Incredible. A Must Read. I ended up buying my own copy (partway through reading this) and have been recommending this to everyone! This is the first in what I am sure will be many Gabor Maté books I read!

I really love Gabor Maté, although his work generally leaves me feeling worried about how the heck any of us are going to manage to keep existing and moving. If you've read his work before, I don't think much in this book will be surprising -- trauma is at the core of everything -- and if you're new to it, it's a strong introduction to his ideas.

Rating: 2.5

Gabor Maté is a physician-author who has long been interested in the psychological and social factors that impact patients’ health. He’s written books on ADHD, addiction, and psychosomatic medicine, and co-authored one on child development. In all his books, he’s demonstrated particular interest in attachment theory—ideas concerning children’s relationships with primary caregivers—and the long-lasting effects of distressing early-life experiences. “Health and illness are not random states in a particular body or body part,” he writes in his new book.” They are, in fact, an expression of an entire life lived, one that cannot, in turn, be understood in isolation.” They arise from “a web of circumstances, relationships, events, and experiences.”

Maté opines that we live in a toxic culture. What we have come to accept as “normal” is actually abnormal and fails to meet natural, inborn needs. In terms of physical health alone, stats from the US, “the epicentre of the globalized economy,” speak volumes about how wrong things are: 60% of American adults have a chronic disorder, such as diabetes or hypertension; over 40% have two or more such conditions; and nearly 70% are on at least one prescription medication. Diagnoses of mental illness, especially anxiety and depression, are also skyrocketing in the Western world.

Other health professionals might reasonably attribute at least some of these conditions to the daily consumption of ultra-processed foods, which set people up for metabolic syndrome—insulin resistance, high blood pressure, and obesity—as well as autoimmune disease. Harvard psychiatrist Christopher Palmer has recently put forward the theory that psychiatric illness may arise from dysfunction of mitochondria, the “powerhouses” of cells that turn glucose into ATP, the compound that fuels physiological processes. Palmer has noted that metabolic disorders and cardiovascular disease rates are extremely high in those who suffer from severe mental illness. Psychiatric conditions, therefore, may essentially be metabolic disorders. Maté, however, is almost exclusively focused on how our society’s failure to meet human needs creates stress (or “trauma”), which in turn causes physical and mental dysfunction. Chronically stressed people’s bodies are flooded with the hormones adrenaline and cortisol. Tissues become inflamed, blood vessels narrow, blood clots form, bones can thin, and the immune system, which normally destroys aberrant cells (including cancer), is suppressed.

In the first of the five parts of his book, Maté expands the concept of trauma. The word is generally used to characterize profound distress related to the experience of war, natural disasters, or extreme abuse. He believes there’s another dimension: what he calls “small-t” trauma, the painful daily events that adversely affect individuals and predispose them to both physical and mental illness. He states many times that it’s not what happens to you, but what happens inside you that is the issue. It doesn’t take a war; a person can become disturbed in seemingly “normal” environments. People with psychic wounds carry residual burdens: suppressed, repressed, or unexamined emotions; shame; poor coping techniques; and automatic neurotic reactions. There appears to be no shortage of papers linking suppressed anger/“niceness,” PTSD, grief, or a history of child sexual abuse to a variety of ailments, including cancer, ALS, or cardiovascular disease.

Maté believes that only a few outliers in our society are not traumatized. I don’t buy this, probably because I do not think of “trauma” and being “traumatized” (or use those words) as liberally as Maté does. I believe there’s value in differentiating between intense, disabling distress arising from extreme conditions or life-threatening events and the suffering that is the result of less skillful or poorly “attuned” parenting, for example. This is not to say that emotionally painful events—in the family, for example—cannot cast a long shadow. Maté points to studies that show that stress can impact humans even before birth. The quality of a potential father’s sperm can apparently be affected by the life pressures the man is under, and the development of a fetus’s stress apparatus can be compromised by the tensions or depression experienced by the mother. Ideally, negative stress should be minimized, but in reality expectant mothers cannot avoid exposure.

