In September 1988, a 6-year-old girl living in Detroit told her mother that she was so dizzy she felt she might bump into a wall. Her mother promptly took her to the pediatrician, who noted that the girl had lost four pounds in a month and advised she be taken to the Children’s Hospital of Michigan. There, the girl was admitted for “failure to eat†and, soon after, diagnosed with anorexia nervosa. She was, at the time, the country’s youngest known eating-disorder patient.
During her first week at the hospital, the girl ate very little; if anything, she acquired new disordered-eating and exercising habits from more practiced teenage anorexics. But upon realizing that eating would be rewarded by visits from her parents, she began finishing everything on her plate. After six weeks, the girl was discharged and, by the following spring, deemed cured. “I had some thing that was a siknis its cald aneroxia,†she wrote in her diary soon after. “I had anexorea because I want to be someone better than me.†Decades later, with more clarity and improved spelling, Rachel Aviv reflects on this childhood experience in the intro to her debut book, Strangers to Ourselves: Unsettled Minds and the Stories That Make Us.
Aviv is now a New Yorker staff writer, frequently covering difficult subjects ranging from mental health to criminal justice. It makes sense then that Strangers to Ourselves is organized as a series of profiles of five people (in addition to Aviv), most of them American, who have struggled with mental illness and the narratives surrounding it. While her subjects’ “lives unfold in different eras and cultures,†she writes, “they also share a setting: the psychic hinterlands, the outer edges of human experience, where language tends to fail.†Much like her New Yorker predecessor Janet Malcolm — whose investigations into psychiatry, such as in her book Psychoanalysis: The Impossible Profession, bled into broader institutional critiques — Aviv’s chapters draw on her talent for narrative feature writing, as she weaves personal stories in and out of structural backdrops. Part reportage, part memoir, and part history, her book might also be read as a series of case studies. While Aviv acknowledges being drawn to the genre of the case study for its interpretive potential, she admits “bristling at the picture it presents of a closed world, limited to one person and one explanation.â€
Freud’s case studies (Dora, the Wolf Man, the Rat Man) came to be seen as models for understanding the modern mind. He wrote largely from a diagnostic perspective. But Aviv’s case studies suggest that it might be the patient who can best describe, and interpret, their own psychological state. By leading with a portrait of herself as a young girl, Aviv quickly collapses the distance between journalist and subject, or even the analyst and analysand. If Freud’s patients were under the narrative control of his final interpretation, then Aviv seeks to have her subjects speak on their own terms.
In order to do so, Aviv draws from a range of literary texts. She quotes medical and scholarly essays, legal documents, and the personal and creative writings of her subjects—because every person Aviv writes about is a writer too. Even the book’s title, Strangers to Ourselves, is taken from the diary of a woman named Hava, whom Aviv met as a child during that initial hospital stay. At first glance, these five people appear to have little in common: a successful white American man, an Indian woman who writes mystic verse, an African American mother who throws herself and her children off a bridge, a hyperprivileged white girl descended from Franklin Roosevelt, and Hava, a woman whose lifelong struggle with anorexia reframes Aviv’s own brief brush with it. But what draws these disparate figures together is their shared impulse to understand themselves through writing — even if the only thing that begets is more writing. Aviv’s choice to focus on writers also performs a more practical function for her as a journalist: Having access to her subjects’ personal archives allows her to track their evolving narratives in real time, as they themselves once sought to understand their lives.
Throughout Strangers to Ourselves, writing often seems to be both symptom and cure. In Aviv’s opening chapter, which also functions as a general introduction to modern psychoanalysis, the story goes something like this: In 1979, Raphael “Ray†Osheroff, a doctor, checked into a Maryland psychiatric institution for depression. A few years later, he sued the facility for, he claimed, failing to treat him and therefore ruining his career and his life; he was convinced that his doctors, committed as they were to the talking cure, had refused to medicate him properly. Ray’s case became one of the most prominent psychiatric-malpractice lawsuits of the 20th century. As Aviv describes, it pitted the psychoanalytical model, which emphasizes culture and insight, against a pharmacological one, which privileges biochemistry and medication. All the while, he was writing his own version.
Aviv frequently quotes from Ray’s unpublished memoir, a bloated document that he had been revising for over 30 years at the time of his death in 2012 and that he called A Symbolic Death: The Untold Story of One of the Most Shameful Scandals in American Psychiatric History (It Happened to Me). As that title suggests, Ray’s desire to reclaim control expressed itself through a kind of logorrhea. “I have become a historic figure,†he writes. “I am the man that everyone knows about but no one knows.†While the memoir began as an effort to pinpoint where it all went wrong, it was less clear to Ray how his story would end. “Two different stories about his illness, the psychoanalytic and the neurobiological, had failed him,†explains Aviv. “If he just framed the story right or found the right words, he felt he could ‘finally reach the shore of the land of healing,’ he wrote.†By incorporating Ray’s voice, Aviv turns him from an emblematic figure — one whose life dramatizes a central tension of psychiatric history — back into a specific one.
From that more privileged American, Aviv moves in her next chapter to the case that is arguably farthest from her own experience: She introduces an Indian woman named Bapu who, around 1970, develops an intense devotion to the god Krishna and begins to write songs dedicated to him in medieval Tamil despite never having studied the language. Some in Bapu’s community saw her ability to effortlessly write this way as an expression of her saintliness — much like that of the 16th-century poet Mirabai, with whom Bapu was obsessed. But when her family took her to an Indian psychiatrist in Chennai who was trained in the western tradition, he diagnosed her as a textbook schizophrenic. But Bapu “understood her devotion through a story that was celebrated by fellow worshippers and by the literature she read,†explains Aviv, “and, when it was forcibly replaced by a new one about mental illness, she felt devalued.â€
Not unlike Ray’s, Bapu’s story illustrates a limit to the models of western psychiatry. As Aviv puts it: “There are stories that save us, and stories that trap us, and in the midst of an illness it can be very hard to know which is which.†Rather than designating one storyline as more or less legitimate, Strangers to Ourselves allows its narrative threads to sit alongside one another in all their incongruities. Bookended by Aviv’s own story and another about Hava — whose eating disorder becomes, as Aviv’s tells it, an “illness ‘career’†— the individual chapters can be read independently, without the need to synthesize or analogize across them.
Beyond Ray and Bapu, there is also Naomi and Laura, a poor Black woman and a rich white woman respectively. During a psychotic episode in which she fears for her life, Naomi jumps off a bridge with her twin toddlers, killing one of them. Though her plea of insanity is rejected and she spends the next 15 years in prison, she is nonetheless forced to take antipsychotics, enduring an endless cycle of institutional gaslighting that she is eventually able to frame in terms of neoslavery and structural racism. On the other end of the economic spectrum is Laura, a high-achieving student on her way to Harvard when she is struck by debilitating depression. This leads to a series of diagnoses from bipolar to borderline personality disorder that precipitate what is known as a “prescription cascade.†Where some people, like Naomi, might have received too few advantages, as Aviv puts it, “others, like Laura, perhaps receive too much.â€
What brings both women out of their holding patterns is a shared desire to write outside the stories they’ve been told about their so-called disorders. They resist inherited scripts, even at the risk of further alienation. And Aviv herself is ultimately more interested in character-driven storytelling than in large-scale structural critique. Her interests lie in the gap between the individual and the institution, in which her subjects’ struggles are often about the “distance between the psychiatric models that explain illness and the stories through which people find meaning themselves.†If there is a through-line to the book, it is that who gets to tell the story matters as much as the story itself.
Aviv is a recessive presence here — so precise and impersonal that some sections risk becoming boring. Aside from the chapters where she writes directly about her own experience, Aviv is ironically a self-effacing guide to this wilderness of mental illness, wary of labels, stigma, or further pathologizing. Her strongest interpretations read as literary analysis, as when she describes the prose in Ray’s unpublished memoir as “alternat[ing] between grandiosity and self-abasement,†or when she observes how “the complexity of Bapu’s early poems gave way to a plain lamenting style.†And while Aviv takes the conceit of exploring the “psychic hinterlands … where language tends to fail†as her thesis, Strangers to Ourselves suggests that this terrain might not be so inaccessible after all. These are not experiences in which language tends to fail so much as experiences that risk generating too much of it.
The book’s shifts models a kind of indeterminacy about how one could approach the self: “Am I really this? Am I not this? What am I?†goes the subtitle to one chapter. Perhaps it mirrors the aftereffects of Aviv’s own childhood “siknis,†and its sustained influence on her thinking in all its sublimated, digressive, displaced narrative forms, in all its parallel and counterfactual plots. Aviv’s journalistic voice is deft, and she moves with a light touch. But in her hands, writing is revealed to be an obsessive act, even — perhaps especially — when it is also an attempt to heal.