Obcy dla samych siebie. Jak choroba psychiczna zmienia to, kim jesteś

by Rachel Aviv

Wszyscy czasem zastanawiamy się nad sobą. Co jednak, gdy w poszukiwaniu odpowiedzi na pytanie „Kim jestem?” zderzamy się z trudną do zaakceptowania diagnozą?

Zaburzenia i choroby psychiczne zniekształcają nie tylko nasz obraz rzeczywistości, lecz także to, jak myślimy o sobie. Mamy nadzieję, że terapia i leki przywrócą nasze dawne, prawdziwe „ja”, ukryte za zmianami chemicznymi w mózgu lub traumą. Ale gdzie przebiega granica między rzeczywistością a opowieścią, którą snujemy na jej temat? Obcy dla samych siebie to pełna fascynujących historii próba odpowiedzenia na nurtujące wielu z nas pytania:
• Czy moje doświadczenia i emocje to wyłącznie efekt zaburzenia, a jeśli tak, to czy mogę w ogóle ufać swoim zmysłom?
• Czy przyjmowanie leków, po których czuję się szczęśliwszy, jest tylko sposobem oszukiwania samego siebie?
• Czy gdybym należał do innej kultury lub wyznawał inną religię, moja choroba byłaby przez otoczenie traktowana inaczej? Czy sam myślałbym o sobie lepiej?
• Czy mam prawo czuć żal do bliskich, gdy przestają próbować mnie zrozumieć?

Obcy dla samych siebie to książka, która zainteresuje nie tylko osoby dotknięte zaburzeniami psychicznymi, lecz także ich najbliższych lub tych, których fascynują nieoczywiste przypadki w historii psychologii i psychiatrii. To introspektywna opowieść o niezwykłych ludziach, którzy wymknęli się poza ramy psychiatrycznego opisu, a także o tym, jak budujemy obraz samych siebie w obliczu kryzysu psychicznego, zaburzenia i diagnozy.

Genres: Nonfiction, Psychology, Mental Health, Memoir, Audiobook, Science, Essays

330 pages, Paperback

First published September 13, 2022

About the author

Rachel Aviv joined The New Yorker as a staff writer in 2013. She has written for the magazine about a range of subjects including medical ethics, criminal justice, education, and homelessness. She was a finalist for the 2018 National Magazine Award for Public Interest for “The Takeover,” a story about elderly people being stripped of their legal rights, and she won the 2015 Scripps Howard Award for “Your Son Is Deceased,” a story on police shootings in Albuquerque. Her writing on mental health was awarded a Rosalynn Carter Fellowship, an Erikson Institute Prize for Excellence in Mental Health Media, and an American Psychoanalytic Association Award for Excellence in Journalism. She has taught courses in narrative medicine at Columbia University Medical Center and the City College of New York. In 2010, she received a Rona Jaffe Foundation Writers’ Award. She was a 2019 national fellow at New America.

Reviews

[Thomas · Rating 4 out of 5]

3.5 stars

A sometimes interesting and sometimes not-too-interesting book that follows four people who struggle with mental illness, as well as the author’s experience of anorexia as a child. Starting with some of my perceived negatives before going into the positives, I thought that a couple sections of Strangers to Ourselves just felt boring to read (e.g., “Ray,” “Bapu”.) In these sections, Rachel Aviv’s writing didn’t come alive to me and I felt like I was reading a series of facts as opposed to something more stylistically compelling. I also wonder if the book would have benefitted from a more explicit unifying theme.

However, other sections of this book impressed me a lot. For example, the section about Naomi Gaines, a Black woman who struggles with schizophrenia, did a great job of capturing how anti-Black racism and incarceration interact with mental health symptoms. I also enjoyed how Aviv explored the nuances of psychotropic medication in “Laura” and touched on the impacts of colonialism in “Bapu.” While I had leaned toward giving the book three stars, the epilogue “Hava,” in which Aviv writes about a girl who she met during her inpatient treatment for anorexia and what happened to her afterward, touched my heart. Though I don’t think Strangers to Ourselves achieves this on every page, at its finest, it speaks to the importance of destigmatizing mental illness and creating a world where people can heal and thrive even from difficult circumstances.

[Diane S ☔ · Rating 4 out of 5]

This is the best book I've read about mental illness in quite a while. The author herself was the youngest patient to be diagnosed with anorexia and she tells how her life was effected by this diagnosis. She uses actual people, cases that showcase how the treatment of mental illness has changed through the years. From talk therapy to medication and how once medication was thought to solve all problems, many mental health facilities closed, leaving those for whom medication didn't work, floundering.

She also shows through her cases that the one diagnosis for all, doesn't in fact fit all. The story of the young wife and mother in India, who wanted to leave her family and marry, dedicate her life to Krishna, had after much struggle, a happy ending. The case of the young black mother from Chicago, raised in the Robert Taylor homes, was horrific. They show that how we treat mental illness often fails. More medication is piled on but the personality, genetics, background, to life struggles in general often has a role to play in when and how the illness manifests. This is not taken into consideration, in essence, the whole person needs to be treated, not patched up like a bandaged knee.

Very interesting book and thought provoking book. The narration by Andi Amdt was excellent.

ARC from Netgalley

[Book Clubbed · Rating 4 out of 5]

An astute, informative, tender-hearted balm for all the feckless social media conversations about mental health. It does seem that our current milieu is obsessed with mental illness labels. Labels can be helpful, for sure, and naming a previously perplexing set of symptoms can be empowering. Unfortunately, in my personal experience, labels tend to obfuscate the harder, more tedious work of making the mind an ally. But, in our age of convenience, labels lead to a diagnosis, a diagnosis leads to pills, and pills lead to the hope of a quick fix.

