Strangers to Ourselves

Rachel Aviv

Harvill Secker, 2022

Review by Alice Peck

‘There are stories that save us, and stories that trap us, and in the midst of an illness it can be very hard to know which is which,’ writes Rachel Aviv. The New Yorker staff writer’s specialism in psychology, criminal justice, and education comes to the fore in Strangers to Ourselves.

What are the stories we tell to interpret our world and narrate our place in it? How much do the stories work for us? How do they, as Aviv suggests, ‘trap us’ into ‘self-fulfilling stories’ that shape our very personhood?

Her book explores mental illness and, specifically, the struggles of five people across eras and cultures whose stories are very different yet connected by a shared setting which she describes as ‘the psychic hinterlands, the outer edges of human experience, where language tends to fail’. 

The book opens with Aviv’s own story. Aged six, she was admitted to the Children’s Hospital of Michigan, in Detroit, for ‘failure to eat’. She became an inpatient on the anorexia unit, alongside older girls who saw her as ‘a kind of mascot, an anorexic-in-training’. Aviv did not know the meaning of the diagnosis, and anorexia ‘didn’t provide the language’ with which she understood herself. After six weeks, she was discharged; she returned to school and reintegrated. 

Hava was a fellow patient on the anorexic unit. Aviv presents Hava’s story as a kind of parallel life to her own. Hava’s adolescence and early adulthood was spent in and out of psychiatric hospitals. She died young. Anorexia was the defining story of her life; a story that trapped her.

Strangers to Ourselves explores this determining power of a diagnosis of mental illness. Aviv narrates the lives of Ray, Bapu, Naomi, Laura, and Hava with empathy and sensitivity; five stories which show the gap between a diagnosis of mental illness, as applied by psychoanalytic or biochemical frameworks, and the actual lived experiences and uniqueness of each person. While a diagnosis might offer a framework for making sense of behaviour, it is not neutral; it carries meaning that is sustained through society in dominant narratives of mental illness and fixed ideas about what constitutes ‘normal’ behaviour. The complication arises in the ‘hinterland’ between the story told by psychiatry and the story told by an individual. Bapu’s and Naomi’s stories show the failure of psychiatry, formed in the West, to account for cultural differences, or acknowledge the impact of race on an individual’s self-narration. 

Strangers to Ourselves is captivating and unsettling. Aviv’s exploration of the interplay between personal narrative, illness, and the power of a diagnostic label in determining beliefs and behaviours is fascinating. The five stories align in exposing the complications of diagnosis, while offering diverging experiences which challenge readers and prevent them from forming a fixed idea about these contradictions. Aviv’s craft is evident – thoughtful and probing, presenting these stories without forcing conclusions. 

We are left questioning our own process of self-narrating, questioning the stories we tell and have told about ourselves, and are pushed to explore the very permeable and porous divide between the ‘psychic hinterlands’ and what we understand as normal. At the end of the book, reflecting on her ‘narrow escape’ from being ‘recruited’ into a life of anorexia, Aviv writes, ‘it’s startling to realize how narrowly we avoid, or miss, living radically different lives.’