Our health consumes a growing share of our economy and our attention, but we are not in great shape. Even as a ruinous pandemic subsides, epidemics of chronic disease, obesity, addiction and mental illness continue. Systems of care strain to cope and many of us engage in an anxious and often thankless quest for wellbeing.
In his latest book, The Myth of Normal, Gabor Maté offers a diagnosis for our health crisis. The problem, he suggests, is the burden of trauma people endure and the toxic culture that creates and compounds it. He prescribes profound societal change, holistic healing practices and spiritual growth assisted by psychedelics.
Both diagnosis and prescription have proven to be controversial. Skeptics worry that Maté’s explanations for ill health oversimplify a complex and incompletely understood web of causes and that his solutions dart ahead of the scientific evidence, sometimes veering towards quackery.
Maté is a Canadian physician who has become a global celebrity in wellness circles. He recently participated in a very public therapeutic dialogue with Prince Harry, in which he conversationally “diagnosed” the prince with ADHD.
The Budapest-born son of Holocaust survivors, Maté has profound personal experience of trauma and suffering. As an infant, his mother left him in the care of strangers for several weeks to save his life, and he believes the themes of abandonment, loss and rage have continued to play out in his adult life.
In previous books, Maté has explored addiction and attention deficit hyperactivity disorder (ADHD), both of which he has identified in himself, as well as the nature and cause of chronic disease.
Reverberating throughout his work are a few fundamental ideas: the centrality of trauma, the intimacy of the mind-body connection, and the culpability of capitalism and the materialistic and individualistic culture it breeds.
The trauma explanation
Maté’s 2018 book In the Realm of Hungry Ghosts prosecutes the case that addictions spring from the pain of unresolved trauma, rather than from brain disease or self-destructive choices. Maté combines a compassionate lack of judgement for addicts with fierce condemnation of a society that foments and criminalises substance use.
His subsequent work, Scattered Minds, argues ADHD is a way of coping with childhood trauma, rather than the highly heritable brain disorder or form of neurodivergence it is usually taken to be. (Maté has three children diagnosed with ADHD, as he is, but attributes this to “emotional stresses” in their early environment, including his own parenting.) This unorthodox position, which dismisses the genetic contribution to the condition and sees it as linked to sensitivity to stress and anxiety, has been controversial.
When the Body Says No argues that life stress plays a part in conditions as varied as cancer, multiple sclerosis and diabetes, whereas Hold on to Your Kids makes an extended plea for more actively engaged and attuned parenting.
The Myth of Normal, written with his son Daniel, is a culmination of Maté’s prior work, drawing its threads together into a large and sometimes tangled skein of ideas. Its ambitions are grand.
Illness, he writes, is “a function or feature of how we live” in a time of deteriorating collective health. It is rooted in a society where “much of what passes for normal […] is neither healthy nor natural” and where conformity is “profoundly abnormal in regard to our Nature-given needs”.
To Maté, “normal” is a myth because our culture has skewed our sense of what is acceptable and accustomed us to damaging ways of living.
Read more: Is psychiatry shrinking what's considered normal?
Trauma and ‘illness of all kinds’
Fittingly, Maté opens the book with a discussion of trauma, his pivotal concept. He sees it as an experience of being emotionally wounded rather than an extreme event, as it is typically seen within mainstream psychiatry.
It encompasses relatively severe “big-T trauma” – responses to extraordinary events – but also “small-t trauma”, which includes more mundane experiences of stress and adversity or even of “good things not happening”.
In promoting this expansive, subjectivised definition, by which “someone without the marks of trauma would be an outlier in our society”, Maté follows current trends favouring a broadened concept of trauma.
This shift has been documented in recent studies, and although it arguably draws welcome attention to the prevalence of adversity, it also risks diluting the concept, trivialising the experiences of “big-T” trauma survivors and promoting a counterproductive sense of being permanently damaged by one’s past.
To Maté, trauma is a contributor to “illness of all kinds”, as well as causing personal fragmentation, disconnection from other people, shame, a loss of flexibility in how we behave and alienation from the present. How we cope with trauma forges our personality, which is therefore implicated in susceptibility to a wide range of medical conditions, through immune and inflammatory processes.
