The Myth of Normal

Overview

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. 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.

My top 20 points

1. There is a two-fold problem, which is leading to epidemics of chronic mental and psychical health problems such as depression, burnout, autoimmune diseases, heart diseases etc. The first problem is that our whole conception of medicine and healthcare is too much split into a biological view and a psychological view, and that while we know that many health problems are psychosomatic in nature, we do not treat them that way. The second problem is that our society exacerbates these health problems and more often than not profits from these health problems.
2. We live in a toxic culture. What we have come to accept as “normal” is actually abnormal and fails to meet natural, inborn needs. In terms of physical health alone, stats from the US: 60% of American adults have a chronic disorder, such as diabetes or hypertension; over 40% have two or more such conditions; and nearly 70% are on at least one prescription medication. Diagnoses of mental illness, especially anxiety and depression, are also skyrocketing in the Western world.
3. Maté expands the concept of trauma. The word is generally used to characterize profound distress related to the experience of war, natural disasters, or extreme abuse. He believes there’s another dimension: what he calls “small-t” trauma, the painful daily events that adversely affect individuals and predispose them to both physical and mental illness.
4. Once, these mental strains were addressed by communal activities and personal connections, but those remedies are vanishing in the digital age. The second level is the economic organization of techno-capitalism, which creates conditions of inequality, reclusiveness, and manipulation. Taken together, these issues create a yawning gap between how people live and how their biology wants them to live.
5. A caregiver’s failure to respond to children’s distress induces panic. The preverbal child gets the message that the world is unsafe, that no one will help him when he’s scared. Anxiety and other psychological problems begin to take root.
6. Two human needs—attachment and authenticity—compete during childhood. Attachment will always win out over authenticity. The child learns early that nothing must threaten the bond with his parent; survival depends on it. If certain of the child’s tendencies—the expression of anger, for example—are considered unacceptable or unlikeable by the parent, the child will suppress or repress them so as not to compromise the relationship. It is this stifling of aspects of one’s essential nature that leads to problems, including physical illness, down the road.
7. The prenatal effects of stress in the mother on the brain of the developing baby is shocking especially how stress in the mother can lead to emotional and behavioural problems in the child years later, and shocking how our culture has so little eye for stress-free pregnancy.
8. Maté dismisses genetics and contends that many mental afflictions are understandable adaptations to needs that went unmet early in life. He laments that so few clinicians ask patients, even those who present with autoimmune disorders, what they’ve gone through in the time leading up to symptom presentation.
9. The distinction between the “mind” and the “body” is a relatively recent invention of Western Medicine, and one that even by its own standards of evidence doesn’t hold up to scrutiny. Our “mental” illnesses can be felt in the body, and our “physical” problems are often connected to our mental states, traumas, and outlooks.
10. Maté’s observation about the link between “niceness” and chronic illness has been the subject of research. A 1965 survey showed that people with rheumatoid arthritis—another chronic disease— displayed “an array of self-abnegating traits: a ‘compulsive and self-sacrificing doing for others, suppression of anger, and excessive concern about social acceptability.’”
11. Given these personality traits, it shouldn’t be a surprise that women are at higher risk for chronic illness. Stress plays an “incendiary role” in whether or not a genetic predisposition will result in illness. And the gender gap has been borne out in the research. Women take twice as many anti-depressants, get 80 percent of autoimmune disease, they get more chronic illness, more chronic pain than men do.
12. Yet women’s stress is often overlooked, Maté argues. How many women are asked during prenatal checkups about their mental and emotional states, what stresses at home or on the job they may be experiencing? How many future physicians are even taught to pose such questions?
13. Women are society’s “shock absorbers,”. During Covid, on top of their own duties, women took on alleviating the stress of their husbands and their children. And they felt guilty when they couldn’t successfully do so. Women have always played that role in this patriarchal culture. It’s a society that imposes a certain expectation on one gender.
14. Stress can show up in two forms: as an immediate reaction to a threat or as a prolonged state. While acute stress is a necessary reaction that helps maintain our physical and mental integrity, chronic stress, ongoing and unrelieved, undermines both. Situational anger, for example, is an instance of acute stress being marshaled for a positive purpose. Chronic rage, by contrast, floods the system with stress hormones long past the allotted time.
15. Research shows that the more people value materialistic aspirations as goals, the lower their happiness and life satisfaction. Depression, anxiety, and substance abuse also tend to be higher among people who value the aims encouraged by consumer society thanks to four central principles of ACC — American corporate capitalism: it fosters and encourages a set of values based on self-interest, a strong desire for financial success, high levels of consumption, and interpersonal styles based on competition.
16. The rise of loneliness as a health hazard tracks with the entrenchment of values and practices that supersede any notion of “individual choices.” The dynamics include reduced social programs, less available “common” spaces such as public libraries, cuts in services for the vulnerable and the elderly, stress, poverty, and the inexorable monopolization of economic life that shreds local communities.
17. Racism is another factor. A study observed higher rates of inflammation in African Americans than in Caucasians, an epigenetic effect that remained even when comparing those of the same socioeconomic level. Experiences with racism and discrimination accounted for more than 50% of the black/white difference in the activity of genes that increase inflammation.
18. Maté is frustrated with the medical profession. While there have been many scientific studies highlighting the link between trauma and illness, doctors still focus on “biological psychiatry,”. There’s almost like a wall between science and practice. We keep talking about evidence-based practice, but there’s vast evidence that’s totally ignored. He calls resistance to these ideas “institutional inertia”.
19. When we cease to view illness as a concrete, autonomous thing with a predetermined trajectory we can start to exercise agency in the matter. After all, if disease is a manifestation of something in our lives rather than merely their cruel disruptor, we have options: we can pursue new understandings, ask new questions, perhaps make new choices. We can be active participants in the process, rather than remain its victims, helpless but for our reliance on medical miracle workers.
20. Individuals must accept their traumas in order to move past them and toward true healing. Stress, alienation, and isolation should be denormalized. At the sociopolitical level, making the medical, legal, and teaching professions more humanistic would be a good start.