“Rachel Aviv speaks to the stories that help and stories that harm—the narratives that will fashion the identity we will have for a lifetime.”
by Rachel Aviv
Farrar, Straus & Giroux, 2022; 288 pages
Reviewed by Lloyd I. Sederer, MD
Consider what the following individuals have in common: a Black mother of 4 young children who commits infanticide; a man in his early 40s who is still “rootless and alone” after decades of failed psychiatric and psychoanalytic treatments; a young, Brahmin South Asian woman who was either psychotic or a saint; a privileged, New York debutante and Harvard College student with anorexia nervosa; and the author of Strangers to Ourselves: Unsettled Minds and the Stories That Make Us, who herself has been a veteran of psychiatric treatment since she was 6 years old.
These are quite diverse human subjects whom Strangers to Ourselves author Rachel Aviv portrays with her longitudinal, highly detailed, scholarly, and illuminating “case studies” in this, her first book. Each person’s story—more so, each person’s identity—reveals Ms Aviv’s broader subject, namely the “stories that make us.”
Not only did Ms Aviv chronicle the troubled lives of all these individuals—she also became part of their lives. She built the trustworthy bonds essential to bringing into the light each person’s (and ours as well) jumble of often contradictory, inchoate ideas and sentiments—the raw mental material that can, in disciplined, dyadic conversation, become the narrative of a person’s life, actual or fabricated.
Ms Aviv keenly depicts the paradox inherent in our lives—for example, how a diagnosis of mental illness can quiet the mind or constrict it, and certainly disquiet it. Or how psychiatric medications can help, or not, or how their action diminishes or morphs over time. There is also the bedeviling quandary of distinguishing medication withdrawal from the recurrence or relapse of a psychiatric illness—or how suffering can destabilize one person or, however unintended, be transformative, and serve to launch recovery in a person’s life.
Moreover, Ms Aviv tells her story as well. She draws upon the stories, “…that made them [us],” and that shaped the identities and the life courses of her subjects, including herself. Throughout, she weaves in her view that identity is more than the product of chemistry, life experiences, mental illness, and character (although these surely are formative). She is not an opponent of psychiatry, but her writings have revealed so much that is inconclusive and ideological about my field, especially about psychiatric medications, though not only.
In Strangers to Ourselves, Ms Aviv draws our attention to “…the stories that save us, and stories that trap us.” Stories that fashion meaning for us, including the meaning of mental illness when it is a co-traveler in a person’s life. Stories spawned by illness and crisis and shaped by context. Stories that can change while building over the course of time. Stories that help and stories that harm. Stories instrumental to understanding who we are, that serve as pathways to what we often term identity.
Ms Aviv’s writings unfailingly offer dignity to her subjects. No wonder the individuals she profiles in this book stay with her for the long run of seeking an identity and making a better life—one of recovery with hard work, and one that we all want, namely a life with relationships and of contribution.
Ms Aviv has been a staff writer at The New Yorker since 2013 who probes medicine, including its specialties of psychiatry and medical ethics; our criminal justice system; and education, among other complex and contentious topics. In 2022, she won a National Magazine Award for Profile Writing and coauthored a screenplay with Ta-Nehisi Coates.
In other words, Ms Aviv has range, depth, erudition, and humanity—all of which make her a very exceptional writer whose work is always worth reading.
Dr Sederer is a psychiatrist, public health doctor, and non-fiction writer.