Often, Maté argues, disease-prone people suppress and repress their emotions, and appear stoical, hyper-responsible and overly conscientious. These and other strong claims about links between personality and illness overstate the scientific evidence – which typically finds them to be small, absent or inconsistent with the hypothesis of excessive responsibility.
For example, very large studies have found no links between personality traits and suffering or dying from cancer, and revealed a small association between diabetes and low, rather than high, conscientiousness. The research literature on this topic is littered with debunked theories, such as the supposed association between Type A personality and heart disease.
Personality aside, Maté proposes that trauma and abuse histories underpin many autoimmune disorders – a case of scleroderma is ascribed to “inflamed emotions” – in a way that demonstrates the hyphen-dissolving unity of the “bodymind”. Disease, Maté believes, is a systemic imbalance of the whole person rather than something external that afflicts them.
Nature and nurture
Maté traces a great deal of the trauma that ails us to our childhood. He amplifies the many obstacles to healthy child development: the effects of parental stress on the growing child in utero, medicalised birth, weakened communal ties, excessive screen time and corporate marketing to children.
In one instance of intra-Canadian sniping directed at Jordan Peterson, his political mirror image, Maté disparages parenting advice that aims to socialise and shape desired behaviour. Instead, parents are counselled to express an innate parenting “instinct” whose call, he argues, is better heeded by First Nations people.
Maté’s commitment to the “nurture” side of the nature-nurture binary is accompanied by a dismissal of “the prevalent myth that genetic traits account for human behavior.” What a “genetic trait” might be, as distinct from a genetically influenced one – essentially all of them, according to behavioural genetic research – is not clarified.
To Maté, any genetic influences that exist are typically conditional on environmental conditions (epigenetics) and have been exaggerated by problematic science.
‘Addiction is a kind of refugee story’
Developmental processes underpin psychological problems. Addiction – understood expansively as any behaviour that brings relief or pleasure, causes lasting suffering to the self or others, and is difficult to stop – is ascribed to trauma.
All addiction is a kind of refugee story: from intolerable feelings incurred through adversity and never processed, and into a state of temporary freedom, however illusory.
Addiction – whether to heroin or video games – is a way of coping with pain and a lack of love, writes Maté. The addict attempts to reproduce feelings of warmth that should arise naturally if development had not blocked them.
Genes play no meaningful role in addiction, Maté advises. “No single addiction gene has ever been found – nor will ever be,” is a flatly false statement. Unless “addiction gene” is straw-manned as a gene that singlehandedly and invariably causes addiction, a requirement that would also be failed by every life experience, personality trait, brain chemical, or subjective feeling.
Maté acknowledges genes may contribute to our susceptibility to addiction, but imagines that contribution to be causally irrelevant.
The same dogmatic and disingenuous rejection of genetic influence is repeated in the book’s exploration of mental illness, which it conceptualises as trauma-caused psychological injury.
Despite the identification of 64 genomic loci associated with bipolar disorder, Maté finds the scientific evidence for a genetic contribution to it to be “nearly nonexistent” and he rejects twin studies, a staple of genetic research in psychiatry and far beyond, as fatally flawed.
Here, as elsewhere, Maté’s extreme position against genetic and brain disease explanations contains germs of truth. Biologically reductionist explanations deserve to be challenged, even if they are caricatures of how most mental health professionals understand or treat mental illness in practice. The role of trauma in mental ill health has indeed often been neglected in psychiatry.
But to neglect the role of genetic factors in mental illness is just as ideologically distorted and over-simplifying as neglecting the role of adversity. The truth here is frustratingly complex. Decades of research show that myriad life experiences and genetic variants combine in intricate ways to make some people more vulnerable to illness than others.
Genetic influences may be expressed only in specific environmental conditions, and apparent environmental influences – such as traumas – may themselves be genetically influenced, rather than being uncaused causes. Recollections of childhood adversity are themselves influenced and distorted by adult personality and emotional distress.
A more evenhanded evaluation of the scientific evidence would recognise this complexity, rather than wish it away out of a desire to highlight the undoubted importance of adverse life experiences.
Read more: Treatment for drug and alcohol misuse should involve families and communities
A toxic culture
Maté’s analysis of the forces responsible for the excess of trauma in the world condemns several societal and cultural pathologies. A series of chapters in The Myth of Normal variously identify corporate malfeasance, poverty and inequality, racism and the patriarchy.
Women’s anger suppression and self-silencing, and the burdens of care they shoulder, are identified as sources of their high rates of anxiety, depression and a range of autoimmune diseases.
National leaders are dissected under a harsh surgical light. Stephen Harper, Justin Trudeau, Donald Trump and Hillary Clinton receive quick, trauma-centred psychobiographies. The take-home message is bracing, though it comes close to pantomime villainy.
Those with the sorts of early coping mechanisms that prime them to deny reality, block out empathy, fear vulnerability, mute their own sense of right and wrong, and abjure looking at themselves too closely – will be elevated to power.
What is to be done about this mess? Maté advocates an ongoing process of healing that has political and spiritual – as well as psychological – dimensions. We need to become more authentic, agency-seizing, (healthily) angry and accepting, and practice compassion. We must learn to say no, try not to be overly selfless, avoid self-blame and undo self-limiting beliefs.
Beyond this rather standard guidance on how to iron out our psychic wrinkles, Maté has some more radical advice. He promotes the use of psychedelics to get to the unconscious roots of our problems and to activate against “the global corporate capitalist system” to create a trauma-conscious society.
Holistic health
Maté’s vision is a rousing and almost prophetic one that has won him many dedicated followers. His work speaks to a widely held dissatisfaction with the state of contemporary society, health and politics, and offers some powerful correctives.
It’s true that the rise of biological psychiatry has led to a neglect of the role of the social environment and life adversity in mental illness. It’s also true that stigmatising views of substance users and the mentally ill are often grounded in moralistic beliefs about bad choices and fatalistic beliefs about brain disease. Maté’s trauma-focused approach rejects both.
There is a deep appetite for more holistic health care that recognises the emotional suffering in (primarily) physical illness and the embodiment of mental illness. Equally, many people hope for a kind of health and wellbeing that transforms them, rather than merely reduces their symptoms and helps them better tolerate intolerable life circumstances.
Timely corrective or a step too far?
Even so, The Myth of Normal has its own contradictions. It sometimes swings the corrective pendulum to snapping point.
There is something puzzling about a worldview that criticises individualism as a source of human misery but presents personal authenticity as the goal of healing, refers to each person’s “own unique and genuine essence”, and urges us to resist conforming to a sick society. This is just another, therapy-culture form of individualism.
Maté’s focus on trauma as the singular primary cause of ill health is also unbalanced. It’s every bit as reductive and oversimplifying as a single-barrelled genetic or neurobiological explanation. At times, it applies an evidential double standard. To be legitimate explanations, biogenetic factors must fully determine illness. But for trauma to count as the primary source of a problem, some measure of adversity must simply be associated with it.
There is now very solid evidence, for example, that the number of adverse experiences people encounter in childhood is associated with their risk of developing a wide range of illnesses and life problems. This is a genuinely vital insight.
However, many of these associations are relatively modest (like obesity, diabetes, cancer, heart disease) and even the strongest (like problematic drug use, perpetration of violence) are far from perfect. Most people who live through the greatest levels of adversity do not become ill or impaired. And many whose early lives were entirely unruffled do.
The influences of adversity and trauma on mental illness are real and crucially important, but they are not consistently stronger than other influences. Understandings of illness need to recognise this dappled complexity rather than simplify it with overconfident claims.
Too often, Maté writes that some X “invariably” leads to some Y, or that in his clinical experience he has “yet to find an exception” to a pattern he has detected. In the slippery, probabilistic world of human psychology, claims to certainty are simply not credible. They should raise red flags.
Even if they find some questionable assertions in the book, many readers will also find inspiration. It is full of hope and laced with compelling stories of personal transformation and recovery, many drawn from interviews with public figures. Several chapters offer practical advice and exercises.
Readers will also find comfort and solace. The book teaches that we are not alone in our suffering, nor responsible for it. At root, our troubles are caused by what others have done to us and they implicate our selfless, overly obliging personalities. In Maté’s broad world view, individual distress is connected to a larger social justice narrative.
More skeptical readers, who find Maté’s good-individual-broken-by-bad-society framework too stark, will also benefit from reading The Myth of Normal. His voice is an influential example of the increasingly prominent nexus between progressive politics and mental health discourse. Its popularity is all the more reason to take it seriously.