These tales are a good reminder, however, that solutions aren't neat, and any mental state resembling contentment may require an elixir of community, self-love, physical nourishment, therapy, medication, holistic medicine, mushrooms, semi-erotic-but-sorta-tasteful books, biscuits and gravy, or whatever else makes you happy.

Not every story in here will resonate the same with the reader, but the time and attention that Aviv spends with each individual allows for a comprehensive view of their distinct psychological make-up. It's a worthwhile journey, in my opinion, and a reminder that there are limits to empathy, but that doesn't mean we should stop pressing against them.

[Elyse Walters · Rating 5 out of 5]

Audiobook….read by Andi Arndt
…..7 hours and 41 minutes

“Strangers to Ourselves” makes sense!
It’s comprehensible, clearly articulated, well researched, and gives a fresh view on understanding the history of mental illness, with real stories from real people.
This is one of the best books I’ve read on this topic ‘ever’.

It begins with an ‘interesting’ as-hell’ story …..
a powerful true story about Rachel as a six years old.
For some reason, she went through a period of not eating. She was admitted - hospitalized—to an eating disorder unit with teenage girls. (at age six!)
Call it ‘anorexic-in-training’…
Rachel was too young to even know what the word anorexic was. The older girls taught her how to develop the disease.
The story is not only somewhat maddening, ridiculous, potentially dangerous, and counterproductive, but it points to an underline important theme in every other story told.

‘ALL’ the true stories selected for this book (patients with mental illness, diagnosis, and treatment are perfectly prime examples of real situations ( they ‘are’ real) to open one’s eyes to an element about the topic of mental illness that is usually WAYYYYY OVERLOOKED.

This debut book by Rachel Aviv ( journalist for ‘The New Yorker’) is absolutely brilliant
—GOLDEN—
in demonstrating the differences between a
brief period of ‘something off’ (a little upset, a short crisis, mild temporary behavior breakdown), vs. a full career of identity to one’s own story with their struggle, ‘a disease’, and a ‘forever’ PTSD declaration.

My question was — at what point does a person struggling with mental illness ‘become’ the identity through their own story of it. Does the story drive and define a mental disorder?
Why do some people make full recoveries and others don’t?

Rachel Aviv explored questions about the ways depression, distress, and other inner turmoil is measured, stigmatized, and treated.
The failing history—(rising to the demands for more advanced science study), is often thwarted by human-reasoning errors….
making psychiatric interpretation sometimes helpful and sometimes harmful.

I can’t recommend this book enough!!!
Anyone who has experienced even a ‘tad-of-depression’, or has lived with a loved-one who suffers… this book brings forth revolutionary theories between behavior, biological, psychological, social and cultural discrepancies and varied interpretations.

I came away thinking about our older daughter- who was hospitalized five times for anorexic… (oh, the stories I could tell - and the scars that remain ‘from’ those stories)…
This book enhanced for me that it’s both clear and puzzling that no matter how well a person can describe their own disorder, addiction, that understanding —-
—in itself —- It is certainly no prize.
Understanding is no conquest for a cure.
But….
MAYBE….
…..our individual make up, personalities, stuck-in-the identity of one’s own story — chronic storytelling —keeping them alive —
is an aspect to mental illness that needs much more exploration in the process of healing.

The word insight is often used so much — it’s lost it’s meaning ….
but there really is groundbreaking insight (understanding a specific cause and effect within a particular context) in
“Strangers to Ourselves: Unsettled Minds and the Stories That Make Us”….

Even the ‘title’ is ‘right on’ perfection!

5 strong stars!!

[Petra X]

The author becomes anorexic at 6 and is admitted to hospital. When she becomes much better and is desperate to get out of hospital, when she picks her nose, she sticks the boogers right back up, so she won't be even a fraction of an ounce down. That shows you that the author is open, overshares almost (but in a good way), has a sense of humour and has been there herself.

There is a story of an Indian lady, a religious extremist or a schizophrenic or both, whose story is quite cinematic. Riches to the street, through mental institutions and eventually a modification of herself enough to live in a house at least. That was interesting. There were some things to consider like some Indian psychiatrists think that Western way of life for Indians, in India, can make them insane. It points out that part of that is the disdain of Indian religious belief,

Interesting.

[Meike · Rating 4 out of 5]

An excellent non-fiction debut about the connection between mental illness and (self) narration: How does the way patients and doctors talk about, frame and interpret psychological conditions affect our understanding and treatment of these medical phenomena? And Aviv is not only talking about stigma; rather, she presents case studies illuminating how people and their surroundings have dealt with their diagnoses and how that affected their lives in a myriad of ways. The whole book is framed by the author's own experience: The introduction tells us how she was hospitalized for anorexia at six years old, thus becoming the country's youngest patient with an eating disorder, the last chapter tells the very different story of one of her teenage fellow patients with the same affliction.

In between, we hear the stories of four people who suffered from different conditions under particular circumstances, at different times and in different cultures: E.g., a poor Black women with intergenerational trauma has a very different experience with the world of US-American psychiatry than a White Harvard student from an affluent family, but both face particular obstacles due to the way their narratives are framed by the outside world and themselves. We learn about the role religion can play when we hear about an Indian woman caught up in mysticism, and how treatment with medication can be pitted against conversational therapy, as in the case of depressed nephrologist Ray Osheroff, which turned into a famous malpractice lawsuit.

This is a book by a feature writer, so it is strong when depicting personal stories, it does not aim to discuss the intricacies of neurology or psychology. Not unlike Sigmund Freud's case studies though, these examples hold value as stories that point way beyond the individual and say something not only about human consciousness, but also about society - Aviv does not diagnose the patients though, she diagnoses the situation, particularly the effects of how psychiatrists explain mental conditions to the patients and how patients explain their experiences to themselves.

A captivating, insightful book that makes readers think about the complexities of treating mental illness, and the power of narration on a personal and societal level.

