Summary and Appreciation
Main Point:
In this amazing book by the renowned physician and author Gabor Mate with his son Daniel Mate, the authors seek to “make the case that much of what passes for normal in our society is neither healthy nor natural…” (page 7). In spite of all of Western culture’s sophistication and technological advances, we possess a woefully inadequate approach to treating the whole person in all of his or her interconnectedness.
Summary:
The book is divided into five large sections. The first four sections lay out the authors’ perspective on the problems we face in Western society beginning at the individual level and moving to the more macro level. The fifth section sketches the authors’ tentative suggestions for human healing at both the individual and societal levels.
Part I – Our Interconnected Nature:
In this section the authors begin by identifying the nature of trauma and the various facets of trauma. They indicate that trauma manifests itself in “our woundedness, or how we cope with it…” (pg. 16). Trauma is “not what happens to you but what happens inside of you…” (pg. 20). It often separates us from our bodies (pg. 26) and splits us off from our gut feelings (pg. 27). It also limits our “response flexibility” (pg. 29) and causes a “shame-based” view of the self, thereby distorting our view of the world. They show that trauma most often doesn’t simply start with the person experiencing trauma but can be traced through multiple generations.
The authors then highlight the nature of our “bodymind” and the oneness that exists between our bodies and minds. Because of this interconnectedness our bodies have developed a system for handling trauma and stress called the “HPA axis” – the hypothalamus, pituitary gland, and adrenal gland. (pg. 47). They advocate for an approach to medicine that includes a “biopsychosocial” view of the individual that recognizes the “unity of emotions and physiology” (pg. 53).
Next, they introduce the recent work done in the field of epigenetics. Through this work, it has been discovered that the experiences we have over the course of our lives “determine how our genetic potential expresses itself in the end” (pg. 61). In other words, “genes answer to their environment” and are turned “on or off in response to signals from within and outside the body” (pg. 62). This finding leads to asking the question of whether disease might not be “a fixed entity but a dynamic process expressive of real lives in concrete situations?” (pg. 84). In fact, “there are no clear dividing lines between illness and health. Nobody all of a sudden ‘gets’ cancer – though it may, perhaps, make itself known suddenly…” (pg. 91).
The authors then move to discussing the inherent tension between our need and want for attachment (the drive for closeness) and our need to be authentic humans (the quality of being true to oneself). The problem arises when our “needs for attachment are imperiled by our authenticity.” (pages 105 – 107). This dilemma often surfaces in our lives during childhood when we receive the message that certain parts of us “are acceptable while others are not” (pg. 107). And, though both needs (attachment and authenticity) are present in each of us, “there is a pecking order in the first phase of life, attachment unfailingly tops the bill” (pg. 107). As a result, we often adapt through various coping mechanisms (even ones that appear to show strength). These coping mechanisms can be part of addictions as well.
Part II – The Distortion of Human Development:
In this section, the authors survey the many problems our society faces in childhood development. They begin by examining human nature in general. They state that within “our biology are some basic needs and potentials. How our nature unfolds depends on how well these needs are met, and how these potentials are encouraged or frustrated” (pg. 117). Within this context they note that we are “freer from genetics than any other species on earth…no other species has ever had the ability to be untrue to itself, to forsake its own needs, never mind to convince itself that such is the way things ought to be.” (pages 118 – 122).
The authors then sketch a summary of our needs as children that ensure developmental conditions leading to human maturation. These needs are: “1 -The attachment relationship: children’s deep sense of contact and connection with those responsible for them. 2 – A sense of attachment security that allows the child to rest from the work of earning his right to be who he is and as he is. 3 – Permission to feel one’s emotions, especially grief, anger, sadness, and pain – in other words, the safety to remain vulnerable. 4 – The experience of free play to mature.” (pages 132 – 135). They state that in essence, “we are feeling creatures” (pg.124) and as such, it is vitally important that our healthy development include a “felt sense of being alive in a nurturing world” (pg. 134).
Additionally, this “felt sense” is often begun within a child prior to birth. In other words, “prior to becoming creators of our environments, we are its creations” (pg. 138). They state that just as there are prenatal classes to support the physical birth of a child, there should be support for the “emotional birth” as well (pg. 145). Likewise, they contend that the medical establishment needs to support the birthing of children into a more calm and emotionally supportive environment (especially the physical environment of the birthing rooms – pg. 158).
Next, they address the current circumstances that parents and children confront immediately after the birth of a child. The effects of our historical preponderance for physical punishment to gain acquiescence from children is examined and contrasted with pre-historic and ancient cultures’ practices of nurture and respect for the dignity of the child (pages 160 – 170). Also, they examine the effects of stress and loneliness on parents and children, showing the negative effects on both from our current situations of isolation and lessened social cohesion.
The authors then move on to examine the effects of the current state of our culture on the childhood experiences within our society. They contend that because human children “like the young of many species, must attach to someone…[and without] a reliable attachment figure, they experience fear and disorientation…the immature brain cannot abide…an attachment void” (pg. 181). However, “the displacement of adults as the primary source and locus of attachment for a child, in favor of her own age cohort – is disastrous” (pg. 182). The vulnerability necessary for healthy growth into maturity is often squelched within peer group pressures that function as the main attachment for children. They remind us that “down to the very cellular level, human beings are either in defensive mode or in growth mode, but they cannot be in both at the same time” (pg. 186).
Finally, the authors move to the broader cultural level. They quote psychiatrist Dr. Michael Kerr who says, “How we function as individuals cannot be understood outside our relationship to the larger group.” (pg. 188). To a great extent, “what is considered normal and natural are established not by what is good for people, but by what is expected of them.” (pg. 201). They highlight three ways that “normal” for society has served to differ from what we would naturally do. These ways include: Separation from Self; Consumption Hunger; and Hypnotic Passivity (pages 202 – 206). Down to the family level, these traits are often transmitted as requirements to the growing child.
Part III – Rethinking Abnormal: Afflictions as Adaptions:
In this section, the authors explore what they refer to as “myths” associated with addiction and mental illness. They begin by describing the two leading “misconceptions regarding addiction: labeling addiction as either “bad choices” or a “disease” (pg. 213). They contend that neither label serves to adequately describe what is going on with addiction. Instead, they define addiction as “the defense of an organism against suffering it does not know how to endure.” (pg. 216). In assessing addiction, they maintain that “two essential questions” should drive our analysis: “What benefit is the person deriving from their habit?” and, “Ask not why the addiction, but why the pain” (pages 216 – 223). The “three main hallmarks of addiction are: “short-term relief, long-term suffering for oneself or others; and an inability to stop” (pg. 225). They are of the opinion that trauma is often the “foundational factor” in addiction (pg. 229). In addition, they believe that addiction “has relatively little to do with the supposed addictive properties of certain substances, other than providing desirable psychoactive relief…[it is] an understandable attempt at self-treatment with something that almost works, thus creating a drive for further doses” (pg. 231). In addition, and importantly, they contend that though there may be some genetic predisposition to being susceptible to certain substances, “genes are turned on and off by the environment, and we now know that early adversity affects genetic activity in ways that create a template for dysfunction.” (pg. 231).
In a similar vein, the authors contend that genetic predisposition does not determine mental health. They state that “In its predominantly biological approach, psychiatry commits the same error as other medical specialties; it takes complex processes intricately bound with life experience and emotional development, slaps the ‘disease’ label on them, and calls it a day” (pg. 238). Instead, they quote Professor Jejannine Austin, leader at a genetic counseling clinic, who says that genes are “a very long way from causing anything…Literally what separates those of us who suffer from those of us that don’t is what happens to us during our lives” (pg. 251). They trace this separation to many mental health issues from depression to ADHD to more severe forms of mental health issues (pages 253 – 272).
