Rachel Aviv Challenges Mental Health Stereotypes in New Book

The award-winning writer for “The New Yorker” discusses her new book.

By Dina Gachman

What if the story of your life, as you see it, veers wildly from the narrative placed upon you by others — by society, institutions, family members, or psychiatrists? That question propels each chapter in award-winning New Yorker staff writer Rachel Aviv’s first book, Strangers to Ourselves: Unsettled Minds and the Stories That Make Us. Through a mix of narrative reporting, personal journals, and psychiatric records, each chapter illuminates the struggles of a different person existing in what Aviv calls “the psychic hinterlands, the outer edges of human experience, where language tends to fail.”

There’s Ray, a renowned physician who fought to discredit the psychiatric institution that treated him for depression, and who spent years writing an unpublished memoir about his life. Bapu is a wife and mother in India who leaves her family to pursue what she believes to be a mystical quest. Naomi, a Black woman in America, leaps into the Mississippi River from Saint Paul’s Wabasha Street Bridge on the Fourth of July with her 14-month-old twins because she believes government operatives are after her family. And after years of succumbing to the pressures of upper-class Connecticut society, Laura, a Harvard student who was “excellent at everything,” eventually quits the psychiatric medications she’s relied upon, because after so many years of being treated for mental illness, she feels she doesn’t know who she is. And then there’s Hava, a young woman who has struggled her entire life with eating disorders and mental distress, and who becomes a sort of upside-down reflection of the author herself.

With Strangers to Ourselves, Aviv weaves her own story into the narrative, giving us a glimpse into the time she spent in a psychiatric institution, at the age of 6, for an eating disorder. That’s where she met Hava. For years, the experience left Aviv wondering how two people, diagnosed with the same disorder, could continue through life on such different paths. Aviv’s childhood experience inside that institution informs her understanding of mental illness, selfhood, and the stories we tell ourselves to make sense of who we are. This isn’t just her story, though. It’s the story of Ray, Bapu, Naomi, Laura, Hava, and the millions of others existing in “the psychic hinterlands.”

Known for bringing empathy and an uncanny depth of perception to her reporting on those who exist in the margins, Aviv shines a light on stories of abuse, neglect, mental disorders, and social injustice. She helps readers understand the complex humanity of people who may otherwise be dismissed, seeing past labels and preconceptions so we can connect on a deeper level.

Aviv spoke to Shondaland about the challenges of reporting on sensitive topics, her thoughts about modern psychiatry, and the stories we tell ourselves to make sense of who we are.

DINA GACHMAN: Your writing, whether it’s this book or any of your New Yorker pieces, never makes it feel like you’re trying to teach a lesson or guide the reader too much in any one direction. Do you consciously work to not let your personal opinion propel the narrative?

RACHEL AVIV: If anything, I have to consciously work to do the opposite, which is to make an argument. What I really want to do is lay out facts and observations in such a way that I feel like a reader can have a certain impressionistic understanding of the way I’m seeing it, but I still want there to be something that the reader is sort of struggling with. I want to leave it as if a reader feels like he or she has been the one to reach a conclusion, and not that I have sort of fed them a conclusion. I feel like readers have their own life experience that they can map onto whatever I am saying.

DG: You’ve been reporting on mental health for several years, but when did you first think about going deeper into the topic and writing this book?

RA: A long time ago, I wrote a story about people in the early stages of psychosis, back in 2012, and even then I felt like this was the subject that was most important to me. One of the reasons why is because so many of the people I had interviewed at that time were like, “I don’t know how to describe my experiences. I can’t actually put it into words, and the fact that I can’t put it into words makes me feel like maybe none of this ever happened to me.” It felt so slippery to them, and that idea was something I [was] really attached to thinking about. There was a time that I wrote about children in Sweden, which I touch on in the introduction, and that was when I first started thinking about my own story. I identified so much with those children in Sweden, yet they were in such a different cultural and political context. That’s when I started thinking about how a social context can really reinforce one’s story in such a way that it really shapes your health.

DG: You don’t typically bring your own life experience into the narrative, so how was it writing about yourself in this book and telling the story of your own childhood experience in an institution? 

