Introduction
In her thought-provoking book "Strangers to Ourselves," Rachel Aviv delves into the complex world of mental illness, exploring the blurry line between sickness and health. Through a series of intimate stories, including her own, Aviv illuminates the multifaceted nature of psychic crises and challenges our understanding of mental health.
The book takes readers on a journey through the lives of individuals grappling with various mental health conditions, exposing the limitations of current diagnostic frameworks and treatment approaches. Aviv's narrative weaves together personal experiences, cultural contexts, and societal influences to paint a nuanced picture of mental illness that goes beyond simple medical explanations.
As we explore these stories, we're invited to question our assumptions about mental health and consider the profound impact that diagnoses can have on a person's identity and life trajectory. "Strangers to Ourselves" is not just a book about mental illness; it's a testament to human resilience and a call for a more holistic, compassionate approach to understanding and treating psychological distress.
Rachel: The Youngest Anorexic
Aviv begins her exploration with her own story, recounting her experience as perhaps the youngest person ever diagnosed with anorexia nervosa. At the tender age of six, Rachel suddenly began refusing food, an behavior that started during a school lunch and was inspired by the recent celebration of Yom Kippur, a Jewish holiday that involves fasting.
For young Rachel, not eating felt powerful and holy. It also garnered her significant attention from concerned adults, which only reinforced the behavior. After two weeks of barely eating, she was admitted to the Children's Hospital of Michigan in Detroit, where she was placed in the eating disorders unit.
In the hospital, Rachel encountered two older girls, Hava and Carrie, who became her mentors in disordered eating. Despite not fully understanding their motivations for extreme thinness, Rachel was drawn into their world. She began imitating their behaviors, such as compulsive exercising and comparing body measurements.
Rachel's experience in the hospital took on an almost religious quality, reminiscent of medieval Christian women who starved themselves to feel closer to God. Hava, in particular, romanticized their suffering, creating a sense of shared purpose and identity around their eating disorders.
Eventually, the hospital staff made Rachel's visitation rights contingent on finishing her meals. After 12 days without seeing her parents, she finally gave in. Once reunited with her family, the spell was broken, and within six weeks, Rachel had made a full recovery. Remarkably, the illness never returned.
Looking back on this experience, Rachel contemplates how narrowly she avoided a lifelong struggle with an eating disorder. She questions whether she truly had anorexia, given her young age and limited exposure to cultural messages about thinness. She also wonders how her life might have been different if she had fully grasped the meaning of her psychiatric label.
Rachel's story raises important questions about the nature of psychiatric diagnoses and their impact on self-narrative, especially in young children. It also highlights the potential for both rapid descent into mental illness and equally rapid recovery under the right circumstances.
The stark contrast between Rachel's outcome and that of her hospital friend Hava is particularly poignant. While Rachel escaped a lifelong affliction, Hava continued to struggle, spending her life in and out of hospitals before dying at the young age of 41 due to complications likely related to her eating disorder.
Ray: The Doctor Turned Patient
The story of Ray, a once-charismatic physician, illustrates the complex interplay between different approaches to mental health treatment and the ongoing search for self-understanding.
In 1979, Ray checked into the prestigious Chestnut Lodge psychiatric hospital, having descended into a deep depression following his ex-wife and children's move to another country. At the Lodge, he spent his days obsessively walking the halls, covering about 18 miles daily, while ruminating on his professional downfall.
Chestnut Lodge specialized in traditional psychoanalysis, a therapy method pioneered by Sigmund Freud that focused on unearthing unconscious desires, fears, and conflicts. The therapists at the Lodge urged Ray to gain insight into his destructive behavior, attempting to interrupt his cycle of self-pity.
However, Ray's depression proved resistant to this approach. After months without improvement, his mother transferred him to the Silver Hill Clinic in Connecticut. This facility had taken a radical step for the time by embracing newly available antidepressant medications.
At Silver Hill, Ray was put on a combination of the antidepressants Thorazine and Elavil. The effect was dramatic – he rapidly improved, regaining his sense of humor and creativity. This experience transformed Ray into an eager proponent of the new biological model of mental illness. He became convinced that his depression had simply been a chemical imbalance that the antidepressants were able to correct.
Seeking vindication for his suffering at Chestnut Lodge, Ray sued the facility for failing to properly treat his depression with drugs. His case became a flashpoint in the field of psychiatry, pitting the old guard of psychoanalysts against the new wave of "biological psychiatrists" who championed drug interventions.
Ray's lawsuit essentially became a referendum on the proper way to cure mental anguish – through insight or medication? In the end, Ray settled his famous case for $350,000. However, the vindication he sought remained elusive. His career and family relationships remained strained, and he spent decades revising a memoir of his experiences, unable to craft a peaceful resolution to his story.
Even near the end of his life, Ray still felt rootless and alone, poignantly writing: "Am I really this? Am I not this? What am I?" His unresolved search for self-understanding highlights the limitations of both psychodynamic and biochemical models in fully explaining the complexities of human suffering.
Ray's story serves as a powerful reminder that "mental" illness is neither purely mental nor solely physical. It exists at the intersection of mind, body, and lived experience, defying simple categorization or treatment approaches.
Bapu: Spirituality or Schizophrenia?
The story of Bapu illustrates the complex interplay between culture, spirituality, and mental health, challenging Western notions of psychiatric illness.
Bapu's family considered her a lucky bride despite a childhood limp. They arranged her marriage to Rajamani, a wealthy businessman, even buying a house for the couple. However, Bapu quickly became unhappy with her critical in-laws and materialistic household.
She began spending much of her time praying and writing devotional poems to Krishna, likening herself to the 16th-century Indian poet Mirabai, who renounced her marriage for spiritual devotion. Bapu's desire to leave family life behind and live as an ascetic grew stronger, behavior her family found bizarre.
Concerned, they sent her to a local doctor who diagnosed her with schizophrenia. Bapu, however, rejected both the diagnosis and the antipsychotic medication offered, believing she was simply seeking spiritual fulfillment.
Bapu continued living at temples as a wandering saint, finding community among worshippers. Her family, still worried, repeatedly forced her into hospitals against her will, where she underwent electroconvulsive therapy.
In her later years, Bapu reconciled somewhat with her family, living in her house under her daughter-in-law's care before dying from a stroke at 60.
Bapu's adult children, Bhargavi and Karthik, struggled to understand their mother's life. Indian spiritual traditions celebrated their mother's experience as sainthood, while the Western psychiatric framework they later encountered dismissed it as mental illness.
Today, Bhargavi and Karthik have found a way to reconcile the spiritual and psychological aspects of their mother's condition. Bhargavi has even started a mental health nonprofit to revive this pluralistic understanding, recognizing the importance of shared cultural narratives in interpreting psychic distress.
Bapu's story powerfully demonstrates that mental illness is never just an individual phenomenon. It has social, cultural, and spiritual dimensions that Western psychiatry often neglects. Her experience challenges us to consider more holistic, culturally sensitive approaches to understanding and treating mental health issues.
Naomi: The Weight of Racial Injustice
Naomi's story is a stark illustration of how systemic racism and social injustice can contribute to mental health crises, and how the psychiatric system often fails to address these underlying factors.
On July 4, 2003, Naomi Gaines stood on a bridge over the Mississippi River with her twin sons. In a moment of desperation, she kissed her boys goodbye and dropped them into the water before jumping in herself, shouting "Freedom!" A bystander managed to rescue Naomi and one of the twins, but tragically, the other boy died.
Naomi's horrific act shocked the world, but in her mind, she believed she was saving her children from a hostile world. Her journey to this breaking point was shaped by a lifetime of struggle against poverty and racial discrimination.
Growing up poor in Chicago housing projects, Naomi was one of several children of an overwhelmed mother. She longed for the warmth of foster care that her sister experienced, but for her, that rescue never came. In high school, Naomi became a young mother herself. When her mother moved to Minnesota to escape an abusive relationship, Naomi followed with her child.
It was in Minnesota that Naomi experienced her first bout of depression and attempted suicide. Over the years, she had three more children with two different partners. As a young single mother of four, Naomi tried to better herself through education while pursuing a career as a hip-hop artist.
However, as she delved deeper into Black history, Naomi became increasingly aware of the systemic racism stacked against her and her children. This knowledge, coupled with the daily struggles of poverty and single motherhood, contributed to her mental health decline.
The psychiatric institutions Naomi encountered diagnosed her variously with depression, psychosis, and bipolar disorder. However, they failed to fully grasp or address the systemic pressures of racism that weighed heavily on her psyche.
After the bridge incident, Naomi served over a decade in prison, where she received inconsistent mental health treatment and her condition worsened. It was a prison librarian, Andrea Smith, who finally managed to connect with Naomi beyond her diagnosis. By relating to Naomi's curiosity and instinct for social justice, Andrea was able to convince her to resume taking her medication.
Now out of prison, Naomi is working to manage her illness while trying to reunite with her surviving son. She has written a memoir to process her generational trauma and uses her hard-won insights to help others.
Naomi's story highlights the glaring inadequacies of our mental health care system in recognizing and addressing the psychic strain of social and racial injustice. It underscores the vital need for more holistic approaches that integrate personal, cultural, societal, and spiritual contexts when treating mental health issues, especially in marginalized communities.
Laura: The Overdiagnosed Overachiever
Laura's story sheds light on the potential pitfalls of overreliance on psychiatric diagnoses and medication, especially for high-achieving women struggling with societal pressures.
Growing up in the wealthy town of Greenwich, Connecticut, Laura felt immense pressure to achieve and excel from a young age. She learned to present a facade of perfection that masked her true self, a practice that took a significant toll on her mental health.
In eighth grade, after confiding suicidal thoughts, Laura was diagnosed with bipolar disorder. Over the next few years, she was prescribed various medications, including Depakote. However, Laura initially resisted taking them, believing her emotional struggles stemmed from societal expectations rather than brain chemistry.
Despite her mental health challenges, Laura was admitted to Harvard. There, she continued to feel as if she wore different masks – the high-achieving student, the party girl, the nihilist – without a stable identity underneath. She spiraled into another depression, leading a new psychiatrist to diagnose her with Bipolar II and prescribe high doses of Prozac, up to 80mg daily. This time, Laura embraced the diagnosis, feeling it absolved her of blame for her troubles.
Over the next decade, Laura cycled through countless psychiatric drugs and shifting diagnoses, including borderline personality disorder. She surrendered to the disease model, allowing experts to explain and treat her suffering. Her self-concept became increasingly defined by her diagnoses.
A failed suicide attempt at age 25 led Laura to discover Robert Whitaker's book "Anatomy of an Epidemic." The book questions psychiatry's chemical imbalance theory, arguing that long-term use of psychiatric drugs may turn episodic disorders into lifelong disabilities.
This revelation led Laura to see her diagnoses as potentially masking deeper issues related to social and gendered expectations. She made the difficult decision to slowly withdraw from years of benzodiazepines, antipsychotics, mood stabilizers, and antidepressants. The process was challenging, involving months of unfamiliar sensations and emotions. However, she also rediscovered aspects of life that had been dulled for so long, such as her sexuality.
Ultimately, Laura pieced together a new narrative for herself – she was not fundamentally defective, just struggling to find herself within a restrictive social context. Now in her thirties and off medication, Laura has built a community around alternatives to the medical model of mental health.
Laura's story highlights how our healthcare system often overmedicates ambitious, high-achieving women who struggle with their mental health. It demonstrates that medication shouldn't be our only answer to societal pressures and that mental health issues are deeply intertwined with personal, social, cultural, and political factors.
Final Thoughts: The Complexity of Mental Illness
"Strangers to Ourselves" presents a compelling argument for a more nuanced, holistic approach to understanding and treating mental illness. Through the diverse stories of Rachel, Ray, Bapu, Naomi, and Laura, Aviv illustrates how psychiatric diagnoses have the power to shape our identity and self-narrative, for better or worse.
One of the book's central themes is the thin line between mental health and illness. Aviv's own experience as a six-year-old anorexic demonstrates how quickly one can slip into a mental health crisis, but also how rapidly recovery can occur under the right circumstances. The contrast between her outcome and that of her friend Hava underscores the potential long-term consequences of mental illness when left unchecked.
Ray's story highlights the ongoing debate between different schools of psychiatric thought – the psychoanalytic approach versus the biological model. His unresolved search for self-understanding, even after embracing medication, shows that neither approach alone can fully address the complexities of human suffering.
Bapu's experience challenges Western notions of mental illness by illustrating how behavior deemed pathological in one culture may be celebrated as spiritual in another. Her story emphasizes the need for culturally sensitive approaches to mental health care that respect diverse belief systems and ways of understanding the world.
Naomi's journey reveals the profound impact of systemic racism and social injustice on mental health. Her story underscores the limitations of a purely medical approach to treating mental illness, highlighting the need to address broader societal issues in mental health care.
Laura's narrative demonstrates the potential dangers of overreliance on psychiatric diagnoses and medication, especially for high-achieving individuals struggling with societal pressures. Her experience suggests that sometimes, what we label as mental illness may be a natural response to restrictive social contexts.
Collectively, these stories reveal that mental illness is not just a biological phenomenon. It has personal, social, cultural, and political dimensions that must be considered for effective treatment and support. The book challenges us to think beyond simplistic explanations and to consider the broader context in which mental health issues arise.
Aviv's work also highlights the resilience of the human spirit. Despite facing significant challenges, many of the individuals in the book find ways to craft new identities and purposes. They demonstrate that recovery and growth are possible, even in the face of severe mental health struggles.
"Strangers to Ourselves" serves as a call to action for a more compassionate, holistic approach to mental health care. It encourages us to look beyond labels and diagnoses to see the whole person, their experiences, and their social context. The book suggests that by broadening our understanding of mental illness, we can develop more effective, humane ways of supporting those who struggle with their mental health.
In conclusion, "Strangers to Ourselves" is a powerful exploration of the complex landscape of mental illness. It challenges our assumptions, expands our understanding, and ultimately calls for a more nuanced, empathetic approach to mental health care. By sharing these intimate stories, Aviv reminds us of the humanity behind psychiatric diagnoses and the ongoing need for better ways to support those grappling with mental health challenges.