Why Normal Is a Myth (And Why That Matters)

The fact that millions of people share the same vices does not make these vices virtues, the fact that they share so many errors does not make the errors to be truths, and the fact that millions of people share the same forms of mental pathology does not make these people sane.

—Erich Fromm, The Sane Society

In the most health-obsessed society ever, all is not well.

Health and wellness have become a modern fixation. Multibillion-dollar industries bank on people’s ongoing investment—mental and emotional, not to mention financial—in endless quests to eat better, look younger, live longer, or feel livelier, or simply to suffer fewer symptoms. We encounter would-be bombshells of “breaking health news” on magazine covers, in TV news stories, omnipresent advertising, and the daily deluge of viral online content, all pushing this or that mode of self-betterment. We do our best to keep up: we take supplements, join yoga studios, serially switch diets, shell out for genetic testing, strategize to prevent cancer or dementia, and seek medical advice or alternative therapies for maladies of the body, psyche, and soul.

And yet our collective health is deteriorating.

What is happening? How are we to understand that in our modern world, at the pinnacle of medical ingenuity and sophistication, we are seeing more and more chronic physical disease as well as afflictions such as mental illness and addiction? Moreover, how is it that we’re not more alarmed, if we notice at all? And how are we to find our way to preventing and healing the many ailments that assail us, even putting aside acute catastrophes such as the COVID-19 pandemic?

As a physician for over three decades, in work ranging from delivering infants to running a palliative care ward, I was always struck by the links between the individual and the social and emotional contexts in which our lives unfold and health or illness ensue. This curiosity, or should I say fascination, led me in time to look deeply into the cutting-edge science that has elegantly delineated such links. My previous books have explored some of these connections as they manifest in particular ailments such as attention deficit hyperactivity disorder (ADHD), cancer and autoimmune disease of all types, and addiction. I have also written about child development, the most decisively formative period of our lives.[1]

This book, The Myth of Normal, sets its sights on something far more encompassing. I have come to believe that behind the entire epidemic of chronic afflictions, mental and physical, that beset our current moment, something is amiss in our culture itself, generating both the rash of ailments we are suffering and, crucially, the ideological blind spots that keep us from seeing our predicament clearly, the better to do something about it. These blind spots—prevalent throughout the culture but endemic to a tragic extent in my own profession—keep us ignorant of the connections that bind our health to our social-emotional lives.

Another way of saying it: chronic illness—mental or physical—is to a large extent a function or feature of the way things are and not a glitch; a consequence of how we live, not a mysterious aberration.

The phrase “a toxic culture” in this book’s subtitle may suggest things like environmental pollutants, so prevalent since the dawn of the industrial age and so antagonistic to human health. From asbestos particles to carbon dioxide run amok, there is indeed no shortage of real, physical toxins in our midst. We could also understand “toxic” in its more contemporary, pop-psychological sense, as in the spread of negativity, distrust, hostility, and polarization that, no question, typify the present sociopolitical moment.

We can certainly fold these two meanings into our discussion, but I am using “toxic culture” to characterize something even broader and more deeply rooted: the entire context of social structures, belief systems, assumptions, and values that surround us and necessarily pervade every aspect of our lives.

That social life bears upon health is not a new discovery, but the recognition of it has never been more urgent. I see it as the most important and consequential health concern of our time, driven by the effects of burgeoning stress, inequality, and climate catastrophe, to name a few salient factors. Our concept of well-being must move from the individual to the global in every sense of that word. That is particularly so in this era of globalized capitalism, which, in the words of the cultural historian Morris Berman, has become the “total commercial environment that circumscribes an entire mental world.”[2] Given the mind-body unity to be highlighted in this book, I would add that it constitutes a total physiological environment as well.

It is my contention that by its very nature our social and economic culture generates chronic stressors that undermine well-being in the most serious of ways, as they have done with increasing force over the past several decades.

