“The western medicine in which I’m trained separates the mind from the body and the individual from the environment. Scientifically speaking not to mention from the point of view of traditional wisdom, mind and body are not separable and the individual manifests something of the culture in which they live. What we consider normal in this society is often very toxic and unhealthy. To give you a quick physical example the more racism a black woman experiences the greater her risk of asthma. So the inflammation of her air tubes is not simply a biological pathology in an isolated organ in this individual, it manifests a social malaise…”
This was Dr. Gabor Maté talking to Glenn Greenwald about his latest book The Myth of Normal: Trauma, Illness and Healing In A Toxic Culture. I wondered how it is possible to separate the body from the mind. After all, it is the mind that runs the body. Also, how can you separate the body from the environment that feeds and grooms it? I also questioned if it is true that Western medicine does separate the mind from the body. I did a mental survey of the medical interventions I have had over the decade or so. I realized that the only doctors (apart from a psychiatrist who was only interested in my mind) that inquired about my emotional status and life had been those trained in TCM (Traditional Chinese Medicine). And they have been the ones who produced the most effective treatments.
After having just finished The Gene, a monumental read, I wanted to take it easy, read something light, like a novel, but I abandoned the idea and picked up Dr. Maté’s book instead. I was intrigued to hear more of what this physician with experience in areas ranging from childbirth to addiction to palliative care, had to say.
The Myth of Normal starts with some alarming stats:
“In the United States, 60 percent of adults have a chronic disorder such as high blood pressure or diabetes, and over 40 percent have two or more such conditions. Nearly 70 percent of Americans are on at least one prescription drug; more than half take two. In Canada, up to half of all baby boomers are on track for hypertension within a few years if current trends continue. Among women there is a disproportionate elevation in diagnoses of potentially disabling autoimmune conditions like multiple sclerosis (MS). Among the young, non-smoking-related cancers seem to be on the rise. Rates of obesity, along with the multiple health risks it poses, are going up in many countries, including in Canada, Australia, and notably the United States, where over 30 percent of the adult population meet the criteria.
Throughout the Western world, mental health diagnoses are escalating among the young, in adults, and among the elderly. In Canada, depression and anxiety are the fastest-growing diagnoses; and in 2019 more than fifty million Americans, over 20 percent of U.S. adults, suffered an episode of mental illness. In Europe, according to the authors of a recent international survey, mental disorders have become “the largest health challenge of the 21st century.”(Maté, Gabor; Maté, Daniel. The Myth of Normal(p. 4-5).
I asked, haven’t we seen big advances in medical science that has helped to propel life expectancy to double, and caused debilitating diseases such as polio and guinea worm to be nearly eradicated? According to Dr. Maté, “the problem with good news stories like these…is that they stoke the reassuring conviction that we are, overall, making advances toward a healthier standard of life, lulling us into a false passivity. The actual picture is quite different. Far from being on the verge of curbing the contemporary health challenges facing us, we are barely keeping pace with most of them. Often the best we can do is mitigate symptoms, whether surgically or pharmacologically, or both…The crux of the problem is not a dearth of facts, not a lack of technology or techniques, but an impoverished, out-of-date perspective that cannot account for what we are seeing.” (Maté, Gabor; Maté, Daniel. The Myth of Normal(p. 10). Hence his objective to propose an alternative perspective.
The foundation of modern life
Dr. Maté starts by defining trauma because he believes that trauma is a foundational layer of experience in modern life, but one largely ignored or misunderstood. I thought I knew what trauma meant but his explanation of what it is I find illuminating. “Trauma” is an inner injury, a lasting rupture or split within the self due to difficult or hurtful events.” (Maté, Gabor; Maté, Daniel. The Myth of Normal(p. 20). How does it manifest itself? “It constrains our inborn capacities and generates an enduring distortion of our view of the world and of other people. Trauma, until we work it through, keeps us stuck in the past, robbing us of the present moment’s riches, limiting who we can be. By impelling us to suppress hurt and unwanted parts of the psyche, it fragments the self. Until seen and acknowledged, it is also a barrier to growth.” (Maté, Gabor; Maté, Daniel. The Myth of Normal(p. 21).
He distinguishes two types of trauma. Trauma with a capital-T trauma occurs when things happen to vulnerable people that should not have happened, for example, a child being abused, or violence in the family. Further, “it underlies much of what gets labeled as mental illness. It also creates a predisposition to physical illness by driving inflammation, elevating physiological stress, and impairing the healthy functioning of genes, among many other mechanisms.” (Maté, Gabor; Maté, Daniel. The Myth of Normal(p. 22). The second type is “small-t trauma” is less memorable but hurtful and far more prevalent misfortunes of childhood—can live on the psyches of children and as adults. He believes that this is the kind that is nearly universal in our culture. Examples 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 nurturing adults. Dr. Maté asserts that if the impact of the capital-T trauma despite decades of evidence has barely registered on the medical profession, small t- trauma doesn’t even register a blip.