Part IV – The Toxicities of Our Culture:
In this section, the authors trace the connection between trauma, illness and healing, and how we are “biopsychosocietal beings” (pg. 275). Everything in our society has effects that are felt at the cellular level and have profound effects on our levels of stress. The marker of stress is inflammation (at the cellular and gene level). On top of this, the authors draw attention to the fact that in the midst of the societal stress that we all feel, we are continually bombarded by stimuli from the marketplace that purposely targets our “brain circuits of pleasure and reward to foster addictive compulsions” (pg. 298). What the market (or system as the authors refer to it) sells as happiness is really in fact only pleasure. Happiness says, “that feels good and I am content,” where pleasure says, “that feels good and I want more.” (page 298). The two are similar but “run on different neurochemical fuels” (pg. 298). From food to pharmaceuticals, we have been plied with products that work on the circuits of our brains to encourage us to want more of the pleasure they provide without ever really bringing us contentment.
In addition to the assault that occurs from the products that are foisted upon us by our culture, the authors show the correlation between race and class, and the health outcomes observed in our world. They state that “The beast of inequality has many tentacles with which to squeeze the life out of peoples’ lives…your relative position on the social ladder is a predictor of health across all strata” (pg. 327). In the midst of this, they show that women function as society’s “shock absorbers,” and as a result suffer “chronic illness of the body far more often than men” (pg. 329). They pin the blame for much of this on Patriarchy which they are quick to point out negatively affects both men and women (page 324 – 342).
The authors conclude this section by tracing the sickness in our political world, “the outermost layer of the biopsychosocial onion” (pg. 343). They contend that “when trauma manifests on the political stage, the consequences for people and planet are massive” (pg. 345). As a case in point, the authors point out that many of the top politicians in our world routinely can be identified as suffering from negative traits characteristic of psychosociopathy. One of those traits found in both Hilary Clinton and Donald Trump is “cold-heartedness” (pg. 349). Though thought of as diametrically opposite in many ways, these two public figures share remarkable similarities that seem to have grown out of their wounds from childhood. Those wounds then factored into how they coped with their pain later in life in very similar and unhealthy ways.
Part V – Pathways to Wholeness:
In this final section, the authors delve into their tentative proposals for “healing.” By healing they mean “a natural movement toward wholeness.” (pg. 361). They are quick to point out that as their colleague Dr. Lissa Rankin says, “It’s possible to be healed but not cured, and it’s possible to be cured but not healed.” (pg. 362). Being healed is a direction not a destination and more of a process and movement. The bedrock that sits at the center of Dr. Mate’s thinking on this subject is to let the heart work “as a guide, and the mind as a willing and curious partner” in the healing process.
They present four principles that “each represent a healthy quality corresponding to a human need, often stunted and forced underground early in life by emotionally or physically inimical conditions…” (pg. 375). These principles are: Authenticity, Agency, Anger, and Acceptance (pages 375 – 382). Authenticity is difficult to define and more often known by its absence or what it is not. It is the embodied truth of who we are in our essential self. Growing out of our authentic self is our capacity to act with agency and “freely take responsibility for our existence, exercising ‘response ability’ in all essential decisions that affect our lives, to every extent possible” (pg. 377). Healthy anger functions as a “boundary defense” when we perceive a threat. And finally, acceptance “has to do with allowing things to be as they are…[not] with complacency or resignation…” (pg. 380).
Next, the authors explain the five levels of compassion that they believe can “encourage, guide and orient us on the pathway to wholeness” (pg. 383). The first is ordinary human compassion. Being aware that someone is suffering “does not register as a neutral fact” (pg. 383). Secondly, having curiosity and developing understanding about the pain around us is more than feeling bad for that pain, but truly being curious about real causes and effects. Thirdly, the level of compassion associated with the compassion of recognition entails seeing the commonality of the suffering around us as something that we all share in. Fourthly, the compassion of truth sees that pain and the need to be honest about that pain and its causes go hand in hand. And finally, the compassion of possibility leaves the door open “so that we can see that victory is coming” and we “have some confidence, some hope of victory” (pg. 389).
In the next two chapters, the authors explore their perspectives on healing disease and other traumas to the body. They remind us again that “healing is the movement toward experiencing oneself as a vital whole, whatever may be happening corporeally” (pg. 391). They hope to offer “potent practices…that can retrain mind and body to become more sensitive and responsive to these calls from within.” (pg. 408). They begin with a “self-inquiry exercise” of six questions: 1 – what am I not saying no to; 2 – how does my inability to say no impact my life; 3 – what bodily signals have I been overlooking; 4 – what is the hidden story behind my inability to say no; 5 – where did I learn these stories; and 6 – where have I ignored or denied the ‘yes’ that wanted to be said? (page 413 – 421).
