In ‘Strangers to Ourselves,’ a Revelatory Account of Mental Illness

2019 National Fellow Rachel Aviv's book Strangers to Ourselves was reviewed by the New York Times.

Psychiatrists talk a lot about “insight,” or what one defined as “the correct attitude to a morbid change in oneself.” Aviv points out the professional presumption baked into the term, as if insight is supposed to measure “the degree to which a patient agrees with his or her doctor’s interpretation.” Aviv, for her part, finds more resonance in Keats’s notion of “negative capability” — the capacity to experience “uncertainty, mysteries and doubts, without any irritable reaching after facts or reason.” She admits how hard it is for her to sustain such patience for her own anxieties and preoccupations, but “Strangers to Ourselves” is a book-length demonstration of Aviv’s extraordinary ability to hold space for the “uncertainty, mysteries and doubts” of others.

Looking back on her hospitalization three decades ago, Aviv remains haunted by what happened to another girl in the ward, named Hava, who died in her early 40s from complications of bulimia. In her journals, the 12-year-old Hava showed plenty of insight about her condition, referring frequently to her “chemical imbalances,” whereas the 6-year-old Aviv “had basically none.”

But perhaps it was this lack of insight — “I never felt stuck in a particular story that others had created for me” — that made Aviv’s diagnosis feel more malleable to her, allowing her to pursue other possibilities. The divide between her fate and Hava’s was enormous but also porous. “There are stories that save us, and stories that trap us,” Aviv writes, “and in the midst of an illness it can be very hard to know which is which.”