Normal is healthy and natural, right? That’s what we assume. However, if you take good care of your dog, but others don’t, you’re actually the one who’s not normal. Normal is average, after all. Gabor Maté questions this normality through our perception of health, within the framework of mind-body unity.
Let’s start with a story.
We’re at the Cleveland Clinic in the 1990s. Nurses are predicting which patients coming to the hospital for ALS diagnosis will actually develop ALS. They write notes on patients’ files like, "Likely ALS patient, very nice person" or "Won’t develop it, not nice enough." The interesting thing is, these predictions almost always turn out to be accurate.
ALS is a degenerative autoimmune disease that attacks nerve cells in the brain and spine. Research over the years since then supports the nurses' observations. The title of one article published in this field reads: "ALS Patients Are Usually Nice People." And this holds true for other diseases as well. In 2000, "Cancer Nursing" examined the relationship between suppressed anger and cancer. But how can there be a connection between a personality trait like kindness and disease?
According to world-renowned doctor Dr. Gabor Maté, the answer lies in trauma and chronic stress. In this book, Maté argues that factors like these are at the root of most of what we call disease, and he convincingly discusses how the values society considers normal actually make us sick, while offering guidance on how compassion can be a path to healing.
In this post, I summarize the four main ideas of the book.
Main Idea 1:
A child’s two fundamental needs, attachment and authenticity, are in conflict with each other.
Attachment is our fundamental need for emotional closeness and love; but also survival. Attachment theory, one of the most widely accepted theories in psychology, also suggests that a baby’s most basic need is to form a bond with its caregiver.
At the same time, we also need to shape our lives guided by the deep knowledge of our authentic selves. In other words, being authentic is another basic need. Here, Maté argues that being authentic is not just a luxury for those new agers' curiosity about self-improvement; it’s also essential from an evolutionary perspective: "Imagine our African ancestor on the savanna sensing the presence of a natural predator: How long could they survive if they suppressed the instinctual feelings that warn of danger?" In its most concrete and pragmatic form, authenticity is about being honest with ourselves, understanding our innermost feelings, and honoring them.
However, in childhood, our need for attachment takes precedence over our need for authenticity. Unlike other mammals, human offspring are born less developed and are dependent on care for a long time; otherwise, they cannot survive. Indeed, Stephen Porges’ polyvagal theory, which has transformed our understanding of the nervous system, also describes how crucial connection is for nervous system regulation.
The phrase "Good children don’t shout," said in an angry tone, unintentionally carries a very effective threat: "Angry children are not loved." Being "kind" (like suppressing one’s anger) and trying to be acceptable to the parent can become the child’s way of survival. Or a child might internalize the idea, "I can only be loved if I do everything right," and boom! They prepare themselves for a life filled with perfectionism and rigid roles. This internalization leads the child to suppress the emotions they believe are not liked.
Here, Maté also discusses a nuance that personally resonates with me: the difference between repression and suppression. Repression develops unconsciously. You know how some people say, "Oh, I never get angry"? But anger is also an emotion, and like all emotions, we all feel:) Our state of not even realizing the ‘bad’ emotions we feel is repression, while suppression involves consciously repressing our emotions, which can be necessary in many situations in our lives. For example, there were times when I was very emotional while interviewing refugees, but I had to suppress my emotions. Many of us have had, and will have, such times. However, according to Maté, if a person suppresses their emotions habitually or out of constant necessity, the effects will likely be toxic. Both repression and suppression can create stress from the emotions we cannot express, but repression makes it even harder to resolve because we are not even aware of it. "When we’re not aware that we’re angry, we can’t talk to the responsible person or solve the problem in any other way. We cry; we eat; we comfort ourselves in thousands of different ways."
Now let’s go back to the child who was prevented from expressing their anger. Here, Maté makes a distinction between small-t and big-T trauma and says: a child’s needs may not be met due to major traumatic events, yes, but even without such traumas, unmet needs can also cause trauma: "The things that haven’t happened but should have happened." In other words, even if a child grows up in a loving family, if they do not grow up in an environment that allows their authentic self to shine, they may still go through traumatic experiences. And he says: "In my experience, even people with the most insistent 'happy childhood' narratives will quickly realize that their autobiographies are full of blind spots if the right questions are asked."
Since for a child, the need for attachment is stronger than the need to be authentic, during childhood, the need for attachment and acceptance almost always takes precedence over the need to be authentic. Life’s journey, if we’re lucky, is somewhat about rediscovering our authentic self. It’s a journey of embracing the parts of ourselves we felt we had to give up to receive care as children.
Main Idea 2:
Stress harms the body and lays the groundwork for diseases.
We’ve seen how the conflict between our need to connect with others and our need for authenticity (our need to be honest with ourselves) can lead to distancing from our true selves. We can suppress our emotions to gain approval or love.
Constantly suppressing our emotions and needs triggers the stress response. Let’s see how that works:
An emotional stressor first activates a complex network of connections between the hypothalamus, the brain center responsible for keeping our biological systems in balance, and the pituitary and adrenal glands that secrete stress hormones like adrenaline and cortisol. If you’ve ever felt the jitters before a big presentation or exam, you’ll understand this. Imagine that tension continuing indefinitely without ever calming down. Long-term or chronic stress leads to the excessive release of these hormones, which gradually exhausts the entire system. It also damages our nervous system.
