September 29, 2022
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The Myth of Normal by Gabor Maté - Summary & Quotes

Table of Contents

Table of Contents

Three Takeaways

Note: The following are excerpts from The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture by Gabor Maté and Daniel Maté.

1. What is Trauma?

A more basic question comes first: What is trauma? As I use the word, “trauma” is an inner injury, a lasting rupture or split within the self due to difficult or hurtful events. By this definition, trauma is primarily what happens within someone as a result of the difficult or hurtful events that befall them; it is not the events themselves. “Trauma is not what happens to you but what happens inside you” is how I formulate it. Think of a car accident where someone sustains a concussion: the accident is what happened; the injury is what lasts. Likewise, trauma is a psychic injury, lodged in our nervous system, mind, and body, lasting long past the originating incident(s), triggerable at any moment. It is a constellation of hardships, composed of the wound itself and the residual burdens that our woundedness imposes on our bodies and souls: the unresolved emotions they visit upon us; the coping dynamics they dictate; the tragic or melodramatic or neurotic scripts we unwittingly but inexorably live out; and, not least, the toll these take on our bodies.

When a wound doesn’t mend on its own, one of two things will happen: it can either remain raw or, more commonly, be replaced by a thick layer of scar tissue. As an open sore, it is an ongoing source of pain and a place where we can be hurt over and over again by even the slightest stimulus. It compels us to be ever vigilant—always nursing our wounds, as it were—and leaves us limited in our capacity to move flexibly and act confidently lest we be harmed again. The scar is preferable, providing protection and holding tissues together, but it has its drawbacks: it is tight, hard, inflexible, unable to grow, a zone of numbness. The original healthy, alive flesh is not regenerated.

Raw wound or scar, unresolved trauma is a constriction of the self, both physical and psychological. 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. In many cases, as in mine, it blights a person’s sense of worth, poisons relationships, and undermines appreciation for life itself. Early in childhood it may even interfere with healthy brain development. And, as we will witness, trauma is an antecedent and a contributor to illness of all kinds throughout the lifespan.

Taken together, these impacts constitute a major and foundational impediment to flourishing for many, many people. To quote Peter Levine once more, “Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering.”

The Two Forms of Trauma

As my medical work taught me and as research has amply shown, painful things happen to many children, from outright abuse or severe neglect in the family of origin to the poverty or racism or oppression that are daily features of many societies. The consequences can be terrible. Far more common than usually acknowledged, such traumas give rise to multiple symptoms and syndromes and to conditions diagnosed as pathology, physical or mental—a linkage that remains almost invisible to the eyes of mainstream medicine and psychiatry, except in specific “diseases” like post-traumatic stress disorder. This kind of injury has been called by some “capital-T trauma.” 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. To sum up, then, capital-T trauma occurs when things happen to vulnerable people that should not have happened, as, for example, a child being abused, or violence in the family, or a rancorous divorce, or the loss of a parent.

There is another form of trauma—and this is the kind I am calling nearly universal in our culture—that has sometimes been termed “small-t trauma.” 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. These might 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.

Manifestations of Trauma Avoidance in Society

I once shared a meal in an Oslo restaurant with the German psychologist Franz Ruppert. The noise was overwhelming: loud pop music pumping through several speakers and multiple TV channels blaring from bright screens mounted high on the walls. I have to think that when the great Norwegian playwright Henrik Ibsen used to hold court in that same establishment a little over a century before, the ambience was much more serene. “What’s this all about?” I shouted to my companion over the cacophony, shaking my head in exasperation. “Trauma,” he replied as he shrugged his shoulders. Ruppert meant, simply, that people were desperately seeking an escape from themselves. 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. We are caught up in pursuits of all kinds that draw us on not because they are necessary or inspiring or uplifting, or because they enrich or add meaning to our lives, but simply because they obliterate the present.

Trauma is in most cases multigenerational. The chain of transmission goes from parent to child, stretching from the past into the future. We pass on to our offspring what we haven’t resolved in ourselves.

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2. A Self-Inquiry Exercise

This exercise is best done in written form, in a quiet room where you can be with yourself and your experience, free from distractions. You will want to write out your answers, because doing so will engage the mind more actively and profoundly than observing your mental ideas or insights; also, because you may want a record of your progress.

