Chapter 8: Who Are We Really? Human Nature, Human Needs

The author begins with the “broad and elusive” subject of what it means to be human. He notes that the types of behavior ascribed to “human nature” are generally negative but finds any fixed idea of human nature to be misleading. Jesus and Hitler, he points out, were both human. Human nature has a wide range of possible outcomes from basic biological needs and potentials. Environment determines whether the needs are met and which potentialities are made manifest. An acorn only becomes an oak tree if the conditions are right.

Jean Liedloff has proposed the idea that life develops as “an expectation for its environment.” Lungs have an inherent expectation for oxygen and ears for sound waves. People can only grow in a healthy manner when all their basic expectations, physical and mental, are met. Even a small matter such as receiving brusque and charmless service in a shop interferes with inherent expectations, altering the mood of the subject. The brain processes the perceived hostility as a threat. The hunter-gatherer ancestors of modern humans lived in communities where good relations with other members were of supreme importance for survival.

The notion that human nature expects a state of mutual care and cooperation conflicts with the received wisdom that human nature is essentially selfish and aggressive. This, the author suggests, is the result of living in a competitive, materialistic capitalist society. Such a toxic culture causes human nature to develop in an aberrant and unhealthy manner.

Chapter 9: A Sturdy or Fragile Foundation: Children’s Irreducible Needs

The musician Raffi Cavoukian has spent years “advocating for a world that honors children.” Although everyone agrees that childhood is a formative period, this idea is not reflected in societal norms. Cavoukian believes that the “felt knowledge” of children is routinely subordinated to the intellect. The author agrees that this is destructive: feeling precedes thought, and thought is built on feeling. The child’s brain and future character are shaped by emotional interactions with caregivers.

Maté stresses that it is futile and illogical to blame parents for the growing numbers of children suffering from ADHD, depression, anxiety, and other mental illnesses. Both parents and children exist in a toxic culture which is not well adapted to their flourishing. However, caregivers must show unconditional love for children and respond to their needs, even while correcting misbehavior. A 2010 study by researchers at Duke University shows that children who received the highest levels of affection from their mothers in infancy had the lowest levels of distress and anxiety later in life.

The author refers to a discussion about the irreducible needs of children with the developmental psychologist Dr. Gordon Neufield. Neufield believes there are four such needs.

1. The attachment relationship, a sense of connection to the child’s caregiver.
2. A sense of security which allows the child to relax, instead of continually striving for approval.
3. Permission to feel such emotions as pain, sadness, grief and anger.
4. The experience of free play, which is necessary for development.

He invites the reader to consider how fully contemporary society allows such needs to be met.

Chapter 10: Trouble at the Threshold: Before We Come into the World

The idea that life begins with conception has been heavily politicized in debates about abortion rights. The author does not intend to intervene in these debates but contends that the child’s experiences in the womb, although not consciously recalled, live on as “emotional and neurological imprints embedded in the cells and nervous system of the human organism.” Recent studies have underscored the importance of a woman’s physical environment during pregnancy to the development of the child.

An early factor in this development is the stress experienced by the mother, which society largely ignores. Physicians seldom ask about the mental and emotional states of expectant mothers, and businesses rarely provide significant support for their pregnant employees, particularly in lower-paid jobs. Serotonin, dopamine and other neurotransmitters are affected by the mother’s stress levels. Children born to women reporting high levels of stress during pregnancy have more difficulty developing learning skills and a lower response to social stimulation. There is also evidence that the actual structure of the child’s brain can be affected.

The emotional stress experienced by a pregnant woman does not occur in isolation. The father’s emotional state is also important. A large survey in Sweden found that the effects of paternal depression were even more significant than those of depression in the mother. The author believes that this is because many women are expected to take responsibility for managing their partners’ emotional states as well as their own. Men need to be aware of the effect they have on their pregnant partners, and society should support and protect pregnant women, acknowledging that everyone has a stake in the child’s future.

Chapter 11: What Choice Do I Have? Childbirth in a Medicalized Culture

As a physician, the author always followed the standard operating procedure of performing an episiotomy when delivering a baby. He later learned from some midwives that episiotomies are not necessary in most cases and that many other unnatural procedures that take place in hospital births are also best avoided. Research has now validated the value of such traditional practices as women giving birth while squatting and being held from behind by their partners as they do so. Maté does not advocate any particular style of birth but does think it is important that the woman should be treated as an agent rather than the passive recipient of medical care. Medical interventions such as cesarean sections often add nothing valuable to the process of childbirth and merely complicate matters, Maté contends.

The medicalization of childbirth not only robs women of choice but frames the process as a dangerous and frightening one, as though “women are unexploded bombs that need defusing.” The author refers to a woman named Sherri Dolman, who agreed to have a cesarean section the first time she gave birth and had to fight for her right to experience a natural vaginal birth on subsequent occasions. The women who report the most positive experiences of giving birth are those whose doctors listen to them.

Animals seek out quiet, dark, solitary places in which to give birth. Such an environment is the precise opposite of the mechanized, brightly-lit operating theater where most human babies are delivered. This is a situation that violates the “inherent expectation” of human nature. The author concurs with the view of Ilana Stanger-Ross, who says that a woman giving birth should be treated “as a full person who is experiencing a sacred life passage. . . not a sick patient.”