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

In Chapters 1-3, Maté highlights the limitations of modern medicine. Specifically, he draws attention to trauma’s effect on our health and how modern medicine, with its atomized view, has ignored or downplayed this connection. Yet, it is only in Chapters 4-7 that Maté explains the true origins of this trauma. It is not mostly a result of explicit abuse or neglect, “capital-T-trauma.” Nor is it simply a result of contingent “small-t-trauma” stresses in our environment. Rather, it is a consequence of “a disconnection from the self” (105) originating in infancy. Namely, trauma originates in the childhood conflict between the “two essential needs” (105) of attachment and authenticity.

Attachment, as Maté defines it, is “the drive for closeness” (105), both physical and emotional. It is rooted in the need, as infants, to be taken care of by parents to ensure survival. In contrast, authenticity is “the quality of being true to oneself” (106). Taken in this sense, authenticity means allowing oneself to acknowledge and express one’s feelings, particularly when these are socially problematic or controversial. These two needs, Maté argues, often come into conflict: “[C]hildren often receive the message that certain parts of them are acceptable while others are not” (107). Certain behaviors and expressions of emotion are condemned as wrong and met with explicit or implicit threats to attachment. Conversely “good” behaviors, which may not be in keeping with the feelings or desires of the child, are rewarded with parental approval and intimacy.

In this way, love and, on a deeper level, survival, are seen as conditional upon conforming to social expectations, and this belief is often carried into adolescence and adulthood. Even though the individual is no longer dependent on parents, the linking of self-suppression to survival and acceptance is so ingrained that it affects all future relationships. Hence, we have the “people-pleasing” personality type with “a compulsive concern for the emotional needs of others” (101) in which “one must justify one’s existence by doing and giving” (102). Whether in relation to a partner or society at large, such people subconsciously replay the psychic dynamics and trade-offs of infancy. It then takes a crisis of the body or mind before they are awakened to the needs of the self that have been ignored.

However, many questions remain for Maté’s account. While he appears to have provided an explanation of trauma’s origins and ubiquity and linked them to a range of otherwise hard-to-explain illnesses, his account is by no means complete. He fails to explain why an excessive trade-off between attachment and authenticity occurs in some children and not others. Likewise, he must explain why the “people-pleasing” personality type leads to illness in only some, and why incidences of this, and its manifestation as illness, have increased in recent decades. Maté also needs to address the extent to which the sacrifice of authenticity for attachment is socially necessary.

Maté states that we all require “agenda free, unconditional attention” (109) in childhood to avoid later problems, but it is worth asking whether this is a realistic or achievable goal. Following Freud and the “reality principle” concept, we may ask whether children need to obey certain social standards and suppress aspects of the self to survive in the outside world. If so, as Freud thought, psychic conflicts and illness are unavoidable. Maté must address this problem and show how this conflict is avoidable to safeguard his account. He must explain, looking at the specifics of childhood, how authenticity can healthily co-exist with attachment if he is to point a way to treatment of the problems and sickness he diagnoses in modern culture.