Gabor and Daniel Maté are the authors of the new book The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture.
In the agonized national debate about the crisis besetting Canada’s health care system, two dynamics go largely unnoticed: stress and trauma. Both operate on the individual and the societal levels as the drivers of much pathology of mind and body, yet both fly under the radar so far as medical practice and social policy are concerned.
Everyone knows we’re living in a fraught and fractured time. The bad news emanates from everywhere: climate collapse and financial insecurity, war’s dreadful comeback in Europe, rancorous fault lines of political and cultural identity at home. The pandemic has both exposed and worsened many pre-existing dysfunctions in our society: economic and racial inequities, burgeoning addiction and mental illness, the erosion of trust in institutions, governments and other people.
All this is chronically, ineluctably stressful and thus hazardous to human beings. A 2013 study comparing the health and stress status of young Swedes to those of young Greeks during the financial catastrophe then engulfing Greece found the latter to be at a marked disadvantage. “One can suspect that the social crisis in Greece is beginning to have biological effects on the residents of the country,” the study warned. These effects included higher rates of anxiety and depression, as well as abnormal cortisol levels, a marker of long-term stress – evidence that the protective stress-response mechanism has been disrupted.
Furthermore, the health consequences of stress are intergenerational. In Canada it was found that when women are under economic pressure, their children’s stress-hormone levels rise significantly by age 6, elevating the risk of illness later in life.
The three major factors psychological researchers have identified as having the most dire impact on our body’s stress apparatuses and therefore on health – uncertainty, conflict and loss of control – are rampant in our world. No wonder we’re seeing elevated levels of self-reported stress in poll after poll.
Although we Canadians pride ourselves on our publicly funded health care system, research shows that, at most, only about 25 per cent of population health is attributable to health care. A full 50 per cent is determined by social and economic conditions. In the city of Saskatoon, a 2006 study showed that people in the poorest neighbourhoods were 2½ times more likely to die in any one year. The infant mortality rate was tripled in the city centre compared with its more affluent environs.
Were doctors to take information about social determinants of illness or well-being to heart, Canadian health expert Dennis Raphael mockingly suggests, they would stop issuing injunctions such as “Stop smoking” and instead dispense prescriptions such as “Don’t be poor,” “Don’t live in damp, low-quality housing” and “Don’t work in a stressful, low-paying manual job.”
Even for people spared economic hardship, inequality is a major health hazard in a society that prizes and even worships wealth. In a culture built to enshrine competition, materialism and alienated individuality, how people are induced to see themselves can be almost as sharp an irritant as are objective, material conditions. Being lower on the ladder – even if in a relatively stable position – is itself a source of stress. In the words of neuroscientist Robert Sapolsky: “Health is particularly corroded by your nose constantly being rubbed in what you do not have.”
Beyond the continuing stress of living in an increasingly unequal and unstable world, there is another common thread we tend to miss – one so normalized in our culture as to be invisible, so misunderstood that it is difficult to address even when we do see it: emotional trauma, a phenomenon the famed psychologist Peter Levine has called “perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering.”
Trauma in our culture functions both as an input and an output, a cause and an effect, on every level from the individual to the familial to the collective – and, crucially, influencing not only our psyches but our bodies throughout the lifespan. Decades of cascading scientific research has linked childhood trauma to illness of all kinds, from mental distress to physical diseases such as multiple sclerosis, heart disease and rheumatoid arthritis. A University of Toronto study, for example, showed that men sexually abused as children had a tripled rate of heart attacks, quite apart from lifestyle factors such as smoking. Similarly, recent research from Harvard found a doubled risk of ovarian cancer among women with marked symptoms of post-traumatic stress disorder. As to the documented relationship of early trauma and mental illness, the psychologist Richard Bentall, a fellow of the British Academy, summed up the science a few years ago: “The evidence of a link between childhood misfortune and future psychiatric disorder is about as strong statistically as the link between smoking and lung cancer,” he wrote. Addiction is a frequent and well-documented example, as are, say, depression, anxiety and psychosis.
