PDF Summary:The Myth of Normal, by Gabor Maté

In The Myth of Normal, physician and trauma expert Gabor Maté writes that much of what society labels as abnormal behavior, mental illness, or dysfunction actually represents normal responses to adverse life experiences. He contends that the conventional medical model pathologizes normal coping mechanisms like emotional numbing as “diseases” requiring pharmaceutical treatment. He instead advocates a trauma-informed perspective that addresses the root psychological and social causes of what we label as illness.

In this guide, we’ll explore Maté’s argument, focusing on:

• How what we define as “normal” health and behaviors are determined by social, economic, and cultural systems
• The role of trauma in determining our health
• How racism, misogyny, and capitalism instill and reinforce that trauma
• How the biopsychosocial model of health and nontraditional healing practices like yoga, meditation, and psychedelics can improve health outcomes

We’ll also supplement his analysis with insights from other experts on trauma, early childhood development, addiction, and more.

(continued)...

Trauma Comes From Unmet Needs

Maté observes that trauma largely stems from the accumulation of unmet needs. He posits that these unmet needs, especially during your formative years, can deeply affect your psychological and emotional development, leading to trauma. Below, we’ll explore two commonly unmet needs in more detail: the need for secure attachment—a strong and trusting bond between a child and their caregiver—and the need for connection.

The Need for Secure Attachment

Maté writes that certain parenting practices can hinder the development of secure attachment, potentially leading to trauma that manifests as illness later in life.

He explains that the fundamental human need for attachment originates in childhood, with babies biologically hardwired for behaviors and characteristics designed to elicit caregiving and attachment responses from their parents. These innate mechanisms have evolved to maximize the chances of children receiving the necessary emotional and physical care for their development.

(Shortform note: Although attachment and unconditional love are today commonly understood to be crucial to human development, this wasn’t always the case. In The Happiness Hypothesis, psychologist Jonathan Haidt notes that, in the early days of psychology, the school of thought known as behaviorism eschewed unconditional love. Behaviorists believed that human action was governed by conditioned responses to reinforcements. Accordingly, people would only engage in behaviors they associated with rewards and refrain from behaviors they associated with punishment. Behaviorists argued that providing positive reinforcement regardless of the underlying behavior would make children weak and dependent.)

Maté notes that when a secure attachment is lacking or disrupted, it can lead to a host of challenges that extend well into adulthood—such as an impaired ability to regulate emotions, difficulty in forming healthy relationships, a deep-seated sense of insecurity, and an increased vulnerability to stress. This is because, without the foundation of trust and safety, individuals may struggle with feelings of worthlessness, chronic anxiety, and an overarching sense of being unsafe in the world. These early traumatic experiences of attachment disruption can then manifest as chronic health conditions later in life.

(Shortform note: In Unconditional Parenting, author and lecturer Alfie Kohn writes that traditional concepts of “good” and “bad” behavior, and the system of rewards and punishments that reinforces them, harm children by making them feel that their parents’ love, approval, and affection are contingent on them behaving well. He writes that these methods make children selfish as adults because the focus on threats and bribes causes them to focus on the consequences to themselves rather than on the consequences to others.)

The Need for Connection

Maté highlights that humans are inherently social, wired for connection with other humans from the moment of birth. He posits that this need for connection is not merely a preference or a social construct, but a fundamental aspect of our biological and psychological makeup. He writes that our brains and bodies operate within the context of relationships—our drive to seek out and maintain social bonds is as essential to our survival as food and shelter. This need for connection comes from our evolutionary history; our ancestors relied on social bonds for survival, making connection an ingrained part of our genetic heritage.

(Shortform note: Other writers have explored the evolutionary origins of our need for connection. In Influence, psychologist Robert Cialdini writes that it goes back to the practice of reciprocity in early human communities. According to Cialdini, these communities survived because of social cohesion and an ability to work together—and reciprocity was the glue that enabled this social cohesion. If another individual brought you some firewood, for example, bringing them some of your own firewood later would help the two of you survive and make the overall clan or tribe stronger. This, in turn, created networks of obligation among early humans that made it easier for the group as a whole to multiply and survive.)

Maté argues that these connections do more than just fulfill emotional needs—they impact our health, development, and well-being. Positive, supportive relationships can bolster our mental health, enhance our resilience to stress, and even positively influence our physical health. Conversely, isolation and poor-quality social connections can lead to a host of mental and physical health issues.

(Shortform note: Indeed, some governments have recognized the lack of social connection as a public health crisis and formed ministries and departments to address it. In 2018, the United Kingdom appointed Tracey Crouch as its first “Minister for Loneliness” to address the widespread issue of loneliness affecting millions of its citizens. The ministry’s role is to coordinate public policies and strategies to combat loneliness; support community organizations and local initiatives that foster social connections; treat loneliness as an acute public health concern; and create a coordinated approach to improve the well-being and quality of life for those affected by social isolation across the country.)

Part 3: How Social Conditions Hardwire Us for Disease

Having established the role of trauma in physical, emotional, and psychological health, Maté describes how certain deeply ingrained structures in Western society like racism, misogyny, and capitalism instill and reinforce that trauma. According to Maté, these factors don't just shape our societies—they have tangible, harmful effects on our physical and mental health.

The Embodied Trauma of Internalized Racism

Maté discusses the destructive impact of institutionalized racism, which teaches minorities to internalize hate and reject their identities—both overtly through direct discrimination and subtly through systemic bias and cultural messaging. According to Maté, this enforced self-rejection triggers profound psychological wounds that translate into physiological stress responses. This can lead to biological responses like elevated levels of cortisol and inflammation. Sustained over time, this can contribute to health problems such as heart disease, hypertension, and diabetes among affected populations.

For example, in a society that devalues Black womanhood, a Black teenage girl will encounter pervasive messages denigrating her racial identity, such as criticism that her natural hair texture is “unprofessional.” This exposure to racist messaging can lead to chronic psychological stress, which in turn triggers significant physiological reactions. The stress activates her body’s fight-or-flight response, triggering the release of stress hormones like cortisol and adrenaline and disrupts her normal bodily functions, leading to the dysregulation of her hormonal processes.

How Racist Systems Make Black Americans More Prone to Illness

Other writers have expanded on Maté’s argument about the impact of racism on the physical health of minority populations. In The 1619 Project, journalist Nikole Hannah-Jones writes that specific economic policies promoted at the local, state, and federal levels in the United States

have made Black Americans more prone to illness than white Americans.

She writes that policies developed during the 19th and 20th centuries by white elected officials, city planners, and mortgage bankers forced Black Americans into segregated neighborhoods. City planners then targeted these Black neighborhoods for highway construction, which caused overcrowding, pollution, and health issues for residents. The combination of overcrowding, a lack of clean outdoor places like parks, and poor air quality from passing traffic greatly increased residents’ risk of diseases, especially respiratory illness.

Moreover, writes Hannah-Jones, segregation also puts Black Americans at higher risk for diseases like diabetes because healthy food is harder to find in Black neighborhoods while mini markets selling junk food proliferate. And indeed, one 2013 study shows that the more impoverished a neighborhood was, the fewer supermarkets and fresh, nutritious, and low-fat meal and snack options were available—and these findings were especially true for predominantly Black areas.

How Ingrained Misogyny Fractures Mind-Body Wellness

Similarly, Maté explores how structural misogyny teaches women and girls to view themselves—and especially their sexuality—through a lens of self-hatred and shame. He asserts that Western culture commodifies female sexuality, which reinforces the subservience of women. He writes that this isn’t just a cultural or moral issue; it’s a health issue, with wide-ranging effects on the physical and mental well-being of women and girls.

(Shortform note: This structural misogyny and commodification of female sexuality Maté describes has existed for centuries. In Ways of Seeing, art critic and novelist John Berger explores how the objectification of women was prevalent in the last five centuries of European art. In paintings commissioned by wealthy men, nude women were depicted as passive, alluring subjects of attention. These women were “owned” by the men who owned the paintings, and instead of depicting real women’s bodies, these images showed a fantasy ideal of the women that men wanted to possess—not unlike modern-day airbrushed pictures of sexualized pop stars.)

The Unhealthy Impact of Capitalism

Maté further writes that capitalism, with its relentless pursuit of profit and efficiency, makes us less healthy by making us feel more vulnerable, more lonely, less secure, and less empathetic. The instability of jobs and the pressure to succeed financially can isolate individuals, weakening social bonds. When we’re encouraged to prioritize our success over the welfare of others, we hurt our collective social fabric, which impacts our physical and mental health because we’re wired for the kind of deep connection and mutual care that capitalism erodes.

How Markets Corrupt Our Values

In What Money Can’t Buy, philosopher Michael Sandell writes that not only is capitalism bad for our physical health, but it’s harmful to our most innate values as human beings. Sandel describes a commercialization effect, in which the very act of subjecting certain goods, services, and experiences to the market alters our attitudes toward them and degrades our collective moral and social well-being—forcing us to view them as mere commodities whose value is reflected in their price instead of having intrinsic, nonmonetary value.

Sandel notes that the intrusion of market forces into non-market spaces can often be seen literally, in the form of prominent commercial advertisements in the kinds of public spaces—city squares, public transportation systems, sports stadiums, government buildings, educational institutions, and even houses of worship—where they were once off-limits. He argues that the clutter of advertising and its intrusion into nontraditional spaces changes not only the aesthetics of the physical space, but also the ways we experience them.

Sandel argues that filling these spaces with eye-catching and garishly commercial advertising irrevocably alters their character and severs our connections to one another as a community: We are no longer full and equal citizens congregating in the public square. Instead, we lose our shared, communal identity and become a disconnected set of individual, atomized consumers.

Part 4: Toward a Holistic Healing Model

Having explored the mind-body connection and the impact of social conditions on our health, Maté proposes a new approach to health and healing—one in which we integrate the parts of ourselves we’ve ignored, reconnect with our true selves, and regain a sense of wholeness. To move toward this new approach to wellness, Maté encourages the medical community to embrace a more comprehensive biopsychosocial model of health, to accept the role of trauma in shaping health outcomes, and to encourage patients to adopt nontraditional healing practices like yoga, mindfulness, and plant-based psychedelics.

Embrace the Biopsychosocial Model

A critic of the conventional biomedical model, Maté instead advocates the biopsychosocial model, which recognizes that our thoughts, feelings, social interactions, and environment profoundly impact our health. In this model, total health encompasses emotional balance, social connection, and a harmonious relationship with your surrounding environment. By moving toward this more holistic model, Maté argues, we can better address the root causes of illness rather than merely treating symptoms.

For example, a physician who decides to integrate the biopsychosocial model into her practice might treat a patient complaining of chronic headaches by exploring the patient’s work environment, stress levels, and emotional state before prescribing medication. This physician might discover that the patient is experiencing significant job-related stress and social isolation. She might then refer the patient to a stress-management workshop and a community group to improve his social connections.

Tension Myositis Syndrome

Maté’s work in The Myth of Normal and some of his other works like When the Body Says No is influenced by the late John Sarno, who was a pioneer in research on the mind-body connection in disease, publishing several books on the topic between 1982 and 2006. Sarno coined the term Tension Myositis Syndrome (TMS) to refer to any condition in which one’s psychological state causes physical symptoms, such as chronic pain or digestive issues. Fibromyalgia, for example, is one of those conditions that has no identifiable physiological cause, but induces chronic symptoms like debilitating fatigue and widespread pain.

Sarno theorized that TMS symptoms were related to the psychological pressures people live with when they feel the constant need to live up to others’ expectations and then repress their negative emotions.

Although much of Sarno’s work was disregarded by his colleagues and the larger medical community, some physicians today, like John Sacks, have followed in his footsteps and are actively treating TMS through a variety of psychological therapies and integrative medicine.

Accept the Reality of Past Trauma

Maté writes that acknowledging and accepting the reality of past trauma is a key step toward healing. He posits that denial or suppression of trauma can not only prevent you from understanding the root causes of your suffering but can also block the path to resolving your emotional wounds and moving forward. Therefore, by embracing our traumas and working through them, we can reclaim our power over our lives and begin the path toward holistic healing and well-being.

For example, a psychiatrist working with a support group for people experiencing PTSD might introduce exercises to help participants identify how their traumas have shaped their behaviors, relationships, and health. Techniques could include creating a personal narrative timeline, where members can visually plot significant traumatic events alongside their physical and emotional responses, fostering a deeper understanding of their life’s trajectory and the intersections of trauma and health.

Is Trauma Necessary for Growth?

Despite Maté’s emphasis on the harmful effects of trauma, some authors take a different view. In The Happiness Hypothesis, psychologist Jonathan Haidt points to research suggesting that people need some amount of struggle in their lives to reach their full potential. He notes that people who suffer setbacks, even tragedies like the loss of a loved one, often find new strengths as a result of their experience.

Setbacks, according to Haidt, can alter our life story or self-narrative. The experience of triumph over loss enables us to replace a story about our frustrated hopes or positive experiences turned sour with a more compelling story about overcoming adversity and using that experience to learn compassion and empathy for others. And in the end, this is a more fulfilling story to have about ourselves.

Haidt notes that our teenage years in particular are the period in our lives when our self-narratives begin to truly coalesce and some of our most important life experiences take place. Events that happen during this time are those we revisit the most throughout the rest of our lives, serving as a constant point of self-reference. Accordingly, some adversity in your teenage and early adulthood years, if properly overcome, can provide a real character-building boost later in life.

Implement Holistic Healing Practices

Maté writes that there are various practices, including yoga and meditation and the use of psychedelics, that have healing potential. He writes that these practices can jump-start the process of healing from trauma and overcoming deep-seated emotional and psychological issues.

Yoga and Meditation

Maté explains that yoga and meditation offer more than just physical benefits; they facilitate a deeper connection with the self. Through these practices, you can achieve a state of mindfulness that allows you to be present and fully engaged with your current experiences, free from judgment. This state of mindfulness allows you to observe your own thoughts without becoming entangled in them—offering a sense of peace and control.

(Shortform note: Despite its beneficial effects on mental and physical health, yoga can result in severe injuries—especially for those with pre-existing physical weaknesses and amateurs who lack proper training. Medical literature has documented serious injuries like Achilles tendon tears, sciatic nerve damage, and strokes caused by certain yoga poses. These injuries arose from extreme neck movements and hyperflexion, which can damage vertebral arteries and significantly affect the brain. As a result, some practitioners prioritize awareness and simple poses over complex postures and inversions like headstands, which can be too risky for many people.)

The Therapeutic Potential of Psychedelics

Maté also explores the therapeutic potential of psychedelics—emphasizing the importance of using them within proper guidance and protocols. He notes that they dissolve the barriers between the subconscious and conscious mind, providing individuals with access to hidden fears, desires, and anxieties. This can be a powerful experience that allows for significant insight and personal growth. He writes that psychedelics can facilitate transformative experiences that reshape how individuals perceive themselves and the world around them, enabling a deeper understanding of—and healing from—trauma.

The Risks of Psychedelics

Although Maté does emphasize the importance of using psychedelics under proper supervision, it’s important to note the very real risks that can come from using these substances. Experts warn that psychedelics like ketamine and psilocybin, while promising in treating conditions like depression and presenting little addiction risk, can potentially trigger psychotic or manic episodes, primarily in individuals predisposed to schizophrenia or bipolar disorder.

Psychedelics can have physical effects as well as psychiatric ones. Notably, they’ve been shown to increase heart rate and blood pressure. While this doesn’t pose a significant concern in controlled clinical scenarios, regular or frequent use of these substances might present cardiovascular risks. These substances are also known to significantly change brain activity, potentially leading to seizures in epilepsy patients or exacerbating conditions like intracranial pressure. Finally, their interaction with antidepressants and other medications can cause dangerous or unpredictable responses.