Strangers to Ourselves

From The Wall Street Journal:

When Rachel Aviv was 6, she stopped eating. Psychiatrists diagnosed her with anorexia nervosa, a disorder typically brought on by reading magazines that present thinness as the ideal of femininity. But young Rachel was only just learning to read; she didn’t yet have a concept of ideal femininity. Her case was the earliest recorded onset of anorexia in America. During her hospitalization, she met other girls in the anorexia unit, including Hava, a 12-year-old whose circumstances mirrored her own. Both girls came from Jewish families (Rachel got the idea of fasting from Yom Kippur); had parents engaged in a long, hostile divorce; and heard derogatory jokes about obese people. But while Rachel soon began eating again and returned to normal life, Hava became a “career” anorexic—in and out of hospitals her entire life until her premature death in her early 40s.

Why do some people recover from mental illness and others don’t? Why doesn’t having insight into one’s condition provide a cure? By all accounts, Hava at 12 had excellent insight, precociously recorded in her journals; at 6, Rachel had none. In “Strangers to Ourselves: Unsettled Minds and the Stories That Make Us,” Ms. Aviv, now a staff writer for the New Yorker, draws on her own brush with mental illness to explore the limits of psychiatric frameworks for understanding minds in crisis.

The book unfolds in what are effectively case studies of subjects suffering from different disorders—depression, schizophrenia, psychosis—but these cases are not closed. They do not lend themselves to neat, scientific conclusions. Though the subjects come from different times and cultures, they all occupy what Ms. Aviv calls the “psychic hinterlands, the outer edges of human experience, where language tends to fail.” Ms. Aviv wanders out to these far reaches, reporting with deep empathy and nuance on a category of experience that, she acknowledges, she might not have recognized “if I hadn’t been there myself.”

The case of Ray Osheroff is notorious in psychiatric circles. In the late 1970s, Osheroff, a successful physician, was sent into a debilitating depression when his once-thriving dialysis company failed. Consumed by regret and thoughts of the parallel life in which “he could have been a great man,” Osheroff received psychoanalytic therapy at an institution called Chestnut Lodge. The ethos of Chestnut Lodge was that no cure was possible without self-knowledge—but self-knowledge did not cure Osheroff. It wasn’t until he left for another institution, which prescribed antidepressants, that he began to feel restored. In 1982, Osheroff sued Chestnut Lodge for negligence and malpractice. The case set up a conflict between two models of treatment—the psychoanalytic and the neurobiological.

In the end, though, medications failed Osheroff, too. In an unpublished memoir, he struggled to resolve the different theories of his illness. Which approach was correct? As Ms. Aviv writes, “he also sensed that any story that resolved his problems too completely was untrue, an evasion of the unknown.”

. . . .

In Minnesota, a young black mother named Naomi is terrified that her children’s lives will be blighted by racism. But her astute sociological observations bleed into psychosis. She believes she is being watched, and that the government is out to kill her children. During a July 4 celebration, she throws her 1-year-old twins off a bridge, then jumps, too, shouting, “Freedom!” Following Naomi’s years in prison for second-degree murder, Ms. Aviv examines the intersection of racism and mental illness, shining a light on the social forces that are often ignored in the treatment of black, brown and poor patients. “Mental-health institutions,” she writes, “were not designed to address the kind of ailments that arise from being marginalized or oppressed for generations.”

While Naomi is undertreated, a privileged white woman in Connecticut named Laura is overtreated. Diagnosed first with bipolar disorder, then later with borderline personality disorder, Laura is on 19 different medications over the course of 14 years until, suffering from emotional and sexual numbness, she decides to find out who she is without them. Her struggle, like the struggles of Osheroff, Bapu and Naomi, is not simply with mental illness but with narrative. “There are stories that save us, and stories that trap us,” Ms. Aviv writes, “and in the midst of an illness it can be very hard to know which is which.”

Link to the rest at The Wall Street Journal

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