Rachel Aviv was just six when she stopped eating and drinking. She is unable to recall why and her medical records paint an unclear picture, offering psychological assessments that might apply to almost anyone. Nevertheless, she found herself admitted to an anorexia unit, where she was denied contact with her family until she began eating again. After almost two weeks she managed breakfast, then lunch. Once her parents were allowed to visit “it was as if the spell had been broken”, she recounts.
Was she truly anorexic at such a young age? Now a staff writer at the New Yorker, Aviv has her doubts. Prior to being admitted to hospital, she had never encountered the word; to her child’s ears, it sounded like a species of dinosaur and yet seemed to hold such power, she was afraid to say it.
That early apprehension fuels a conviction at the heart of her first book, a subtle and penetrating investigation into how mental illness is diagnosed, and the ways in which the language used – far from neutral – moulds a patient’s innermost self, promising to explain who they are by weaving narratives that free and entrap.
Framed by Aviv’s personal experience, Strangers to Ourselves profiles five “unsettled minds”, each embedded in a different political and cultural moment. Among them is Naomi, a black single mother from Minnesota who was convicted of murder after jumping into the Mississippi with her infant twins, certain that racist killers were hunting her, and Hava, an older girl from the anorexia clinic whom Aviv came to idolise during her brief stay there and whose life would take a course at once sadly predictable and surprising.
Aviv is an instinctive storyteller and her book’s episodic, immersive format is underpinned by in-depth reporting as she tracks down those closest to her subjects. It drives home her view that “our illnesses are not just contained in our skull but are also made and sustained by our relationships and communities”.
Woven throughout is an intimate examination of the roles that injustice and inequality play in mental distress and of the evolution and limitations of modern psychiatric practice. When a charismatic physician named Ray sought help for his depression in 1979, for instance, psychoanalysis still held sway. Ray wound up suing an elite hospital famed for its commitment to the talking cure, triggering a legal showdown between two competing approaches to mental illness: the Freudian and the pharmaceutical.
Pills won and by the 1990s, depression was widely held to be the result of a chemical imbalance, a view that has only recently begun to be challenged. It certainly dominated when Harvard freshman Laura started feeling as if she were trapped in the life of a stranger and was diagnosed with a bipolar disorder. Her search for a cure led her to take 19 different kinds of medication over the course of 14 years. (While black women such as Naomi tend to be undermedicated for depression in America, white women, especially “ambitious” ones, are often overmedicated.)
As Aviv explains, it was the Ayurvedic use of the plant Rauwolfia serpentina that gave rise to antidepressants – a fact generally written out of the history of psychiatry – and it’s to India that she turns for another case study: a Brahmin housewife named Bapu who retreated from a toxic relationship with her in-laws into Hindu mysticism, embracing “madness” (Bapu’s own word) as a sign of devotion. Her family, meanwhile, had her diagnosed with schizophrenia.
Though they unfold in diverse eras and cultures, these stories share a setting, Aviv observes: “The psychic hinterlands, the outer edges of human experience, where language tends to fail.” That hasn’t stopped her subjects from trying to find the right words and she’s been able to draw on their letters and unpublished memoirs, their blogs and poetry.
Her own language is meticulous, empathic, tirelessly inquisitive. Despite – or perhaps because of – her rigour, she also dares to acknowledge facets of identity that elude any theories of the mind currently available to us and to engage with profound mystery in the form of hauntings and religious mysticism.
Into this unexplained category falls an eerie voice she heard in hospital as a six-year-old. “I sometimes think of that voice as a potential entry into a different realm of experience, an alternative path that for reasons I don’t fully understand I never took,” she says. It’s this glimpse of a path untaken that infuses her approach to mental illness with such humility and kinship and her complex, illuminating book is all the stronger for it.
Strangers to Ourselves: Stories of Unsettled Minds by Rachel Aviv is published by Harvill Secker (£18.99). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply
