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

by Rachel Aviv

I wonder how much the stories we tell about them, especially in the beginning, can shape their course. People can feel freed by these stories, but they can also get stuck in them.

Insight is assessed every time psychiatric patients are hospitalized,

William James writes that “the ideal of every science is that of a closed and completed system of truth.” Scholars achieve this goal, he writes, largely by neglecting what he calls the “unclassified residuum”—those symptoms and experiences that do not “wear just this ideal form.”

when questions are examined from different angles, the answers continually change.

It’s startling to realize how narrowly we avoid, or miss, living radically different lives.

melancholia arises when a patient is mourning something or someone but “cannot see clearly what it is that has been lost.”

War was not just about power or resources—it arose from insecurity, neuroses, and other mental wounds.

when a husband becomes angry “it is the wife who politely suffers.”

“apophany”—a revelation that a new realm of existence has been unveiled.

people exposed to Western civilization were more likely to become mentally ill.

psychoanalysis proved largely incompatible with a culture for which mysticism is often essential to people’s lives.

In mystical states, Kakar writes, the “reality of being utterly and agonizingly alone is transiently denied.”

“A perfect knower of God and a perfect idiot have the same outer signs,”

By ignoring these sorts of experiences—the “unclassified residuum,” as William James called it—doctors risk misunderstanding why mental illness can be so isolating, altering people’s lives in ways that cannot be captured only by symptoms.

They avoided diagnostic categories or rigid treatment models that might diminish people’s sense of autonomy, their belief that they could control their own story.

people were more likely to recover from schizophrenia in developing nations than in developed ones.

“Ramana didn’t say, ‘Go into the forest and live alone.’ He didn’t say, ‘Go live forever in this temple.’ What he said was, ‘If you go to those places, beware: the same mind is going to follow you wherever you go.’

In mental illness, the boundary between self and other often seems to erode, but pregnancy gives that confusion physical form.

clear signs of postpartum psychosis, an illness that affects one in a thousand mothers.

to have a new explanatory framework foisted onto one’s life is not always healing or generative. It can also feel diminishing, a blow to one’s identity and worldview.

therapeutic and empowering when she acknowledges the societal structures that have contributed to their state of mind.

Delusions are not spun from pure fantasy.

doctors seemed to expect that delusions couldn’t on some level make sense.

“the pain has to go somewhere—it can’t disappear,” Smith said. “It doesn’t simply dissipate. You pass it on.”

“The patient needs an experience, not an explanation.”

“regardless of age, race, or sexual orientation, the common denominator was not a tendency for violence, but a history of trauma.”

“prescription cascade”: the side effects of one medication are diagnosed as symptoms of another condition,

realigned her life, consciously or not, so it more purely expressed the way she’d been classified.

their self-identity changes from being normal to abnormal—

PSYCHOANALYSIS WAS ONCE a lifelong process. Now, nearly two decades after the closure of Chestnut Lodge, psychopharmacology has entered a similarly chronic mode. Today, antidepressants are taken by one in eight people in America, and a quarter of them have been doing so for more than a decade.

For adolescents who go on medications when they are still learning what it means to be their best self, they may never know if they have a baseline, or what it is.

in many cases withdrawal symptoms, misdiagnosed and never given time to resolve, may create a false sense that patients can’t function unless they go back on their drugs.

no longer sure if it was due to their underlying disorder, the heavy medications they’d taken for it, or the way their families or communities had responded to them—a process that sometimes coincided with the pressure of needing to prove their disability, in order to receive social security benefits.

My first six months on Lexapro were probably the best half year of my life. I was what psychiatrists call a “good responder.” My brain suddenly felt like a fun, fresh place to be.

bioethicist Carl Elliott writes that for some people antidepressants do not address an inner psychic state so much as “an incongruity between the self and external structures of meaning—a lack of fit between the way you are and the way you are expected to be.”

the medication is invested with magical powers while the pathology becomes chronic.”

They were able to move on, it seemed, because they had reoriented their lives around a new story.

“The writing was part of her sickness,”