Question #1: In my life’s important areas, what am I not saying no to?

In other words, where did I, today or this week, sense a “no” within me that wanted to be expressed, but I stifled it, conveying a “yes” (or a silence) where a “no” wanted to be heard?

Question #2: How does my inability to say no impact my life?

You will find this impact lands in three main spheres: the physical, the emotional, and the interpersonal.

Question #3: What bodily signals have I been overlooking? What symptoms have I been ignoring that could be warning signs, were I to pay conscious attention?

The third question reverses the direction of the previous one: here we start with the physical impacts, trusting them to reveal where authenticity has been missing. It requires you to take an inventory of your body—a regular and deliberate scan—for the day or the week

Question #4: What is the hidden story behind my inability to say no?

What feeds our habitual pattern of denying our “no” is what I call the story. By this I mean the narrative, the explanation, the justification, the rationalization that makes these habits seem normal and even necessary. In truth they sprout from limiting core beliefs about ourselves. Most often we are not aware that they are stories. We think and act as if they’re true.

Question #5: Where did I learn these stories?

No one is imbued at birth with a sense of worthlessness. It is through our interactions with nurturing caregivers that we develop our view of ourselves.

The intention in looking at the past is not to dwell on it but to let go of it. “The moment you know how your suffering came to be, you are already on the path of release from it,” the Buddha said. Hence this fifth question calls for a frank look at our childhood experiences—not as we would have liked them to be, but as they were.

Question #6: Where have I ignored or denied the “yes” that wanted to be said?

If stifling a “no” can make us ill, so can withholding an authentic “yes.” What have you wanted to do, manifest, create, or say that you have forsaken in the name of perceived duty or out of fear? What desire to play or explore have you ignored? What joys have you denied yourself out of a belief that you don’t deserve them, or out of a conditioned fear that they’ll be snatched away?

3. Undoing Self-Limiting Beliefs

The following exercise will suggest some first steps to liberating ourselves, to waking up from the hypnotic reverie of unworthiness.

Step 1: Relabel

The first step is to call the self-limiting thought what it is: a thought, a belief, not the truth. For example, “I seem to believe that I’m responsible for everyone’s feelings.” Or, “I’m having the thought that I have to be strong.” Or, “I’m acting as if I think I’m only worthy when I’m being helpful.” Bringing conscious awareness to this step in particular is vital: we are awakening the part of ourselves that can observe mental content without identifying with it—acting as our own interested but impartial observer.

Step 2: Reattribute

In this step you learn to assign the relabeled belief to its proper source: “This is my brain sending me an old, familiar message.” Rather than blaming yourself or anyone else, you are ascribing cause to its proper place: neural circuits programmed into your brain when you were a child. It represents a time, early in life, when you lacked the necessary conditions for your emotional circuitry’s healthy development. You’re not pushing the thought away, but you’re also making clear that you didn’t ask for it, nor have you ever deserved it.

Step 3: Refocus

This one is all about buying yourself a little time. Being mind phantoms, your negative self-beliefs will pass—if you give them time. The key principle, Jeffrey Schwartz points out, is this: “It’s not how you feel; it’s what you do that counts.” That doesn’t mean you suppress your feelings or beliefs, only that you don’t let them pull you under or derail your inquiry. You stay in relationship with them even as you consciously take a detour.

Step 4: Revalue

Here’s where you take stock and get real. Up until now, the self-rejecting belief has ruled the roost, overshadowing whatever else you may consciously believe about yourself. Let’s say you’ve told yourself, “I deserve love in my life,” but all the while your mind is assigning greater value to the currency of “I’m worthless.” It’s that second one that tips the scales at least nine times out of ten. You can think of this step, then, as a kind of audit, an investigation into the objective costs of the beliefs your mind has invested so much time and energy in.

Step 5: Re-create

What has determined your identity up until now? You’ve been acting out mechanisms wired into your brain before you had a choice in the matter, and from those automatic mechanisms and long-ago programmed beliefs you have fashioned a life. It is time to re-create: to imagine a different life, one truly worth choosing.

