What do we really know about mental illness?
When Rachel Aviv was six years old, she stopped eating. Shortly after, she was hospitalized with anorexia. His doctors were baffled. They had never seen a child so young develop an eating disorder, yet there she was. Was it a response to her parents’ divorce? Dietary culture? Innate ascesis? The episode remained mysterious. As Aviv recovered fully and relatively quickly, she developed a lifelong interest in the boundaries between illness and health.
In his new book, Strangers to ourselves: the unstable minds and the stories that make us, Aviv wonders if she really had anorexia or if the episode was perhaps pathologized too hastily. While she came out of her bout of eating disorders without seeing it as a fixed part of who she was, the girls she was living with in treatment — older, more self-aware — didn’t care. not cleared. Instead, their identities were subsumed by anorexia. “Mental illnesses are often seen as chronic, intractable forces that take over our lives, but I wonder how much the stories we tell about them, especially in the beginning, shape their course,” Aviv writes. “People can feel liberated by these stories, but they can also get stuck in them.”
If anyone knows the weight of stories, it’s Aviv. It’s a star New Yorker writer, able to break through complicated and morally uneasy situations and extract definitive stories from the chaos. (Read his work on abuse of the child welfare systemplease.) But strangers to ourselves stubbornly resists sounding definitive. Instead, he insists on ambivalence. The book is divided into four chapters, each focusing on a different person with unusual mental health issues. (A prologue and epilogue delve into Aviv’s personal experiences.) These characters include Ray, a dermatologist who sues a posh mental institution for not giving him antidepressants; a Hindu mystic named Bapu, whose family institutionalized her for schizophrenia; and a single mother named Naomi, incarcerated after jumping off a bridge with her two sons during a suicide attempt, killing one. Their circumstances and conditions have little in common except extremity and uncertainty as to what is really happening to them.
Aviv’s thesis is that there can be no grand unifying theory of mind. “The chemical imbalance theory, which had become popular in the 1990s, has survived so long, perhaps because the reality – that mental illness is caused by an interaction between biological, genetic, psychological and environmental factors – is harder to conceptualize, so nothing has taken its place,” she wrote. strangers to ourselves is a look at that void of understanding – at what happens when there’s no easy-to-digest story to explain what’s going on in your head, when Freud and pharmaceuticals and everything else fails.
A later chapter, “Laura,” functions as an elegant but inconclusive interrogation of contemporary psychiatry. Connecticut blue blood Laura Delano was diagnosed with bipolar disorder early in her life and started her first psychiatric medication at the same time. She was a high achiever, attending Harvard, but she continued to struggle with her sanity; in her early twenties, she was heavily medicated and had survived a suicide attempt when she came across a book criticizing psychiatric drugs. She decided to stop taking hers. Despite experiencing severe withdrawal symptoms as she weaned herself off the pills, she preferred her life without medication. She became active in anti-psychiatric drug circles on the Internet, eventually creating a popular blog. Aviv reveals that she found Laura’s writing while trying to figure out her own relationship with psychopharmaceuticals – she’s been taking Lexapro for many years and wondered if she could quit. Aviv doesn’t go so far as to embrace the anti-psychiatric movement herself, though she treats Laura’s position with respect. She makes peace with her continued reliance on anti-anxiety medications for sanity, even as she reflects on the few doctors who know exactly why it works. But she worries about how diagnoses can limit people’s understanding of themselves and what is possible.
In this regard, strangers to ourselves is a topical book. This summer, an article reviewing the available literature on the link between depression and a serotonin imbalance concluded that there was no clear link. “The chemical imbalance theory of depression is dead” The Guardian declared. Renewed skepticism about the biological model for understanding a wide variety of mental illnesses is on the rise. So Aviv’s persuasive writing about the need to consider the whole person, rather than just their brain chemistry, is appropriate, if not particularly novel. strangers to ourselves joins a growing body of recent nonfiction complicating our understanding of the mind. In 2019, medical historian Ann Harrington published Mind Fixers: Psychiatry’s troubled research into the biology of mental illness, an often mind-boggling tour of psychiatry as it moves from the Freudian to the biological model, underscoring how strained the chemical imbalance theory has always been. 2021 book by neurologist Suzanne O’Sullivan Sleeping Beauty: and other stories of mysterious illnesses explored culture-bound syndromes and psychogenic illnesses, illustrating how our environments and experiences can impact how our bodies and minds function. The strength of strangers to ourselves is in its captivating case studies, which bring vivid anecdotes to this ongoing conversation about the complex and confusing nature of the mind.
Early on Aviv explains that she chose an episodic structure for the book, rather than an overarching narrative, to emphasize the wide variety of emotional and psychic experiences, their fundamental irreducibility, their need for specific contextualization. Only a series of stories could illustrate the fact that there is not a single singularly true story. “When questions are examined from different angles, the answers continually change,” she writes. This sentence is both undeniably true and maddeningly ambiguous, as if someone were saying “all music is good…according to individual tastes”. Of course, but then what? Taken individually, each story in strangers to ourselves is as typically excellent as Aviv’s magazine journalism, viscerally rendered and thoughtful portraits that slip into meditations on the mind. As a collection, however, they coalesce into an eloquent shrug. I wondered, as I closed the book, if it would have left a firmer impression had it been published as a serial—say, in a magazine—rather than collected in a collection so opposed to clarity.
Better a heartfelt, beautifully written whine than a dishonest bang, of course. Aviv’s fuzzy but honest irresolution is far preferable to the brutal tendency to turn mental health diagnoses into cornerstones of identity, fixed personality traits rather than often slippery and tentative snapshots of one person at a time. some time they often are.