Introduction: Why Normal Is a Myth (And Why That Matters)

Maté begins by observing that, although society is more obsessed with health than it has ever been and people spend billions of dollars in the quest for wellness and long life, people’s collective health is deteriorating. Having been a physician for over thirty years, the author wants to diagnose the sickness in contemporary culture that is causing this “epidemic of chronic afflictions, mental and physical.” He asserts that “the entire context of social structures, belief systems, assumptions, and values that surround us and necessarily pervade every aspect of our lives” is toxic and is making people ill.

The author uses the analogy of a biochemical culture used to grow microbes in a laboratory. A suitable culture allows the microbes to flourish and proliferate. A toxic, contaminated culture does not. He points out that although the United States is the wealthiest country in history, sixty percent of American adults have chronic disorders such as diabetes or high blood pressure, while almost seventy percent take prescription drugs. Cancer and rates of obesity are rising in many countries, as are mental health problems such as depression and anxiety. Suicide is becoming more common among young people, many of whom feel that humanity has no future. Because humans adapt quickly to circumstances, this state of affairs has now come to seem normal.

David Foster Wallace once told a story about fish who did not understand the concept of water. The point of this is that ubiquitous realities are the most difficult to discuss. The author believes that the aspects of life which are commonly accepted as normal are the very ones which demand scrutiny, since much that passes for normal in contemporary society is neither healthy nor natural. Sickness should be expected as a consequence of the toxic environment and of the medical profession’s failure to see the connections between physical and mental health. The author aims “to lift the veil of common knowledge and received wisdom” in order to show how healing can begin, both for individuals and perhaps for humanity as a whole.

Chapter 1: The Last Place You Want to Be: Facets of Trauma

The author begins with a story about a trivial incident which happened a few years ago. His wife failed to pick him up from the airport, and he was filled with resentment. He admits that this was not an adult response but says that, like most people, he spends a lot of time emotionally living in the past. This is one of the effects of trauma. In the author’s case, his trauma comes from a childhood spent in wartime and postwar Budapest, when he felt abandoned by his mother, who had to entrust him to a stranger to allow him to escape from the ghetto. 

Most people think of trauma as arising from catastrophes: wars, hurricanes, serious abuse, and neglect. In fact, however, the vast majority of people are traumatized. A complete lack of trauma would in itself be an abnormal state. Trauma is the lasting psychic injury caused by a painful event, an injury which distorts the subject’s view of the world and of other people. The author distinguishes between “big-T” Trauma—for instance, the effects of abuse or a bitter divorce—and “small-t” trauma, which is brought about by everyday misfortunes and omissions. However, not every stressful event is traumatic, since trauma is marked by lasting psychological effects.

Trauma separates people from their bodies, making them feel constantly ill at ease, and from their feelings. It also causes one to be inflexible in responding to disappointment, since traumatized children, in particular, are apt to freeze when both fight and flight are impossible. Trauma often leads to a paralyzing sense of shame, distorting people’s view of the world and preventing them from living in the present. It is multigenerational, passed down through families and even through “entire nations and peoples at different moments in history.” One notable example of collective trauma in Canada and the United States is the legacy of colonialism, racism, and slavery.

Chapter 2: Living in an Immaterial World: Emotions, Health, and the Body–Mind Unity

Caroline was diagnosed with breast cancer at the age of thirty-six. Doctors said that she had one or two years to live, but at the time of writing, she has survived for twenty years. She told the doctors that she needed this time to raise her sons to be men and said, “Fuck your statistics.”

The author believes that Caroline’s profanity probably helped to extend her life. The mind and the body are linked, and cannot properly be understood in isolation. The author uses Candace Pert’s term “bodymind” to express this unity. People who are “too nice,” meaning that they repress their anger, are at greater risk from various illnesses, from cancer to amyotrophic lateral sclerosis (ALS). Grief can have similar physiological effects, as can post-traumatic stress disorder, depression, and other psychic factors.

Maté believes that modern research is confirming traditional wisdom in the relatively new science of psychoneuroimmunology, which explores connections between the mind and the body, including how stress might cause disease. For instance, the amygdala, which processes fear in the brain, is linked with cardiovascular disease. A study by the University of Toronto has shown that men who were sexually abused as children had triple the usual incidence of heart attacks. While stress is a useful response to immediate danger, prolonged or chronic stress has been linked to a wide range of physical ailments.

Finally, the author points out that the “bodymind” exists among many other bodies and minds which shape the subject’s sense of self. In emphasizing the unity of body and mind, it is important to go beyond the boundaries of the unitary individual.

Chapter 3: You Rattle My Brain: Our Highly Interpersonal Biology

In this brief chapter, the author points out that people are deeply and vitally connected with each other and with the rest of the world. This is natural, but in the toxic contemporary culture, it has ceased to be normal. Ancient cultures, from Native communities in Canada to Hindus and Buddhists, understand “the individual’s multidimensional bond with the entire world.” This bond requires a biopsychosocial approach to medicine, one which treats the whole person in context, rather than attempting to isolate and destroy an abnormal pathology.

A psychiatrist named Daniel Siegel has introduced the concept of interpersonal neurobiology, a way of understanding the brain and the nervous system through human connections. The author’s refinement is to extend this to “our entire mental-physical makeup” with the notion of interpersonal biology. People know through experience the visceral effect that other people can have on them. This extends to the effects of such interpersonal experiences as marriage, racism, and employment on both physical and mental conditions.