By Dr. Gabor Maté
As a physician I have witnessed and treated what we call mental illness; as a person I have experienced it. I say ‘what we call mental illness’, because disease is a very narrow perspective from which to view a complex process, one that cannot be reduced to subjective symptoms, observed behaviors or to the biology of an individual human being’s brain and nervous system. Yes, this process entails suffering—in my most depressed moments I have felt life is not worth living and, though I have never contemplated suicide, I have envisioned it; in intense moments of frustration I have fervently wished that may ADD-addled brain would not scramble my attempts at creativity and organization; in the midst of addictive compulsions, I have yearned to be free. But suffering is not the same as disease.
To pathologize certain people as ‘mentally ill’ is to assume a baseline standard of normal ‘mental wellness’ met by the rest of humanity. Let’s dispense with this myth of normality. Prior to his trial for war crimes, the head Nazi engineer of genocide SS-Oberstrumbannführer Adolf Eichmann was certified as ‘normal’ by several psychiatrists—’more normal, at any rate, than I am’, one of them was said to have exclaimed, according to Hannah Arendt’s famous account. ‘Another’, Arendt reported, ‘had found that Eichmann’s whole psychological outlook, including his relationship with his wife and children, his mother and father, his brothers and sisters and friends, was “not only normal but most desirable”‘. This is what the American psychiatrist Robert J. Lifton has called ‘malignant normality’.
Closer to home for this audience, 2019 marks the centennial of the infamous Amritsar massacre, an indiscriminate mass killing by British troops in the Punjab of over several hundred unarmed and peaceful demonstrators gathered to protest the deportation of two of Ghandi’s followers. The atrocity was decreed under the authority of perfectly normal men within the imperial hierarchy, graduates no doubt of the finest schools. The sort of men, perhaps, of whom the journalist and author Ben Macintyre has said that ‘There is no deceiver more effective than a public-school-educated Brit. He could be standing next to you in the bus queue, having a Force 12 nervous breakdown, and you’d never be any the wiser’.
So much for ‘normal’. Meanwhile, one of our modern-day heroes, the teenage climate activist Greta Thunberg has been diagnosed with a number of mental health disorders, including Asperger’s. ‘I’ve had my fair share of depressions, alienation, anxiety and disorders’, she revealed on Facebook. ‘But without my diagnosis, I would never have started school striking. Because then I would have been like everyone else’. The people on both sides of the Atlantic who have dismissed her as mentally unstable have done so in the service of denying climate change, a stupendous dissociation from reality that will never be inscribed in the diagnostic compendium of mental illnesses, despite the fact that it threatens to destroy human habitats and much of the natural world. ‘I’m not public about my diagnosis to “hide” behind it’, Thunberg has said, ‘but because I know many ignorant people still see it as an “illness”, or something negative. And believe me, my diagnosis has limited me before’.
So let’s all drop the pretense that we are either normal, or abnormal. We are all in the same support group: ordinary people who must deal with the struggles that come with being human. Not that these diagnostic terms are useless: though they don’t explain much, they can help us name certain characteristics and patterns. Hello, I’m Gabor: I have ADD, have had depression, and am an addict, at least some of the time.
Except, I don’t have ADD. Nor does anyone have depression or anxiety. No one fundamentally is an addict, a schizophrenic, a mentally ill person. These conditions are not solid, discrete entities on their own, to be possessed or to be possessed by, even though sometimes they feel like they own you—like they are you. Rather, they are processes that manifest in the lives of certain people at certain times under certain conditions—and yes, they have their biological dimension, even as they have their emotional and social and psychological dimensions. Being dynamic processes, they have their roots in the life histories of people, histories which themselves are imprinted on people’s biology. Beyond the individual, these afflictions bear a stamp of the interpersonal: the travails of previous generations, our relationships with our parents beginning with the moods, stresses, and sorrows of our mothers while we were still in the womb. The process we call mental illness also reflects the nature of the political, social, cultural and economic environment in which we are reared and in which we live, work, love and seek to be loved.