[William2 · Rating 4 out of 5]

Beyond brilliant and utterly heartbreaking. Yet not without its antecedents, which go largely unmentioned here.

[Jennifer nyc · Rating 4 out of 5]

3.5

Intensely detailed case studies of people’s lives to make points about mental health and how we must see it in context. There’s fascinating stuff in here, but it has to be weeded out–I can’t imagine anyone enjoying this unless they enjoy academic or psychological case studies.

Here are some of the issues examined that I found interesting:

1) How the medical field and diagnosis can generalize to the point where one can learn unhealthy behaviors from others in treatment centers, much like prisoners can learn how to become better criminals from their environment.
2) How understanding individual nuance is much more therapeutic than diagnosis.
3) How racial prejudices are ingrained in the health field to the extent that anyone outside it will get compromised care.
4) How cultural roles for females result in dismissal of warning signs for care.
5) How as recent as midcentury, medication was considered a road block to healing depression, and then when proof changed the public’s mind, it outbalanced talk therapy to create cascading medications, a term used to describe the pile of meds one takes in reaction to side effects of others.

Despite not loving this, I’m keeping my copy. I’ll never read it again as a whole, but find value in revisiting the parts.

[Vincent Scarpa · Rating 5 out of 5]

Rachel Aviv has long been my favorite staff writer at The New Yorker, so I was eager to read this book from the second I heard it was coming into the world. It did not disappoint on any account. Her writing/reportage is as insightful, human, and complex as it has always been, and is suffused with a curiosity that has everything to do with empathy. A terrific read.

[Flo · Rating 4 out of 5]

Fascinating narratives about mental health.

I don't know if the conclusions have scientific value, but these are good stories.

[Gaetano Venezia · Rating 2 out of 5]

Idiosyncratic Anecdote
I don’t get the hype. The writing is unobtrusive and good; none of the musings or conclusions are obviously wrong. But somehow the case studies don’t add up to anything useful or insightful for mental health in general. These aren't the stories that make most of us—even the mentally ill.

A story repeats in the case studies: early treatment of mental illness is filtered through psychiatry, the middle of the patient’s life sees the rise of pharmaceutical and medicalized therapy via anti-depressants and a cascade of other pills, patient’s later lives sees the tide turning somewhat against over-medicalizing mental illness—they gradually go off some or all their medications and learn to cope with the sharper edges of reality.

This generic pattern isn’t explicitly called out by Aviv, and if anything the book seems to fall more into the research mode of the early history of mental illness, where case studies were meant to be more indicative than meta-analyses, reproducibility, and standardization. No doubt, scientism can obscure outliers and be heavy handed, but Aviv’s counter narratives swing too far back into the early concerns of mental illness. I think that is the main reason I felt skeptical and unimpressed with the book: She crafts strong narrative, but I’m not sure how those idiosyncratic cases of mental illness say anything about the human condition or other big philosophical questions she raised and her publisher touted in the press release.

For what it's worth, I have clinical depression (10-15 on the Hamilton scale) and I much prefer the style and tone of something like Peter Kramer's Ordinarily Well: The Case for Antidepressants. He balances medical findings with his own case work and so pragmatically balances the idiosyncratic outliers and the representative evidence.

[Camelia Rose · Rating 5 out of 5]

A friend and I attended Rachel Aviv’s talk about her book, Strangers to Ourselves: Unsettled Minds and the Stories That Make Us, at the National Book Festival in September 2022. I was moved by the author’s personal story and impressed by her careful observations of mental illness patients. Strangers to Ourselves is one of the best books about mental illness I’ve ever read.

Rachel Aviv was diagnosed with anorexia at the age of 6. Aviv’s doctor blamed the illness on her parents’ chaotic divorce. Yet, in retrospect, Aviv had doubts on the label. She probably wasn’t fully anorexic until she “learned” what it meant from older girls after she was admitted to a children’s hospital. Throughout the book, she asks this question: what’s the effect of a mental illness diagnosis on a patient? It may differ greatly from person to person.

There are four case studies in the book, each representing a different aspect of how our society treats mental illnesses. The first case, Ray, shows the change of mental illness treatment in the United States--from psychoanalysis to psychopharmacology, and to the realization that pills can’t fix everything. What strikes me is that the distinction between personality and mental illness is not as clear as one might think. Is Ray a narcissist? If so, is that the cause or consequence of his illness?

The third case is Naomi Gaines, a Black Minnesota woman who tried to kill her babies and herself. Mental illnesses of underprivileged groups are chronically undertreated in the United States. Their trauma is largely caused by social injustice, therefore it can not be solved by medicine alone. In contrast, the last case, Laura, a White upper-class woman who let the medical diagnosis define her, is an example of how privileged groups can be overtreated and over-medicated, which, ironically, is also bad. It asks questions: Does over-medication make an episodic mental disturbance chronic? And why do some people find it hard to taper off antidepressants?

A recurring theme in the book is this: modern medical science still knows very little about mental illnesses. Different patients react differently to their diagnosis. Some may see it as liberating, others as limiting. For some patients, the medical diagnosis becomes a “career”, which hinders their recovery.

My favorite is the second case study. It tells the story of Bapu, a Hindu schizophrenia patient. Childhood polio damaged Bapu’s leg hence her marriage prospects. Bapu’s rich parents married her to a man who wanted her money. The husband and the in-laws abused her. Bapu sought solace in religion. She wrote poems to Krishna, a Hindu deity. She even published poetry collections. She believed Krishna to be her true husband who would offer unconditional love. The stronger Bapu's devotion became, the more abuse she received from her family. Later she abandoned the household duties, became uncommunicative, attempted multiple times to run away, and sometimes succeeded. She was found living on the street with other pilgrims and later locked up in a cell in a mental hospital. Eventually, Bapu’s family became more tolerant, but she was still shunned until her children grew up and took care of her.

