Review and Reflection on “The Myth of Normal” by Gabor Mate, MD

I was excited to read this book, based on the title alone. The subtitle is “Trauma, Illness and Healing in a Toxic Culture.” This is what we are living in. I have often said that we don’t do health care in America, we do sick management. We don’t do proactive medicine and prevention, we do reactive care only after a person is experiencing dis-health. And we’re so stuck on just physical ailments, that often the more abstract things like mental, emotional, relational, and spiritual health are ignored by our culture, much to our detriment. 

In my own situation in life, I started reading this in the fall of 2022, soon after this book was published. I was suffering from long COVID systems constantly (pain from migraines and brain fog) and I wanted to read something that would help in my healing. My situation has changed thankfully and while I still suffer from long COVID systems, they are much more manageable than they were in the fall. I’ve been able to tap into a variety of ways to find some healing and peace. 

As I said, I was drawn to the title because ever since the pandemic started, the question that we have all been faced with is “what is normal?” So many people have said they wanted to “get back to normal,” but was exactly is that? And is normal healthy? And if not, then why would we want to go back to it? These are questions that Mate deals within his book. 

Mate makes the claim early on that our culture is not healthy. “…chronic illness – mental or physical – is to a large extent a function or feature of the way things are and not a glitch; a consequence of how we live, not a mysterious aberration.” (Pg. 2). Mate then goes on to describe what we are experiencing is a “toxic culture.” (Pg. 3). “We could also understand ‘toxic’ in its more contemporary, pop-psychological sense, as in the spread of negativity, distrust, hostility, and polarization that, no question, typify the present sociopolitical moment.” (Pg. 3). Thank you, Dr. Mate, for naming it clearly. And for defining health beyond just physical symptoms or the lack of those symptoms. Health is more wholistic after all. If your emotional state is not well, it has an impact on your physical state. All the different parts of who we are, are interconnected and affect one another. And far too often we approach health in compartmentalized ways that just end up maintaining a toxic status quo. 

Mate declares that the purpose of the book is to present “a new vision of normal that nurtures the best in who we are.” (Pg. 10). That is a welcome set of words. 

This is a long book at 497 pages, but well worth reading. Mate gives the reader personal antedates from his own life and struggles, as well as cultural references, medical knowledge, and alternative medicine from non-Western sources to make his argument for a new normal. It’s not about whether we agree with his approaches or not – he’s merely offering alternatives to what we currently experience. The point is to open us to new possibilities of what normal and healthy can be. 

As Mate begins this journey, he describes what trauma is. We need to know what we are dealing with after all. “The meaning of the word ‘trauma,’ in its Greek origin, is ‘wound.’ Whether we realize it or not, it is our roundedness, or how we cope with it, that dictates much of our behavior, shapes our social habits, and informs our ways of thinking about the world. It can even determine whether or not we are capable of rational thought at all in matters of greatest importance to our lives.” (Pg. 16)

Going deeper, Mate says, “Trauma pervades our culture…What is trauma? As I use the word, ‘trauma’ is an inner injury, a lasting rupture or split within the self due to difficult or hurtful events…Trauma is not what happens to you but what happens inside you…Trauma is a psychic injury, lodged in our nervous system, mind, and body, lasting long past the originating incident(s), trigger able at any moment.” (Pg. 20). 

This description of trauma is important. Trauma is one of those words that gets thrown around society pretty easily, but without a good understanding of what it is for most people. And in our instant-gratification oriented society, real trauma ends up being far more prevalent than most people understand. “Trauma, until we work it through, keeps us stuck in the past, robbing us of the present moment’s riches, limiting who we can be.” (Pg. 21). 

Mate goes deeper into what trauma is, what it is not, how it impacts us, and this description allows the reader to get a better grasp of the concept and how he is using the term through the rest of the book. 

Dr. Mate then brings out his expertise from the medical field talking about how emotions, health, and the body and mind are interconnected. Or as Mate says, “Our biology itself is interpersonal.” (pg. 54). He describes this through an example: “We all know the power of interpersonal biology from a lifetime of personal experience. Think of the effect that other people can have on you: it can be quite literally visceral. Poets and songwriters tell of being weak in the knees, shot through the heart, or even, in Bruce Springsteen’s vivid image, stabbed in the brain by a dull, serrated blade. Jerry Lee Lewis was right: we really do shake each other’s nerves and rattle each other’s brains.” (Pg. 56).

