BECAUSE RACHEL At the age of six, AVIV stopped taking any food. Anorexia soon followed, landing her in the hospital. Her medical team was at a loss. Nobody had ever heard of such a young child suffering from an eating disorder before, but here she was. Did she do it as a result of the separation of her parents? Food habits as a cultural norm? Is asceticism hardwired into us? There were still unanswered questions about the incident. While Aviv recovered fully and quickly, she had a lifelong fascination with the thresholds between health and illness.
Aviv questions in her new book if she ever really suffered from anorexia, or if the event was perhaps too swiftly pathologized. In contrast to the older, more introspective girls she lived with in treatment, she was able to overcome her disordered eating and move on with her life.
However, the anorexia became more central to who they were. Aviv writes, “I wonder how much the tales we tell about them, especially at the beginning, affect their trajectory.” “Mental diseases are generally perceived as chronic and intractable entities that take over our lives,” Aviv writes. “These narratives can make people feel liberated or they might trap them.”
Aviv is the person who understands the significance of storytelling the most. She’s a big deal at the New Yorker because she can dig into sticky circumstances that make you uncomfortable with your own morals and pull out compelling stories. (Check out what she has written about the abuses of the child welfare system.) Strangers to Ourselves, on the other hand, stubbornly avoids coming off as conclusive.
As an alternative, it stresses ambiguity. The novel is broken up into four sections, each of which follows a different character with peculiar mental health difficulties. (Aviv’s life is explored in depth in the prologue and conclusion.) Among these people are Ray, a dermatologist who sues a fancy mental institution for not giving him antidepressants; Bapu, a Hindu mystic whose family has her institutionalised for schizophrenia; and Naomi, a single mother who jumped off a bridge with her two sons in a suicide attempt, killing one of them, and is now serving time in prison. The only thing they have in common is that they’re in dire straits and don’t know what’s going on.
According to Aviv’s argument, there is no way to have a comprehensive theory of the mind. That “mental illness is caused by an interplay between biological, genetic, psychological, and environmental factors” is more difficult to conceptualise, and thus nothing has taken its place, she writes, which may explain why the “chemical imbalance” theory, which had become widespread by the nineties, has survived for so long. The book Strangers to Ourselves delves into this void of comprehension, discussing what occurs when there is no simple narrative to explain the inner workings of the mind, when both Freud and drugs fall short.
Rachel Aviv examines the severe lack of mental-health care available to refugees in America: https://t.co/dbDQF07q9u pic.twitter.com/8Sn3iuqxWN
— The New Yorker (@NewYorker) December 6, 2015
Later on, the chapter “Laura” serves as an eloquent but ultimately unsatisfying investigation of modern psychiatry. Elite bloodline from Connecticut The first psychiatric medicine Laura Delano ever took was prescribed to her at the same time she received the diagnosis that she had bipolar disorder. Although she attended Harvard and had a lot going for her, her mental health was never great. When she was in her early twenties, she was extensively medicated after having survived a suicide attempt.
As a result, she stopped taking her own. She had severe withdrawal symptoms as she weaned herself off the drugs, but she still preferred living drug-free. Over time, she established herself as an online activist against mental medication by way of a widely read blog. Aviv explains that she came across Laura’s work when she was contemplating her own relationship to psychopharmaceuticals; for example, Aviv has been taking Lexapro for a long time and had been wondering if she might ever stop taking the medication.
Aviv does not fully agree with the anti-psychiatry movement, but she does acknowledge and appreciate Laura’s perspective. She accepts her need for antianxiety medicine to maintain mental health, even as she muses on the fact that medical professionals still know so little about how or why these drugs function. However, she is concerned that people’s diagnosis may restrict their sense of identity and potential.
Regarding this, Strangers to Ourselves is a contemporary read. In the summer of this year, researchers reviewed the literature on depression and serotonin imbalance and came to the conclusion that there is no clear connection between the two. Depression can no longer be explained by a “chemical imbalance,” as The Guardian put it. The biological model for understanding many forms of mental disease is facing growing scrutiny.
Aviv’s eloquent writing is appropriate, if not very innovative, on the importance of taking into account the full individual rather than just their brain chemistry. A burgeoning amount of contemporary nonfiction, including Strangers to Ourselves, has further complicated our understanding of the mind. A tour of the evolution of psychiatry from the Freudian to the biological model, Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness (2019) by medical historian Ann Harrington is frequently eye-opening and demonstrates how problematic chemical imbalance theory has always been.
The Sleeping Beauties: And Other Stories of Mystery Illness, written by neurosurgeon Suzanne O’Sullivan in 2021, explores culturally specific syndromes and psychogenic illnesses to show how profoundly our circumstances and experiences may affect the way our bodies and minds operate. Strangers to Ourselves excels because of the fascinating case studies it presents, which add concrete examples to the continuous discussion of the mind’s mysterious workings.
Aviv emphasizes early on that the book’s episodic structure, rather than a single overarching narrative, was chosen to highlight the wide range of human emotional and psychological experiences, their essential multiplicity, and the importance of placing them in their proper contexts. There is no single, correct story, and this can only be demonstrated through a series of stories.
She argues that the “answers continually alter” as new information is gathered and analysed. It’s like hearing someone remark, “all music is good… depending on a person’s taste,” in that it’s both true and frustratingly equivocal. Yeah, but so what? Each piece in Strangers to Ourselves stands on its own as an example of Aviv’s consistently high-quality magazine journalism, with its vivid descriptions and introspective portrayals that easily transition into reflective musings.
But when taken together, they form a collective shrug with a lot of philosophical undertones. As I put the book down, I pondered whether or not it would have had a more lasting effect if it had been published in installments, perhaps in a magazine, rather than a cohesive whole.
A well-written, honest whimper is preferable to a blustering, insincere bang any day. The blatant propensity to make mental health diagnoses become pillars of the identity, fixed personality qualities, rather than the frequently slippery, provisional snapshots of a person in one moment that they often are, makes Aviv’s fuzzy but honest irresolution far more desirable.
This trend, which is pervasive on social media and was coined by author P.E. Moskowitz as the “BuzzFeedification of mental health,” is widespread. Not only are the causes of mental disorders known for sure, but the disorders themselves serve as unmistakable labels.
From direct-to-consumer stimulant firms to specialized productivity applications and planners, an entire cottage economy has been developed upon the new mountain of ADHD diagnoses made in the past decade. Ads for these products play into the assumption that having ADHD affects all aspects of a person’s life and personality, including mundane things like losing one’s keys or putting off an unpleasant chore.
Moskowitz, an editor of a weekly on mental health, is a strong and thought-provoking modern voice on the absurdities of this line of argumentation. They aren’t only picking out the weaknesses of the biological model. Much like Aviv, they find reductionist perspectives to be limiting. In one of their best newsletter issues, author James Greig laments the left’s propensity to attribute all mental health problems to capitalism without offering solutions.
While technically true (yes, capitalism is driving us all nuts), Greig argues that emphasizing collective blame and a lack of personal responsibility for one’s own mental health can discourage people from taking any action at all to better their own lives.
When you tell yourself, “It’s the system’s fault, so there’s nothing I can do if I’m depressed, because it’s the system,” your outlook changes dramatically. As a result of adopting such a worldview, one may become mired in a hopeless nihilism in which any activity short of revolutionary upheaval is seen as futile.
Although it does not provide any solutions, Aviv’s book also does not share this pessimism and lack of optimism. The story concludes on a tragic note when she discovers that Hava, the girl she grew close to in the anorexia ward, has passed away owing to problems brought on by her long-standing eating illness. She goes to see Hava’s family and finds out about Hava’s recovery ordeal.
Aviv finishes the novel by contemplating how she and Hava could be mistaken for sisters after hearing numerous compliments about their resemblance. It’s unsettling to read about a famous, successful person using the example of someone who was never able to overcome her sickness.
Even though it shouldn’t, it does work. You can feel Aviv’s grief and empathy via the page; it’s evident that she doesn’t wish to highlight their differences but rather highlight their essential similarities. She wants to close by emphasizing, once more, how easily our narratives can blend into one another.
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