Here’s an analogy I find helpful. In a laboratory, a culture is a biochemical broth custom-made to promote the development of this or that organism. Assuming the microbes in question start out with a clean bill of health and genetic fitness, a suitable and well-maintained culture should allow for their happy, healthy growth and proliferation. If the same organisms begin showing pathologies at unprecedented rates, or fail to thrive, it’s either because the culture has become contaminated or because it was the wrong mixture in the first place. Whichever the case, we could rightly call this a toxic culture—unsuitable for the creatures it is meant to support. Or worse: dangerous to their existence. It is the same with human societies. As the broadcaster, activist, and author Thom Hartmann asserts, “Culture can be healthy or toxic, nurturing or murderous.”[3]

From a wellness perspective, our current culture, viewed as a laboratory experiment, is an ever-more globalized demonstration of what can go awry. Amid spectacular economic, technological, and medical resources, it induces countless humans to suffer illness born of stress, ignorance, inequality, environmental degradation, climate change, poverty, and social isolation. It allows millions to die prematurely of diseases we know how to prevent or of deprivations we have more than enough resources to eliminate.

In the United States, the richest country in history and the epicenter of the globalized economic system, 60 percent of adults have a chronic disorder such as high blood pressure or diabetes, and over 40 percent have two or more such conditions.[4] Nearly 70 percent of Americans are on at least one prescription drug; more than half take two.[5] In my own country, Canada, up to half of all baby boomers are on track for hypertension within a few years if current trends continue.[6] Among women there is a disproportionate elevation in diagnoses of potentially disabling autoimmune conditions like multiple sclerosis (MS).[7] Among the young, non-smoking-related cancers seem to be on the rise. Rates of obesity, along with the multiple health risks it poses, are going up in many countries, including in Canada, Australia, and notably the United States, where over 30 percent of the adult population meet the criteria. Recently Mexico has surpassed its northern neighbor in that unenviable category, with the result that thirty-eight Mexicans are diagnosed with diabetes every hour. Thanks to globalization, Asia is catching up. “China has entered the era of obesity,” Ji Chengye, a child health researcher in Beijing, reported. “The speed of growth is shocking.”[8]

Throughout the Western world, mental health diagnoses are escalating among the young, in adults, and among the elderly. In Canada, depression and anxiety are the fastest-growing diagnoses; and in 2019 more than fifty million Americans, over 20 percent of U.S. adults, suffered an episode of mental illness.[9] In Europe, according to the authors of a recent international survey, mental disorders have become “the largest health challenge of the 21st century.”[10] Millions of North American children and youths are being medicated with stimulants, antidepressants, and even antipsychotic drugs whose long-term effects on the developing brain are yet to be established—a perilous social experiment in the chemical control of young people’s brains and behavior. A chilling 2019 headline on the online news site ScienceAlert speaks for itself: “Child Suicide Attempts Are Skyrocketing in the US, and Nobody Knows Why.”[11] The picture is similarly stark in the U.K., where the Guardian recently reported, “British universities are experiencing a surge in student anxiety, mental breakdowns and depression.”[12] As globalization envelops the world, conditions hitherto found in “developed” countries are finding their way into new venues. ADHD among children, for example, has become “an increasing public health concern” in China.[13]

The climate catastrophe already afflicting us has introduced an entirely new health hazard, a magnified version—if that is possible—of the existential threat that nuclear war has posed since Hiroshima. “Distress about climate change is associated with young people perceiving that they have no future, that humanity is doomed,” found the authors of a 2021 survey of the attitudes of over ten thousand individuals in forty-two countries. Along with a sense of betrayal and abandonment by governments and adults, such despondence and hopelessness “are chronic stressors which will have significant, long-lasting and incremental negative implications on the mental health of children and young people.”[14]

Casting ourselves as the organisms in the laboratory analogy, these and other metrics indicate unmistakably that ours is a toxic culture. Worse yet, we have become accustomed—or perhaps better to say acculturated—to so much of what plagues us. It has become, for lack of a better word, normal.

