THE SUNDAY REVIEW | STRANGERS TO OURSELVES – RACHEL AVIV

Unlike many early readers of this book, I hadn’t heard of Rachel Aviv, who is a writer for The New Yorker. This book is her first, and it traces her own experiences as, at that time, the youngest child to ever be diagnosed with anorexia (she was six). From this she moves on to the stories of a variety of other patients who are dealing with mental illnesses – from different backgrounds, in different parts of the world, and with different issues – and describes their experiences and all the information she can glean about their treatment, including what helped and what didn’t. It is, in essence, a collection of small biographies told through the lens of mental illness.

I’ll talk about the things that worked about this book first. I liked that the author did a lot of research about each of the people whose stories she presents, and that she uses their own words to describe particularly poignant observations and insights into their illnesses and experiences. I liked that she looked at people whose circumstances differ – a wealthy and successful white man who goes to a private clinic; a Black woman who is bounced out of hospital quickly several times due to lack of insurance coverage, only to suffer a psychotic break; a woman in India who is by turns shunned and revered as having divine inspiration; and a high-achieving woman and Harvard alum who has been suffering from bipolar disorder her entire adult life, and who has taken more than nineteen different medications with varying results. She also includes her memories of her time in an eating disorder ward in hospital at the age of six, which was a hard account to read.

She also shrewdly ties in larger contexts to both mental illness and treatment – the time of treatment and medical thinking at that time, how people from different racial backgrounds take different views of mental illness diagnoses (for white people a diagnosis of, say, bipolar disorder may be a relief as it then alleviates self-blame, whereas such a diagnosis for a Black patient may serve only to push blame away from the larger societal issues that often contribute to or cause their mental health problems in the first place), cultural beliefs and practices and how support from a community can affect outcomes. I liked the questions she raised with these pieces of information and the intersectionality that is acknowledged by looking at concurrent pressures.

I had a bit of a hard time connecting to this book, however. While I liked the research and how she wove in the patients’ own words, it did sometimes feel like it didn’t flow as well because of it, and read a bit more like a research paper than a cohesive narrative work. There’s nothing wrong with that, but it did make it harder for me to feel any sense of emotional tie to the patients. Some were more sympathetic than others, but even the more sympathetic ones I felt removed from, and the stories lacked a sense of immediacy – perhaps trying to work in so many quotes both from patients and experts made it harder to focus on making sure the stories were engaging and emotionally impactful. It’s hard for me to figure out how to put this, because it should have worked, and I’m not entirely sure why it didn’t quite land for me.

I also felt that, while the book is looking at mental health issues, it lacked any other cohesive element to draw these particular stories together. They’re dealing with different mental health issues, in different parts of the world, in different time periods and different circumstances. I wanted more of a structure surrounding the stories to really pull them together – maybe sections that had more, shorter stories that gave insight into one overarching theme (like a section on the origins of medication for mental health issues, another on how mental health issues are viewed and treated in a few different parts of the world, a section on race and mental health, and another on maternal mental health, etc.). Because there wasn’t a solid unifying theme, it felt a bit fragmentary, as it would jump from one patient to another without much in the way of a transition or connection. I kept asking: why these stories? Why these experiences? Why this one after the last one? Am I missing something that draws these stories into one book?

I didn’t think this book was perfect, but the issues I had were largely structural and to do with the style of writing. I think this might come down to my personal preferences, and the fact that when I’m reading non-fiction books that are about topics like this one, I look for an emotional connection, and I just didn’t really find one here. That said, there have been a lot of rave reviews about this book, and a lot of people found it to be a brilliant portrayal and examination of mental illness. So I think it’s all about what you’re looking for when you go into it, and what you need to get out of it.

Despite the aspects that didn’t work for me, I do think there is a lot of value in this book. The discussion of the complexities of mental health issues is such an important topic in helping to remove stigma from those suffering from mental illness. I think it will also be an incredibly valuable reading experience for both those suffering from any of the mental health issues discussed herein, or those in their lives who are seeking to understand their diagnosis better. It doesn’t romanticize mental illness, but neither does it demonize it. It accurately shows that the causes of a particular mental health issue are not singular, and often require a particular confluence of factors to materialize. It shows how people with mental illness can manage their condition and life a full life – even if it is one they will have to deal with permanently. So for these things, I commend Aviv for her efforts in creating this book, and I think it’s a very important addition to the topic. I’d highly recommend it to anyone who is seeking information on the topic, and, of course, any fans of Aviv’s work.

In Strangers to Ourselves, a powerful and gripping debut, Rachel Aviv raises fundamental questions about how we understand ourselves in periods of crisis and distress. Drawing on deep, original reporting as well as unpublished journals and memoirs, Aviv writes about people who have come up against the limits of psychiatric explanations for who they are. She follows an Indian woman, celebrated as a saint, who lives in healing temples in Kerala; an incarcerated mother vying for her children’s forgiveness after recovering from psychosis; a man who devotes his life to seeking revenge upon his psychoanalysts; and an affluent young woman who, after a decade of defining herself through her diagnosis, decides to go off her meds because she doesn’t know who she is without them. Animated by a profound sense of empathy, Aviv’s exploration is refracted through her own account of living in a hospital ward at the age of six and meeting a fellow patient with whom her life runs parallel―until it no longer does.

Aviv asks how the stories we tell about mental disorders shape their course in our lives. Challenging the way we understand and talk about illness, her account is a testament to the porousness and resilience of the mind. – Goodreads

**Thanks to Flatiron Books and Macmillan Audio (via Netgalley) for providing an ARC of this book in exchange for an honest review!**

Book Title: Strangers to Ourselves
Author: Rachel Aviv
Series: No
Edition: Audiobook
Published By: Farrar, Straus and Giroux/Macmillan Audio (via Netgalley)
Released: September 13, 2022
Genre: Non-Fiction, History, Mental Health, Medical 
Pages: 288
Date Read: September 16-19, 2022
Rating: 7/10
Average Goodreads Rating: 4.21/5 (102 ratings)