We are honoured and delighted to inaugurate our new ‘Author Interviews’ series by speaking with the acclaimed New Yorker writer, Rachel Aviv, about her new book, Strangers to Ourselves: Unsettled Minds and the Stories That Make Us.” The book has received a flurry of accolades; it was selected as one of the top ten books of 2022 by The New York Times Book Review, The Wall Street Journal, and New York magazine, and is a finalist for the National Books Critics Circle Award.

Strangers to Ourselves, Aviv notes at the outset, “is about people … whose lives unfold in different eras and cultures, but they also share a setting: the psychic hinterlands, the outer edges of human experience, where language tends to fail.” Bapu, a mother of two living in India, rejects her mental illness diagnosis and goes on to live as a mystic in Kerala; Ray, a physician afflicted by depression, seeks revenge on his psychoanalysts for having failed to cure him; Naomi, an African American woman incarcerated for infanticide, tries to make sense of life and love while recovering from psychosis; and Laura, a wealthy young woman who has spent her entire adult life on psychiatric medications, embarks on a quest to reclaim her identity. Then there’s Rachel, a six-year-old girl diagnosed with anorexia, who makes a brief appearance in the prologue and epilogue. Each chapter of the book is devoted to one of these subjects. To enter their universe is to witness the limits of psychiatry’s imagined script: show me your diagnosis and I will tell you who you are.

Aviv shows early on, and convincingly so, the ways in which psychiatry has been clothed in the language of morality: there are good patients and bad patients, ones who are lucid and others lacking in “insight,” credible and incredible witnesses. Hers is a compelling case against facile explanations. “I wonder if those of us who write about mental illness have too often taken our cues from psychiatry,” she writes. As a framework, psychiatry “may … estrange us from the many scales of understanding required, especially in periods of illness or crisis, to maintain a continuous sense of self.” The stories it tells, in other words, may make us or break us. In any case, they are always incomplete.

Strangers to Ourselves invites profound and profoundly important questions about the status of the patient in contemporary psychiatric care; the uneasy tensions between labelling and identity; the boundaries separating official from unofficial forms of discourse; and the possibilities that can come from not knowing.

Interviewed by Alexandra Bacopoulos-Viau

[ABV] There’s something haunting in your book about your presence as both a patient and a narrator. Could you tell me about this experience of weaving yourself into the story? How is it different from writing about someone else? Did you discover or rediscover yourself as a subject in the process?

[RA] I’m not sure if I ever really thought of myself explicitly as a subject. I think it was more that I had certain questions that I could only explain by making reference to how I got to the place of formulating those questions. That question began with a story I wrote for The New Yorker about children in Sweden who were diagnosed with what was called, “resignation syndrome”: when they were denied asylum they took to their beds and stopped eating and talking and sometimes even moving. At that time, I read a lot of work by Ian Hacking, who had also attempted to analyze what was happening with these children in Sweden. He proposed that, once the children were diagnosed with “resignation syndrome,” their behavior was reinforced. There was what he called a “looping effect.” Not consciously, they conformed their behavior to better fit the way it had been classified. The idea of a circular interactive process—the diagnosis altering the thing diagnosed—really resonated with me, because at the age of six I had been diagnosed with anorexia, a word I had never even heard of, and for a period of time the diagnosis changed my behavior and understanding of myself. The retelling of my own experience as a six-year-old felt like a way of walking the reader through the process I had gone in terms of thinking about the relationship between self/identity/behavior and the way it is diagnosed.

One element that brings together your protagonists, you note, is that they’ve all left textual traces—journals, poems, memoirs. Yet there remain gaps—there are always gaps—in the archives, in the fragmented sources to which you had access in researching this book. What would you say are the challenges of constructing a narrative when there are some protagonists whom you met only through their writing? And could you tell me, more generally, about these gaps and silences you encountered (archival or otherwise)? How did they affect your storytelling process?

I met Naomi and Laura in person—I was able to talk to them for an extended period of time. With Bapu, I never met her, but in a way, it felt like that chapter was as much about her family as it was about her, so her journals and poetry offered one way of portraying her concerns and aspirations and struggles, but I was also able to see her from the perspective of her two children, who were always kind of chasing after her, trying to understand her on their own terms.

As for silences, I was really sad that I wasn’t able to get medical records of my entire stay at the hospital—I imagine there would have been a thousand or so pages—but the records had just been destroyed. I had missed the window of time before the hospital shreds records. I ended up being able to gather some medical records from different sources—for instance, a psychologist who had evaluated my family to make a custody recommendation, or files that my parents had kept. And I tried to make up for missing gaps by interviewing my psychiatrists from that time and family members. But I also tried to console myself with the thought that I wasn’t actually setting out to tell the story of the hospitalization anyway. I was just trying to tell the story of how I reached the point of having the question which would frame the book. And in that sense I had to be careful about not including a detail just because it was funny or something. When it came to myself, I wanted to tell a story that was inquiry-based as opposed to narrative-based.

And this is what I like so much about your book, that it opens up questions more than it attempts to answer them.

Yeah, I just wanted to be very disciplined because just because this weird thing happened to me, it doesn’t make it interesting or relevant. I kind of felt like it was interesting because it had led me to a place of seeing connections between people in very disparate psychological situations. But the center of it was this interactive dynamic between the way that experts understand and describe an illness and the way that a person may either internalize it (or, conversely, reject it)—and what that means for both the course of the illness and for people’s understanding of who they are and who they can be.

