Strangers to Ourselves: Unsettled Minds and the Stories That Make Us

Book Title: Strangers to Ourselves: Unsettled Minds and the Stories That Make Us

Author: Rachel Aviv

Publication Details: Farrar, Straus, and Giroux, 2022, 274 pp., $28.00, hardcover

Strangers to Ourselves: Unsettled Minds and the Stories That Make Us presents a series of intricately woven narratives exploring the deeply layered experiences of individuals with mental illness diagnoses, including an autobiographical reflection of the author’s personal experiences. Rachel Aviv is a journalist for The New Yorker who turns her attention to mental health and mental illness and the way current understanding and treatment have morphed historically based on societal and cultural influences. Throughout the book, Aviv threads reflections from psychiatrists, psychologists, philosophers, sociologists, and historians, along with study results to help contextualize the anecdotal stories in a way that continually pushes examination and reexamination of the limits of current knowledge. These insights are threaded seamlessly into the overall narrative in a way that seems as though Aviv has read everything ever written on mental illness because she compellingly distills its complexities for a lay audience in a readable way.

Her first narrative describes Dr Ray Osheroff, a successful White male physician who stays in a renowned psychoanalytic hospital for months to receive nonpharmaceutical treatment for major depressive disorder. Through his experience (deteriorating until being discharged, improving after starting an antidepressant, and eventually suing the hospital for not adequately treating his condition), readers learn of the journey of pharmacological treatment from obscurity to mainstream while the popularity of psychoanalysis fades into oblivion.

Her second narrative describes Bapu, a married mother of two in India who is diagnosed with schizophrenia and becomes obsessed with her spiritual connection to God. She is intermittently estranged from and entrenched in the dynamics of her extended family and its assigned gender roles. Her son and daughter are profoundly impacted by their mother’s journey and later create the Bapu Institute to help create awareness and treatment of mental health conditions across India.

Next, Nadia is described as a young Black mother of four whose consciousness of the way that racism and discrimination kept generations of her family both poverty-stricken and traumatized emerges in tandem with the development of schizophrenia. Nadia becomes convinced that she must save her infant twins from this suffering and jumps with them off a bridge. She and one son are rescued, but one dies, and she serves 15 years in jail for filicide. This narrative highlights the way this country’s prison system has become a de facto mental institution for poor people of color and how engrained institutional and systemic racism is embedded in the doling out of punishment and the withholding of intervention or treatment.

Finally, Laura’s story is posed as the antithesis of Nadia’s, in that her Whiteness, abundance of education, wealth, and access to resources do not necessarily result in better outcomes. While Nadia’s story shows a lack of recognition and treatment, Laura’s demonstrates the concept of being “overserviced and underserved.” Laura’s journey illustrates how young people who acquire multiple mental health diagnoses at a young age can accumulate a cornucopia of psychopharmaceuticals, all of which impact the body and brain but none of which are effective at solving the distress they are prescribed for.

This book begins and ends with Aviv’s personal narrative of the uniqueness of being one of the youngest documented patients hospitalized for anorexia and her ubiquitous experience of being one of thousands of adults who take an antidepressant but find stopping difficult if not impossible. Her personal openness and vulnerability combined with her journalistic research illuminate how her portrayals are empathetic yet detached.

Aviv presents multifaceted material in a way that provides a sense of understanding and then offers an equally compelling but opposite viewpoint, flipping any comfort of certainty on its head. This book embodies the essence of why mental illness is so difficult to wrap one’s arms around as a clinician: It is complex in the way it depends on biology, psychology, social support, cultural background, spiritual understanding, racial stress or privilege, trauma history, wealth, and resources. Aviv reminds readers that mental illness will not work in algorithms nor in the dichotomous boxes that modern health care hinges on. This is an important book for health care workers and anyone whose life has been touched by mental illness. It will make your head hurt. It will make you recommend the book to others so that you have someone to discuss the concepts with. And finally, it will leave you with a thirst for a few more chapters.