Rachel Aviv’s “Strangers to Ourselves: Unsettled Minds and the Stories That Make Us” is a powerful book about mental illness. The personal stories of mentally ill people are interwoven with the history of how mental illness has been defined and treated. This book expanded my knowledge of mental illness and of how little we really know about the workings of the mind. My son was diagnosed with schizoaffective disorder, and this book helped me understand his condition better.
Aviv is an investigative reporter. She digs deeply into the lives of six people — including herself — who have diverse experiences of mental illness. She selected people who had written personal diaries and letters so that she could learn how they view their world.
Aviv was admitted to a mental hospital for anorexia at the appallingly young age of six years old. When she was in the hospital, she met a couple of teenage girls who taught her more about losing weight. She was not allowed to talk to her parents on the phone unless she ate.
Three decades later, Aviv visits with the doctors who had treated her. Her main doctor told her that he didn’t think she liked the interventions. After talking with them, she felt that, at this point in her life, she was not interested in what they told her. She no longer believed that she was anorexic. She thinks that she was given a label for a behavior that the doctors wanted to explain without really knowing who she was.
She writes, “The experience (of being considered anorexic) has made me attentive to the windows in the early phases of an illness, when a condition is consuming and disabling but has not yet remade a person’s identity and social world.”
As the visit with her former doctors ended, she mentioned one of the other girls she knew, but the doctors deferred. Soon, Aviv learned her friend died 10 weeks earlier. She contacted her friend’s parents, who let her read her letters and journals, where she read the phrase “strangers to ourselves.”
Aviv said that a psychiatric model of the mind may be essential to the people with mental illness, but her friend’s words were a “reminder that this framework may also estrange us from the many scales of understanding required … to maintain a continuous sense of self.”
Next, Aviv winds together her interview with Ray, a white man whose history of mental illness starts in 1979, and the history of mental illness treatment. Ray was admitted to two different hospitals, each with a different idea of how to treat patients. He stayed a year at the Chestnut Lodge, which at the time was believed to be the best. The doctors there psychoanalyzed patients so they could gain “insight into interpersonal dynamics.” But his condition deteriorated, so his mother pulled him out and put him in Silverhill in Connecticut. At the time, the doctors at Silverhill had started prescribing drugs to relieve symptoms. After several days of receiving drugs, Ray started functioning better. He later sued Chestnut Lodge for not giving him the treatment he needed. He won the case, and the hospital started using drugs to treat patients.
The next story is of Naomi, a Black woman whose story shows how unfair treatment has been for Black people suffering from mental illness. Naomi had four children and lived in St. Paul, Minnesota, in the largest public housing project; I lived in a St. Paul high-rise as a single parent and worked nights as a waitress, so I can understand a little how discouraging life can be living in a high-rise with others who are struggling. In 2003, she jumped off a bridge with her two youngest children; she and one child were saved by passersby, who jumped in from the river bank, but the other baby died. She was charged with murder and ended up in the Shakopee women’s prison. Sixteen years after she jumped off the bridge with her children, she was freed.
Laura is the next person Aviv researched. Laura was a white woman who grew up in a wealthy family that claimed kinship to Franklin Delano Roosevelt. Aviv interwove her own story with Laura’s because they both took drugs to feel better. Laura was prescribed 19 different medications in 14 years. When she started to decrease her usage, she ended up with difficult withdrawal symptoms. Aviv also talks about her own use of Lexapro. Although she stopped taking it when she was pregnant, she had to start it again and has stayed on it. She feels that it makes her a better person, more flexible in her thinking and able to give good feedback in her relationship with her husband.
We still don’t really understand mental illness. For more than 50 years, scientists have searched for the genetic or neurobiological origin of mental illness, but they have not been able to locate a specific biological or genetic marker associated with any diagnosis. Doctors don’t know why antidepressants work. Aviv believes mental illness is an interplay between biological, genetic, psychological and environmental factors, an explanation far more complex than the simple diagnosis of “a chemical imbalance.”
She writes, “It’s impossible to go back in time and uncover what baseline feelings existed before a story was told — when a person’s anger and loneliness and disorientation had yet to be given a name and a vessel.” After reading this book, I’m not sure that I could have helped my son. His illness kept him within his own confused thoughts so that he couldn't be reached with other ideas that might have helped him.
“There are stories that save us, and stories that trap us, and in the midst of an illness it can be very hard to know which is which,” Aviv writes, “It’s startling to realize how narrowly we avoid, or miss, living radically different lives.”
Read more of the May 24-30, 2023 issue.