I almost didn’t believe Bapu had schizophrenia. Sure she just didn’t fit in? Even during her self-imposed “exile”, Bapu never could get over the desire of holding her children again. When Karthik introduced his future bride Nandini to Bapu, Bapu’s face was “baby-like, approachable, easy”. Nandini said: “She asked me, ‘Do you like me? Do you want to come and live with us? Do you like my son?’ I was so moved.” But according to Bhargavi, the daughter, Bapu was often incoherent in speech and in writing. At least, her schizophrenia was directly triggered by abuse and intolerance under patriarchal rules, as Bhargavi understood after studying feminism. Would Bapu have been “normal” if she were loved and supported?

My second thought is that the line between religious devotion and schizophrenia is very thin. What is schizophrenia anyway, if not deviation from social norms?

Bapu’s story also makes me want to know more about Hinduism. Study shows the recovery rate of schizophrenia is the highest in India, although this result is subjected to contradicting interpretations. I am not religious. Organized religions, especially monotheistic religions, have caused immense human sufferings in history. And yet, religions can offer psychological comfort to those who believe them. It’s complicated, because humans are complicated.

[Lisa Vegan · Rating 4 out of 5]

I really liked this book.

My primary feeling/thought when reading each of the stories:

Rachel: confusion

Ray: despair

Bapu: irritation

Naomi: outrage

Laura: anger and fear

Hava: sadness

I’ve been more in the mood for fiction than non-fiction but I’ve been reading a lot of non-fiction books. This non-fiction book was such an entertaining and easy read and it was also smart and well written. It was so engaging that it was harder to put down than my very good children’s mystery series comfort read book.

It’s been a long time since I’ve read a book like this. Case studies. Psychiatric histories where people I’ve extensively read and read about make appearances. I learned some things I hadn’t known before about certain historical figures and places.

The author tells her own story both in chapter one and throughout the book when writing about her other subjects. I was interested in all of them and all their stories.

“It's startling to realize how narrowly we avoid, or miss, living radically different lives.”

4-1/2 stars

[Emma Deplores Goodreads Censorship · Rating 5 out of 5]

4.5 stars

A fabulous, empathetic book that tells the stories of six people dealing with mental illness, about their lives and how they understand their distress and the various ways the system worked or didn’t work for them. Aviv is an excellent storyteller, and though this book is short it’s very meaty—she evidently considered writing a book entirely about each of the people profiled, and packs so much in here that I can see it, without feeling that this format gave them short shrift. This book is probably the best example I’ve read of an author writing about mental illness in someone other than themselves (she does include herself, but she isn’t the focus) yet keeping the focus firmly on the person, not the illness. Illness—or distress manifested or understood as illness (it’s not as bright a line as we might believe)—is part of each story, but they’re all still individuals and the author is most interested in how they understand themselves.

Some brief notes on the stories included:

Ray: A successful doctor who goes into a tailspin when facing professional setback. This story is largely focused on the conflict between doctors favoring psychotherapy and those favoring medication when psychiatric medication began to take off, and Ray was right in the middle of it, as he sued a psychotherapy-only hospital for failing to cure him. But life went on and meds also failed to provide a cure-all in the end.

Bapu: A well-off Indian woman treated as second-class by her in-laws (even as they all lived in her house), she took refuge in religion and ultimately took it to extremes—or perhaps suffered from schizophrenia, and made Krishna her focus? This is a fabulous chapter, exploring the ways western models of mental illness interact with very different cultures. The fledgling mental health care system in India at the time sounds incredibly traumatic, but it was also a fledgling, which perhaps accounts for the fact that outcomes for people diagnosed with schizophrenia there were better than in the developed world. Ultimately Bapu’s own remedy (devoting herself to a less all-consuming god) seems to have done her more good than anything else.

Naomi: This is a wild ride of a story, an African-American woman who grew up in abject poverty, then began suffering from serious distress as a young woman, which culminated in throwing herself and her twin infant sons off a bridge in the belief that this was necessary to save them all from racism. She and one boy were rescued, but the other was not, leading to her conviction for murder. This chapter takes a hard look at poverty, intergenerational trauma, racism, and the justice system, whose definition of insanity hasn’t changed in centuries despite everything we’ve learned in the interim.

Laura: A privileged young white woman who seems to have had a difficult childhood (she didn’t want to talk about it with the author, making this perhaps the weakest of the stories) and began to be heavily medicated as a young adult, until she didn’t know who she was on her own. This chapter looks at the epidemic of psychiatric medication, with people potentially being prescribed dozens of pills primarily to counter the side effects of other pills, all of it severely limiting their lives (such as killing people’s sex drives), as well as the question of when distress becomes something that should be medicated, and for how long. At what point are people, especially those with high expectations, being medicated to achieve more or simply to avoid medication withdrawal, rather than because they’re still sick?

This segues into the author’s own life—she is rather bizarrely hospitalized for anorexia at age 6 (fortunately, it didn’t last), and then as an adult, winds up taking Lexapro long-term even though she isn’t depressed, to make her more productive and improve her personality. This is uncomfortable to read about, and the author is evidently uncomfortable with it too—but at the same time, she doesn’t want to be dysfunctional for her own kids in the same way her parents were dysfunctional for her (leading to the whole 6-year-old anorexia hospitalization episode) and it’s hard to argue with that.

Then there’s the epilogue, focusing on a woman named Hava who was hospitalized alongside the author for anorexia. Unfortunately, for Hava this was a lifelong problem, and this section points out the way people with anorexia are often denied care by insurance despite the fact that it is the deadliest mental illness.