RA: I think because I was 6, I was almost able to approach it like it was a different person. I feel so curious about that 6-year-old, and I feel like I have so little contact with her that I can approach it in a different way. I did have these memories, but so much of it was about interviewing my family and using records and journals and things like that. So, even though it’s personal, it didn’t feel as personal because I felt like I was writing about a 6-year-old who is an exotic creature.

DG: Was it always this group of people — Ray, Bapu, and the others — whom you intended to write about in the book, or were there others?

RA: Originally, I always knew I wanted to write about Bapu because I had come across her story many years earlier. I thought about writing about her daughter’s organization [Bapu Trust for Research on Mind & Discourse] for The New Yorker, and I realized what I was really interested in was this family story, which wasn’t anything that had news value. And then, there was a man I really wanted to write about. I spent more than a year corresponding with him, and I met with him. He was maybe the reason why I wanted to write the book, because his experiences kind of taught me so much, but he was schizophrenic and didn’t feel comfortable with the idea, and it took him a long time to get to the space of realizing that. I felt like my conversations with him really shaped the book, even though he’s not present. 

DG: Speaking of Bapu and her daughter, the stories in the book are about individuals and their struggles with mental disorders, but all of them show the ways these experiences impact not just a single person but also children, relatives, and future generations. Ray’s story is the same, the way his illness impacted his sons, and Naomi, who was convicted of second-degree murder when one of her twins didn’t survive her jump off that bridge. Was that sense of the generational impact of mental disorders there from the beginning?

RA: In general, I came into the book thinking I was writing individual stories, and then I realized that’s sort of impossible, that they were all family stories and that a person’s illness can filter down for generations.

DG: You show so much empathy for the people you write about, regardless of their circumstances or actions. Do your personal feelings about someone you’re interviewing ever get in the way of the story you’re telling?

RA: With Ray’s story, I really struggled because I just didn’t like him. But I felt like his life very clearly showed these two dominant methods of understanding the self and how they’re sort of pitted against each other. I thought Chestnut Lodge [where Ray was treated] was such a beautiful place on some level that started with incredible ideals about the way to heal is to listen, and then had really lost its way. I found the story of the institution really compelling. But Ray was hard for me because I understood why his therapists reacted to him the way they did, and it did raise these questions of pathology versus personality.

DG: How did you get past that with Ray?

RA: I was so sympathetic to the fact that Ray was trying to write his story. That impulse was very endearing to me, so I tried to focus on these desperate attempts that he was making to make sense of it. It was hard for me to remind myself that he was a person who was struggling, because his behavior was often like some arrogant guy that we all know.

DG: I had a similar reaction to one of Bapu’s psychiatrists, Peter Fernandez, who just sounded so callous when he was talking about treating patients with electroconvulsive therapy, and whose cultural biases seemed so at odds with a person who should be trying to understand other people. What was your experience like speaking with him?

RA: First, I was amazed that I was able to find him, and that he was willing to talk, and that he did have some memories. He was just sort of delightful. He was so proud of the work he did. He was a pioneering psychiatrist. He may have been in his late 80s or 90s, so you sort of forgive him for being of a different era. What he said was kind of violent; it was completely objectifying and dehumanizing. But on a personal level, he was a charming man, and he had no shame because I don’t think he actually understood that what he did was wrong or harmful.

DG: What did you take from Bapu’s story? She was this woman kind of thrust into marriage and motherhood who was searching for meaning even though she obviously had serious mental health issues. Did your sense of her story change as you got deeper into telling it?

RA: I came into that story thinking it would be about Western psychiatrists foisting this explanatory model on this family, and sort of ruining the meaning that she found through her mystical community and readings. But I think that there was another story she was being offered, and that was that she was a mystic, and that also shaped her identity in ways that took her away from her family. I almost think it was the rigidity of these ideas about what her sickness was and how it would shape her life that alienated her from her family. So, when she found a psychiatrist who told the family, like, talk to her and sort of integrate these other experiences with her life, she didn’t feel like she was being judged or told she was crazy. She was also able to maintain contact with these things that had a lot of meaning in her life. Her daughter expressed it well to me, like, you can’t deny that she was disabled in some fundamental way, if she was hungry and living on the streets and unable to be with her family, but you also can’t deny that she had this beautiful relationship with poetry and the gods that gave her life meaning. It was sort of a balance between the two, and it was when she could maintain both, that was when she felt most well.

