Gabor Mate M.D. with Daniel Mate, The Myth of Normal: Trauma, Illness & Healing in a Toxic Culture
Avery, New York; 2022, 576 pages
Review by Barry Blackwell
PART 1: Our Interconnected Nature (Chapters 1-7)
PART 11: Distortions of Human Development (Chapters 8-14)
PART 111: Rethinking Abnormal; Afflictions & Adaptations (Chapters 15-18)
PART 1V: The Toxicities of Our Culture (Chapters 19-24)
PART V: Pathways to Wholeness (Chapters 25-33)
Notes & References (pp 503-546)
The Introduction sets the tone for the book and its novel approach related to the previous INHN posting, A triad of Treatments and change in the Zeitgeist? (Blackwell 2023):
“In the most health-obsessed society ever, all is not well. At the pinnacle of medical ingenuity and sophistication we are seeing more and more chronic physical disease as well as afflictions such as mental illness and addictions. Behind this epidemic our culture is creating suffering and ideological blind spots that keep us ignorant of the connection between our health and our social-emotional lives, a consequence of how we live, not a mysterious aberration.”
The toxic culture includes the spread of negativity, distrust, hostility, stress and polarization embedded in social structure, belief systems, inequality, climate catastrophe, assumptions and values that pervade every aspect of our lives. Over the past several decades our social and economic structure has generated chronic stress that undermines wellbeing.
The prevalence of chronic metabolic and mental disorders is increasing worldwide creating despondence and hopelessness fed further by doom and distress associated with climate change. Incremental changes are “normalized” and enquiry into causes stifled. What is most needed is “harder to see” or talk about, therefore neglected.
The current medical paradigm reduces these complex events to their biology, separating them from the body, concerning itself with one or other without appreciating the unity, constraining the good that medical science could accomplish. Health and illness are not random events, but an expression of an entire life lived.
The Last Place You Want To Be; Facets of Trauma
This chapter deals with the ubiquitous presence of trauma in everyday human life, how it manifests and how to cope with it. It begins with an event in Gabor’s own life. At the age of 71 he was returning from a successful lecture to an enthusiastic audience and begins to become angry because his wife chose not to accompany him. He traces this back to an episode when he was 14 months old, living in war torn Budapest when his mother was forced by an anti-Semitic fascist group to move into a ghetto and then a dwelling so poor, she gave him to an aunt to be cared for five or six weeks. On returning to his mother he rejected her for several days, a behavior John Bowlby describes as “detachment.” Whether or not we regard behavior like his own as “traumatized” they “pervade our culture, from personal functions through social relationships, parenting, education, economics and politics. Someone without the marks of trauma would be an outlier in our society. We are closer to the truth when we ask, “where do we each fit on the broad and surprisingly inclusive trauma spectrum?”
This leads to a broader analysis of trauma as an inner injury, a lasting rupture or split within the self, due to difficult or hurtful events. It is a psychic injury, lodged in our nervous system, mind and body, lasting long past the originating event(s), triggerable at any point. It is a constellation of hardships, composed of the wound itself and the residual burdens that imposes on our bodies and souls.
The chapter continues to define forms and characteristics of trauma. There are two major types. Severe Capital T trauma that creates a mind-body response and adaptations to specific, identifiable, hurtful, overwhelming events, whether in childhood or later. Happening early on these are called adverse childhood experiences (ACE’s) and often foretell severe forms of mental illness. The other form Small t trauma is less memorable but far more prevalent due to misfortunes of childhood, bullying, repeated harsh comments by a well-meaning parent. Big T trauma has barely registered on the mental radar screen until the pioneering work of Bessel van der Kock and small t trauma does not even cause a blip. However, the lines are fluid, not easily drawn and should not be rigidly maintained. Both types share what Bessel succinctly summarizes as “Trauma is when we are not seen and known.”
The remainder of this chapter outlines the characteristics that define trauma, details in the book.
What Trauma is Not
Trauma Separates Us from Our Bodies
Trauma Splits Us Off from Gut Feelings
Trauma Limits Response Flexibility
Trauma Distorts Our View of the World
Trauma Alienates Us from the Present
The chapter concludes with a case history that illustrates how trauma is in most cases multigenerational and blame becomes a meaningless concept. It also emphasizes that trauma also exists in a collective manner affecting groups and citing the traumatic legacy of slavery and racism in America.
Living in an Immaterial World: Emotions, Health, and the Body-Mind Unity
This chapter, as its title implies, summarizes data that supports the ancient wisdom that the human psyche is linked to the body (soma) and its ailments. Mate documents case reports and scientific studies, including Candice Pert’s 1997 book, Molecules of Emotion.