What, then, is trauma? People mostly associate the word with specific adverse events, such as incest or abuse, rape and violence, war and genocide. This trauma-as-catastrophe framing fosters the belief that there exists a certain unlucky, relatively uncommon class of humans called “trauma survivors.” The corollary, of course, is that most of us must not fit the bill. While all of the above calamities are potent sources of trauma, they do not fully capture its essence or its range.
We are closer to the mark when we see the word’s Greek origin: a wound, in this case a psychic injury. When we emerge from a difficult event cut off from parts of our whole self – our emotions, our self-esteem, our ability to appreciate life’s beauty or connect with others – that disconnection is the core trauma. Trauma, then, is found not in what happens to a person but in what happens inside them as a result of distressing circumstances at vulnerable periods of development. Trauma is the injury, not the accident; the concussion, not the cross-check.
A less overt but potentially pernicious form of trauma is ushered in by what did not happen but ought, by Nature’s mandate, to have happened. Every human being is born with certain irreducible needs on which healthy development depends. These include not just the survival requirements of nourishment and shelter but also a non-negotiable set of emotional, interpersonal experiences such as love, care, support, security and the freedom to feel all of one’s feelings without fear of rejection or punishment.
It is difficult to imagine a culture that makes it harder for parents to provide this sort of nurturance than ours does. The challenge can stem from acute stresses on parents in the present, such as increasing isolation and the erosion of community life, economic anxieties or spousal tensions. Even more commonly, it also arises from parents’ own unwitting emotional wounds, those incurred in their own infancies and childhoods that might have left them insensitive or misattuned to aspects of their children’s emotional repertoire. This is where the traumatic severance of certain parts of self often takes place: far safer not to feel one’s emotions than risk running afoul of those on whom one utterly depends. That disconnect, in turn, can profoundly affect both physical and mental health later on.
There also exist collective traumas on a massive scale. We Canadians have a dismaying example right here at home, one to which many of us are still woefully, sometimes willfully, blind. Addiction, physical maladies, suicide and incarceration beset First Nations communities out of all proportion to the rest of the population. It is no accident, for example, that Indigenous women, the most traumatized segment of the population, are at six times the risk for rheumatoid arthritis – a disease fuelled by stress, as the great Canadian physician Sir William Osler recognized well over a century ago. No virtuous repetitions of well-meant land acknowledgments or earnest pledges by politicians will suffice to redress matters so long as we do not fully face the many grim ways this country’s past haunts its present.
We might even take our telescopic trauma lens and zoom out to view the entire human species. There is no going back to pre-Neolithic times, nor would many of us wish to give up the many comforts and advantages that human technologies from agriculture to app stores have brought us. But we have lost something in the bargain. Before the advent of modern civilization, our kind lived mainly in small hunter-gatherer groups tailored pretty much perfectly toward satisfying basic human needs for contact and connection. Children were raised collectively, interdependence was woven into every custom, communality was the governing ethic, and generosity was indistinguishable from self-interest – a far cry from the Hobbesian, me-first and, yes, stress-inducing ethos we in the modern world insistently mistake for human nature. This was what the psychologist and University of Notre Dame professor emerita Darcia Narvaez has called “the evolved nest.”
We have now become, as she puts it, “species-atypical”: the only creatures on Earth capable of creating environments that frustrate our essential needs, then convincing ourselves that this is the natural way of things.
There is good news embedded in this new understanding of trauma. The past being past, we can do nothing about what has already happened to us as individuals, families or ethnic groups, much less as a species. We do, however, have considerable say in how we tend and respond to the inner wounds we are carrying, personally and socially. The sooner our medical institutions – our governmental, legal and educational ones too – train their gazes on the stress and trauma infusing our agitated world and begin to respond to it with compassionate intelligence, the sooner we can all look ahead to a better, healthier day.
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