“I hope that they will read it not as something that is against psychiatry because I don’t feel that way at all. I guess I feel like psychiatry shouldn’t swoop in with hubris and think it has all the answers…” Photo Courtesy of Rachel Aviv

DG: The next chapter follows Naomi, another mother struggling with the divide between her impulse to care for her children and her increasingly fraught mental health issues. You write that you were drawn to Naomi’s story because you’d learned about a woman who grew up in the same housing development Naomi once lived in, and both women ended up being convicted of the same crime, killing one of their children. 

RA: Because I had been in the space of thinking about Bapu, that felt kind of supernatural to me, like how is it that these two women committed the same unthinkable crime? It was also the way [Naomi] talked about her experience. Naomi spoke with a level of detail and nuance that made me drawn to her. I think I was drawn to the fact that she, like Bapu, had this other way of explaining why she was having this crisis. For her, it was about racism and injustice. Again, she felt alienated by the idea that you could just throw out that explanation and say that she was mentally ill.

DG: Your book isn’t against psychiatry, but it does suggest that psychiatric diagnoses like bipolar or schizophrenia might not be the whole story when it comes to someone with mental health disorders, and that it’s crucial to account for social and cultural forces at play as well. Do you worry at all that you might get pushback from the psychiatric community?

RA: I hope that they will read it not as something that is against psychiatry because I don’t feel that way at all. I guess I feel like psychiatry shouldn’t swoop in with hubris and think it has all the answers, but I do think a lot of people like Naomi really found healing from psychiatry and taking medications, and that was a necessary part of her recovery. Ray’s story shows the dangers of ignoring psychiatric medication. So, I’m hoping that it’s not read that way, but that’s one of the interpretations I fear is that people will think it’s criticizing the field itself, as opposed to the way the field is often used as the only explanation.

DG: The book ends with the story of Hava, the young girl you met at the institution as a child when you were both being treated for eating disorders. Did you always know you wanted to sort of bookend the story with her? Was she someone you’d always thought about even though you lost touch?

RA: She in my mind was this mythical, beautiful child, and my family had always talked about her over the years. My mom was always very intrigued by her. I don’t know why she was like a presence in our family. The way I learned about her dying was just so shocking to me, and the more that I learned about her, the more I was struck by how parallel our life stories were. We just had a lot of random similarities in terms of our family upbringings. I know that in my psychiatric records there was this expectation that I would do very poorly in later life, so it was that that struck me so much — you have these two girls who are very similar, and part of me wondered, did I do better because I had it when I was younger, and it was sort of a developmental phase, and I moved on? If I had gotten it later on, would it have stuck? The fact that you can have two people who are so similar and their lives go in such different directions, that felt like an important question. There was this quote that someone at Chestnut Lodge said, something like, until you know why people stay sick, you have no right to call them chronic. That question felt relevant. Why was one chronic and another a blip?

DG: How does the book release feel compared to putting a New Yorker piece out into the world?

RA: It feels like more of me, or putting yourself out there for judging, whereas with a piece, it’s like a contained item. This feels like more of an expression of my preoccupations for my adult life and childhood, so that feels more personal.

DG: You started out at The Village Voice. Do you ever look back at your early writing and think about the ways you’ve changed or the ways your writing has changed and evolved?

RA: I think about the writing I did before I became a parent versus after I became a parent. I feel like there are pieces where I feel like I missed important questions I should have asked, or I failed to understand certain dynamics. The piece I think about most in this realm is I wrote about a woman whose son was taken from her because she left him home alone. She was a single mother, and child protective services came in. I think about that piece a lot because I have an appreciation for how hard it would have been to be a single mother in a way that I just did not at the time. Almost like if I had been a smarter, wiser person, I would have asked different sorts of questions.


Image: Shondaland Staff