It so happened, for example, that Adolf Eichmann had a lot to do with my own ADD and depression and addiction. It was as a Jewish infant in Nazi-occupied Hungary that I had to tune out, to dissociate from the anguish around me as Eichmann organized the transport of over half a million humans to the death camps, including my grandparents and nearly including my mother and I. It was then, and even before then, in the womb, that I absorbed my mother’s fear and anxiety and grief and it was then that I experienced the pain that my later addictive behaviors tried, with only fleeting success, to soothe. Here in Britain, too, many infants and children absorbed the wartime suffering, tensions, stresses and traumas of their parents, or had to endure separation from mothers and fathers at a time of their lives when attuned, joyful proximity with the parent would have been the most essential condition for healthy brain development.
Of course, we don’t need the dire circumstances of bombing raids or genocide to initiate a dynamic in which a young human disconnects from themselves, dissociates from reality, or pushes down—depresses—emotions too distressing to bear, or internalizes anxieties that reflect the unresolved traumas of their parents and their parents before them. These dissociations and depressions and anxieties, the raw material for what we call mental illness, are, in the own way, coping patterns wired into our brains when the early environment cannot meet our needs—not because our caregivers fail to love us or to do their best, but because their best is constrained by relational, transgenerational, political, and social circumstances beyond their control— and even, perhaps, beyond their awareness. The seeds of all so-called mental illness are planted when the basic needs of human beings are, for whatever reason, not satisfied especially in the early years, but throughout our lives—or, in the worst-case scenarios, when these needs are devalued and demeaned.
As one American scholar has put it, ‘human beings are creatures with special needs’. These needs include the physical, the emotional, the social and the spiritual. In the words of the great social psychologist Erich Fromm, sanity and mental health ‘depend on the satisfaction of those needs and passions which are specifically human, and which stem from the conditions of the human situation: the need for relatedness, transcendence, rootedness, the need for a sense of identity and the need for a frame of orientation and devotion’. Accordingly, Fromm wrote, ‘mental health cannot be defined in terms of the “adjustment” of the individual to his society, but, on the contrary… it must be defined in terms the adjustment of society to the needs of man, of its role in furthering or hindering the development of mental health. Whether or not the individual is healthy is primarily not an individual matter but depends on the structure of his society’.
Now, for some people, including, famously, for a certain former British Prime Minster, society does not exist. Under her policies and those of her successors and fellow ideologues throughout the world, social programs have been cut, services to the needy curtailed, communal enterprises devalued, communities torn asunder, inequality has risen—in other words, the environment required to meet people’s fundamental needs has been degraded. Does anyone believe it to be pure coincidence that loneliness has reached epidemic proportions, the number of children and adults diagnosed with and medicated for mental health problems has burgeoned, suicide rates are skyrocketing, and the number of people afflicted by and dying from substance addictions has dramatically increased?
In the lives of millions, Mrs Thatcher’s thoughts and deeds had a dreadful effect. As for her intentions, no one can say for sure— but I am certain that much of the suffering she inflicted was an outward projection of her own unacknowledged pain. When I hear someone say, as she did, ‘and you know, there is no such thing as society’, I hear an isolated human soul confessing, ‘I am so utterly alone’. Only such a person would deny the communal dimension of human life. We may wonder what features of our current world lead us to elevate profoundly damaged people to govern us. The problem is systemic.
As Fromm says, it is to the very nature of a society we must look when seeking to understand the sources of mental illness or health. For ultimately, as humans, we are biopyschosocial creates, a fancy word that simply means our biology—including the biology of our brains—is inseparable from our psychological processes or from the social environment throughout the lifetime.
The dynamic nature of what we call mental illness also means that healing is possible— it is the same dynamic moving in the other direction, from fragmented to whole. Healing is not the same as pharmacologically suppressing symptoms. Medications may have a role, as I can both professionally and personally testify, but they are not the answer because they do not address the fundamental trauma of disconnection from the self and from safe and nurturing social affiliations—the disconnection at the core of all psycho-emotional distress and symptomatology. The best case would be that medications allow those who need them the space to do this deeper work.
Before I conclude with some more thoughts about healing, I want to briefly touch on addictions, a major issue in our society. Addiction, too, is a complex process, manifested in any behavior in which a person finds temporary pleasure or relief, and therefore craves, but cannot give up or denies despite negative consequences. In a nutshell: pleasure, relief and craving in the short term, negative impact in the long term, and an inability to desist. Note that I said any behaviour—that could, obviously, mean drugs or substances from heroin to tobacco, but it could also mean a compulsive relationship to sex, pornography, shopping, eating, gambling, gaming, cell phones, social media—the list is endless.