In medical practice, the word “normal” denotes, among other things, the state of affairs we doctors aim for, setting the boundaries delineating health from disease. “Normal levels” and “normal functioning” are our goal when we apply treatments or remedies. We also gauge success or failure against “statistical norms”; we reassure worried patients that this symptom or that side effect is completely normal, as in “to be expected.” These are all specific and legitimate uses of the word, enabling us to assess situations realistically so that we can aim our efforts appropriately.

It is not in these senses that this book’s title refers to “normal,” but rather in a more insidious one that, far from helping us progress toward a healthier future, cuts such an endeavor off at the pass.

For better or worse, we humans have a genius for getting used to things, especially when the changes are incremental. The newfangled verb “to normalize” refers to the mechanism by which something previously aberrant becomes normal enough that it passes beneath our radar. On a societal level, then, “normal” often means “nothing to see here”: all systems are functioning as they should, no further inquiry needed.

The truth as I see it is quite different.

The late David Foster Wallace, master wordsmith, author, and essayist, once opened a commencement speech with a droll parable that well illustrates the trouble with normality. The story concerns two fish crossing aquatic paths with an elder of their species, who greets them jovially: “‘Morning, boys. How’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, ‘What the hell is water?’” The point Wallace wanted to leave his audience pondering was that “the most obvious, ubiquitous, important realities are often the ones hardest to see and talk about.” On its surface, he allowed, that might sound like “a banal platitude” but “in the day-to-day trenches of adult existence, banal platitudes can have a life-or-death importance.”

He could have been articulating this book’s thesis. Indeed, the lives, and the deaths, of individual human beings—their quality and in many cases their duration—are intimately bound up with the aspects of modern society that are “hardest to see and talk about”; phenomena that are, like water to fish, both too vast and too near to be appreciated. In other words, those features of daily life that appear to us now as normal are the ones crying out the loudest for our scrutiny. That is my central contention. My core intention, accordingly, is to offer a new way of seeing and talking about these phenomena, bringing them from the background to the foreground so we might more swiftly find their much-needed remedies.

I will make the case that much of what passes for normal in our society is neither healthy nor natural, and that to meet modern society’s criteria for normality is, in many ways, to conform to requirements that are profoundly abnormal in regard to our Nature-given needs—which is to say, unhealthy and harmful on the physiological, mental, and even spiritual levels.

If we could begin to see much illness itself not as a cruel twist of fate or some nefarious mystery but rather as an expected and therefore normal consequence of abnormal, unnatural circumstances, it would have revolutionary implications for how we approach everything health related. The ailing bodies and minds among us would no longer be regarded as expressions of individual pathology but as living alarms directing our attention toward where our society has gone askew, and where our prevailing certainties and assumptions around health are, in fact, fictions. Seen clearly, they might also give us clues as to what it would take to reverse course and build a healthier world.

Far more than a lack of technological acumen, sufficient funds, or new discoveries, our culture’s skewed idea of normality is the single biggest impediment to fostering a healthier world, even keeping us from acting on what we already know. Its occluding effects are particularly dominant in the field where clear sight is most called for: medicine.

The current medical paradigm, owing to an ostensibly scientific bent that in some ways bears more resemblance to an ideology than to empirical knowledge, commits a double fault. It reduces complex events to their biology, and it separates mind from body, concerning itself almost exclusively with one or the other without appreciating their essential unity. This shortcoming does not invalidate medicine’s indisputably miraculous achievements, nor sully the good intentions of so many people practicing it, but it does severely constrain the good that medical science could be doing.

One of the most persistent and calamitous failures handicapping our health systems is an ignorance—in the sense either of not knowing or of actual, active ignoring—of what science has already established. Case in point: the ample and growing evidence that living people cannot be dissected into separate organs and systems, not even into “minds” and “bodies.” Overall, the medical world has been unwilling or unable to metabolize this evidence and to adjust its ways accordingly. The new science—much of which isn’t all that conceptually new—has yet to have significant impact on medical school training, leaving well-meaning health providers to toil in the dark. Many end up having to connect the dots for themselves.

