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

by Rachel Aviv

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.”

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.

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

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

The divide between the psychic hinterlands and a setting we might call normal is permeable, a fact that I find both haunting and promising. It’s startling to realize how narrowly we avoid, or miss, living radically different lives.

“The act of making love,” he wrote, “was not so much sexual or biological, but it was an act of defiance, a reaching out, a groping, a grabbing back of our humanness.”

“extremely Northern perspective about the enlightened native”—a modern reprise of the colonial myth that those who haven’t been exposed to civilization are innocent and happy.

Black Americans are systematically undertreated for pain, as compared to white patients,

“It is woven into the fabric of this country that Black women’s role is to do the work, to do the suffering, so why would we—the mainstream mental-health field—be chasing them down and asking, ‘Can I treat you for your sadness?’”

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.

‘How am I going to get help for my problems?’ Nobody will know about your problems if you don’t speak up.”

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.

“Prisons don’t disappear problems, they disappear human beings.”

interviewed fifty-one women about their experiences in segregation—a project she sent to state policymakers. She concluded that, “regardless of age, race, or sexual orientation, the common denominator was not a tendency for violence, but a history of trauma.”

“All these years Naomi had been asking for help—she was willing to do whatever the psychologist told her to do to get well, and that didn’t seem to mean anything,” Smith said. “It was really hard not to say, ‘Yeah, it’s because you’re Black.’ That was in the back of my mind, because I follow the news. I see white women commit crimes, and I notice that they’re not coming to meet me in prison—they’re going other places.”

In her writing about injustice, Miranda Fricker reflects on the ways that “epistemic goods” (like education or access to expert guidance) are unfairly distributed. Some, like Naomi, receive too little, whereas others, like Laura, perhaps receive too much.

The Anatomy of an Epidemic, written by Robert Whitaker,

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.

they are told that, basically, there is something wrong with their brain, and it isn’t temporary—and it changes their sense of resilience and the way they present themselves to others.”

raise the idea of going off her drugs. In fourteen years, she had taken nineteen different medications. “I never had a baseline sense of myself, of who I am, of what my capacities are,”

“It is relatively simple to determine when to start treatment,” he wrote, “but much more difficult to know when to stop.”

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.”

Peter Kramer, the author of Listening to Prozac, told me that the SSRIs were “eerily consonant with what the culture required of women: less fragility, more juggling outside of the home.”

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.

“I’m sitting in front of you and I’m off all these drugs, and I’ve never felt more vibrant and alive and capable, and yet I had this serious mental illness. How do you make sense of that?”

The field has neglected questions about how to take people off drugs—a practice known as “deprescribing.

“Seeing how poorly patients fared when they were cautious and inhibited, and how the same people flourished once medication had made them assertive and flexible, I developed a strong impression of how our culture favors one interpersonal style over another.”

In Listening to Prozac, Kramer asks whether some people might feel pressure to take medications, as they watch their colleagues and friends take the drugs and become, in a social and emotional sense, upwardly mobile.

Hava was discharged from the Hawthorn Center because she had exceeded her insurance cap for inpatient mental-health care.

She kept in touch with friends from previous hospital stays, and she was troubled to realize that “each person that was doing well was attributing their newfound life to God.” They were able to move on, it seemed, because they had reoriented their lives around a new story.

They described their psychological experiences with deep self-awareness, but they also needed others to confirm whether what they were feeling was real.

Despite her deep knowledge about her illness, she still felt unknown. “I suppose I am one of those people that thoroughly understands myself yet am a stranger to myself,”