Quotes by Gabor Maté and Daniel Maté

Chronic illness—mental or physical—is to a large extent a function or feature of the way things are and not a glitch; a consequence of how we live, not a mysterious aberration.
An event is traumatizing, or retraumatizing, only if it renders one diminished, which is to say psychically (or physically) more limited than before in a way that persists.
It is sobering to realize that many of the personality traits we have come to believe are us, and perhaps even take pride in, actually bear the scars of where we lost connection to ourselves, way back when.
Over my decades of medical practice and thousands of conversations, I have learned that the first question to ask is not what is wrong with an addiction, but what is “right” about it. What benefit is the person deriving from their habit? What does it do for them? What are they getting that they otherwise can’t access?
Just as I have never met anyone who chose to become addicted, neither have I met anyone whose addictions did not, at their onset at least, provide for some essential human need.
Ask not why the addiction, but why the pain.
In our world there is a category we can label “addicts,” designating some identifiable group of poor, unfortunate souls, and then, neatly segregated from “those people,” there are the rest of us “normal” folks. To twist a line from the great George Carlin, it’s a big club—and we’re all in it.”
Like all concepts, mental illness is a construct—a particular frame we have developed to understand a phenomenon and explain what we observe. It may be valid in some respects and erroneous in others; it most definitely isn’t objective. Unchecked, it becomes an all-encompassing lens through which we perceive and interpret.
Despite the genetic hoopla in the popular media and all the lavishly funded DNA-hunting in the scientific world, no one has ever identified any gene that causes mental illness, nor any group of genes that code for specific mental health conditions or are required for the presence of mental disorder. Professor Jehannine Austin, an academic and researcher, leads a genetic counseling clinic for mental health in Vancouver. “Everybody has some genes that predispose to mental illness,” she told me, but these are “a very, very long way away from causing anything . . . Literally what separates those of us who do suffer from those of us that don’t is what happens to us during our lives.”
What the system sells as happiness is actually pleasure, a philosophical and economic distinction that makes all the difference between profit or loss. Pleasure, Rob Lustig pointed out, is “This feels good. I want more.” Happiness, on the other hand, is “This feels good. I am contented. I am complete.”
Contentment sells no products—except when evanescent, in which case it is no contentment at all, rather the bogus kind of “happiness” meant by Mad Men’s fictional ad whiz Don Draper when he muses, “What is happiness? It’s a moment before you need more happiness.” True happiness, being a non-commodity, does not make itself obsolete.

Quotes Featured in The Myth of Normal

For if medicine is really to accomplish its great task, it must intervene in political and social life. It must point out the hindrances that impede the normal social functioning of vital processes, and effect their removal. — Rudolf Virchow, nineteenth-century German physician
When you’re trying to survive, you turn malady into a coping strategy, and loss into culture. — Stephen Jenkinson
The fact that millions of people share the same vices does not make these vices virtues, the fact that they share so many errors does not make the errors to be truths, and the fact that millions of people share the same forms of mental pathology does not make these people sane. — Erich Fromm, The Sane Society
Trauma is when we are not seen and known. — Bessel van der Kolk
Cancer is no more a disease of cells than a traffic jam is a disease of cars. A lifetime study of the internal-combustion engine would not help anyone to understand our traffic problems . . . A traffic jam is due to a failure of the normal relationship between driven cars and their environment and can occur whether they themselves are running normally or not. — Sir David Smithers, Lancet, 1962
Most of our tensions and frustrations stem from compulsive needs to act the role of someone we are not. — János (Hans) Selye, M.D., The Stress of Life
We don’t understand any major mental disorder biologically. — Professor Anne Harrington
Perhaps the line between sanity and madness must be drawn relative to the place where we stand. Perhaps it is possible to be, at the same time, mad when viewed from one perspective and sane when viewed from another. — Richard Bentall, Madness Explained: Psychosis and Human Nature
Not all psychopaths are in prison. Some are in the boardroom. —R. D. Hare, Ph.D.
Everything in nature grows and struggles in its own way, establishing its own identity, insisting on it at all costs, against all resistance. — Rainer Maria Rilke, Letters to a Young Poet

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