For me, the process of putting the pieces together began several decades ago when, on a hunch, I went beyond the standard repertoire of dry doctorly questions about symptom presentation and medical history to ask my patients about the larger context for their illnesses: their lives. I am grateful for what these men and women taught me through how they lived and died, suffered and recovered, and through the stories they shared with me. The core of it, which accords entirely with what the science shows, is this: health and illness are not random states in a particular body or body part. They are, in fact, an expression of an entire life lived, one that cannot, in turn, be understood in isolation: it is influenced by—or better yet, it arises from—a web of circumstances, relationships, events, and experiences.

Of course, we have cause to celebrate the past two centuries’ astonishing medical advances and the tireless fortitude and intellectual brilliance of those whose work has led to giant strides in many different fields of human health. To take just one example, the incidence of polio—an awful illness that killed or maimed countless children only two or three generations back—has dropped by more than 99 percent since 1988, according to the U.S. Centers for Disease Control and Prevention; most kids today probably have never heard of the disease.[15] Even the more recent epidemic of HIV has been downgraded in a relatively short period of time from a death sentence to a manageable chronic condition—at least for those with access to the right kinds of treatment. And as destructive as the COVID-19 pandemic has been, the rapid development of vaccines may be counted among the triumphs of modern science and medicine.

The problem with good news stories like these—and they are very good news—is that they stoke the reassuring conviction that we are, overall, making advances toward a healthier standard of life, lulling us into a false passivity. The actual picture is quite different. Far from being on the verge of curbing the contemporary health challenges facing us, we are barely keeping pace with most of them. Often the best we can do is mitigate symptoms, whether surgically or pharmacologically, or both. As welcome as medical breakthroughs are, and as fruitful as research can be, the crux of the problem is not a dearth of facts, not a lack of technology or techniques, but an impoverished, out-of-date perspective that cannot account for what we are seeing. My aim here is to offer a fresh one that I believe brings with it enormous possibilities for a healthier paradigm: a new vision of normal that nurtures the best in who we are.

This book’s arc follows the concentric circles of cause, connection, and consequence that influence how healthy or unhealthy we are. Beginning from the inside at the level of human biology, and then examining the close relationships within which our bodies, brains, and personalities develop, we will make our way outward to the most macro dimensions of our collective existence, namely the socioeconomic and the political. Along the path I will show how our physical and mental health is intricately interwoven with how we feel, what we perceive or believe about ourselves and the world, and the ways that life does or does not satisfy our nonnegotiable human needs. Because trauma is a foundational layer of experience in modern life, but one largely ignored or misapprehended, I will begin with a working definition to set up everything that follows.

At each stage, my task is to lift the veil of common knowledge and received wisdom, considering what science and watchful observation tell us, with the aim of unfastening the myths that keep the status quo locked in place. As in my previous books, the science and its health implications will be brought home via real-life stories and case studies of people who have generously shared something of their journeys through illness and health with me. These range from the mildly surprising to the truly incredible, the heartbreaking to the inspiring.

Yes, inspiring. For there is a heartening corollary to all the difficult news. When we can look soberly at what we as a culture have normalized about health and illness, and realize that it is not, in fact, the way things are meant or fated to be, there arises the possibility of returning to what Nature has always intended for us. Hence the “healing” in our subtitle: once we resolve to see clearly how things are, the process of healing—a word that, at its root, means “returning to wholeness”—can begin. That statement contains no promise of miracle cures but simply the recognition that each of us contains as-yet-unimagined possibilities for wellness, possibilities that reveal themselves only when we face and debunk the misleading myths[*] about normality to which we have become passively accustomed. If that is true for us as individuals, it must also be true for us as a species.

Healing is not guaranteed, but it is available. It is no exaggeration to say at this point in Earth’s history that it is also required. Everything I have seen and learned over the years gives me confidence that we have it in us.