Parts II and III of <i><b>The Myth of Normal</i></b> focus in turn on the distortion of human development and the need to look at afflictions as adaptations. Maté writes about the ways that children’s needs in particular go unmet. The problem starts with the medicalization of pregnancy and birth and parents’ deferring to experts rather than trusting their own instincts about what their kids need. (In my opinion, he presented no compelling evidence to support either of these ideas.) He does single out Dr. Benjamin Spock’s 1946 <i><b>Baby and Child Care</i></b> which continues to have some influence on childrearing practices. In that bestseller, Spock counselled parents not to respond to an infant’s cries once the child had been put to bed. The baby needed to learn that nighttime was for sleeping; “tyrannical” tendencies had to be curbed. Maté counters that a caregiver’s failure to respond to children’s distress induces panic. The preverbal child gets the message that the world is unsafe, that no one will help him when he’s scared. Anxiety and other psychological problems begin to take root. According to Maté, two human needs—attachment and authenticity—compete during childhood. Attachment, he says, will always win out over authenticity. The child learns early that nothing must threaten the bond with his parent; survival depends on it. If certain of the child’s tendencies—the expression of anger, for example—are considered unacceptable or unlikeable by the parent, the child will suppress or repress them so as not to compromise the relationship. It is this stifling of aspects of one’s essential nature that leads to problems, including physical illness, down the road. I think this is a valuable insight, but I’m doubtful that a child’s having a time-out to calm down after an angry or aggressive outburst (for hitting a sibling, for example, or not getting something he wants) is going to damage him for life. Learning to self-regulate and self-soothe are important early lessons.

Maté summarily dismisses genetics and contends that many mental afflictions are understandable adaptations to needs that went unmet early in life. He laments that so few clinicians ask patients, even those who present with autoimmune disorders, what they’ve gone through in the time leading up to symptom presentation. For him, the clues lie in the patient’s story. Maté goes so far as to suggest that even the delusions, hallucinations, and paranoia of a psychotic patient make sense in light of the person’s early-life story. He presents cases in which extreme psychiatric symptoms resolved when patients were invited to tell what happened to them or to articulate what they believed to be the problem. If only it were that simple. It may work for some, but severely mentally ill people often experience anosognosia: they don’t recognize they are ill and are incapable of being insightful about their condition. Maté does allow that such a patient’s understanding may be facilitated by the use of psychotropic drugs.

In Part IV, the author tackles the sense of dislocation and lack of meaning many feel in Western capitalist society, where sociopathic corporations reign supreme. I found his brief discussion of our polarized political scene and the psychology underpinning people’s attraction to certain types of leaders interesting to read.

In the fifth and final part, Maté presents ways that healing might occur, as well as a few, hardly typical, stories of people who have been transformed by (and, in one case, spontaneously freed of) severe illness. He outlines principles and exercises for psychological healing, including a practice he calls “compassionate inquiry,” which struck me as a useful tool. Maté himself has undergone treatment with psychedelics and has facilitated retreats in which ayahuasca, a bitter traditional South American psychoactive drink, is used. Seeking answers to individual life problems and insights into personal conflicts, retreat participants drink the brew during ceremonies guided by indigenous shamans. I was surprised to read about this New-Age-style direction in Maté’s work—though I’m aware that psilocybin is being investigated as a treatment for depression and end-of-life distress. Many aspects of Maté’s work, including his interest in early trauma, reminded me of psychiatrist Stanislav Grof’s preoccupations. Years ago, Grof, one of the founders of transpersonal psychology, pioneered experiments with psychedelics, believing that these substances could provide people with transcendent or mystical experiences. Like psychologist Arthur Janov, who developed Primal Scream Therapy, Grof was also keenly interested in birth trauma. He thought hallucinogens might allow patients to retrieve otherwise inaccessible early memories. It seems that those ideas never went away.

<i><b>The Myth of Normal</i></b> is an ambitious and <i>very</i> long book. With endnotes included, the print version runs to an excessive 576 pages. Maté has synthesized a large body of information and refers to the research and big ideas of many social and neuroscientists, but at times it appeared to me that he wanted to document <i>everything</i> he’d read and <i>every</i> interview he’d conducted pertaining to his subject. A judicious selection of supporting evidence would’ve cut the book in half and increased its readability. I particularly question the need for separate “Woke” chapters on race and socioeconomic status, women and the patriarchy, and the medicalization of childbirth. These three chapters could easily have been collapsed into a single short one. Was the race and gender material (complete with pronouns and critical-race-theory/identity-politics jargon) actually necessary, or was it included primarily to put the author’s commitment to “social justice” on display? Only those who’ve lived under a rock for the past few years would be unacquainted with the key points in the chapter. Another feature of the book that I found strange in its excess was the author’s frequent obeisance to his wife, Rae, for her wisdom and forbearance in the face of his neuroses and self-absorption. At one point, he observes, “I talk a much better gender-equality game than I sometimes play.” Maybe the Rae-themed hymns of praise are further evidence of that tendency.

