Chapter 22: The Assaulted Sense of Self: How Race and Class Get Under the Skin

Malcolm X recalled that his “first really big step toward self-degradation” came when he seared his scalp to make his hair straighter and therefore more like a white man’s. Black people, he said, were taught by the dominant culture to hate not only the color of their skin but every detail of their appearance. Racism, like poverty and other forms of marginalization, is a major determinant of health. The author agrees with Ta-Nehisi Coates that “race is the child of racism.” The word “race” and the idea of race, based on a few trivial differences in skin color and facial features, “did not exist in any meaningful way” until the eighteenth century.

Coates says that it is part of the heritage of America to destroy the black body. The author points out that there are various ways in which this has occurred, not only through direct violence but also through more insidious assaults on health, with higher rates of diabetes, obesity, hypertension and strokes. This is true even among the young. Black children in America are six times more likely to die of asthma than children of other races. Black women are also three to four times more likely to die as a result of childbirth as white women. Similar disparities are suffered by the First Nations people of Canada.

The health effects of poverty are similar to those of racism. In Chicago, the difference in life expectancy between the richest and poorest neighborhoods is almost thirty years, the same difference as the gap between Canada and Iraq. Such inequality is not only damaging in itself but causes stress and anger which damage the health of the marginalized even more.

Chapter 23: Society’s Shock Absorbers: Why Women Have It Worse

The author begins by asking why women suffer from chronic illness and mental health conditions far more frequently than men. He does not, however, believe that these facts are at all mysterious in a patriarchal culture which always places the needs of men first. He records an interview with a firefighter named Liz, who was sexually abused at the age of seven and suffers from a litany of physical and mental health issues. Liz, like most women, became used to being sexually objectified and to putting her own needs second to those of others. The idea that women should do this is regarded as normal and impairs their health.

The objectification of women is exacerbated by the ubiquity of pornography, particularly online. Much of this is not softcore erotica but physically violent and demeaning. Female sexuality is conflated with subservience in such images, which normalize abusive sex. Meanwhile, men are taught to associate sex with domination and humiliation rather than the expression of love.

Even in less obviously oppressive circumstances, a woman’s role as caregiver to others erodes not only her sense of self but her physical health. The author cites a Canadian study published in 2016 which showed that women who had bypass surgery normally returned to their caregiving roles immediately, while men were more likely to be the objects of care in the same situation. In an interview with his wife, Rae, she observed that the tension from which he suffers always seems to be her responsibility. The chapter ends with a brief examinations of the ways in which patriarchal structures also harm men, dissociating them from their emotions with results that include alcoholism and other addictions, violence, and suicide.

Chapter 24: We Feel Their Pain: Our Trauma-Infused Politics

Political life in America is now so toxic that, according to a 2019 study by researchers at the University of Nebraska-Lincoln, many Americans believe that their health, both physical and emotional, has been harmed by exposure to politics. These harms afflict both the governors and the governed, in a structure the author describes as “the traumatized leading the traumatized.” The political character resembles the social character described by Erich Fromm in that it is deeply inauthentic, inhumane, and “literally sickening” but necessary for a career in politics even to begin.

Childhood trauma has a bearing on political orientation. The harsher a child’s parents were and the more physical punishment they received, the more likely they are to support aggressive and authoritarian political policies. The Polish Swiss psychotherapist Alice Miller pointed out that most of the Nazi leaders and their more enthusiastic supporters had harsh childhoods. Canadian Prime Minister Stephen Harper also seems to have had such a strict upbringing, whereas Justin Trudeau experienced a different type of trauma with a womanizing father and a mother who suffered from bipolar disorder.

In American politics, Maté sees the continual lying and sociopathic personality of President Donald Trump as evidence of childhood trauma. Hillary Clinton was not such an obviously pathological figure but also received harsh parenting from both her father and her mother, who once told her not to be a coward when she was being bullied at the age of four. Both politicians have unforgiving views of life shaped by childhood suffering. However, many members of the public have also experienced such suffering and want to see politicians expressing it.

Celebrity is adjacent to politics, and people like Trump and Barack Obama are both politicians and celebrities. There is much in celebrity that is pathological, and the glamor often masks secret suffering, as it did in the case of Aretha Franklin and many of the famous people the author has interviewed. The author concludes by pointing out that a superficial culture founded on mistaken beliefs is perpetuated by the social policies enacted by deeply wounded leaders.