The evidence is substantive and compelling, requiring an understanding of “The Machinery of Stress,” the way in which mood states and personality traits are linked to the bodily reactions. The list is long and includes immune responses, inflammation, narrowing vasculature, cancer growth, osteoporosis, insulin resistance, blood pressure and coagulation. A major player in this process is the HPA Axis: the link between the hypothalamus, pituitary, and adrenal glands.
The chapter ends with a reminder that “choreography of the psyche and soma” extends beyond individuals to include relationships, social circumstances, history and culture.
“You Rattle My Brain”: Our Highly Interpersonal Biology
This chapter begins where the last left off, with a review of the hypothesis that interpersonal relationships influence the individual person’s wellbeing and research which supports that. This begins with George Engel’s concern that modern medicine ignores the psycho-social aspects of illness and then Mate recalls that Jerry Lee Lewis’s music really does “shake each other’s nerves and rattle each other’s brains.” The research that supports this includes a British study finding that unemployed workers had higher markers of inflammation and greater risks of illness. Another study of the British Civil Service found that lower ranking on the ladder of authority was a greater predictor of cardiac death than smoking, cholesterol or hypertension. Australian researchers found that a bad job was worse for mental health than being unemployed. Finally, a review of multiple studies, including 300,000 participants concluded that deficient interpersonal relationships are comparable to risk factors such as smoking, alcohol or dangers posed by inactivity or obesity.
Everything I’m Surrounded By: Dispatches from the New Science
In 2009 the Nobel Prize in Physiology and Medicine was shared by Dr. Elizabeth Blackburn for research on telomeres, minute DNA structures at the end of chromosomes, protecting their integrity. This included the finding that telomeres bear markers that reflect the life circumstances of the person such as poverty, racism and urban blight. These effects are not small and are readily noted.
Candice Lewis, a neuroscientist, expert in epigenetics, studied how life events influence genes and notes that “this is everything surrounding the person, not to see that is to remove helping from medicine. One of the biggest take home messages from my work is how malleable we are, how responsive to environmental cues throughout the lifespan.”
The mechanisms of epigenetics include adding molecules of DNA to change gene function, modifying the number of receptors, influencing interactions between genes. Experience determines how our genetic potential expresses itself.
Dr. Mose Szyf of McGill University takes this further: “Epigenetics is part of evolution but demands a new look at how it works. It improves upon the Darwinian view of spontaneous mutations and random selection; it demonstrates that circumstances themselves can shape how genes react to the environment.”
One study in infant rats showed that the quality of maternal care improved the offspring’s capacity to respond to stress. This in turn is passed on to their own offspring later in life.
One of Canada’s worse ever devastating ice storms in 1998 left pregnant women living in darkness, cold and home damage. The more “objective stress” they suffered their kid’s physiology was marked by the adversity even later in puberty. “We found that objective stress explained a whole host of things. Body mass index, language, obesity, insulin secretion, their immune system, even IQ.”
Another study found higher rates of inflammation and susceptibility to illness in African Americans compared to Caucasians, an epigenetic effect correlated to experiences with racism and discrimination which accounted for 50% of the black/white difference. Racism makes people old.
Like gene expression, telomeres reflect the vagaries of fate, history, stress, trauma, race and class. They also diminish with age; from about 10,000 as a baby, down to 4,000 at death.
Telomeres have been called “cellular clocks” that measure biological rather than chronological age. Even identical twins can differ.
The good news is that building stress resilience can lengthen telomeres, even in illness and adversity, opening new pathways to healing.
Mutiny on the Body: The Mystery of the Rebellious Immune System
This chapter begins with a case history told in two parts. Mee Oak, born in Korea, lives as Mandy in America where her illness, scleroderma, began at age 27 as told in this chapter, while her remarkable recovery is related in Part V, Chapter 31, where her name is now Mee Ok Icaro.
Scleroderma is Greek for “hard skin,” also known as systemic sclerosis. It is an autoimmune disorder in which hardened painful tissue builds up in many organs, the joints, limbs, esophagus, blood vessels and lungs. Mandy described it as “the pain was everywhere, it flooded my whole body.” She lives in Boston and receives medical care at “one of Western medical science’s most hallowed venues.” Her physiognomy was grim, her face a rigid mask, her taut lips barely able to cover her teeth, unrecognizable to herself.