Having said all this, I did appreciate Maté’s discussion of the (new-to-me) work of many scientists and researchers. Also valuable were recaps of his interviews with people familiar with the food industry and big-tech’s strategies to hook people on their products—sugary or electronic. These corporations employ neuroscientists who can advise on how best to exploit the brain’s dopamine (reward/motivation/pleasure) pathways. Maté’s consideration of addiction is also informed and illuminating. This perhaps shouldn’t surprise, as he spent many years working with the homeless, marginalized, and addicted people of Vancouver’s notorious Downtown Eastside. It’s unclear, however, why he chose to present quite so many snippets of his interviews with celebrities—including Darrell Hammond of <i>Saturday Night Live</i> fame, Lena Dunham, and Alanis Morrisette. After a while, I became irritated by these reports on the famous, which felt like so much name-dropping, but it’s possible that they were intended to highlight that the “successful” can be as troubled or addicted as the down-and-out.

In the end, I have a very mixed response to this book. I found some sections absolutely tedious. I did not see the themes as at all “groundbreaking,” but it’s possible that those who’ve never read Maté before might think otherwise. To me the book was mostly preaching to the choir. No doubt Maté’s audience of thoughtful readers already know the world is a pretty messed-up place and that stress obviously has a lot to do with both physical and mental illness. However, I think many illnesses are multifactorial, and to suggest that almost all are due to adverse events of early childhood and the stresses of living in Western capitalist society is gross oversimplification. (Our mammalian animal friends, cats and dogs, get cancer too. Can we attribute this to early small-t trauma of kittenhood and puppyhood? Could pet cancers be due to our human failure to meet our companions’ needs? They have bodies and emotions that function like ours, after all. We’re not as different as we might think. Chemical exposure, poor quality food, overfeeding, and genetic factors seem more likely culprits.) While I can’t say I disagree that the ills of our society are multitudinous, by the halfway point in the book I felt overloaded, even oppressed, by dysfunction laid before me. Even an occasional nod to human resilience would have been received with gratitude. At one point Maté comments on his “wondrously stubborn Eeyore setting;” I’d argue that the tone of <i><b>The Myth of Normal</i></b> generally reflects the author’s self-identified temperamental default. I regularly considered bailing, but did manage to complete this book relatively free of trauma. Overall, I’m relieved that the experience is over.

Thank you to Net Galley and the publisher, Penguin Random House Canada, for providing me with a digital copy of the book for review.

It took me a while to read this book, and it’s not because it was long (I mean, it’s not short, but it’s also not that long). It was because it is so impactful. This book looks at both physical and mental illnesses, the root causes of both, and the connections between the two. It looks at the ways our culture affects our health – and how negative health outcomes are disproportionately seen in oppressed groups. It explains how trauma impacts our mental and physical health, how the ways in which we were parented lead to our own parenting styles and impact our wellbeing in unexpected ways, and how some mental health issues like anxiety can be perpetuated within families.

Now, that might sound like a lot – and it is. This book covers a huge range of material, but it does so in a way that is absorbing and easy to follow. I didn’t have a hard time being pulled along the paths this book led me down while reading, and I was really interested in what the authors had to say. I bookmarked, tabbed and underlined my way through the book, leaving very few sections unmarked. One of the best parts of the book is how it calls out parts of our culture and medical systems that are perpetuating or creating complex trauma, and examines assumptions we make about our health and mental landscapes that we just accept as how things are – but that are only that way because that’s how we made them. This has been a huge realization for me as I’ve become more reliant on this system, and discovered the ways in which it lacks a holistic viewpoint.