Worse still, this stress hinders the body’s natural defense against diseases. When working properly, the immune system attacks a foreign substance and then regulates itself, but under chronic stress, it suppresses the signals that regulate this process, leading to chronic inflammation—meaning autoimmune diseases. For this reason, emotional stress always physically affects us. Maté calls this the mind-body unity. While the stress response evolved to help us survive, modern social conditions keep it constantly active—this is what we’ll explore next.
Main Idea 3:
The culture we live in feeds chronic stress and disease conditions.
For those who made grass-heads or sprouted lentils in primary school, hats off to you. You’ll remember that for sprouting to happen, you need to provide the right conditions, like the right amount of light and water. If we consider the social values of modern life as the human flora, according to Maté, this flora is not suitable for human flourishing; in fact, it’s filled with toxicity, and that’s why it actually feeds chronic stress and disease conditions.
Humanity is making progress in many areas, but at the same time, there is an increase in stress-related illnesses. For instance, in Canada, depression and anxiety are the fastest-spreading illnesses. In 2019, more than 50 million Americans, over 20% of adults in the U.S., experienced a mental health episode.
In his book, Maté discusses how economic hardships, belonging to certain minority groups, or practices related to motherhood and childbirth can make us sick. For example, a study on rats showed that pups raised by more attentive mothers were better able to cope with stress, and Maté explains how children who do not receive adequate care may be more prone to health problems and addiction. He even describes how addiction is linked to unregulated dopamine release in adulthood, stemming from the inability to develop emotional regulation during child development phase.
Additionally, the suppression of emotions mentioned in the first main idea, along with personality traits like being kind and giving to the point of always prioritizing others’ needs over one’s own, are respected by society and seen as high virtues. According to Maté, this societal glorification of these traits is also linked to why the relationship between these traits and illness is so invisible.
When discussing the damage that being kind could cause, Maté’s suggestion should not be understood as promoting rudeness. What he’s talking about is prioritizing others’ needs over our own to be loved and accepted while ignoring our own needs. Here, he says: "True compassion is an offer made to others, providing equal opportunities because we know and honor exactly what we feel." and adds: "A healthy sense of self does not prevent us from caring for others or being influenced by or influencing them. It is not rigid; it is broad and inclusive."
Main Idea 4:
Healing is about finding the path to wholeness.
After explaining his argument with reasons and methods, in the last section of the book, Maté shares the practices he has worked on for years regarding how we can heal. Maté says: "If the heart is our best compass on the path to healing, the mind—both conscious and unconscious—is the field where we will use this compass. Healing brings them into alignment and cooperation." According to Dr. Maté, healing is a natural movement towards wholeness. A powerful strategy that we can start using in our own lives is the practice he calls Compassionate Inquiry, which we can all do.
According to Maté, compassion is an attitude that can be developed, unlike emotions that come and go spontaneously. This attitude is a state of non-judgmental awareness, and when judgment arises, it involves looking curiously at where these judgments come from without believing in their content. Kristin Neff, known for her work in the field of compassion, says that compassion is the courage to stay with pain. Similarly, Maté says:
"In fact, pain is compassionate by its nature because it tries to alert us to what is wrong. Healing, in a way, is about forgetting the idea that we need to protect ourselves from our own pain. In this sense, compassion is a gateway to another fundamental quality: courage."
And with a compassionate attitude, he suggests a set of questions we can regularly ask ourselves.
The following questions are about identifying how we deny our emotions and needs and prioritize others:
When do I struggle to say no in important areas of my life, and how does that affect me?
When have I refused to follow the urge to say yes?
And the following question is about identifying where emotional stress is held in your body:
What bodily signals am I ignoring? What symptoms might be trying to warn me?
I find yoga and similar modalities especially helpful for raising body awareness.
Then, try to identify the hidden story behind our inability to say no. Where did we learn these stories? This is about unraveling the narrative so that we could see how our responses and behaviors once served us.
In this last section of the book, Maté goes into detail about how we can do this work. Perhaps it will be the topic of another blog post.
The purpose of this healing work is to learn to hear the voice of our authentic self. When we achieve this, we can maintain our connection to ourselves and preserve our authenticity instead of reacting automatically to intense stress or trauma.
Final Summary
Together with Maté’s other books, which tackles similar issues around mind-body unity, have been very helpful to me in making sense of my own experience and healing journey. Despite growing up in a very loving family, I was the middle child between two very cool siblings (shoutout to middle children). And I quickly realized that I received a lot of attention when I was successful. As a child, I associated this with love. My need for connection led me to give up on authenticity before I could even grasp it. At 18, I was diagnosed with idiopathic portal hypertension. Idiopathic means unknown cause in Latin. How meaningful, isn’t it? Understanding that cause, Maté’s books touched my heart; as someone who has had an organ transplant, I’m indeed a miracle of Western medicine. And yet, it has helped me understand why I question the system. What I love most about Maté’s approach is how holistically and clearly he explains health. When he talks about mind-body unity, he emphasizes the word "unity" rather than "connection" (as in connection or relationship). He says it’s not the coexistence of two separate things; they form a whole. And I think this nuance is very valuable. He says: "Even 'connection' is a misleading word: only entities distinct from each other can be connected, whereas reality knows only oneness." Which is the mind-body unity.
If you’re interested in the topics I’ve briefly touched on in this post, I sincerely recommend reading the book or please write in the comments if you want me to explore any part of it further in the next blog post.
with health,
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