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

by Rachel Aviv

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

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.

Even if questions of interpretation are secondary to finding effective medical treatment, these stories alter people’s lives,

Our illnesses are not just contained in our skull but are also made and sustained by our relationships and communities.

They have come up against the limits of psychiatric ways of understanding themselves and are searching for the right scale of explanation—chemical, existential, cultural, economic, political—to understand a self in the world.

sometimes all of them can be true.

“What occurred at the hospital,” the authors wrote, “was a type of collective evaluation in which neurosis or illness was Evil and the ultimate Good was mental health.”

“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.”

“the conventional belief, held even by some doctors, that chronic depression is not an illness, but merely a character flaw.”

mystic Sri Aurobindo, who said, referring to Freud, “One cannot discover the meaning of the lotus by analyzing the secrets of the mud in which it grows.”

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.

in mental illness “there is a sense of loosely hanging together, not hanging together at all, of not owning your body or thoughts. You lose a sense of being able to predict what you are about.”

“A modest dose of nature,” the study concluded, “could enhance an individual’s capacity to manage the most important issues in her life.”

to survive here, you had to be crazy, chemically saturated, Christian, or some kind of character.”

Mental-health institutions were not designed to address the kinds of ailments that arise from being marginalized or oppressed for generations.

Psychotherapy has rarely been considered “a useful place of healing for African Americans,” wrote the scholar bell hooks. For a Black patient to reveal her fears and fantasies to a therapist, trained in a field that has been dominated by middle-class white people,

She felt debilitated by the historical resonances of her own story.

In Hope Draped in Black, the scholar Joseph R. Winters revisits Freud’s “Mourning and Melancholia” to describe what happens when Black people realize that an ideal, like freedom or equality, has been withheld from them. The loss becomes internalized, undermining “any notion of self-coherence,”

Barred from full recognition, the grief never resolves. “That’s what makes it all so hysterical, so unwieldy and so completely irretrievable,” James Baldwin said,

Drugs will not “change the heartache in the world,” she had told her psychiatrist.

‘Girl you ain’t got time to be sad,’” she said. “‘You’re a strong Black woman, pick yourself up, pray about it, and it’s going to be all right.’”

two white psychoanalysts in a widely cited book, The Mark of Oppression, from 1951. “There is only one way that the products of oppression can be dissolved, and that is to stop the oppression.” But this approach also risked becoming another iteration of dismissing individual accounts of Black people’s pain.

greater incidence of psychosis in communities with less “ethnic density”—the proportion of people from the same ethnic group.

a bunch of suburbanite psychiatrists who don’t see what we see.

staff rarely “speculate directly about economic or political causes of the patients’ problems. They were able to tune out the larger social background.” Their work, she writes, “can be described in terms of an implicit expectation: they had to produce empty beds.”

“When it comes to affluent white patients you can take care of moral blame using a biological explanation,”

“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.

books she intended to request from the library: All God’s Children, by Fox Butterfield; The Resurrection of Nat Turner, by Sharon Ewell Foster; We Real Cool: Black Men and Masculinity, by bell hooks; The Silent Cry: Mysticism and Resistance, by Dorothee Soelle.

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

wanted her to know that I didn’t judge her,” he told me. “I didn’t want to be the law. I just wanted to be someone who wasn’t going to let go of her in the river.”

someone who no one expects to be greater than her past and can’t necessarily prove that now, not even to herself.”

Still, she worried that she hadn’t met people’s expectations. “There was the best, and there was everything else,” she said.

Laura felt as if she were living two separate lives, one onstage and the other in the audience, reacting to the performance. She felt exhausted by the effort, which made her feel as if she had an “empty core.”

Laura wandered the campus and thought, “This is everything I’ve been working for. I’m finally here.” She tried out new identities. Sometimes she drank until early morning and was praised by boys for being chill. Other times, she was a nihilist, disillusioned that her peers were all competing for an ultimately meaningless goal.

she didn’t believe in the adult she was supposed to become. She told me, “I was trapped in the life of a stranger.”

her psychiatrists seemed to feel a duty to preserve her capacity to function at the highest levels, almost treating subpar performance as a symptom of its own. They kept tinkering with her drugs, as if they could eventually bring her to an emotional state that corresponded with all the advantages she’d been given.

let’s get over this intense addiction to the intense passion of pouring out one’s soul”;

Laura stopped trusting her own view of herself and the world. She required confirmation from experts to make her unhappiness feel real.

His explanation didn’t match hers, and she decided “he wasn’t legit.”

While Black women tend to be undermedicated for depression, white women, especially ambitious ones, are often overmedicated, in order to “have it all”: a family and a thriving career. And yet, a common side effect of the drugs is loss of sexuality, an experience perhaps more compatible with contemporary gender roles than we would like to imagine.

psychiatrists such as R. D. Laing and Thomas Szasz proposed that insanity was a natural response to the madness of contemporary life. But that question—“Am I the insane one, or is it society?”—diminishes the reality of mental disability and presumes the impossible: that the self can be divorced from the society that shapes it.

She had discovered that “real loneliness,” as Fromm-Reichmann writes, is “potentially a communicable experience, one which can be shared.”