However, if we are constantly overloaded, there comes a time when the line breaks: we get sick or otherwise get stuck. This is summed up succinctly by these two quotes from José Al’s “The Soiled Nest” (on pages 148 and 201, respectively).

Early childhood trauma gets under the skin and usually sooner or later reveals itself through the body as a disease. The pain of childhood abuse, neglect, and emotional overload can also manifest as emotional distress or social dysfunction. Moreover, the quotations highlight a very special contradiction. On the one hand, the body sends out signals that should be interpreted as a sign of underlying pain. On the other hand, those who have grown up with trauma are so used to that pain that they tend to ignore it. They will often not consciously interpret them as signals of pain that is stored in the body.

Breaking free from this dilemma is what the trauma healing process is all about. How can a person learn to feel the pain in the body and understand it with the mind? Sometimes the healing starts with feeling in the body and sometimes the recovery process starts with increased knowledge, which helps to properly interpret physical signals. What feels like the safest route will vary from person to person. For those who managed to work their way out of misery with intellectual skills, it will be a challenge to let themselves be guided more by the body (again). For those who have managed through physical complaints to receive certain forms of care and attention that were otherwise lacking, it can be a confrontation to discover that the body reflects trauma through illness. Disease suddenly turns out to be not just ‘bad luck’, but to have neurophysiological explanations. With her book, José Al shows how far-reaching it is to analyse one’s own background and to give life a different spin. What some children have to endure is so intense that it is truly a miracle that many of them manage to build a seemingly satisfying existence despite everything. It is therefore problematic that there is still so much stigma attached to openness about abuse, neglect and trauma. Adults with a wounded inner child especially deserve compassion. In the words of Al: “Let us not forget (…) that a child who survives a soiled nest has to be very resourceful in surviving under difficult circumstances. It is used to persevering when things go wrong and to see opportunities where others might get stuck” (p. 164). With that as a starting point, we, also as a society, can learn to look differently at people who are mentally struggling or who are unable or unwilling to keep up with the pace and demands of society.


The structure of the book

The book is made up of three parts. The first part describes the personal story of the character ‘Astrid’. We become part of her intense life history, in which many events are just not written out to the end.  This leaves the reader with a kind of threat in the air and one can only guess how an event will end – exactly what makes life so complicated for a child in a soiled nest. There is a constant threat and the child is therefore constantly hyper-alert. The child lives continuously in a state of readiness to receive and correctly interpret all signals from the social environment. This may give the opportunity to anticipate what is to come.

The second part contains, as the author herself calls it, the ‘explanation and substantiation written and approached from my daily practice in psycho-trauma care’. Through a thematic discussion, all kinds of aspects of the life of a child who has or has had to do with abuse and neglect are discussed. Below we briefly mention some of the themes.
Growing up in a soiled nest – about the social environment that saw the problems but took no action, about the fear of not being believed, about the illusion of safety, and about the signals a child sends at school.
Invisible personal boundaries – about a diminished body experience, about privacy being trampled on, and about the continuous silence and the guilt and shame that go with it.
Magical thinking – about the child’s own explanations to understand what is happening, about the cornerstone and the millstone, about role reversal.
Intertwinement with the internalised perpetrators – about the power relations between child and parent(s), about breaking free from those and stopping the inner terror, about the dance between rescuer and victim.
Shame – about shame for the parents, about guilt, about the prohibition of bad thoughts about the parents, about the resulting negative self-image.
Masking myths and blind spots – about misconceptions: about victims, about homes and mothers as a safe place, about abuse as only a phenomenon within socially weaker environments.
Hidden trauma like an inner sleeping crocodile – about the past that keeps catching up with the present.
Grieving for parents you never had – about grieving for what you missed, even when you get better later on, and about carers who give what they never got (out of desire for recognition).

The third part describes the answers to the research questions to a population of two hundred clients. They indicate what it meant to them to have two unsafe parents.


Design of the book

The book is beautifully designed. It is published in hardcover in a handy format and contains beautiful photos. These have a sober, tranquil and yet warm colour scheme, in which the loneliness is almost tangible. This is partly due to the dark tones, which create a sad, heavy atmosphere. Throughout the book, many poems are included that poetically articulate aspects of the subject matter discussed. What would be nice is an added bibliography and a keyword index.

You do not have to be a professional to absorb the contents of this book. The language is accessible and makes the sadness and pain very palpable. This effect is partly achieved by the liberally applied metaphors in all kinds of passages. For example, Al speaks about restrained anger that malignantly proliferates in the body in the form of tumors (p. 37), about furniture and crockery that is destroyed by an aggressive parent as if by a whirlwind (p. 74), about wanting to disappear down the drain, because you feel so vulnerable in front of your father who suddenly stands in the shower facing your nakedness (p. 85), about lack of respect for your personal boundaries that feels like uninvited strangers going about their business in your home (p. 125), about the experience of all-enveloping uncertainty that hangs around the child like a heavy grey coat that cannot be taken off (p. 131).


Interest in trauma topics is usually related to personal experiences. Many of us have had traumatic experiences in childhood; have we conquered these or do they consciously or unconsciously still abundantly influence how we function? How are you aware of these in your role as a parent, partner, teacher, caregiver, police officer? How do your own (unprocessed) experiences play a role in your contact with and expectations towards other people? How does the neoliberal society judge people who find life complicated and get stuck on the high demands? What does it mean to conclude as an adult that your parents did not want the best for you? Or did they, but was their reality based on their own traumatised background?

The book raises a lot of questions and provides a lot of food for thought. One thing is certain: it is courageous for people to tell their story, no matter what position they were or are in. This often calls for a certain amount of letting go of loyalty towards parents who soiled the nest, who could not offer their child safety and a loving start. Also those who have not experienced serious sexual abuse by both parents, but who have often felt unsafe and insecure at home, will recognise many things. This can nurture insight into and compassion for one’s own life history.

For professionals, the book is also a powerful statement: when you fail to make the client or patient feel safe and secure with you, when you fail to see ‘beyond your own blind spots’ (p. 110), when you do not dare to ask the hard questions, you risk adding instead of healing trauma. Your courage, your commitment and your gentleness in dealing with survivors of abuse, neglect and trauma can be a vital factor in their recovery. When you dare to let yourself be touched by what has crawled under their skin, a real connection can arise between you and your fellow man… and perhaps between you and your own inner child. This book provides a wealth of material for this, and the invitation to ‘dare to look around us with a broader view’ seems more than worth accepting!