The Myth of Normal

Why normal is a myth

The Myth of Normal by Gabor Maté, written with his son Daniel Maté, came out in 2022. Its subtitle is Trauma, Illness, and Healing in a Toxic Culture. Maté is a Hungarian-born Canadian physician. He worked for decades in family practice, in palliative care and in Vancouver's Downtown Eastside, where he treated people with severe addiction. His earlier books cover stress and disease (When the Body Says No), attention deficit disorder (Scattered Minds) and addiction (In the Realm of Hungry Ghosts). This book pulls those threads into one argument.

The argument is that what our society calls normal is not healthy. Chronic illness, anxiety, depression and addiction are rising in rich countries. Maté says this is not bad luck or bad genes. It is the predictable result of a culture that cuts people off from each other, from their bodies and from their own feelings. In his view, much of what we treat as individual disease is a reasonable response to an unreasonable way of living. "Normal" in the medical sense means common. Maté wants it to mean natural, and he argues that the two have drifted far apart.

The book has five parts. They move from the science of the body, to childhood, to a new view of mental illness, to the culture as a whole, and finally to healing.

Part I: Our interconnected nature

Maté starts with a definition. Trauma, in his use, is not the bad event itself. It is the wound left inside a person by what happened, and the way that wound limits how they think, feel and act. He separates two kinds. Capital-T trauma follows clear harm: abuse, violence, war, the loss of a parent. Small-t trauma comes from many less dramatic experiences, such as a parent who is present but emotionally unavailable, or a child who learns that some feelings are not welcome. Small-t trauma is so common that it looks normal.

He gives his own history as an example. He was born in Budapest in January 1944, months before the Nazi deportation of Hungary's Jews. His maternal grandparents were murdered in Auschwitz. As an infant he was handed to a stranger for some weeks to keep him safe. He argues that a baby cannot understand such events, but the baby's body still learns that the world is unsafe and that he is alone in it. He traces his own lifelong workaholism and restlessness back to that early lesson.

The rest of Part I makes the scientific case. Maté draws on psychoneuroimmunology, the study of how the mind, the nervous system, hormones and the immune system interact. Stress hormones change immune function. Emotional states shape inflammation. He argues that the body and mind are one system, and that medicine errs when it treats disease as a thing that arrives from outside instead of a process that unfolds over a life. He also stresses that human biology is interpersonal. Our nervous systems regulate each other. A child's brain develops in contact with the brains of caregivers.

Part I ends with what may be the book's central idea: the conflict between attachment and authenticity. Every child has two core needs. Attachment is the need for closeness and care. Authenticity is the need to be in touch with one's own feelings and to express them. When a child has to choose, attachment wins, because a child cannot survive without care. So a child whose anger or sadness threatens the bond learns to hide it, and in time stops feeling it. Maté argues that this early trade-off sets a pattern that can last a lifetime.

Part II: The distortion of human development

Part II asks what children need and how modern life fails to provide it. Maté lists what he calls a child's irreducible needs: secure attachment, freedom to feel all emotions, unhurried play and the presence of calm, available adults. He argues that these needs evolved over a very long period and that modern culture ignores them.

He moves through the stages of early life. Stress during pregnancy affects the fetus. Childbirth in hospitals is often more medical than it needs to be, with high rates of intervention and early separation of mother and baby. Parents, especially mothers, are isolated and short of time and support. Maté borrows his colleague Gordon Neufeld's view that children now orient to peers and screens rather than to adults, which leaves them without guidance. He describes schools and economic pressures that push children toward early performance and away from play.

He is clear that he does not blame parents. Stressed parents raise stressed children, and parents are stressed because of the society around them. The trauma is passed down through generations, and each generation does the best it can with what it received.

The last chapter of the part argues that culture builds character. A society that rewards competition, consumption and image produces people who learn to suppress their own needs in order to fit in.

Part III: Rethinking abnormal

Part III reframes conditions that medicine treats as diseases. Maté calls them adaptations. A symptom often began as a way to cope with pain that a child could not escape.

The longest section is on addiction. Maté repeats his familiar line: the question is not why the addiction, but why the pain. He defines addiction broadly. It is any behavior a person craves, finds short-term relief or pleasure in, suffers harm from and has trouble giving up. By this definition, addiction includes drugs and alcohol, but also work, shopping, gambling, food, sex, screens and the pursuit of status. He argues that addiction is not a choice and not mainly a genetic disease. It is an attempt to soothe pain, and the pain usually comes from trauma. He describes many of the patients he treated in the Downtown Eastside, most of whom had suffered severe childhood abuse.

He then applies the same lens to mental illness. Depression, anxiety and attention deficit disorder are, in his view, signs of distress, not simply chemical faults. Diagnosis can help people get care, but it can also hide the life story behind the symptoms. He includes a chapter on the mind's ability to split off from overwhelming experience, which he links to dissociation and other strong defenses.

Part IV: The toxicities of our culture

Part IV widens the frame from the family to society. Maté argues that economic and social systems reach down to the level of cells. Insecurity, inequality and isolation produce chronic stress, and chronic stress produces disease.

He discusses several sources of harm:

• Disconnection. Many people lack community and meaningful work, and loneliness has measurable health costs.
• Corporate behavior. He describes companies that sell harmful products while knowing the damage, and he calls this sociopathy as a business strategy.
• Race and class. Racism and poverty attack a person's sense of self and show up in higher rates of illness. He discusses Indigenous communities in Canada and the long harm of residential schools.
• Gender. Women carry more of the emotional and caring work in families. Maté argues that this is one reason autoimmune diseases and some other chronic illnesses are more common in women.
• Politics. He argues that unhealed trauma shapes political life, both in leaders who act from their own wounds and in voters drawn to them. He discusses Donald Trump as an example.

Part V: Pathways to wholeness

The final part turns to healing. Maté defines healing as a return to wholeness, not the same thing as a cure. A person can heal while still ill, and a person can be cured of a disease without healing.

He offers four A's as healing principles: authenticity, agency, anger and acceptance. Authenticity means learning to know and say what you feel. Agency means taking back the power to make choices about your life. Healthy anger is a boundary, a clear no, and he argues that people who never feel it often turn it against themselves. Acceptance means seeing your life as it is without resignation.

He pairs these with five compassions: ordinary human compassion, the compassion of curiosity, the compassion of recognition, the compassion of truth and the compassion of possibility. The idea is to approach your own pain with interest instead of judgment, to see that all people share the same struggles and to believe that change is possible. This approach underlies his therapy method, Compassionate Inquiry.

Other chapters treat illness as a teacher, give first steps for people who sense they are near their limit, and address the self-limiting beliefs that keep people stuck. One chapter covers psychedelics. Maté describes his work with ayahuasca ceremonies and the research into psychedelic-assisted therapy. He presents them as possible tools, with risks, and not as a cure. The book closes with a call to build a saner society that meets human needs instead of treating the results of unmet needs as personal failure.

What the critics say

Reviewers praise the book's compassion but question its evidence. Much of the argument rests on patient stories, interviews and Maté's own clinical experience. Several reviewers say he moves too quickly from studies that show associations to claims about cause. His suggestion that personality traits such as self-suppression play a role in diseases like cancer and ALS is disputed by many researchers, and some readers worry it can make patients feel responsible for their illness. Others find the political chapters broad and the definition of trauma so wide that it loses precision.

Who should read it

Read it if you want a big-picture account of how stress and early experience may shape health, and you are willing to read it as an argument rather than a medical guide. It suits readers of The Body Keeps the Score and people who want to understand the thinking behind Maté's work on addiction.