Overall, I was riveted by the stories (and they’re told in bite-size sections, making it easy to read), and loved the way Aviv weaves together individual stories and the larger picture. The stories are thorough and insightful—everyone she profiles is exceptional, most if not all being writers who kept extensive journals, which helps paint a complete picture of their experiences. She’s thorough in putting together pictures of their lives, too, getting to know family members and contacting doctors and anyone else who will speak to her. Aviv also clearly did her big-picture research: it would be easy for a book mostly focused on the U.S. to resort to stereotypes for the chapter set in India, or for one mostly following well-off people to fail to dig in to the chapter dealing with poverty and racism. But every chapter feels fully explored, and all of them compassionate and respectful of people’s experiences and their right to define their own stories. I highly recommend this one.

[liv ❁ · Rating 5 out of 5]

Through the stories of four different people, bookended by a more personal story, Aviv explores severe mental illness and how society's viewings of each of these people exacerbated their issues. This is a devastating illustration at how hard it can be to find the right resources for severe mental health issues and the cost of not having access to them. Aviv takes a neutral approach with each of these stories, not placing blame anywhere or acting like she has the solutions, just telling the story of what it means to categorize and define mental illness, and raising the question as to whether or not we as a society take the right approach. I really loved that there was a focus on the nonclinical side, with loneliness versus an uplifting community discussed at length. Aviv also does an excellent job discussing religious, cultural, race, and class nuances that factor heavily into these stories.

I am no stranger to severe, life-altering mental illness. Most of my life was filled with living with someone who, try as the doctors might, could not have her illness correctly defined. I know first hand the devastation and life-ruining affects of being in treatment for decades with things only getting worse, but my view is often more angry than I would like and is not very humanizing towards the person that is hurting so badly by this illness. This offered a very nuanced perspective that I appreciate not only on a societal level, but on a personal level.

4.5/5

[aPriL does feral sometimes · Rating 5 out of 5]

The title describes the book spot on.

Rachel Aviv, the author of ‘Strangers to Ourselves’, at the age of 6 years old became anorexic. She thinks that because of her youth, anorexia was a temporary experience. But she met others while she was in treatment (she was the youngest one) for whom anorexia was a chronic mental health condition they struggled against most of their lives. Having experienced a mental illness and observing others with mental illness interested her in the subject. She is a writer today.

In the book, Aviv researched the lives of five people, giving four of them a chapter of their own. A girl she met who had anorexia when they both were being treated for the illness, Hava, is discussed in the prologue and epilogue. In each biography, Aviv includes interviews with the afflicted person’s family, psychiatrists and friends.

The author shows how culture, economic resources, education, race and religion affect the treatments, as well as the symptoms, of the mentally ill. She also is able to give a brief history of the development of the theories of treatments for abnormal psychology, which often conflicted with each other. She includes when and how pharmaceuticals began to be prescribed and used. For some mentally-ill people drugs worked spectacularly. For others, the drugs which were meant to minimize mental illness seemed to make the illness worse. Psychiatric treatments sometimes do not take culture into consideration, which can cause the failure of any prescribed treatments. I think the author makes a case for the necessity of mental health professionals to be more prescriptively flexible and investigative when they feel they have the correct course of treatment based on their subjective certainties of diagnoses. When mental health professionals insist on continuing with a treatment that is ineffective it is almost criminal, imho.

The spectrum of mental disorders in human society is very large in my opinion, but Aviv describes only five people who suffered from five different kinds of mental illness. These five individuals grew up in different social and economic classes, too, which changes how and what treatments they are given for their mental disorders.

Readers get an excellent overview of types of mental illness through the author’s description of the symptoms experienced by the five individuals. Precise diagnosis often is uncertain, imho, because symptoms overlap into several possible Diagnostic and Statistical Manual of Mental Disorders’ descriptions https://en.wikipedia.org/wiki/DSM-5).

This book isn’t a dry datapoint list of individual symptoms. The biographies are written in such a manner as to cause her biographical subjects to seem like neighbors or friends you personally know.

I found the book extremely interesting and enlightening. There is an extensive Notes section.

[Terry ~ Huntress of Erudition · Rating 2 out of 5]

I am not sure what to make of this book -
A 6 year old girl is diagnosed with anorexia.
A woman stops taking her meds because she can't remember what she is like without them.
A successful doctor disintegrates into depression and spends the next 30 years writing a memoir without any apparent insight into what he was writing about.
A woman is obsessed with her religion and her writing is considered divinely inspired. She eventually abandons her family and tries to go to a Hindu monastery. She is later diagnosed as schizophrenic and lives a tortuous life.
A psychiatric hospital failed to successfully treat patients, because the author says the personal doctor/patient relationship turned into a corporate provider/consumer relationship.
There is another heartbreaking story about a woman with anorexia.
The only common thread is that it seems conventional practices & medicine do not work for certain people.

[Ashley Peterson · Rating 4 out of 5]

Strangers to Ourselves: Unsettled Minds and the Stories That Make Us by Rachel Aviv explores the different ways in which people try to make sense of mental illness, both on an individual and societal level. The book tells the story of six different people who experienced mental illness, including the sociocultural factors that shaped those experiences. One of these stories is of the author's own experience of being hospitalized at age six for anorexia nervosa.

The author is a writer for The New Yorker, and her journalistic background is very apparent in the stories she tells. Of the other five individuals whose stories were told in the book, two of them were still alive and directly interviewed by the author. One of these five was someone who had been a co-patient of the author’s during her childhood hospitalization.

The book opens with the author’s own story, then moves on to Ray Osheroff, who was a notable figure in the conflict between a psychoanalytical approach to psychiatry and an evidence-based approach. He had a lengthy stay for severe depression at an institution called Chestnut Lodge, where the treatment team insisted that psychoanalytic therapy was the only way he could get better. Although he was only getting worse, they refused to put him on medication. He later sued Chestnut Lodge for malpractice for not using evidence-based treatment, and the book explores the debate that this lawsuit sparked within the field of psychiatry.

Next up is Bapu, a deeply spiritual Indian woman who was diagnosed with schizophrenia. In telling her story, the author explores issues around spirituality and psychosis, culture, and the ways families respond to mental illness.

The story of Naomi Gaines, a Black woman who killed one of her children while psychotic, addresses how racism impacts how mental illness is framed and treated and how it impacts access to care. It also looks at the effects of deinstitutionalization, the large numbers of mentally ill people who end up in the criminal justice system, and the limitations of the M'Naghten Rule, which is the legal test that's commonly used in the US to establish an insanity defense. In Naomi's case, doctors didn't feel that she met the M'Naghten standard, and her public defender didn't think a jury would accept an insanity defense. The book also looks at the poor care that people with mental illness receive in prison. In Naomi's case, while in prison for second-degree murder, her antipsychotic was stopped due to cost. Unsurprisingly, her mental health deteriorated, and she was put in segregation for two months.

Next was the story of Laura Delano, a woman who'd been diagnosed with bipolar disorder and later borderline personality disorder. She took 19 different medications over the course of 14 years. The author observes, “While Black women tend to be undermedicated for depression, white women, especially ambitious ones, are often overmedicated, in order to ‘have it all’: a family and a thriving career.”

Laura ended up going off of medication because of emotional and sexual numbness, and she had significant difficulties with withdrawal, which led to her getting involved in online communities of others who'd also struggled with psychiatric medication withdrawal. The book explores the ways that people relate to the medications they are taking or have stopped taking and how this can shape identity and the stories people construct about their illnesses. The author also contrasts her own experience with Laura’s—while Laura’s doctors had pushed meds, the author had been taught to see her illness as “a kind of stress reaction… In a sense, Laura and I were mirrors on which different faces of psychiatry had been reflected.”

The author also shares her own experiences taking the antidepressant Lexapro as an adult. It sounds like it was prescribed not because of a psychiatric diagnosis, but rather to help with psychological rigidity around feelings of inadequacy. It was initially intended to be for short-term use, but she felt better on it and worse when she tried to come off of it. On a low dose, the author writes, “I was not depressed, but I was less social, flexible, and spontaneous. It seemed I had reached my baseline personality.” She ended up deciding to go back up to the full dose, and she's remained on the Lexapro for over a decade. She adds, “I also realize that I’ve endowed my pill of choice with mystical capacities—it contains the things I’m not but wish I was—and merely the idea of swallowing such a thing has healing power."

It was interesting to examine my own reactions to this. I’m very pro-medication as an option for treating mental illness, but I must admit, I judged the psychiatrist who started her on the Lexapro. Why? In part, it’s because I’m into evidence-based medicine, and prescribing medication for something it’s not indicated for seems like poor practice, but there’s also a more personal element to the reaction. I think that’s at least partly because I take meds to try to get back some of the self that my illness obscures, and taking meds to be a different person from the self feels… backward, maybe? Or maybe I’m just envious of the idea of taking meds as a self-enhancer rather than in an attempt to stay alive and maintain some degree of functioning.

The book has a lot of detail, drawing on interviews with many people associated with each story. It’s impressive in terms of journalistic quality, although my personal preference would have been to leave out some of the details that seemed less relevant. Then again, that’s at least partly because I wasn’t feeling well when I read it. I liked the author’s approach of looking at the bigger picture factors that came into play in each individual’s story and how this shaped the way these individuals and those around them understood the illness. Both the depth of investigation and the big-picture view make this a unique and fascinating book.


I received a reviewer copy from the publisher through Netgalley.

[Claire Reads Books · Rating 4 out of 5]

3.5⭐️ I picked this up sort of on a whim after seeing Rachel Aviv in conversation with Elif Batuman earlier this year, and after a friend spoke highly of Aviv’s writing for The New Yorker. I found it to be an interesting exploration of different approaches to mental illness (and the limits and biases of those approaches) across time, geography, and demographics. And while the individual case studies here were very compelling, Aviv is, perhaps unsurprisingly, at her most reflective and probing toward the end of the book, when looking at cases of two white women whose experiences with psychiatry and medication more closely parallel her own. Some of the other chapters feel more like a recounting of medical and personal histories, and I wish Aviv had infused more analysis into those sections to make the whole book feel more cohesive.

[Matt Quann · Rating 4 out of 5]

I really go with the flow when choosing a new nonfiction read. A review, sufficient hype or, in this case, a podcast can drive me towards my next non-fiction pick. Today, Explained had a great episode where Aviv was interviewed discussing the history behind today's uptick in antidepressant usage. It was a compelling topic and one that serves as a guidepost to the rest of Aviv's book where questioning our current approaches and understand of mental health is at the forefront.

Though relatively short, Strangers to Ourselves covers a lot of ground and ideas in four case studies. Each profile offers, if not an entirely new understanding of a specific disease, a new facet that I'd not previously considered. Though it's long been known that psychiatry is largely geared towards the white population in which it was studied, the middle two chapters really elucidate the difference that culture and environment can play in mental illness.

As someone who works in mental healthcare, this book prompted me to think about my work in a new light. It may not radically alter my day-to-day practice, but for those patients who present with a range of complex issues, multiple medication trials, or a different socio-cultural or economic background, I now have additional factors to consider.

All in all, a great piece of journalism and one I'll be passing around to my friends and colleagues in the months to come.

[Bonnie G. · Rating 5 out of 5]

This is so spectacularly good. I don't think I have read another book that looks at mental illness from different perspectives. How can we define sanity from a very particular POV and apply it to people from entirely different cultures? Do we medicate and modify people's behavior to fit a White, Western, male perspective defining appropriate behavior? This concept of normal being a neutral state is rubbish. Why do we make it compulsory to fit in? When we do "assist" people who are a danger to themselves or others what intervention is correct, and why do we stop thinking about helping beyond medication?

Aviv looks at the experiences of an Indian woman who speaks with and seeks to emulate gods, a poor Black woman living in one of the worst public housing complexes in the nation who kills one of her children to save him from what she perceives as a worse fate at the hands of America, a Greenwich wasp Queen Bee who ascends to the Ivy and then struggles when she feels out of synch with others" expectations of her and her own struggles with mental illness. Why do we not acknowledge that mental illness is, in most cases, biochemistry, environment, psychology and other factors choosing instead to simply chemically moderate behavior? Are we creating dependency that changes brain chemistry and thereby createing actual mental illness in people who were simply a bit down or tired? (There is a section about giving women Lexapro that is terrifying in a Stepford Wives way.)

Aviv addresses the harms that have radiated from the current common "wisdom" that mental illness is biological, and also with the concept that difference (or perhaps weirdness) is something that needs to be treated. I have not seen much said about any of this, and it is eye-opening. In what I found the most chilling portion the tale of Naomi, the Black mother who dropped her youngest babies onto the river to save them from a life of “inferiority, indifference and ridicule” in a racist society. When she was examined to determine her fitness to stand trial the psychiatrists opined that though she talked about an impending apocalypse and living in another dimension, her remarks about racism were too astute for her to meet the legal bar for insanity. So America helped to drive her mad, and then decided she was not legally insane because she could see that.

This is a brilliant piece of reporting, and also a starting point for meaningful advocacy. Incredibly important work.

[theresa · Rating 5 out of 5]

“it’s like trying to explain what a bark sounds like to someone who’s never heard of a dog”

damn omg this shit was so good lol what the fuck!!!!! i was hesitant going into this bc sometimes i feel like case studies feel exploitative but i really appreciated how the author weaved in her own experience & intentionally chose from such a wide diversity culturally across the spectrum. i can tell how much the author cared about bringing these stories to light & i appreciated that intentionality a lot. i hope people read this book, i thoroughly enjoyed it :’)


i will also add that i do personally relate to this heavily bc i know how important storytelling has been to my own recovery & healing, esp as a young woman of color who didn’t know anyone else with similar struggles at the time. i have often struggled w my impulsive decision to write abt my journey and diagnosis publicly, as it has impacted the trajectories of my own intimate relationships. yet over the years, i find myself returning to storytelling over & over. reading this has also brought me a lot of peace given that storytelling is very much so also affirming, & also has brought many wonderful people into my own life that i’ve cherished deeply over the years. so to an extent i understand how powerful storytelling is for people like us who already struggle with the stigma of it all, & i’m touched by their tremendous courage to be vulnerable with us all. i found pieces of myself in every story.

[Rennie · Rating 3 out of 5]

I actually liked this a lot, I think especially Naomi’s story was very affecting and well told, incorporating important social contexts and systems without understanding of which would make it difficult to have sympathy for her. But this lacked something unifying, or maybe I was just missing what exactly that was.

[Anna · Rating 4 out of 5]

Strangers to Ourselves: Unsettled Minds and the Stories That Make Us consists of four detailed case studies of mental illness within social contexts, as well as the author's account of her own experience. All four are recounted in a compassionate and enquiring style. The first, Ray, was an American man with depression who brought a malpractice suit against a psychiatric institution because psychoanalysis didn't cure him. The second, Bapu, was a very religious Indian woman who ran away from home to sites of pilgrimage. The third, Naomi, is a black American woman who was jailed for throwing her twins sons into a river then jumping after them while experiencing psychosis. The fourth, Laura, spent her twenties receiving a confusing series of diagnoses and taking a complex cocktail of psychiatric medications.

Each case study addresses the conflicting psychoanalytical and biomedical psychiatric notions of both illness and treatment, as well as the influence of personality, family, and culture on how mental illness is experienced and understood. Bapu's story is inseperable from religious belief; Naomi's from American racism. The narratives of Ray and Laura, both privileged white Americans, reveal changes in US psychiatry resulting from the invention of antidepressants. Bapu's case study includes some interesting points about the disjunct between Western psychiatry and Indian culture:

N. C. Surya, who directed Bangalore's All India Institute of Mental Health in the 1960s, warned his colleagues that they were adopting Western theories as if they were universal truths. 'We will end up as ineffectual caricatures of Western psychiatric theory and practice, or reduce our living patients into a set of prestige-loaded foreign jargon,' he wrote. He did not accept the Western view of mental health as the 'statistical norm'. A healthy person, according to this view, is 'like any other John or Jean in the neighbourhood'. But Indian healing cultures were meant to raise the self to a higher ideal - detached, spontaneous, free of ego - rather than simply restore the person to a baseline called normal.

Laura's case study emphasises that popular notions of mental illness can be deeply misleading:

The book prompted Laura to begin reading about the history of psychiatry. She hadn't realised that the idea that depression was caused by a chemical imblalance was just a theory - 'at best a reductionist oversimplification', as Schildkraut, the scientist at the National Institute of Mental Health, had put it. Nathan Kline, Ray's onetime doctor, had been confident that 'we'll find a biochemical test or series of tests that will prove highly specific to a particular depressive condition'. But such a test never materialised. For more than fifty years, scientists have searched for the genetic or neurobiological origins of mental illness, spending billions of dollars on research, but they have not been able to locate a specific biological or genetic marker associated with any diagnosis. It is still unclear by antidepressants work. The theory of the chemical imbalance, which had become widespread by the nineties, has survived for so long perhaps because the reality - that mental illness is caused by an interplay between biological, genetic, psychological, and environmental factors - is more difficult to conceptualise, so nothing has taken its place. In 2022 Thomas Insel, who directed the National Institute of Mental Health for thirteen years, published a book lamenting that, despite great advances in neuroscience, when he left the position in 2015, he realised, 'Nothing my colleagues and I were doing addresses the ever-increasing urgency or magnitude of the suffering millions of Americans were living through - and dying from'.