Dr. Maté made a pertinent point about trauma in our culture society that really resonates with me:
“If trauma entails a disconnection from the self, then it makes sense to say that we are being collectively flooded with influences that both exploit and reinforce trauma. Work pressures, multitasking, social media, news updates, multiplicities of entertainment sources—these all induce us to become lost in thoughts, frantic activities, gadgets, meaningless conversations. Awareness of the moment has become something to fear. Late-stage capitalism is expert in catering to this sense of present-moment dread—in fact, much of its success depends on the chasm between us and the present, our greatest gift, getting ever wider, the false products and artificial distractions of consumer culture designed to fill in the gap.” (Maté, Gabor; Maté, Daniel. The Myth of Normal(p. 33).
I see this in my own life, it is a constant battle to be present and not be distracted by the noise of our society. There are times though when I don’t want to be present, overwhelmed by incessant societal noise. What do I do? I seek refuge in the noise of on-demand entertainment. Hahaha! I tell myself that it is better than drinking alcohol or doing drugs.
Next he addresses the question I had, if and how you can separate the body from the mind when it comes to our health. He quotes the pioneering neuroscientist Candace Pert: “I’ve come to believe that virtually all illness, if not psychosomatic in foundation, has a definite psychosomatic component,”. (Maté, Gabor; Maté, Daniel. The Myth of Normal(p. 38). Put simply, it is impossible to separate. He cites numerous studies to support his answer, some I found astonishing. For example, a study from 2016 of physicians that work with Amyotrophic Lateral Sclerosis (ALS) patients found that these physicians could predict based on personality traits who will be diagnosed with the condition. The physicians had observed that those diagnosed with ALS are high in agreeableness. Hence the title of the paper: “Patients with amyotrophic lateral sclerosis (ALS) are usually nice persons”-How physicians experienced in ALS see the personality characteristics of their patients. Another study from 2019 found that women who suffer from severe post-traumatic stress disorder (PTSD) have twice the risk of ovarian cancer than with women with no known trauma exposure. Closer to home, on a recent visit to my physiotherapist. He informed that based on his decade long experience working in several countries that 70% of the injuries he treats are stress induced. He said he always asks people about their lives prior to the injury so he knows what he is dealing with. I recall that he did the same with me., I wonder if this is the reason why he managed to heal me of a nagging shoulder pain I had for over 5 years where others had failed.
Disease as a process
The rest of the book asks (and answers) many questions, some I had asked, others that I didn’t have the words to articulate and some that I had never thought to ask. For example, it had never occurred to me to ask what is a disease or illness? Everyone knows that it is an entity that inhabits (hopefully temporarily) your body, that disruptors your life and is to be avoided. Dr. Maté describes a disease not as an entity but as a process, “one that can’t be extricated from our personal histories and the context and culture in which we live. It is both a culmination of what came before and a pointer to how things might unfold in the future.” (Maté, Gabor; Maté, Daniel. The Myth of Normal(p. 88). He believes that such reframing would revolutionize how medicine is practiced.
I’ve always wondered why it is so hard to diagnose and treat mental illness. I was stunned to read:
“We don’t understand any major mental disorder biologically…There are no measurable physical markers of mental illness other than the subjective (a person’s description of their own mood, say) and the behavioral (sleep patterns, appetite, etc.). Like all concepts, mental illness is a construct—a particular frame we have developed to understand a phenomenon and explain what we observe.” (Maté, Gabor; Maté, Daniel. The Myth of Normal (p. 235)).
This is why he is an opponent of the diagnostic model when it comes to something as abstract as the mind. I wondered, why is medication prescribed for mental illness such as depression if there are no physical markers? I’ve heard of depression referred to as a chemical imbalance in the brain. He answered that psychiatric drugs can temporarily help to ease pain. He himself has prescribed and even taken the serotonin-enhancing drug Prozac when he was going through a depressive period. However these drugs don’t solve the underlying problem because the physiology of the brain is a manifestation and a product of life in motion and in context (Maté, Gabor; Maté, Daniel. The Myth of Normal(p. 247)). I can deduce from this that mental illness is hard to treat because of the limitations of the diagnostic model that often ignores trauma and stress inducing challenges a person is facing.
Other questions I had that Dr. Maté also addressed: Why do autoimmune diseases occur? Why do they affect disproportionately more women? And why are autoimmune diseases rising? Again the answer lies in trauma (both two types described above) that the body-mind has experienced. This confirms the conclusion I had reached based on my personal experience with autoimmune disease. I had to face up to my capital-T trauma in order for me to live a normal, comfortable life that is medication free. With women specifically he attributes it to the impact of living in a culture of patriarchy that constantly demeans and harasses them. For example, according to the WHO 1 in 3 of women worldwide have been subjected to either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime. These are just known cases, the actual figure would be higher as many women find it hard to speak out due to fear of stigma. Then there is the objectification, combined with stress of managing a professional career while having to shoulder the bulk of child and household care. The former they are financially less compensated for than men even when they do the exact same job. The latter is unpaid. He presents numerous studies and observations to back this up. This confirms the conclusion I had reached based on my personal experience with autoimmune disease. In order for me to live a medication free and comfortable life I had to face up to my capital-T trauma and be attentive in maintaining my stress level at a healthy level.
The question is how do we get to a new and healthy normal? With 8.1 billion of us, that’s not an easy task. Dr. Maté used the words of James Baldwin to answer this: “Not everything that is faced can be changed. But nothing can be changed until it is faced.” Thus if we want to get to a new healthier normal we first have to face up to the detrimental impact of our culture on the health of the body-mind.