Gabor Maté’s stirring book explores trauma’s devastating impact on people and our society – and what we can do to reverse the damage
The Myth of Normal is a big-hearted mess of a book—by turns compassionate, repetitive, compelling, irritating, insightful, overwrought, and deeply moving. The author, Gabor Maté, is a Hungarian-Canadian physician and a popular author and public speaker. He is known for his focus on the health impacts—physical and mental—of trauma, and especially childhood trauma. One of his previous books, In the Realm of Hungry Ghosts: Close Encounters with Addiction, explored the role of such trauma in driving the actions of people grappling with substance use and other compulsive behaviors.
In this new work, Maté is in evangelical mode – on a mission to disseminate the broader message that personal and societal trauma has a devastating impact on the psyches and bodies of human beings as well as on the world we inhabit. According to him, it is imperative that we acknowledge and address this trauma and its impacts in order to halt, and start to reverse, some of the damage. Only then can individuals, and society, find the pathway to healing. (Maté’s son Daniel, a composer and lyricist, is credited as the book’s co-author.)
As Maté writes: “Although modern medicine’s focus on the individual organism and its internal processes isn’t wrong as such, it misses something vital: the pivotal influence of the mental, emotional, social, and natural environments in which we live.”
It is hard to argue with that basic premise. The book explores the influence of these pivotal landscapes, both internal and external. In particular, Maté marshals the abundant evidence linking childhood trauma with later mental and physical disorders. He highlights the ground-breaking Adverse Childhood Experiences (ACE) study, conducted jointly by Kaiser Permanente and the U.S. Centers for Disease Control and Prevention.
The study, which the CDC called “one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being,” included data from 17,000 Kaiser Permanente members collected from 1995 to 1997. Adversity was defined as psychological, physical, or sexual abuse; physical or emotional neglect, or household dysfunction, such as loss of a parent, divorce, or mental illness in the home, among other factors.
The study inspired dozens of papers by other researchers and provided powerful evidence that traumatic experiences in childhood were linked to a higher risk of mental health problems and life-threatening diseases across the lifespan, although buffering from a trusted adult could help reduce or even reverse the impact. The greater the number of adverse childhood experiences, the greater the likelihood of these negative outcomes. And as Maté notes, the risks increased dramatically with each additional ACE.
“The impacts of such experiences did not merely add up; they multiplied each other,” he writes. “An adult reporting an ACE score of 6 had a risk of intravenous drug use forty-six-fold greater than a child with none of the adversities named.”
Of course, the ACE study is not especially new, nor is some of the other research cited by Maté. Stress, anxiety and related mood states have long been associated with higher morbidity across a range of conditions. Moreover, it is a tenet of the field of public health that “social determinants”—in other words, all the factors in the surrounding environment that Maté highlights—play a critical role in shaping individual trajectories of wellness and disease.
Maté himself frequently references Besser van der Kolk, the psychiatrist whose 2014 New York Times bestseller—The Body Keeps The Score—mapped out similar terrain. And the use of psychedelics for healing trauma, which occupies the book’s final section, has already been popularized by journalist Michael Pollan, one of Maté’s interviewees.
So yes, absolutely—trauma is traumatic! Who could disagree? As Maté explains, even those of us not traumatized as kids by societal upheavals like war or personal violence like sexual abuse, which he refers to as “capital-T trauma,” can be traumatized by “small-t trauma”–the less dramatic wounds kids suffer on a regular basis.
“I have often witnessed what long-lasting marks seemingly ordinary events—what a seminal researcher poignantly called the ‘less memorable but hurtful and far more prevalent misfortunes of childhood’—can leave on the psyches of children,” he writes. These more prevalent misfortunes, he adds, 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.”
The “myth” Maté wants to bust is that any of this trauma is “normal.” These ordinary but harmful behaviors are themselves driven, he argues, by “the toxicities of our culture”—our hunger for wealth and material possessions and our collective obsession with celebrity and status, for example, which undermine healthy interpersonal relationships. Because we are individually and collectively traumatized, he suggests, we have accommodated and normalized this state of being while expressing our pain and unhappiness and suppressed or subconscious rage in the form of mental and physical ills. Maté wants to shake us out of our damaging, unhealthy complacency.
“Disconnections in all its guises—alienation, loneliness, loss of meaning, and dislocation—is becoming our culture’s most plentiful product,” he writes. “No wonder we are more addicted, chronically ill, and mentally disordered than ever before, enfeebled as we are by such malnourishment of mind, body and soul.”
While reading The Myth of Normal, I often found myself nodding in agreement—or at least thinking of doing so. I considered how some of my own childhood traumas have marked my life and my choices. Sometimes these memories made my eyes tear up. I found myself thinking about my own addictive behaviors, or about times when my defensiveness or emotional pain led me to act like a judgmental jerk. In other words, the book was a good read.
However, it was also a bit discombobulating. Maté covers an enormous range of topics: Each chapter is a hodgepodge that might include, for example, stories of individuals triumphing over catastrophic childhoods and/or devastating illnesses; quotes from famous or not-so-famous experts on health-related issues, some of whom he interviews directly; doses of Buddhism or Buddhist-style philosophy; accounts of this or that major study or key psychological theory or construct; mentions of articles and columns in The New York Times; and smart words from a potpourri of cultural figures like Lena Dunham, Ashley Judd, and Canadian-American singer Alanis Morissette. He discusses the trauma of medicalized childbirth, the suicide of comedian Robin Williams, and the science of addiction, among many other vignettes.
