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

by Rachel Aviv

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.”

the early phases of an illness, when a condition is consuming and disabling but has not yet remade a person’s identity and social world.

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.

In the starkest terms, insight measures the degree to which a patient agrees with his or her doctor’s interpretation.

it became apparent that gaining insight into interpersonal conflicts, though intellectually rewarding, did not provide a cure.

Studies show that people who see mental illness as biological or genetic are less likely to blame mental conditions on weak character or to respond in punitive ways, but they are more likely to see a person’s illness as out of her control, alienating, and dangerous.

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.

“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?”

“To make a person look at himself when he’s in no condition to do so,” Ayd said, “can be a very dangerous thing to do.”

She came to resemble the sort of patient described in Love in the Ruins, Walker Percy’s 1971 novel about a small-town psychiatrist. “Every psychiatrist knows the type,” Percy writes. “The well-spoken slender young man who recites his symptoms with precision and objectivity—so objective that they seem to be somebody else’s symptoms—and above all with that eagerness, don’t you know, as if nothing would please him more than that his symptom, his dream, should turn out to be interesting, a textbook case. Allow me to have a proper disease, Doctor, he all but tells me.” A patient like this, Percy observes, “has so abstracted himself from himself and from the world around him, seeing things as theories and himself as a shadow, that he cannot, so to speak, reenter the lovely ordinary world.”

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.”