Facing a death sentence, “there was no prognosis that really gave me a reason to stick around,” she investigated the possibility of medically assisted suicide. Needing a wheelchair and unable to get out of bed without assistance, anticipating her torments would only intensify the longer she lived.
In Chapter 31 she reappears. In defiance of all conventional medical logic, she is completely off all medications – walks, travels, and hikes independently. She is currently writing her memoir, a true victory, entirely unexpected, unexplainable to standard medical thinking.
Autoimmune diseases are among the great unsolved mysteries of medicine, considered “idiopathic” – of unknown origin and 70 to 80 % are women. Autoimmunity amounts to an assault by one’s own immune system on the body it is supposed to defend. In the last half century its prevalence has increased sharply, affecting an estimated 1 in 13 Americans. “Environmental” factors are often blamed but have not been identified.
Miray & Bianca; Grief & Vexation
Miray developed diplopia at age 18 and had attacks whenever she visited her mother until, at age 24, an MRI confirmed multiple sclerosis. She emigrated to Canada and was symptom free for years until she became pregnant and her husband became abusive, demanding and demeaning. She left the marriage and re-united with her parents. Fear and anger, instilled in childhood, were activated, inflamed her nervous system and she became unable to walk.
MS patients experiencing significant life stressors have a quadrupled incidence of disease flare-ups, recalling the “grief and vexation” which Charcot noted a century and a half ago.
Bianca, another patient of Mate’s, developed diplopia while stressed over exams in her 20s. Contrary to medical expectation she made the disease work for her. “With MS, I finally had a reason to relax and focus on myself.”
Ending the chapter Mate ventures a subtle speculation. “What If disease is not, in fact, a fixed entity but a dynamic process expressive of real lives in concrete situations? What new (or old) pathways, unthinkable within the prevailing medical view, might follow from such a paradigmatic shift in perspective?” This would require something he suggests, a capacity for the individuals own freedom from guilt or blame.
It isn’t a Thing. Disease as Process
Mate cites Eve Ensler (V) of the Vagina Monologues as a model for her evolution from surviving Stage IV cancer, viewing it not as a disease but as a process, “like having your heart broken or getting a new job.”
She was an incest victim, adored by her father, hated by her mother and she hated herself. She worried every day for 47 years that she wasn’t good enough. The trauma had not been processed sufficiently. Like the cancer it was not a hard matter, an unresolved thing but “much more a psychological, spiritual, emotional condition, “not an external enemy, not requiring war, or a foe to be battled against, but a process encompassing all of her life, present past and future. Something for hope and healing, not anger, shame and despair. Illness became an imbalance in the entire organism, not just cells, organs or pathology. This made persons active participants, not victims reliant on medical miracle workers.”
Work by Dr. Will Cole and colleagues found that activation of the body’s stress response can promote the release of inflammatory proteins that instigate damage to DNA and impede DNA repair. One of the things many diseases have in common is inflammation, acting as a kind of fertilizer for the development of illness.
Chapter 6 ends with a case report of “A Physician who Heals Herself.” In her 1997 book, The Anatomy of a Calling, Lissa Rankin tells how, dedicated to over work by age 33, she had developed cardiovascular problems, was on multiple medications and nearly suicidal. “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.” Within six months of quitting her job she was off all medications, recognizing her entire life was the ground for her physical and mental state.
A Traumatic Tension. Attachment vs Authenticity
This chapter begins with best-selling author Anita Moorjani describing the disease that nearly killed her. “I completely lost myself in satisfying other people, I was a pleaser, a rescuer, I was someone who could not say no.” Now a vibrant 61 she is convinced that chronic stress, induced by the compulsive suppression of her own needs was one of the roots of her metastatic lymphoma. Attached to the needs of others she neglected her own authentic needs. This “selfless concern for the needs of others” also hides behind the benevolent English term of “altruism,” its universal roots conveyed by its OED linguistic derivation (from French altruisme, Italian altrui and Latin alteri huic). Despite diverse linguistic origins Susan Sontag, also a talented author, and Marcia Angel, first woman editor of The New England Journal of Medicine asserted that such a body mind connection was “folklaw,” “anecdotal,” or “myth.” Mate pushes back: “Recognizing this mind-body link helps respond intelligently and effectively to illness, to mitigate risk in the first place.”
History supports his case. Hippocrates spoke of “The Choleric Temperament”, The English speak of people who are habitually grumpy as “bilious.” In Chinese medicine the liver, source of bile, is linked to anger, bitterness and resentment. Sir William Osler, father of modern medicine, connected angina and coronary artery disease to the “keen and ambitious man whose engine is always full speed ahead.”