The authors then offer five steps for moving beyond limiting beliefs and perspectives about what is possible for healing: Relabel; Reattribute; Refocus; Revalue; and Re-create (pages 422 – 429). The first step is to make sure that we recognize that self-limiting thoughts are just that – thoughts, and not the truth. Secondly, we must assign the incorrect thoughts to their proper place as just there, in the present moment, and recognize it as such. Thirdly, we must shift focus to buy time to make needed change. Fourthly, we need to evaluate the effects this belief has had on our life what we might have perceived as a benefit of having that limiting belief (i.e. safety, etc.) and what are the true costs of that belief. And finally, in the re-creation step we must determine what you really want in place of the limiting beliefs that have trapped us.
They then move in the next chapter to offering ways of overcoming “obstacles to healing: crippling guilt; self-loathing and its close cousins, self-rejection, self-sabotage, and self-destructive impulses; and blocks in our emotional memory, or what we call denial of pain” (pg. 430). They remind us that these obstacles to healing are often part of what came along within us to help us through trauma, but now need to be realigned so that we, and not they, are in the lead of our lives. They examine the “myth of the happy childhood” syndrome that often clouds the perspectives of people who have difficulty assessing their past for clues to present problems (pg. 443). The question presented to readers is: “when [you] felt sad, unhappy, angry, confused, bewildered, lonely, bullied, who did [you] speak to? Who did [you] tell? Who did [you] confide in?” (pg. 443).
Next, the authors examine the role that experiences of the transcendent has in healing. They insist that “healing is outside the thinking mind’s wheelhouse.” (pg. 464). We often have no control over this aspect of healing. They recount several stories of intense spiritual experiences presented by various people and explore the importance of being still and engaging in mindfulness.
In the final chapter, the authors summarize their thesis that “for our society to right itself and chart a course for maximum health, certain conditions will have to be met….[and]..They all derive from the core principles of this book: biopsychosocial medicine, disease as teacher, the primacy of both attachment and authenticity, and above all, fearless self-inquiry, here on a social scale” (pg. 482). They then finish by imploring the world to become a more “trauma-conscious society” (pg. 486). They point to three specific areas where they believe our world would benefit immensely from being more aware of trauma: medicine, the law, and education.
Appreciation/Critique:
Clearly identifying problems functions as the first, and to a great extent, most important step in discovering good solutions to those problems. The authors of this book do a marvelous job in this identification process. In fact, they do such a good job of recognizing and evaluating a wide variety of problems that I will only highlight a few of the insights that stood out in a particularly bright manner.
I found their insights on the nature of trauma as often being multi-generational to echo much of the work of Edwin Friedman and others with a family systems perspective on human relations (see Friedman – Generation to Generation). In a similar vein, they also echo many of the views presented by Parker Palmer about the “divided self” (see Palmer – A Hidden Wholeness) when they warn of the dangers people face when they separate from themselves.
I also found their information about epigenetics to be very interesting in a variety of ways. It complimented information presented by Roizen, Linneman, and Ratner in their book, “The Great Age Reboot.” This book’s emphasis on the indeterminacy of genetics and our agency in forging a new path for our lives dovetailed nicely with their presentation on addiction and mental health as well as their sections on physical disease.
Finally, I appreciate their concentration on childhood issues and their impact on a person’s difficulties over a lifetime. Their continual weaving of the formative impacts of childhood trauma with the multiple ways that this affects individuals and society at large was one of the most helpful parts of the book.
In terms of critiques, I have almost none. The only slight concern centers on the authors’ use of the term “capitalism” and how they seem to equate it with the market. How markets work and our individual and collective relationship to markets is a complex subject. I believe that all too often, many people who weigh in on our destructive relationship with markets and economics in general should exercise more care and precision in their critique. At a minimum they should show a greater recognition of the complexities that surround the subject.
Todd Rivetti 