This is a book that will appeal to many readers, but that will resonate each reader for different reasons. Some will resonate with discussions of childhood trauma. Others with his viewpoint on addiction. Still others with his perspective on the connection between trauma and physical health. For me, the parts I resonated most with were the ones on how anxiety can be perpetuated within families easily; how women are the stress absorbers for society because of how it is structured today (pressure trickles down onto us and increases the stress we experience, leading to a higher level of autoimmune disorders and mental health issues like anxiety and depression); and the deep connection between mental health, stress, and management of chronic health conditions. These all speak to my experiences and rang so true that it was hard for me to keep reading at times. These are things that are huge drivers of health issues, and yet we have so little control over them. Sure, we can try to manage stress through lifestyle changes and healthy habits, but we can’t change how society treats minorities and women, and we can’t undo the trauma we have experienced. It’s important to be aware of all of these things – and this will be particularly helpful for those who might just be starting to learn about these connections. It can be hard, though, to immerse yourself in the parts of this that just can’t be helped, as much as we all need to be aware of them.

Though I didn’t agree with every single point or anecdote the Matés shared in this book, I did enjoy following along the thought processes and connections that were made. It’s rare that I’ve felt so represented but also so revealed by a book. I’ve been dealing with the health system in Canada my whole adult life, and while I’ve had some wonderful experiences – a family doctor who really listened, cared about his patients and went out of his way to check in during difficult circumstances; nurses who went above and beyond to help me while I was in their care (I still remember Betty, who brought me tomatoes from her garden when I was in hospital for weeks following a medical event that led to one of my chronic illness diagnoses) and even just the admin staff working in offices who went above and beyond to help me access care during the pandemic – I’ve also had my share of really terrible ones. I have been belittled, dismissed and overlooked regularly when dealing with my kid’s doctors. I have been given faulty instructions and then snapped at when I questioned them – then when I followed them they made me even sicker. I’ve been prescribed medication without checking interactions with my other medications (I’ve since learned to always check all my meds with pharmacists). I’ve been stuck in a hospital waiting for transfer for twelve hours because the two hospitals wouldn’t communicate with one another. And the list goes on and on. Sure, we are incredibly lucky here to have a great medical system that is, largely, free to access. But it’s understaffed, many areas to do with mental health are not covered by MSP or extended insurance, the medical personnel are overworked and rushed, there’s often a lack of training for sensitivity, women are often dismissed out of hand and assumed to be of inferior intelligence, and if you’ve got a mental health diagnosis on your file you might as well just not bother. You won’t be heard. So the discussions this book presented about the connections between trauma, mental health and physical ailments was really vindicating. Hearing some criticism of the way our medical system is structured was likewise important for me, as hard as it was to immerse myself in.

I was glad that this was my first Gabor Maté book, because while it is definitely a cohesive whole, I also felt like it was a review of a lot of the themes that are explored in greater detail in his previous books. He has so many years of experience and has such a wide range of knowledge that he can speak with authority on very complex and interconnected issues in a way I’ve rarely encountered before. I think this is a great place to start if you’re new to his work, but also a great book to read if you’re looking for a refresher.

This is Mate's best book yet! I think having his son as a co-author really helped, because I thought the writing was more evocative and clear than his other books. Myth of Normal goes way further into many subjects that Mate has talked about before, as well as some new topics. There are chapters on pregnancy and prenatal development, politics, race, class, and gender; social media, depression - and a bunch of other salient topics that are all intertwined in how people interact with the world and deal with trauma/are traumatized. This will definitely be a book I re-read and I will recommend it widely!

A lot to digest here! The Myth of Normal is a nuanced look at the impact trauma has on our physical and mental health, and how those two things are intertwined. I especially appreciated the last section which included some tangible ideas about how to move forward. Thank you to Netgalley and Penguin Random House for the advance copy.

This is a sobering book about the toxicity of our society and how to make things better. While I enjoy the author's voice and respect his scholarship, this was too much to be packed in to a single book. In some ways, it overwhelms the reader. If you buy this, approach it a bit at a time. Otherwise it can be like trying to take a sip of water from a fire-hydrant.

This was an informative and in depth conversation about trauma and healing. There are so many people who would benefit from its wisdom.
I liked the book and learned a lot from it and I think readers of self help and those interested in trauma and our toxic culture will love it.
Though interesting, it was a lot to take in and isn’t my usual pick. I felt it was a bit over my head.

Wow! This book was scary but informative.
It truly shows just how detrimental the way we are existing, effects our mental and physical well being.

Everyone should read this eye opening book!