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

It would be wrong to say that diagnostic categories for mental health serve no function. By generalizing about sets of symptoms and making distinctions between commonly occurring groups of them, treatments can be better tailored and trends identified. For example, identifying a set of symptoms as ADHD allows us to look at which treatments generally work for that condition in contrast to others. We can also note that cases of ADHD-like symptoms have been growing in recent decades and speculate about possible causes for this.

There is also therapeutic benefit to diagnostic categories. As Maté says, “for the individual in question, a diagnosis may seem to account for and validate a lifetime of experiences previously too diffuse or nebulous to put one’s finger on” (241). Much of the suffering of mental health conditions lies in a sense both that nobody knows what is wrong with you and, relatedly, that it is not something “real.” Having a label to put on one’s plight resolves these concerns to some degree. One may feel that one’s symptoms are at least acknowledged and understood and, as Maté says, “that can be a first and positive step toward healing” (241).

However, an undue focus on, or excessive faith in, diagnostic labels can be dangerous. Especially combined with modern medicine’s tendency to see phenomenon in terms of distinct, atomistic units, this can lead to a belief that, as Maté says, “descriptive labels were really a thing” (244). Instead of viewing diagnostic categories as provisional markers for groups of symptoms, doctors begin to see them as distinct, and distinctly caused, pathologies like HIV or Covid. They start to see them as the result of specific malfunctioning chemicals in the brain and ignore the complex and highly personal roots of psychic distress. The example of “oppositional defiant disorder” (243), or “ODD,” is a case in point. Defined as a “frequent and persistent pattern of anger, irritability” and “defiance” (243) toward authority figures, ODD seems to epitomize what is wrong with diagnostic labelling. Such a category pathologizes and potentially medicates for the common childhood impulse to rebel. Worse, it suppresses any attempt to understand the way in which childhood recalcitrance results from flawed or broken relationships with adults. For, as Maté says, it is natural for children to resist “people they do not fully trust or feel close enough to” (243).

These problems with categorization can also be seen in the case of more serious psychiatric concerns. For instance, with what is known as bipolar disorder and schizophrenia both are viewed as distinct “conditions” by modern psychiatry. They are viewed, suggests Maté, as different kinds of the severely aberrant functioning of an otherwise “normal” human brain and personality. And they are medicated, and medicated differently, accordingly. Yet if we focus less on the diagnostic labels for those suffering from the symptoms and look instead at the personal stories of the individuals involved, we see that there are essential similarities. In schizophrenia, the symptom of dissociation and the mind “splitting” or disconnecting from a stable identity, can be seen as “a form of instantaneous defense” (263). When the trauma of the present moment is too intense the individual escapes by whatever means possible, even from their own self.

Something similar occurs in the case of bipolar disorder Maté describes. The woman in Maté’s example, Caterina, imagined herself simultaneously to be to blame for everything in the world and have an absolute power to transform it. Forced as a child to witness the destructive breakdown of her parents’ lives but unable to process that experience, she adopted a delusion of potency to cope with it. As such, her bipolar traits were not the mysterious, discreet anomalies of a “mental illness.” Instead, as with schizophrenia, they were a last-ditch attempt of the psyche to cope with “overwhelming life experience” (263). And this point has implications for Maté’s broader argument. It suggests that, just as there is no absolute dividing line between addicts and non-addicts, nor is there one between those with labeled psychiatric conditions and those who are “normal.” Rather, as with addiction, we are all on a spectrum. Within this broken culture, we are all caught up to different degrees and in different ways in using means of distraction and evasion to suppress an otherwise intolerable reality. It is just that those carrying diagnostic labels are the most conspicuous examples and outliers of this plight.