Maté also reveals his own harrowing history—born to Hungarian Jews during World War II, given away as an infant to a stranger for six weeks for safekeeping, forced to flee Hungary at 12 in the wake of the Soviet invasion. He discusses how these events left him with deep-rooted fears, anxieties and insecurities and have impacted his actions as a husband and father as well as a doctor. The material is often fascinating, but within each chapter the various components often seem presented in no particular order.
It is indisputable that adversity is a risk factor for multiple negative mental health and disease outcomes through multiple physiological pathways. But these outcomes are themselves unpredictable. It’s not like a specific sort of trauma—say, having been sexually abused–always leads to breast cancer, for example, while being neglected leads to drug addiction. Maté does suggest some such links—he argues that people-pleasers are more likely to develop chronic diseases, for example. (I found this argument unpersuasive.)
In any event, resolving and addressing childhood trauma, while likely to have positive effects on a person’s mental and physical health, is not likely to lead to the reversal of disease progression in many cases. Indeed, Maté makes an important distinction between “curing,” which he defines as “the absence of disease,” and “healing,” which he suggests is a spiritual state of self-acceptance and grace, a “coming to wholeness.” Unfortunately, that distinction appears to be lost when he presents portraits of people who seemingly not only healed themselves but cured themselves of serious diseases as well.
Mee Ok, for example, was abandoned by her birth mother in Korea, adopted by an American couple, and then sexually molested for years by her adoptive father. At age 27, she was diagnosed with scleroderma, an extremely painful and sometimes fatal autoimmune disease that involves joint inflammation and tightening of the connective tissues. Her condition worsened so much that at one point she considered suicide.. Finally, with the aid of the psychedelic drug ayahuasca, she was able to confront the long-suppressed fears and terror of her childhood and found herself on a path to recovery.
“Once Mee Ok reconnected with her authentic self…she was able to divest from the trauma-confined personality,” writes Maté. “She began to free herself from the conditioned set of beliefs, behaviors, and emotions, and hence from the physiological responses these dictated. Her body—nervous system, immune system, and tissues—followed her lead.” In short, she was apparently cured of her disease.
It can be inspiring to read such seemingly miraculous stories, but they can also raise false hopes. It is impossible to prove or disprove Mate’s confident assertion that Mee Ok’s psychological and spiritual experiences led directly to her body’s recovery. Perhaps they did. Who knows? But Maté could have just as easily focused on the large numbers of patients who might have felt similarly empowered and acted in similarly empowered ways but died anyway—healed spiritually, perhaps, but not cured of their fatal conditions.
He insists that self-cure stories should not cause anyone else to blame themselves for their illnesses or for failing to improve. But that is inevitably the effect on many patients. How can touting such rare cases not generate some self-recrimination or self-doubt among those who pursue similar strategies but continue to deteriorate? It is hard to square that circle, and perhaps disingenuous to try.
Despite its potent message, the book suffers in comparison with In Search of Hungry Ghosts. Perhaps because that tome included extensive and moving accounts of Dr Maté’s interactions with patients, it offered a window onto his compassion, warmth and humanity as a clinician—a perspective that feels largely missing from this volume. And the earlier book maintained a sharp focus on the specific topic at hand: addiction.
In contrast, The Myth of Normal seems to aspire to be a grand summation of more or less everything. It reads like the author is so eager to disseminate the gospel of universal healing that he can’t stop going on about it. The book would have benefited from a more rigorous editing process.
The messianic tone becomes more understandable in the final chapters. On page 452, we finally learn that Maté –despite his great erudition, his success, his fame as an addiction and trauma specialist—only recently gained his own experience of the spiritual healing he envisions for us all. That occurred in Peru, while taking ayahuasca under the guidance of shamans. Maté had for years led other health care workers to Peru on ayahuasca workshops, but the drug had never produced much effect on him–until the day it finally did. “I need not, indeed cannot, describe what I experienced, but I remember the transcendent joy of it,” he writes. One of the shamans expressed it simply. “Dr Gabor was communing with God,” he said.
Getting to commune with God is no small matter. But Maté reassures readers that healing is not reliant on psychedelics. (That should be a relief to those of us for whom taking ayahuasca journeys in the Peruvian jungle is not possible or practical.) There are multiple pathways, Maté suggests, to achieving what he calls “authenticity” and learning to reject society’s perspective on what is and is not “normal.”
Maté concludes the book with this heartfelt – and, not surprisingly, evangelical – appeal:
“We are blessed with momentous opportunity,” he writes. “Shedding toxic myths of disconnection from ourselves, from one another, and from the planet, we can bring what is normal and what is natural, bit by bit, closer together. It is a task for the ages: one that can redeem the past, inspire the present, and point to a brighter, healthier future…It is our most daunting challenge and greatest possibility.”
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Citations & References:
"Addiction is rooted in childhood trauma, says prominent specialist." Kaiser Health News. January 10, 2019. https://khn.org/news/addiction-rooted-in-childhood-trauma-says-prominent-specialist/ An interview with Maté by journalist Rob Waters, MindSite News’ founding editor, examines Mate’s work with substance users and his belief that addiction is rooted in childhood trauma.
Adverse Childhood Experiences (ACE) Study. Centers for Disease Control and Prevention. n.d. https://www.cdc.gov/violenceprevention/aces/index.html
"Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults." American Journal of Preventive Medicine. May 1998. https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext