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Rachel Aviv's new book 'Strangers to Ourselves' tackles mental health diagnoses


In Rachel Aviv's new book, "Strangers To Ourselves," we are presented with the stories of six individuals, all who were diagnosed with mental illness at various points in their lives. But the stories are not just of people with mental illness, but rather people who call into question their initial diagnoses and what happens when they do. Rachel Aviv, an award-winning writer for The New Yorker magazine, joins us now. Thanks for being with us.

RACHEL AVIV: Thanks for having me.

RASCOE: The first story in your book is your own. Why offer up yourself as an example?

AVIV: Well, when I was six years old, I stopped eating, and I was hospitalized very quickly for anorexia and put on a unit with other anorexic girls, many of whom were in their teens. I had never heard of the word anorexia at the time. I thought it sounded like some sort of new kind of dinosaur. Like, that was my association.

RASCOE: And you couldn't even really read at the time.

AVIV: Right. I didn't know how to read. I just had no context. And I think it always created a question in my mind, sort of this mismatch between our own experiences of mental distress and the ways that they get classified. And I think a larger question for me was, you know, how do the ways that our mental distress get classified - how do those classifications themselves kind of act on us? Like, how do they change the course of our lives or our expectations for ourselves?

RASCOE: And that's what I found so fascinating about this. You write, 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. So tell us about how that works when it comes to a psychiatric diagnosis.

AVIV: I think I wanted to acknowledge that for some people, having a diagnosis is this wonderful, clarifying moment - like, you realize you're not alone. But then I think when you're told you have, like, a broken brain or a brain disorder, and it's permanent, you know, that is information that changes the way you understand yourself on a really fundamental level.

RASCOE: I want to talk to you about one of the individuals that you focus on, Naomi. Can you introduce us to her?

AVIV: So she is just this amazing woman. She had grown up in poverty, spent some time being homeless, and she'd become a young teenage mother. And she was completely overwhelmed by life and...

RASCOE: And racism.

AVIV: And racism, in the sense that, well, when she started to have psychotic experiences, she felt almost like the scales were falling from her eyes. And she was realizing, oh, this is what it means to be a Black mother raising children in America. Like, the pain I'm feeling is because of that. And when she would talk about it with her doctors, they told her she was bipolar, which - she came to accept that diagnosis, but at the time, it felt like, well, that's beside the point. I'm trying to communicate something about, like, the racism I realize has sort of shaped my identity my whole life. And because she didn't feel like her doctors were acknowledging the thing that was causing her pain, she was kind of alienated from the idea of taking medication at all.

RASCOE: Naomi does end up trying to hurt herself, and she ends up hurting her children. One of her children dies. Was there any hesitance on your part with Naomi to tell her story because it's so horrific what she ends up doing in the throes of mental illness?

AVIV: From my perspective, no, because, you know, I read her interview with the police. I read part of her memoir. Like, I felt for me, the task was to get a reader to a place where they actually, like, did understand how she got to that state of mind, where somehow, by doing this unthinkable thing, she actually felt she was protecting her children.

RASCOE: I will say the passage on Naomi - there were so many parts - because not only are you talking about Naomi. You're talking about her mother, Florida (ph). You're talking about generations of a Black family, Black women in particular, who struggled, went through abuse. And then you also talk about how, like, Black people - you know, they don't get the mental care that other people would get because of systemic racism and discrimination in this country. And it's not even just resources, but it's the idea that's just not what you do. Like, there was this thing where Florida said, in our family, if you feel a little down, you just take a nap. That's the solution. Take a nap. And I can relate to that because that's - in my family, that's what a lot of people do. They say pray and maybe get some sleep.

AVIV: Yeah. And I think, you know, it's interesting because there's been this move in psychiatry to call mental illness, like, a brain disease, which is a good thing, in a way, because it relieves families and people from the guilt that, like, they've caused this suffering. There's also this flipside of that for someone like Naomi. Her circumstances have made her ill in a lot of ways. To pretend that it's all in the body feels for her invalidating and sort of not hearing what she's going through.

RASCOE: I haven't researched all these cases the way you have. You also look at the history of psychiatry in the U.S., around the world. What is your impression of the psychiatric profession in the U.S. today?

AVIV: I think psychiatry is so interesting because it's a really young field, and what is accepted as truth has just changed so much over the years. And I think, you know, one of the ideas that I kept being struck by in each chapter was that when people felt a sense of recovery or healing, it often had so much to do with finding someone to talk to who made them feel like they just weren't alone. I feel like loneliness as a concept is sort of not incorporated into psychiatry that much. But, you know, for Naomi, the thing that she described as most healing was her relationship with a prison librarian who shared book ideas with her, and she felt like she was understanding herself better through this person's eyes and through the fact that this person was sort of trying to understand her as a whole.

RASCOE: Rachel Aviv is a staff writer at The New Yorker magazine. Her new book is "Strangers To Ourselves: Unsettled Minds And The Stories That Make Us." Thank you so much for speaking with us.

AVIV: Thank you. Transcript provided by NPR, Copyright NPR.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.