The Myth of Normal

by Gabor Maté

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Chapters 4–7 Summary

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Last Updated on November 15, 2022, by eNotes Editorial. Word Count: 1132

Chapter 4: Everything I’m Surrounded By: Dispatches from the New Science

Dr. Elizabeth Blackburn won a Nobel Prize in 2009 for her work on telomeres. These are tiny DNA structures which protect chromosomes, and Dr. Blackburn found that they bear traces of the lives people lead. The marks of poverty, racism, and other stressors can be found in a subject’s telomeres. Other researchers into genetics and neuroscience are also finding evidence for a holistic model of human illness and wellness. The field of epigenetics, in particular, offers a way of understanding how genes are affected by the environment without being permanently altered.

Epigenetics is changing the way in which scientists understand evolution by showing how genes adjust to circumstances. Dr. Moshe Szyf at McGill University has conducted experiments showing how a mother rat’s interactions with her offspring affect their responses to stress throughout their lives. These studies show a causal link between the mother’s care and the biochemical capacity of the rats’ brains to respond to stress. These results were replicated in the female rats’ care for their own offspring, in patterns which were found to be nongenetic. Similar results have been found in other rodents and even in humans exposed to stressful circumstances.

Stress, poverty, racism, and a range of health conditions shorten telomeres, and the shorter the telomere, the shorter the life. The US Study of Women’s Health Across the Nation (SWAN) found that black women were, on average, “over seven years more biologically aged than their white counterparts.” While this appears to be bad news, the author points out that experiences which build stress resilience can lengthen telomeres, leading to longer, healthier lives.

Chapter 5: Mutiny on the Body: The Mystery of the Rebellious Immune System

Mee Ok was diagnosed with a debilitating condition called scleroderma at the age of twenty-seven. She was confined to a wheelchair and endured great pain, to the extent that she considered suicide. Now, “in defiance of all conventional medical logic,” she is able to walk and travel independently, takes no medication, and is writing a memoir.

Scleroderma is a disease in which the autoimmune system attacks the body it would usually defend. Autoimmune diseases are particularly difficult to diagnose. Mee Ok’s problem baffled doctors, as did the symptoms of the tennis player Venus Williams, who was eventually found to be suffering from Sjögren’s syndrome, another autoimmune disease. The incidence of these mysterious diseases has increased sharply over the last half century across the developed world. Seventy to eighty percent of sufferers are women.

Mee Ok was placed in an orphanage in Korea when she was six months old. When she came to America, her adoptive father sexually abused her, and her adoptive mother suffered a nervous breakdown. Immediately before she began to feel the effects of scleroderma in her twenties, she went through the breakup of a relationship which caused her to revisit her trauma. The doctors who treated her did not ask about any of this and almost certainly would not have considered it relevant. However, the author cites evidence from other case studies and from medical journals, including the Journal of the American Medical Association, linking autoimmune disorders with trauma and personality. He concludes by positing that disease may not be “a fixed entity but a dynamic process expressive of real lives in concrete situations.”

Chapter 6: It Ain’t a Thing: Disease as Process

V, an author and activist formerly known as Eve Ensler, has said that the cancer from which she suffers may be the product of rape. Ensler was abused by her father when she was a child, and lived in a toxic atmosphere of shame and guilt, hated by her mother and blaming herself for her abuse. She believes that her illness was caused by trauma and her failure to process trauma and observes “A disease is not like a thing. It is energy flow, it’s a current.” The author thinks this perspective contributed to V’s survival.

Maté sees the martial metaphors in which patients “battle against” cancer as unhelpful. He also thinks it is a mistake to say that one “has” cancer in the same way that one has a flat-screen TV. This causes people to visualize cancer as an external “thing” rather than a process through which they are going. This process is the result of trauma and cannot be separated from personal history or the surrounding culture. Disease should be seen as a long-term process, and it is not easy to say when you have it and when you do not.

The hypothalamus is the part of the brain that processes emotional data into physiological functions. This does not mean that stress and other negative experiences and emotions simply “cause” cancer. However, the process by which cancer cells become malignant and create illness is not understood, and some doctors and scientists are now exploring the idea that activity in the hypothalamus may have a role.

Chapter 7: A Traumatic Tension: Attachment vs. Authenticity

In her 1978 essay “Illness as Metaphor,” Susan Sontag dismisses the idea that “diseases are caused by mental states.” To think so, she writes, is merely a sign that one does not understand the illness in question, as well as a reprehensible way of blaming the patient. The author agrees that no one should be blamed for being ill but believes it is possible to assert that the mind and the body are connected without assigning culpability.

Not only is it unscientific to deny the mind–body connection, the idea has been accepted in medicine for thousands of years. The author gives various authorities, beginning with Hippocrates and his comments on the “choleric” temperament. He then lists some of the personality traits he has most often observed in people with chronic illness. These include a compulsive concern with the needs of others, rigid adherence to duty, and repression of anger. People are often unaware of these traits in themselves, meaning that it is possible for the body to experience the resulting stress without the mind being aware of it. The author has even found such traits overrepresented in the obituaries of those who have died from chronic illnesses.

The author discusses the trauma that results from the clash between attachment and authenticity. Attachment is the need to be close to others, while authenticity is the need to be true to one’s own nature. The idea that certain parts of one’s authentic self are unacceptable and will impede attachment often begins in childhood, when children develop the idea that they will be loved only if they follow certain rules. Authenticity is therefore sacrificed to attachment early in life. People do not choose to make this sacrifice, but they can choose to restore the balance in adulthood.

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Introduction–Chapter 3 Summary


Chapters 8–11 Summary