I’m reminded here of a line in the Bapu case where her daughter, Bhargavi, observes that “[t]he lives of the mentally ill have been erased from the public record, but in the writing of history and personal stories, we make ourselves present.”

I love Bhargavi’s work. She’s an amazing advocate and writer, and her interests parallel mine in a lot of ways, because she really emphasizes the importance of finding ordinary, everyday language for people with mental illness to communicate what they’re going through. And I think she sees her mother’s experience as really complicated by the fact that she was having what she felt to be a profound mystical experience—one that her community more or less endorsed—and then it was overlaid by foreign medical terminology that she found shameful and diminishing and alienating. It seemed as if a new identity was being imposed on her from afar, suddenly and with force.

One of the goals of this book, it seems to me, is to restore a sense of humanity to your protagonists—to say something about the singularity of their experience.

Yeah. And to not assume that one explanation will make their lives coherent. I think for Bapu, there were multiple explanations that gave her struggle and suffering a sense of meaning. The medical explanation had its purpose too. But the explanations were not mutually exclusive.

In this vein, yours is a much more nuanced take than the so-called critical psychiatry approach. Has the process of researching and writing this book changed your relationship with some of the key figures/concepts of these movements (Szasz, Foucault, Goffman, Fanon)? Did it bring new light onto something you thought you knew before, or allow you to think through these ideas differently?

I think there was definitely an evolution. An early version of one of the chapters was published in The New Yorker—it was about Laura Delano and the process of withdrawing from psychiatric medications. I had written an early version, and then I came back to it in the book—it was the last chapter I worked on before finishing it—and I think I did feel more critical of the impulse to demonize medications, or to romanticize the idea of a pure self, free of medications. I felt more aware of the similarity between, on the one hand, this very pro-psychiatry approach, where the answer is always medications, versus the anti-psychiatry approach, which, in its most extreme form, can feel like reductive, too: i.e., if you stop taking your medications, if you get in touch with your authentic self, you’ll always feel better. Both approaches have the potential to flatten the complexities of mental illness.

I’m reminded here of The New Yorker piece on the trauma plot, which we talked about recently. The author, Parul Sehgal, interrogates the recent proliferation of memoirs and trauma testimonies which have come to dominate the cultural imagination by claiming that all of it has become fairly reductive; that “the conventional trauma story” has effectively turned into an “unimaginative cultural script.” It’s an interesting and quite important piece, isn’t it?

It’s so good, and I love what she said—“I hear my detractors, I hear that they’re saying that the reason these stories feel repetitive is because trauma makes you repetitive.” She anticipated that interesting objection but goes on to argue that, to see every trouble in terms of someone’s backstory of trauma, is actually to diminish other forms of experience and pain. I think the essay makes the case for using a wider lens—there are multiple, interlocking explanations as opposed to a single one.

What about the language used by Mad activists and similar activist movements? In calling for the depathologization of mental health conditions, the demedicalization of mental healthcare, and the reduction of stigma around psychiatric diagnoses, these movements tend to draw parallels between mental health users/survivors and other historically oppressed populations—the gay rights movement, the disability rights movement. This, some might argue, has the potential to slip into a certain victimisation narrative. What are your thoughts on that?

I felt like to some degree Bapu’s children were asking that same question, or embodying it. Her son understood her odd, avoidant behavior as a sign of her mystical calling. He understood that she was working within a cultural tradition in India, and she was gifted. To him, this was her chosen identity. Her daughter, Bhargavi, recognized that her mother had these moments of radiance, where she was really accessing the divine and writing about it beautifully in her poetry, but she also said: when you see someone famished, covered in scabs and wounds, her body wilting because of lack of food and nourishment—that is real disability. And to deny that is also to deny someone’s reality. And their pain and their needs.

Has anything about the book’s reception surprised you?

I think… [pause] I’m always surprised when—I’m always really glad when people have very personal responses to it, when it gives them a certain framework for seeing something that had been present in their lives but not entirely visible. So, I don’t know if it’s a surprise, but it is what I had hoped.

There hasn’t been, it seems, any reductive reading of the book—anyone claiming that it’s critical of psychiatry or anything like that.

Yeah, that was my fear. I was pretty aware of that fear as I was writing the book, because I felt like that would be an easy place to slot the book in if you weren’t paying that much attention.

Is there any question that you wish people asked you about the book, but haven’t?

Hmm, no! [laughs]

I mean, honestly, I find it easier to talk about writing than I do to talk about mental health, because I feel very aware that I am not an authority. I wanted to present these worlds and these questions. And I think, in interviews, there’s a desire to have someone give you the answers. That’s been something that I’m aware of; people wanting me to give mental health policy recommendations and it’s not the space that I’m coming from.

But this is perhaps the meaning of you including your own story into the book; you’re not writing from the point of view of an expert. Other than, I suppose, an “expert by experience.” I think it positions you as someone who’s really just interested in writing their story and writing other people’s stories.

I thought a lot about a metaphor that my editor had shared early on: he said he thought of the book like a prism. If you look at the same set of questions from different angles, the answer may change. I wanted the book to capture that ambiguity. So that when it comes to interviews, I sometimes worry that I’m supposed to be giving a non-prismatic answer, and that I therefore disappoint!

Well, you’ve certainly given us lots to think about. Many thanks, Rachel, for this conversation, and congratulations on the success of your book! We look forward to hearing about your new projects.