One of the things I appreciate about Mate’s look at normal and health is expansion from just physical and even mental health to relational and systemic health. He touches on issues that impact health, even if the rest of society wants to ignore these things: “Racism is another risk factor for asthma.” (Pg. 57). If people can get past their ideologies and instead look at the realities of social conditions, it would be easy to see that health is broader than we have dealt with it in society, and we would have a much healthier society in a variety of ways. 

Mate dives into a variety of topics related to health, which I’m not going to even touch for space purposes. One of the areas I do want to highlight is his discussion on disease being a process. Here he is taking on the common notion that disease is something that we must fight against, and instead, he calls us to look at disease differently. “It’s not a battle, it’s a push-pull phenomenon of finding balance and harmony, of kneading the conflicting forces into one dough.” (Pg. 88). In other words, disease isn’t something external to the person, something separate, but very much a part of who we are. He cites Dr. Stephen Cole who says, “We now know that disease is a long-term process…a physiological process taking place in our bodies, and how we live influences how quickly that’s going to get us at the clinical level…The more we understand about disease, the less clear it becomes when you have it and when you don’t.” (Pg. 90-1)

Next I want to skip ahead to Mate’s discussion of human nature. He has a nice summary of what human nature is, what is natural, and our nature in relation to health. “Hence my working assumption that our nature, all else being equal, expects or even prefers as its baseline state a condition of caring, relative harmony, and equilibrium, of the kind that obtains when interconnectedness rules the day. It is not that our nature is to be those ways, but that it wants them to be present.” (Pg. 121). If I could mix in a bit of theology into this – I think Mate’s argument is really about how we are wired, or created, to seek and desire shalom (wholeness, completeness, and peace). This is the very message that God has been proclaiming forever. 

Mate has an entire section of the book made up of several chapters devoted to child development, how we are born, parental relationships with children, and other interpersonal relationships and how they impact our development. 

But again, I want to skip again to another subject. In chapter 14, Mate talks about how culture builds our character. It’s about where we get our identity from and how our culture impacts that identity giving us a social character. 

Mate describes the social character inherent in our culture in a series of “character” traits. They are:

• Separation from Self – “an image not of who we are but of how we would like to be perceived by others.” (pg. 203)
• Consumption Hunger – “the social character hatched by our consumerist society confuses desire with need, to the point that the nervous system becomes riled when the objects desired are withheld.” (Pg. 204) 
• Hypnotic Passivity – “you go to school, you’re regimented. You’re taught this is the way you’re supposed to behave, not other ways. The institutions of the society are constructed, so as to reduce, modify, limit the efforts and control of one’s own destiny.” (Pg. 206)

The third section of the book deals with mental health, mental illness, and addiction. It was an interesting look at these things. The core of Mate’s message is this – “Like all concepts, mental illness is a construct – a particular frame we have developed to understand a phenomenon and explain what we observe.” (Pg. 239)

But again, I find myself skipping over this to highlight the next section of the book – Mate writes about the toxicities of our culture. And there are many. He starts by naming capitalism. “A refusal to recognize broad economic and political conditions as relevant to individual health and happiness is a core feature of materialistic ideology.” (Pg. 278). He goes in depth into the challenges we face with our brand of capitalism, which one would question if it is actually capitalism or something more like an oligarchy. “In the realm of political decision-making, a widely circulated US study showed that the views of ordinary people make no difference to public policy: a lack of control on a mass scale.” (Pg. 284)

The second toxicity of our culture is disconnection. We live in a “society that fails to value communality.” (Pg. 287). This runs counter to core human needs of belonging, trust, meaning, purpose, and more. And it creates long term problems for our society. “There is a seesaw oscillation…between materialistic concerns on the one hand and prosocial values like empathy, generosity, and cooperation on the other: the more the former are elevated, the lower the later descent.” (Pg. 296).

The next toxicity of the society has to do with corporate sociopathy. This is quite a claim. But Mate makes a compelling argument about how numb we are to corporate interests that sell us things that we don’t need in order to keep us hooked. He cites Joel Bakan, a law professor, who “set out to assess corporations in the light of standard mental health measures we would apply to people…’many corporations meet the criteria of sociopaths, acting without a conscious: not caring about what happens to other people as a consequence of their actions, having no compulsion to comply with social or legal norms, not feeling guilty or remorse.'” (Pg. 306). To put it more bluntly, “Narcissism and sociopathy describe corporate America.” (Pg. 307). 

The next societal toxicity that Mate deals with is racism. He looks at this from a several angles and forms of racism – anti-Semitism, against indigenous peoples, and against black people. Mate describes racism this way – “The pernicious impact of racism flows from its very nature, which is to see and treat another, in essence no different from you, according to your self-serving, resentful, and twisted fantasy of who they are.” (Pg. 314). Mate goes on to discuss the serious impacts of racism saying, “racism can be life-threatening.” (pg. 320). 

The next societal toxicity that Mate dives into is “why women have it worse.” (Pg. 329). “That we don’t recognize them has everything to do with our taking for granted the ‘normal’ way of things in a culture of patriarchy, which, despite centuries of female resistance and progress, is ruled as often by subliminal male concerns as by overt power dynamics.” (Pg. 329)

The last societal toxicity that Mate deals with is what he calls “Trauma-Infused Politics.” (Pg. 343). This is a pretty good label for what our politics has become. Most of his analysis is a discussion about the bent towards authoritarianism. It comes down to this for all these societal toxicities – the cruelty is the point. 

The last section of the book makes a turn from trauma and dis-health to wholeness and healing. Mate frames this section with the most essential questions – “How to move toward health, after all, in these troubled times? How to move toward health in the context of a socioeconomic system staunchly uninterested in remedying any of its root maladies, and in the face of a pandemic that has both highlighted and deprived us of so much we take for granted? How to keep hope alive when the odds seem so prohibitive?” (Pg. 361). The answer is that healing is a “natural movement towards wholeness…It is a direction, not a destination.” (Pg. 361)

Mate spells out several principles oriented towards healing: 

• Authenticity – “Authenticity can’t be pursued, only embodied…We have to begin with accepting ourselves fully.” (Pg. 375)
• Agency – “Agency is the capacity to freely take responsibility for our existence, exercising ‘response ability’ in all essential decisions that affect our lives, to every extent possible.” (Pg. 377)
• Anger – “Anger in its pure form has no moral content, right or wrong – it just is, its only ‘desire’ a noble one: to maintain integrity and equilibrium.” (Pg. 379)
• Acceptance – “Acceptance is the recognition, ever accurate, that in this moment things cannot be other than how they are.” (Pg. 380)

In addition, he identifies five compassions:

• Ordinary Human Compassion – this is about empathy and “being moved by the awareness that someone is struggling.” (Pg. 383)
• The Compassion of Curiosity and Understanding – “The willingness to seek the why before leaping to the how is the compassion of curiosity and understanding in action.” (Pg. 385)
• The Compassion of Recognition – “We are all in the same boat, roiled by similar tribulations and contradictions.” (Pg. 386)
• The Compassion of Truth – “The compassion of truth recognizes that pain is not the enemy. In fact, pain is inherently compassionate, as it tries to alert us to what is amiss.” (Pg. 387)
• The Compassion of Possibility – “There is more to each of us than the conditioned personalities we present to the world, the suppressed or untrammeled emotions we act out, and the behaviors we exhibit.” (Pg. 388)

Much of the remainder of the section offers steps on how to move towards healing through the body, mind, beliefs, and more. He even has a chapter devoted to psychedelics, with an emphasis being about healing. As he wraps up the book, there are two chapters that touch on important topics – spirituality and a healing culture. In reading these chapters, I see a link in what he is talking about. This comes through in his discussion about myth and the prophetic. “Mythic thinking might help us enshrine and enact the scientific principle that our health derives from connection – to our essence, to each other, and to a culture that honors these interrelationships.” (Pg. 479).

Finally, he closes the book with a look at what a saner society might look like and how we get there. It starts with no longer accepting things as “normal.” “A willingness to be disillusioned means confronting denial, one of the central buttresses of the status quo and a major barrier to imagining or seeking a transformed world.” (Pg. 485). For Mate, he sees a healthy society as a Trauma-Conscious Society (Pg. 486) in a variety of ways – through medicine, the law, and education. Further, transformational change comes through activism and advocacy, two actions designed to counter trauma-inducing effects. 

In the end, Mate is making a final point – “It all starts with waking up: waking up to what is real and authentic in and around us and what isn’t.” (Pg. 497).