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What Do We Really Know About Mental Illness?


When Rachel Aviv When she was six years old, she stopped eating. Not long after, she was hospitalized because of anorexia. Her doctors were confused. They had never seen a child so young with an eating disorder, but she was still there. Was it a reaction to her parents’ divorce? Diet culture? Congenital austerity? The episode is still a mystery. While Aviv made a full, relatively quick recovery, she developed a lifelong interest in the frontier between disease and health.

In her new book, Strangers to Yourself: Unstable minds and the stories that make usAviv wondered if she had ever actually suffered from anorexia, or if the episode was perhaps too hasty to cause illness. While she moved away from disordered eating habits without seeing it as a fixed part of herself, the girls she lived with in treatment — older, more conscious — didn’t shake off get that. Instead, their identities were replaced by anorexia. “Mental illnesses are often seen as chronic and incurable forces, but I wonder if the stories we tell about them, especially in the early part, have shaped their path,” writes Aviv. any”. “People can feel liberated by these stories, but they can also get trapped in them.”

If someone knew the weight of stories, Aviv would. She is a star New Yorkers writer, capable of delving into complicated, morally uncomfortable situations and unearthing definitive stories from tumultuous times. (Read her work on child welfare system overreachedplease.) But Strangers to ourselves has the ability to resist sound definitively. Instead, it insists on its surroundings. The book is divided into four chapters, each focusing on a different person with unusual mental health problems. (The prologue and epilogue delve into Aviv’s personal experience.) These characters include Ray, a dermatologist who sues a lavish mental institution for not giving him antidepressants; a Hindu mystic named Bapu, whose family placed her in a schizophrenic facility; and a single mother named Naomi, are incarcerated after she jumps off a bridge with her two sons in a suicide attempt, killing one. Their circumstances and conditions have little in common except for extremes and uncertainty about what is really happening to them.

Aviv’s thesis is that there can be no great unified theory of mind. “The theory of chemical imbalance, which became popular in the 90s, has persisted for so long perhaps because of the fact that mental illness is caused by the interplay of biological factors, genetic, psychological and environmental – harder to conceptualize. , so nothing happened,” she wrote. Strangers to ourselves is a look at this understanding gap — of what happens when there’s no easy story to explain what’s going on in your head, when Freud and drugs and everything else fails.

The following chapter, “Laura,” acts as an elegant but inconclusive interrogation of contemporary psychiatry. Connecticut blue-blooded Laura Delano was diagnosed with bipolar disorder as a child and started her first psychiatric medication at the same time. She is a high achiever, attending Harvard, but she continues to struggle with her mental health; In her twenties, she was heavily drugged and survived a suicide attempt when she came across a book critical of psychoactive drugs. She decided to stop taking hers. Despite the severe withdrawal symptoms when she quit smoking on her own, she prefers her life to be inattentive. She became active in anti-psychotic circles on the internet, eventually starting a popular blog. Aviv revealed that she found Laura’s post while she was trying to figure out her own relationship with psychopharmaceuticals — she’s been using Lexapro for years and wondered if she can stop or not. Aviv doesn’t go so far as to embrace the antipsychotic movement herself, although she treats Laura’s position with respect. She makes peace with continuing to rely on anti-anxiety medication for mental balance, even as she ponders how little doctors know about exactly why it works. But she worries about how the diagnoses could limit people’s understanding of who they are and what could be.

In this regard, Strangers to ourselves is a book of the moment. This summer, an article reviewing the existing literature on the link between depression and serotonin imbalance concluded that there was no clear link. “Theory of the chemical imbalance of depression is dead” Guardians declare. New skepticism about biological models for understanding many types of mental illness is growing. Thus, Aviv’s compelling article about the need to consider people as a whole, rather than just their brain chemistry, is appropriate, though not particularly novel. Strangers to ourselves Join a growing group of recent non-fiction books that further complicate our understanding of the mind. In 2019, medical historian Ann Harrington published The Mind Repairer: Psychiatry’s Troubled Search for the Biology of Mental Illness, a regular tour of psychiatry as it transitions from the Freudian school to the biological model, highlights how badly the theory of chemical imbalance has become. The 2021 book by neuroscientist Suzanne O’Sullivan Sleeping Beauty: And Other Stories of the Mysterious Disease Delves into cultural syndromes and psychological illness, illustrating how powerfully our environment and experiences can impact the way our bodies and minds function. The power of Strangers to ourselves contained in its fascinating case studies, contribute vivid anecdotes to this ongoing conversation about the complex and confusing nature of the mind.

From the outset, Aviv explains that she chose a multi-volume structure for the book, rather than an overarching narrative, to emphasize the sheer diversity of emotional and spiritual experiences, the incomprehensible their basis, their need for a particular context. Only a series of stories can illustrate the point that no story is true. “As questions are looked at from different angles, the answers are constantly changing,” she wrote. This is both undeniably true and insane, like someone saying “all music is good… it depends on one’s taste.” Sure, but so what? Taken separately, each story in Strangers to ourselves often as brilliant as Aviv’s magazine, the portraits are rendered intuitively and reflectively, gliding with contemplations in the mind. As a set, however, they coalesce into an eloquent shrug. I wonder, at the end of the book, if it would have left a more solid impression if it had been published as a series – say, in a journal – rather than gathered into a contradictory collection. with clarity.

Of course, better than a sincere, beautifully written whimper than a harsh bang. Aviv’s vague but honest approach is more attuned to his blunt tendency to make mental health diagnoses the foundation of identity, fixed personality traits rather than temporary snapshots, Slippery about a person in a moment that they usually have.



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