In 1987 psychologist Lydia Temoshok, identified a “Type C Personality” associated with malignancy connected to being “co-operative, patient, unexpressive of anger and compliant” (Temoshok and Dreher 1992). This was associated with malignant melanoma. Mate noted the same traits in those who showed up with chronic illness in his practice. “The ones who compulsively put others expectations and needs above their own, who repressed their negative emotions. Repression disarms the ability to protect oneself from stress.” Based on Mate’s experience and research he compiled a list of personality traits linked to chronic illnesses including cancer, autoimmune disease, chronic skin conditions, fibromyalgia, chronic fatigue syndrome and many others. These traits are:
- Compulsive concern for the needs of others, ignoring one’s own.
- Rigid identification with social role, duty and responsibility.
- Multitasking hyper responsibility; one must justify one’s existence for doing and giving.
- Repression of healthy self-protective aggression and anger.
- Harboring and compulsively acting out two beliefs: “I am responsible for how other people feel. I must never disappoint anyone.”
These are not conscious traits, nor is anyone born with them, but regarded as “admirable strengths,” normalized and accepted by society, often conflated with other admirable traits such as compassion, diligence and generosity. These are often cited in Obituaries.
The last eight pages of this chapter are a detailed, intensive, wholehearted dissertation on the characteristics of attachment and authenticity as well as the subtle, disturbing and eternal task of holding them in balance, true to oneself and to the one’s you love or hope to heal.
So far this review has included all the chapters in Part 1 in their entirety. The remainder will briefly summarize each chapter in the remaining Three Parts.
The Distortion of Human Development
Chapter 8 spells out how the basic rules of human development work out, starting in early childhood; Chapter 9 during pregnancy; Chapter 10 during childbirth; Chapter 11 as a result of parenting; Chapters 12 and 13; and finally how it is affected in culture, Chapter14.
Afflictions & Adaptations
Chapters 15 and 16 deal with old myths and new ways of dealing with addiction. Chapter 17 portrays the mistakes we make in the diagnosis, causes, management and prognosis of mental disorders. Chapter 18 deals with creative and positive ways to parse aspects of mental illness.
The Toxicities of Our Culture
Chapter 19 provides an overview of the ubiquitous manifestations of stress and its components (understanding, conflict, loss of control) on behavior. Chapter 20 examines how dissconection and its discontents disrupt core human needs. Chapter 21 examines sociopathy, its origins, strategies and outcomes. Chapter 22 reviews the way race and class cause emotional trouble (get under your skin). Chapter 23 examins gender and “Why Women Have It Worse.” Chapter 24 examines politics, its media culture and the damage and trauma it causes in society.
Pathways to Wholeness
Gabor unveils nine chapters that represent the “good news” of healing. Chapter 25 is an overview of the process. Chapter 26 charts the four essential aspects of healing, authenticity, agency, anger and acceptance, before spelling out the “Five Compassions” essential for healing. Chapter 27 explains how features of disease can be educational (a dreadful gift). Chapter 28 reveals coping strategies developed to retrain mind and body to become more sensitive and positive to healing work. Chapter 29 explains how healing requires getting rid of feelings of inadequacy and unworthiness. This involves relabelling, reatributing, refocusing, re-evaluating and re-creating attributions and behaviors tied to illness. Chapter 30 deals with working with the obstacles to healing which include guilt, self-loathing, self sabotage and self destructive impulses.
Chapter 31 Jesus in the Tipi: Psychedelics & Healing
Chapter 32: My Life as a Genuine Thing: Touching Spirit
Chapter 33 Unmaking a Myth; Visioning a Sane Society
These last three chapters are a personal heartfelt gift from author to the reader. They defy abbreviation or interpretation but in this reviewer’s opinion are a “must read” for anyone who wishes to fully understand and appreciate the effort creating this book required and the value of it as a gift to the practice of our profession at a much needed time.
Blackwell B. A Triad of Treatments; A Changing Zeitgeist? By Barry Blackwell M.D. inhn.org.books. March 9, 2023.
Pert CB. Molecules of Emotion: The Science Behind Mind-Body Medicine. Simon and Schuster; 1997.
Rankin L. The Anatomy of a Calling: A Doctor's Journey from the Head to the Heart and a Prescription for Finding Your Life's Purpose. Rodale Wellness; 2015.
Temoshok L, Dreher H. The type C connection : the behavioral links to cancer and your health. New York: Random House; 1992.