Book Review

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

Gabor Maté, MD

Alfred A. Knopf Canada, 2022

Reviewed by Sena Gok, MD

Gabor Maté is a retired Vancouver family physician and the author of several books including: Hold on to Your Kids, In the Realm of Hungry Ghosts, When the Body Says No, Scattered Minds, and The Return to Ourselves. Published in September, The Myth of Normal was listed among bestsellers in North America.

Never one to shy away from challenging our current paradigms, Gabor Maté, in his newest book, makes a bold assertion that trauma, ADHD, cancer, autoimmune diseases, and addiction are all interconnected. He aims to shed light on the ties between our health and our social and emotional lives and, further, how the cultural practices of medicine blind physicians to the effects of emotions and trauma on our health. Throughout the book, mind–body unity is emphasized. Maté suggests that we apply science in a context that seeks to determine how illness and health are related. Reframing our approach to medicine will revolutionize it.

Maté opens the book by providing some definitions. First, “myth” is used in its true sense, being the collective expansion of the human imagination. “Disease” is defined as a result of physiology, childhood trauma, social and cultural conditioning, and generations of suffering. Trauma, as he describes it, means “wound,” and how we cope with wounds defines much of our behaviour and shapes our worldview.

The author takes the reader on a ride of learning about trauma and its impacts on health and personal functioning. According to Maté, trauma is endemic and multi-layered in modern life, but its effects are often overlooked or misunderstood. “Normal levels and normal functioning are our goals when we apply treatments or remedies,” he says. The healing process, according to him, involves achieving wholeness as a direction rather than a destination.

Maté offers an expansive collection of studies on cancer and autoinflammatory diseases associated with adverse childhood experiences. Oncologists, for instance, have decades of evidence linking anger repression to cancer. Moreover, he claims that childhood maltreatment is a preventable risk factor for adult inflammatory diseases. Especially in specialties dealing with autoimmune diseases, he strongly encourages physicians to ask their patients about childhood trauma. Finally, he reminds us that the mind and body exist within a system of relationships, social circumstances, history and culture, all of which impact health.

In further chapters, he discusses poverty, racism and social isolation as factors that affect genetics and molecular functioning. Early experiences and social environments, especially racism and poverty, shape our biology and development. We see clear associations between racial disparities and adverse health outcomes, including, for example, racism’s correlation to inflammatory diseases and mortality. Even without economic disadvantage, the stress of racial prejudice mounts over time, toxifying the body and undermining its capacity to maintain itself, thus resulting in diseases.

Readers are encouraged to note the impacts of trauma in the political sphere and the early childhood experiences of some well-known American leaders. Direct correlations are made between adverse childhood experiences and adult political orientations. As we understand how the suffering in a family system or even in a community extends back generations, the concept of blame on the individual becomes meaningless. Maté adds that trauma awareness and blindness should be discussed in political discourse.

It is promising to read about successful trauma-informed healing approaches for patients struggling with addictions — not just substance abuse, but also food and behavioural issues. Reminding that health care providers can unintentionally traumatize or re-traumatize people, he suggests a view that addiction is anchored in adverse childhood experiences. Focusing on the pain of these often deeply rooted problems and exploring the perceived benefits of the substance/behaviour for the patients is a start to the recovery process. Using trauma-informed care as a universal precaution method can address these concerns for health care providers.  Asking patients broad trauma inquiry such as “Have you had any life experiences that you feel have impacted your health and well-being?” allows surgical teams and providers to understand not only acute traumas present, but also collective/structural trauma.1,2

The author emphasizes that addiction is a complex psychological, emotional, physiological, neurobiological, social and spiritual process. He touches on neurobiology and neuroscience to provide a perspective based on his own clinical and life experiences.

Throughout the book, we learn repeatedly about Native wisdom, a rich tradition contrasting with western medical thinking. Another healing tool described is the help of psychedelics and ceremonies the author himself attended.

This is a fantastic piece of research by the author, and he deserves credit for gathering such valuable experience and data. It was stimulating to read about his and other physicians’ experiences with their own and other individuals’ healing work. It is a powerful reminder of the importance of the biopsychosocial approach to recognize the unity of emotions and physiology in everyone.

Maté emphasizes the importance of being vulnerable; life is worth living because of the feelings we experience, the challenges we face, and the opportunities we open ourselves up to. He calls for a radical shift in perspective in our society. He argues that life should not be lived unexamined, adding that self-examination doesn’t require years of therapy. Trauma unawareness prevents many people from recognizing the effects of difficult life experiences on others. But developing trauma awareness in medicine and creating a trauma-conscious society are some of the suggested solutions, as trauma plays a central role in population health. Recently, a trauma-informed curriculum has been proposed for medical schools to break the cycle of trauma and promote healing.3 The author is hopeful and supports a culture shift through creating trauma-informed medical, legal, and educational systems to care for practitioners’ and students’ emotional well-being.

In The Myth of Normal, we discover how our mental health and social connectivity are intimately related and how our health can improve when we find meaning in life. This book is designed for all types of readers and has a lot to offer to physician leaders to shift the culture and inspire more humanistic approaches to people who have experienced trauma.

References

1.Grossman S, Cooper Z, Buxton H, Hendrickson S, Lewis-O’Connor A, Stevens J, et al. Trauma-informed care: recognizing and resisting re-traumatization in health care. Trauma Surg Acute Care Open 2021;6(1):e000815. https://doi.org/10.1136/tsaco-2021-000815

2.Mikhail JN, Nemeth LS, Mueller M, Pope C, NeSmith EG. The social determinants of trauma: a trauma disparities scoping review and framework. J Trauma Nurs 2018;25(5):266-81. https://doi.org/10.1097/JTN.0000000000000388

3.Brown T, Berman S, McDaniel K, Radford C, Mehta P, Potter J, et al. Trauma-informed medical education (TIME): advancing curricular content and educational context. Acad Med 2021;96(5):661-7.  https://doi.org/10.1097/ACM.0000000000003587

Author

Sena Gok, MD, is based in Toronto.

Correspondence to:

senagokk@gmail.com