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

Gabor Maté

Last accessed on Friday January 20, 2023

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trouble with normality. The story concerns two fish crossing aquatic paths with an elder of their species, who greets them jovially: “‘Morning, boys. How’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, ‘What the hell is water?’” The point Wallace wanted to leave his audience pondering was that “the most obvious, ubiquitous, important realities are often the ones hardest to see and talk about.” On its surface, he allowed, that might sound like “a banal platitude” but “in the day-to-day trenches of adult existence, banal platitudes can have a life-or-death importance.”

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“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.

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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.

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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.

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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.

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Here’s a fairly reliable process-of-elimination checklist. It is not trauma if the following remain true over the long term: It does not limit you, constrict you, diminish your capacity to feel or think or to trust or assert yourself, to experience suffering without succumbing to despair or to witness it with compassion. It does not keep you from holding your pain and sorrow and fear without being overwhelmed and without having to escape habitually into work or compulsive self-soothing or self-stimulating by whatever means. You are not left compelled either to aggrandize yourself or to efface yourself for the sake of gaining acceptance or to justify your existence. It does not impair your capacity to experience gratitude for the beauty and wonder of life.

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Alternatively, some people’s disconnection from their bodies manifests as not knowing when to stop eating or drinking—the “enough” signal doesn’t get through.

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People bearing trauma’s scars almost uniformly develop a shame-based view of themselves at the core, a negative self-perception most of them are all too conscious of. Among the most poisonous consequences of shame is the loss of compassion for oneself. The more severe the trauma, the more total that loss.

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Facing it directly without either denial or overidentification becomes a doorway to health and balance.

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Gene expression in those who were born well-off was markedly different from that observed in their counterparts who grew up disadvantaged.[9]

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One of Dr. Epel’s studies found that caregiving mothers of chronically ill children had shorter telomeres than their counterparts of the same age. This biological age differential was proportionate to both the number of years of caregiving and the degree of stress as perceived by the moms.[13] Similar results were seen in caregivers of people with dementia: shortened telomeres and impaired immunity, reinforcing the idea that “chronic psychological stress has a negative impact on immune cell function and may accelerate their aging.”[14] In other words, stress ages our chromosomes, and therefore ages us.

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hyperfunctioning on top of hidden inner distress is a recurring theme among the many autoimmune patients I’ve encountered in my years of practice and teaching.

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a 1965 survey reported the prevalence in rheumatoid arthritis–prone individuals of an array of self-abnegating traits: a “compulsive and self-sacrificing doing for others, suppression of anger, and excessive concern about social acceptability.”

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patients with RA “usually tried very hard to please both in professional and personal contacts, and either concealed hostility or expressed it indirectly. Many of them were perfectionistic.” The onset of disease was often preceded by stress. He added, sagely, “Frequently as much time is needed for dealing with the emotional problems of the patient with chronic rheumatoid arthritis as with the joint or systemic disorders . . . I think the emotional and psychological aspect of many rheumatoid patients is of first importance.”

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interpersonal stress was correlated with disease severity among a group of women with rheumatoid arthritis.[18]

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The emotional triggers of suppressed fear and anger instilled in her in childhood were activated around her family, and that, in turn, would inflame her nervous system.

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As in the other autoimmune conditions, in virtually every case the childhood patterning that led people to be overconscientious, hyper-responsible, and emotionally stoic about their own needs was evident—as were stresses preceding the illness, such as interpersonal conflict, family crisis, loss of a relationship, or added duties at work.

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“Some people see lupus as an external attacker,” a British woman with lupus has written. “But I prefer to think I did it to myself . . . Too much striving, too much living on the edge, too much stress.

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“A disease is not like a thing. It is energy flow, it’s a current; it is evolution or devolution that occurs when you’re not awake and connected, and trauma is essentially ruling your life.

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In men, the immune system’s capacity to react to prostate cancer was diminished in those with a tendency to suppress anger.

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One of the things many diseases have in common is inflammation, acting as kind of a fertilizer for the development of illness. We’ve discovered that when people feel threatened, insecure—especially over an extended period of time—our bodies are programmed to turn on inflammatory genes.”

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“I had been a stereotypical good girl, overachiever, top of my class, always pushing to develop my talent and intellect, not to satisfy me but to be accepted by others,” she told me. That relentless pressure, she learned, manifested in her medical conditions. She had to let it go.

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Where does such forsaking of the self come from? “Type C,” Lydia Temoshok pointed out, “is not a personality, but rather a behavior pattern that can be modified.”

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Hardwired into our brains, our drive for attachment is mediated by vast and complex neural circuits governing and promoting behaviors designed to keep us close to those without whom we cannot live. For many people, these attachment circuits powerfully override the ones that grant us rationality, objective decision-making, or conscious will—a fact that explains much about our behavior across multiple realms.

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authenticity is not some abstract aspiration, no mere luxury for New Agers dabbling in self-improvement. Like attachment, it is a drive rooted in survival instincts. At its most concrete and pragmatic, it means simply this: knowing our gut feelings when they arise and honoring them.

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child who does not experience himself as consistently and unconditionally lovable may well grow to be preternaturally likable or charming, as with many a politician or media personality. Someone who is not valued or recognized for who she is early in life may develop an outsize appetite for status or wealth.

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We have learned that such groups held values emphasizing hospitality, sharing, generosity, and reciprocal exchange for the purpose not of personal enrichment but of connection. These values were intelligent, time-tested guidelines for mutual survival. And the traditions they generated, passed down from parent to child, generation to generation, characterized human life throughout most of our existence.

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“Bushmen devote much time and attention to the exchange of small gifts that cover many miles and multiple generations.”

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Contrary to our present ways of operating, a traditional view of self-interest would be enhancing one’s connection and membership in the community, to everyone’s benefit. Authentic self-interest need not be conflated with a suspicious and competitive stance toward others.

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children’s sense of security, trust in the world, interrelationships with others, and, above all, connection to their authentic emotions hinge on the consistent availability of attuned, non-stressed, and emotionally reliable caregivers.

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Adults who had received the highest levels of maternal affection in infancy were shown to have the lowest levels of distress.

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In recent decades, a deluge of fresh information has underscored the crucial importance of women’s physical environment, health, and emotional balance during pregnancy to the optimal development of the infant.

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paternal depression in the year from preconception to the end of the second trimester elevated the risk of extreme prematurity (coming between weeks twenty-two and thirty-one of gestation) by nearly 40 percent. This effect was greater, in fact, than that of depression in the mother herself, which raised the risk only of moderate preterm birth (thirty-two weeks or after).[13] “Paternal depression is also known to affect sperm quality, have epigenetic effects on the DNA of the baby, and can also affect placenta function,” one of the researchers pointed out.

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“It would have helped if I had had a community in place. If there existed a larger consensus in our culture of what is required to gestate a baby. It would have helped if I had had a doctor or a social worker or family member who could have stood up for me. If the doctor had asked me, even once, how I was faring emotionally . . . If anyone had phoned my husband: ‘Are you aware you are hurting your baby? Whatever problems you have with your wife, your role now is to be protective of her and of the infant she is carrying.’ We all need to realize that entering a pregnancy should be like entering a shrine, a sacred place and time: a baby is being built.

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the mechanistic approach of Western medicine in general, obstetrical practice ignores the genuine and natural needs of mothers and babies—in

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Suppression of innate knowledge is one of medicine’s unfortunate tendencies.

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“When a baby is born, a mother is born. There is considerable evidence that at this time, and for months thereafter, her needs for contact exceed those of the infant.”[6] Good thing, too: Were there not built-in physiological and emotional incentives for the ones doing the caregiving, parenthood would be even more of a slog than it already is. Fewer babies would have their survival needs met if fulfilling those needs were not rewarding for parents.

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Oster writes that “motherhood can be lonely and isolating.” Too true—but those attributes pertain not to motherhood itself but to motherhood in an alienating culture. Horticulture on the moon would doubtless be a maddening endeavor, but that tells us nothing about gardening, only that certain conditions must be in place if we hope to succeed.

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Extensive research has demonstrated that when stressed, parents are less patient and more punishing and harsher with their young children. Stress impairs their capacity to be calm, responsive, and attuned.

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Parental stress expresses itself in less overt ways, too, such as distraction and emotional absence.

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For parents, giving children the best start in life has come to mean doing everything they can to ensure that their children can climb to a higher class, or at least not fall out of the one they were born into.”[20] The unintended impact of such fearful, status-driven child-rearing is that the child’s irreducible emotional needs fall secondary to the desperation of parents striving to ensure the academic and financial success of their offspring.

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what has happened to local communities within just a very few generations. I and many others in my age cohort can still remember growing up in neighborhoods where nearly everyone knew one another, where children played throughout the day in the streets, and where every adult, known to us all, was a surrogate parent, keeping an eye on us or ready to call us to order when out of line. Families shopped in neighborhood stores; the grocer, the baker, the hardware dealer, and the car mechanic offered their goods and services within walking distance.

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Social creatures by natural design, we have become fish out of water.

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