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

by Rachel Aviv

“The illness used to be the accomplishment of an isolated girl who felt she had found her own way to salvation,” she wrote. “Each one was, in a way, an original inventor of this misguided road to independence.”

But the opposite argument also seems true: anorexia can feel like a spiritual practice, a distorted way of locating some nobler self. The French philosopher René Girard describes anorexia as being rooted in “the desire not to be a saint but to be regarded as one.”

I explained that “I had anexorea because I want to be someone better than me.”

For a child, solipsistic by nature, there are limits to the ways that despair can be communicated. Culture shapes the scripts that expressions of distress will follow. In both anorexia and resignation syndrome, children embody anger and a sense of powerlessness by refusing food, one of the few methods of protest available to them. Experts tell these children that they are behaving in a recognizable way that has a label. The children then make adjustments, conscious and unconscious, to the way they’ve been classified. Over time, a willed pattern of behavior becomes increasingly involuntary and ingrained.

The philosopher Ian Hacking uses the term “looping effect” to describe the way that people get caught in self-fulfilling stories about illness. A new diagnosis can change “the space of possibilities for personhood,” he writes. “We make ourselves in our own scientific image of the kinds of people it is possible to be.”

Pascal’s wager: to avoid the possibility of eternal Hell, we should behave as if God is real even though we lack proof of his existence.

I do have certain traits that make me susceptible to fasting for no reason, like an amorphous sense that self-restraint is a moral good.

Mental illnesses are often seen as chronic and intractable forces that take over our lives, but 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.

But the concept largely ignores how the “correct attitude” depends on culture, race, ethnicity, and faith. Studies show that people of color are rated as “lacking in insight” more often than those who are white, perhaps because doctors find their mode of expressing distress unfamiliar, or because these patients have less reason to trust what their doctors say.

The poet Jane Kenyon describes a similar metamorphosis. After years of feeling as if “a piece of burned meat / wears my clothes, speaks / in my voice,” her doctor proposed that she try an antidepressant. “With the wonder / and bitterness of someone pardoned / for a crime she did not commit / I come back to marriage and friends,” she wrote. “What hurt me so terribly / all my life until this moment?”

Klein believed that the Lodge psychiatrists had, like many in the field, failed to rise to the demands of science. “If the diagnosis and treatment of patients is not an applied science, then what is it?” he asked at a conference. “An art form? A philosophical construction? A ballet?”

The New York Times wrote that the case shook “the conventional belief, held even by some doctors, that chronic depression is not an illness, but merely a character flaw.”

“Many black folks worry that speaking of our traumas using the language of mental illness,” hooks writes, “will lead to biased interpretation and to the pathologizing of black experience in ways that might support and sustain our continued subordination.” Black Americans are systematically undertreated for pain, as compared to white patients, a disparity that holds true even for children.

“When it comes to affluent white patients you can take care of moral blame using a biological explanation,” she said. These families often feel freed by the idea that an illness is no one’s fault. “But when it comes to Black and brown and poor patients, that same biological explanation is used to deflect blame away from the societal forces that brought them where they are. Because there is moral blame: the blame of having disinvested in people’s communities by doing things like taking away affordable housing or protection for workers.” She said that her patients have found it therapeutic and empowering when she acknowledges the societal structures that have contributed to their state of mind.

It is still unclear why antidepressants work. The theory of the chemical imbalance, which had become widespread by the nineties, has survived for so long perhaps because the reality—that mental illness is caused by an interplay between biological, genetic, psychological, and environmental factors—is more difficult to conceptualize, so nothing has taken its place.

“dystalgia,” a wash of despair that one’s life has been futile.

Once the chemical-imbalance theory became popular, mental health became synonymous with an absence of symptoms, rather than with a return to a person’s baseline, her mood or personality before and between periods of crisis. Dorian Deshauer, a psychiatrist and historian at the University of Toronto, told me, “Once you abandon the idea of the personal baseline, it becomes possible to think of emotional suffering as relapse—instead of something to be expected from an individual’s way of being in the world.”

‘See, I’m crying—put me back on my meds.’” She said, “I have to sit them down and say, ‘It’s okay to cry—normal people cry.’ Just today someone asked me, ‘Do you cry?’ And I said, ‘Yes, I do.’”

I remember the moment when the Lexapro seemed to hit: it occurred to me that it would be fine if I just wrote an informative story. It did not have to be the ideal story. I only needed to meet the requirements.

I also realize that I’ve endowed my pill of choice with mystical capacities—it contains the things I’m not but wish I was—and merely the idea of swallowing such a thing has healing power. I wish I had a more flexible approach toward my feelings of inadequacy (“I want to be someone better than me,” I had written in my second-grade diary), but I also feel closer to that space of flexibility when I take Lexapro; it seems to relieve the cognitive rigidity that often accompanies anxiety and depression—the sense that one’s story can unfold only one way.

Bianca, who was still struggling to let go of the idea that depression explained who she was, said, “It’s like your darkness is still there, but it’s almost like it’s next to you as opposed to your totality of being.”