What We Really Know About Mental Illness: Why Isn’t Everyone Taking Mental Health Seriously?

Rachel Aviv’s unflinching and personal new book, Strangers to Ourselves, rejects pat answers in favour of penetrating questions.

BECAUSE RACHEL At the age of 6, AVIV stopped taking any food. Not long after, she was hospitalised for treatment of her anorexia. The medical staff was at a loss for explanations. Nobody had ever heard of such a young infant suffering from the disease before, but here she was. What prompted this behaviour, if any? Culture of diets? Natural austerity? There were unanswered questions about the incident. Although Aviv recovered completely and very quickly, she has maintained a lifelong fascination with the thresholds between health and illness.

Aviv questions in her new book if she suffered from anorexia or if the episode was pathologized too quickly to explain her behaviour. In contrast to the older, more introspective females she lived with in treatment, she was able to overcome her disordered eating and move on with her life without viewing it as a permanent part of who she was. Instead, anorexia became the central part of their identity. Aviv writes, “I wonder how much the tales we tell about them, especially at the beginning, affect their trajectory.” “Mental diseases are generally perceived as chronic and intractable entities that take over our lives,” Aviv writes. “These tales can both liberate and imprison their listeners.”

Aviv is the person to ask about the significance of tales. She has established herself as a leading contributor to The New Yorker by delving into ethically ambiguous situations and emerging with compelling stories. (Please read her research on the overreach of the child welfare system.) Even so, Strangers to Ourselves stubbornly avoids coming off as conclusive. A sense of ambiguity is emphasised instead. The book’s four sections each feature a different individual with particular psychological problems. (Both the prologue and the epilogue focus on Aviv and his life.)

Among these people are Ray, a dermatologist who sues a fancy mental institution for not giving him antidepressants; Bapu, a Hindu mystic whose family has her institutionalised for schizophrenia; and Naomi, a single mother who is incarcerated after attempting suicide by jumping off a bridge with her two sons, one of whom was fatally injured. They are all in extremely precarious situations, with little in common other than their fear and confusion.

According to Aviv, there is no way to create a comprehensive theory of the mind. Because the reality of mental illness being caused by an interaction of biological, genetic, psychological, and environmental variables is more difficult to understand, the chemical imbalance theory, which became popular in the 1990s, has persisted for so long, as she puts it. In Strangers to Ourselves, we take a look into this void of understanding, exploring what occurs when there is no simple narrative to explain the mental processes at play when both Freud and medicines fall short.

The final chapter “Laura” serves as a sophisticated but ultimately unsatisfying examination of modern psychiatry. Blue blood from Connecticut An early diagnosis of bipolar disorder and the use of psychiatric treatment were both positive developments in Laura Delano’s life. She was a great achiever who went to Harvard, but she had ongoing mental health issues. She was in her early twenties and extensively medicated after surviving a suicide attempt. Eventually, she stopped taking hers altogether.

Despite experiencing severe withdrawal symptoms as she weaned herself off medicines, she preferred her life without medication. She joined online communities opposed to psychiatric medications and eventually began writing for one of the most-read blogs of its kind. Aviv explains that she came across Laura’s essay when she was contemplating her relationship with psychopharmaceuticals; she has been taking Lexapro for a long time and was wondering if she might ever stop. Aviv does not fully agree with the anti-psychiatry movement, but she does acknowledge and appreciate Laura’s perspective. She accepts her need for antianxiety medicine to maintain mental health, despite doctors’ lack of understanding of the drug’s mechanism of action. But she is concerned about how labels restrict people’s potential and self-awareness.


With this in mind, Strangers to Ourselves is a timely read. This summer, researchers reviewed the literature on depression and found no clear connection to an imbalance in the mood-regulating chemical serotonin. Depression can no longer be explained by a “chemical imbalance,” as The Guardian put it. There is growing scepticism about the biological paradigm as a means of explaining mental health issues. Therefore, Aviv’s eloquent writing on the importance of taking into account a person’s holistic makeup rather than just their brain chemistry is appropriate, if not very original. As part of the increasing body of recent nonfiction, Strangers to Ourselves adds to the confusion surrounding the human mind.

Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness, written by medical historian Ann Harrington and published in 2019, is an often eye-opening tour of the evolution of psychiatry from the Freudian to the biological model, illuminating the perennial difficulties of the chemical imbalance theory. The Sleeping Beauties: And Other Stories of Mystery Illness, written by neurosurgeon Suzanne O’Sullivan in 2021, explores culturally specific syndromes and psychogenic illnesses to show how profoundly our circumstances and experiences may affect the way our bodies and minds operate. The compelling case studies that makeup Strangers to Ourselves add interesting anecdotes to the discussion of the mind’s mysterious workings.

Aviv states early on that the book’s episodic structure, rather than a single overarching narrative, was chosen so that she could highlight the wide range of human emotional and psychological experiences, their essential multiplicity, and the importance of placing them in their proper perspective. There is no single, correct story, and this can only be demonstrated through a series of stories. The author argues that the “answers continually alter” when the same questions are seen from various perspectives.

It’s like hearing someone remark, “all music is good… depending on a person’s taste,” which is both truthful and frustratingly equivocal. You’re right, but so what? Each story in Strangers to Ourselves stands on its own as an example of Aviv’s usual high quality in his magazine journalism; they are vividly portrayed, introspective portraits that easily transition into meditative reflections on life. However, when taken together, they form a collective shrug. As I put the book down, I pondered whether or not it would have made more of an impression if it had been published in instalments, perhaps in a magazine, rather than as a cohesive whole that impedes understanding.

 Why Isn’t Everyone Taking Mental Health Seriously?

A well-written, honest whimper is preferable to a blustery bang any day. The blatant propensity to make mental health diagnoses become pillars of the identity, fixed personality qualities, rather than the frequently slippery, provisional snapshots of a person in one moment that they often are, makes Aviv’s fuzzy but honest irresolution far more desirable.

P.E. Moskowitz used the term “BuzzFeedification of mental health” to describe this pervasive movement in the online community. There are not only concrete conclusions that may be drawn about the causes of mental disease but also the illnesses themselves serve as unmistakable labels. Over the past decade, a surge in the number of people being diagnosed with attention deficit hyperactivity disorder has spawned a whole cottage economy, from direct-to-consumer stimulant businesses to specialised productivity apps and planners. Ads for these products play into the assumption that having ADHD affects all aspects of a person’s life and personality, including mundane things like losing one’s vehicle keys or putting off a tedious chore.

What We Really Know About Mental Illness
What We Really Know About Mental Illness

Moskowitz, the editor of a weekly on mental health, is a strong and thought-provoking modern voice on the absurdities of this line of argumentation. Critical thinkers aren’t just looking for problems with the biological model. They, like Aviv, feel slighted by reductionist perspectives of any stripe. In one of their best newsletter issues, author James Greig laments the left’s propensity to attribute all mental health problems to capitalism without offering solutions.

While theoretically correct (yes, capitalism is driving us all nuts), Greig argues that emphasising collective blame and a lack of personal responsibility for one’s mental health can discourage people from taking any action at all to better their own lives. It’s the system’s fault, so then I have no control over my feelings of despair. This line of thinking can lead people down the path to nihilism, where they see no point in doing anything besides starting a revolution.

Although it does not provide any solutions, Aviv’s book also does not share this pessimism and lack of optimism. The story concludes on a sad note when she finds out that Hava, the girl she became close with in the anorexia unit, has passed away from difficulties brought on by her long-term eating illness. She goes to see Hava’s family and finds out about Hava’s recovery ordeal.

Aviv finishes the book with a remark on how she could be considered a sister to Hava, as many people have told her that they have recognised striking similarities between the two. It’s jarring to see a famous, successful person draw parallels between themselves and someone who died young from an incurable illness. Even though it shouldn’t, it does work. It is evident that Aviv does not want to highlight their differences but rather highlight their essential similarities, and her pain and empathy come across clearly on the page. She wants to close by emphasising, once more, the fluid boundaries between our narratives.

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