The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture

Book Title: The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture

Author : Gabor Maté, MD, with Daniel Maté

Publication Details: Avery/Penguin Random House, 2022, 562 pp., $30.00, hardcover

This 2022 bestseller—coauthored by renowned Canadian family physician and author Gabor Maté1 and his son Daniel—describes the ubiquity of trauma and the lack of affection and authenticity in modern society. The authors argue for an awakening to assumptions that have limited healing, and they encourage a self-reflection that many readers will find refreshing and inspiring.

The authors suggest that what we view as normal circumstances and interactions—within our environment, among parents and children, and indeed in power dynamics such as those within our health system—are not only abnormal but are the cause of many diseases, within individuals and in society as a whole. What are normal, rather, are our responses to these circumstances.

Like many physician writers, Dr Maté admits that his best teachers are his patients; and so this tome includes many anecdotes collected from interactions with young mothers, from patients in recovery from opioid use disorder, and even from conversations he has had with famous personalities.

Dr Maté references several of his previous books, such as Hold on to Your Kids: Why Parents Need to Matter More Than Peers,2 as well as other notable works such as The Body Keeps the Score by Dr Bessel van der Kolk. 3 He recounts personal conversations with Dr van der Kolk, who has helped Maté along his own self-healing journey.

Like Dr van der Kolk does in his book, Dr Maté addresses the way trauma affects us both physically and psychologically. One group of techniques posited in The Myth of Normal is to embrace authenticity, agency, anger, and acceptance, or what the authors call the Four A’s. Dr Maté suggests, for example, that patients who tend to suppress their own need to express emotion are at an increased risk for inflammation and diseases like multiple sclerosis, fibromyalgia, and amyotrophic lateralizing sclerosis, among others. Thus, the authors advise, we must be true to ourselves.

Further, the authors advocate for, among other things, a compassion of recognition, by which they mean realizing that we are all in the same boat. Dr Maté proposes, for example, that nearly everyone has the capacity for addiction. We also must be compassionate with ourselves, which includes admitting our faults and having the wisdom to understand that we cannot change everything about ourselves.

The authors obviously enjoyed writing this book, mixing very moving patient stories with topical references to popular song lyrics and films. To illustrate the path toward self-compassion, they point out that the word “re-create,” that is, to create again, is just one hyphen removed from the word “recreate,” or to play. They use this similarity as an opportune reminder that to remake ourselves, we might consider engaging in things we enjoyed as children, activities in which we can be spontaneous and feel vital.

All our habits, the authors submit, have probably manifested because they fulfilled some inner need. Using compassionate inquiry when interviewing a patient with opioid use disorder, Dr Maté asks, “What role did this drug play for you?” The authors are at their best when including the most personal stories. In one anecdote, Dr Maté describes his younger self. Colleagues who noted his skepticism about his own potential for self-discovery found him to be, at that time, such a negative influence on patients that he was forced to excuse himself from a retreat he was cohosting and to focus instead on his own healing. The conclusion to this episode is both enlightening and meaningful.

Physicians who care for victims of trauma and drug use disorder will appreciate Dr Maté’s paradigm-shifting insights. He has many techniques he shares both about how to interview and how to counsel. What he has learned from his failures and successes—including interventions ranging from group visits to psychedelics—are presented with humility and provide several teaching opportunities, some of them quite beautifully described.

The language in this text is occasionally outdated, and future editions would do well to omit meaningless associations with the characters of individuals whose stories otherwise highlight particulars of this argument’s overall arc. Nevertheless, this is a compelling and hopeful vision of society—one that moves us forward from Dr Maté’s previous works as well as Dr van Der Kolk’s seminal text. It is a book not only for the lay public but also for any physician whose mission is to work with patients who have been disadvantaged, minoritized, or otherwise mistreated.