If you've experienced mental illness, Strangers to Ourselves: Unsettled Minds and the Stories That Make Us will provoke personal reflection. In my case, on the extent to which I intellectually distance myself from my own distress by reading books like this. I also wondered whether my life would be different now had someone labelled my disordered eating and anxiety as mental illness earlier in my life; this was provoked by Aviv's account of being treated for supposed anorexia in hospital at the age of six. The case studies raise questions about how and why mental states are pathologised, as well as the subsequent treatments applied. I found the book thorough and insightful in its presentation of these, however the focus on individuals rather than groups meant that it wasn't quite as powerful as Crazy Like Us: The Globalization of the American Psyche. That said, the two books are not trying to do the same thing so would read well together.

[Mehrsa · Rating 5 out of 5]

Very well written. Deeply complex and very insightful.

[Rohini Murugan · Rating 5 out of 5]

Reading this book as a cognitive scientist in training, I was left with more questions than the existing philosophical conundrums that me and my brain like to have fun on the side with - side effects include disturbed sleep and anxiety.

It was a journey. A journey through the lives of four humans whose lives were forever altered because their brains were a little different. I say that their brains were different and not abnormal, because to categorize something as abnormal, one has to define what is normal, and that is not a trivial definition in neuroscience.

Which brings me to the questions I was left with when I closed my Kindle - What does a "normal" brain look like? Is there a "normal" brain? Isn't "normal" defined by the society on how it wants its functionaries to function? A woman in the 1900s was trained to be docile whereas a woman in the 2020s is expected to be hard-working and career-chasing while bringing up two kids with fancy education. Does the "model brain" need to keep changing its architecture to serve the various societal roles a person takes on in their lives? How does this change in an individualistic vs a collectivistic culture?

So. Many. Questions.

And then there is a reductionist take of the brain which is another exciting ride to take every single time. And just as other times, you do not get an answer to it. Is everything simply molecules at the end of the day? It surely must not be, right? Is taking 50 different pills okay, if it means one gets to shape their personality the way they want it to be? If a chemical can course through your system and change how you think and how you feel, then at the end of the day, who are you? Is the non-pill persona, the true you or is it the pill-persona?

...... then, what really is a self? Is the today-you, also the tomorrow-you? Is there an essence that you can strain out as a concentrate from all the you-s?

This book invokes existential philosophy without ever putting it in so much as the exact terms. The author takes us through the narratives while also educating us on the history of psychiatry and cognitive theories, along with moral and ethical implications, and legal and societal implications of them in parallel. This book is now easily my go-to book to recommend to anyone who is even remotely interested in brain and/or mental health.

[Elizabeth · Rating 3 out of 5]

I came very, very close to not finishing this book and am surprised it was one of the New York Times Best Books of 2022.

The author begins with her diagnosis with anorexia at age 6. In the end, she felt fortunate that she was so young that the diagnosis didn’t become a part of how she saw herself, so she was able to gain weight and move on. Later, she writes about an older friend in the hospital who was not so lucky.

The rest of the book consists of detailed accounts of a doctor who sued his psychoanalytic treatment center for not using medications that he believed could have helped him recover sooner, a schizophrenic woman from India whose early treatment seems to show how western theories of psychology do not always neatly fit with other cultures, an African American woman who threw her young twins in the Mississippi River killing one of them and how the American mental health system can fail people of color, and, finally a Harvard graduate who was diagnosed first with bipolar disorder and later with borderline personality disorder and works to get off of antidepressants and other drugs.

To be honest I didn’t completely understand what the author was trying to say with this book. The “how a diagnosis affects your perception of yourself” theme was clearest when she was talking about herself and the Harvard graduate. She is a good writer and tells each person’s story with care but most of their clinical histories are pretty upsetting. Had this book been much longer I probably would not have finished it.

[Ali · Rating 3 out of 5]

Great storytelling on mental illnesses based on six case studies detailed with individual challenges starting with author’s her own. However stories are meandering and no overarching theme between cases —message between lines is mostly anti meds or current psychiatric practice.

[Ella · Rating 5 out of 5]

This book was so good and so validating. Each chapter is a case study of someone who has had a mental illness where the etiology or diagnosis is unclear/unique. The book does a lot of work to discuss various theories of mental illness, especially psychoanalysis vs. pharmacological treatment and the chemical imbalance theory which is still a widely held theory. I’ve been learning a lot lately how chemical imbalance is actually a pretty insufficient explanation for mental illness, and there’s so much psychiatrists still don’t know. While serotonin reuptake can make many people feel better, it doesn’t mean serotonin deficiency was the cause of disorder in the first place.

There as a discussion in the last chapter about lexapro and particularly how a lot of high-achieving white women who develop intense anxiety get prescribed it (well yes!). That was super interesting to hear about and made me think a lot more about how socialization and personality played a role in my own illness. The author also discusses her own lexapro prescription and how she tried to come off of multiple times but it never worked— something I just tried for the first time and had the same conclusion about. Super interesting to think about what our “baseline” is and if medication can affect that. And also still so much missing research on if it’s possible/how we should withdraw from psychiatric mediation.

Strongly recommend to anyone who has experienced mental illness or is fascinated by the topic. (And thanks dad for the book)

[Hannah T · Rating 3 out of 5]

I have somewhat complicated feelings about this book. On the one hand, the concept is so interesting, and I think Aviv does a good job at peeling back the layers of morally complex stories. On the other hand, a lot of the book feels disjointed and meandering, with no real overarching point, and a lot of the book feels pretty anti-medicine. I don’t think that’s on purpose, but for some reason this one kind of left a bad taste in my mouth.