[b:Strangers to Ourselves: Unsettled Minds and the Stories That Make Us|59808605|Strangers to Ourselves Unsettled Minds and the Stories That Make Us|Rachel Aviv|https://i.gr-assets.com/images/S/compressed.photo.goodreads.com/books/1651275021l/59808605._SY75_.jpg|94200046] consists of four detailed case studies of mental illness within social contexts, as well as the author's account of her own experience. All four are recounted in a compassionate and enquiring style. The first, Ray, was an American man with depression who brought a malpractice suit against a psychiatric institution because psychoanalysis didn't cure him. The second, Bapu, was a very religious Indian woman who ran away from home to sites of pilgrimage. The third, Naomi, is a black American woman who was jailed for throwing her twins sons into a river then jumping after them while experiencing psychosis. The fourth, Laura, spent her twenties receiving a confusing series of diagnoses and taking a complex cocktail of psychiatric medications.

Each case study addresses the conflicting psychoanalytical and biomedical psychiatric notions of both illness and treatment, as well as the influence of personality, family, and culture on how mental illness is experienced and understood. Bapu's story is inseperable from religious belief; Naomi's from American racism. The narratives of Ray and Laura, both privileged white Americans, reveal changes in US psychiatry resulting from the invention of antidepressants. Bapu's case study includes some interesting points about the disjunct between Western psychiatry and Indian culture:

N. C. Surya, who directed Bangalore's All India Institute of Mental Health in the 1960s, warned his colleagues that they were adopting Western theories as if they were universal truths. 'We will end up as ineffectual caricatures of Western psychiatric theory and practice, or reduce our living patients into a set of prestige-loaded foreign jargon,' he wrote. He did not accept the Western view of mental health as the 'statistical norm'. A healthy person, according to this view, is 'like any other John or Jean in the neighbourhood'. But Indian healing cultures were meant to raise the self to a higher ideal - detached, spontaneous, free of ego - rather than simply restore the person to a baseline called normal.

Laura's case study emphasises that popular notions of mental illness can be deeply misleading:

The book prompted Laura to begin reading about the history of psychiatry. She hadn't realised that the idea that depression was caused by a chemical imblalance was just a theory - 'at best a reductionist oversimplification', as Schildkraut, the scientist at the National Institute of Mental Health, had put it. Nathan Kline, Ray's onetime doctor, had been confident that 'we'll find a biochemical test or series of tests that will prove highly specific to a particular depressive condition'. But such a test never materialised. For more than fifty years, scientists have searched for the genetic or neurobiological origins of mental illness, spending billions of dollars on research, but they have not been able to locate a specific biological or genetic marker associated with any diagnosis. It is still unclear by antidepressants work. The theory of the chemical imbalance, which had become widespread by the nineties, has survived for so long perhaps because the reality - that mental illness is caused by an interplay between biological, genetic, psychological, and environmental factors - is more difficult to conceptualise, so nothing has taken its place. In 2022 Thomas Insel, who directed the National Institute of Mental Health for thirteen years, published a book lamenting that, despite great advances in neuroscience, when he left the position in 2015, he realised, 'Nothing my colleagues and I were doing addresses the ever-increasing urgency or magnitude of the suffering millions of Americans were living through - and dying from'.

If you've experienced mental illness, [b:Strangers to Ourselves: Unsettled Minds and the Stories That Make Us|59808605|Strangers to Ourselves Unsettled Minds and the Stories That Make Us|Rachel Aviv|https://i.gr-assets.com/images/S/compressed.photo.goodreads.com/books/1651275021l/59808605._SY75_.jpg|94200046] will provoke personal reflection. In my case, on the extent to which I intellectually distance myself from my own distress by reading books like this. I also wondered whether my life would be different now had someone labelled my disordered eating and anxiety as mental illness earlier in my life; this was provoked by Aviv's account of being treated for supposed anorexia in hospital at the age of six. The case studies raise questions about how and why mental states are pathologised, as well as the subsequent treatments applied. I found the book thorough and insightful in its presentation of these, however the focus on individuals rather than groups meant that it wasn't quite as powerful as [b:Crazy Like Us: The Globalization of the American Psyche|6402564|Crazy Like Us The Globalization of the American Psyche|Ethan Watters|https://i.gr-assets.com/images/S/compressed.photo.goodreads.com/books/1263266351l/6402564._SY75_.jpg|6591364]. That said, the two books are not trying to do the same thing so would read well together. ( )

Rachel Aviv uses four case studies to explore the interaction between psychiatry and the actual lives of the people who fall under its care for varying reasons. A woman in India becomes increasingly involved in living spiritually, and Aviv uses this case to explore how religious behavior and western psychiatry can conflict. A man spends months in an institute undergoing psychotherapy, losing his family and career along the way, only to have pharmaceuticals quickly lift him from his depression. Aviv here looks at the tension between therapy and modern pharmaceuticals as well as society's belief that certain mental illnesses are personal failings rather than errors in brain chemistry. A young Black woman's mental health issues go unaddressed until she ends up incarcerated, highlighting how society is set up to provide support to some, and punishment to others. And a woman, having been prescribed an ever changing and increasing cocktail of drugs to manage her depression is faced with the difficult task of trying to wean herself off the drugs.

The book is also prefaced and ended with an account of her own early childhood stay in a mental health ward and how the two girls she looked up to while she was there had lives that turned out very differently than her own.

There's so much here, and it's all so fascinating. Aviv isn't advocating for specific approaches (although she is clear on the need for more funding and improvements to mental healthcare), but exploring the places where the contradictions lay. It makes sense that an organ as complex as the human brain would sit uncomfortably with simple answers or that what works for one person would also work for another. Aviv is also so deeply caring of her four subjects and her reporting here includes family members and those who have interacted with them, showing how mental illness doesn't only affect the person disabled by the illness. Aviv knows how to tell a story and her attention to detail is effective here. This is a far cry from the usual "look at this wacky mental illness and how it makes this guy act weird" approach and I'll be thinking about the issues she raises and the very real people she writes about for some time. ( )

An interesting book about psychology that even readers who aren't mental health professionals might find enjoyable. The author doesn't exactly propound a theory as much as present a set of case studies to demonstrate how modern psychology's worldview might not encompass the whole of human psychological experience. "Strangers to Ourselves" doesn't dismiss psychology as much as it calls for a wider vision of how human beings understand and cope with their psychological problems. There is, the author seems to be arguing, a world of experience outside the professional psychological mindset. "Strangers to Ourselves" occasionally makes this observation seem like a truly thrilling idea. Aviv's stories and her willingness to look beyond the professions's limits sometimes reminded me of early psychologists' belief that human experience was deeper and stranger than most of their contemporaries suspected.

It helps that the author seems to have chosen her case studies well. Freud occasionally gets criticized for basing many of his theories on his experiences with wealthy, fin-de-siecle Viennese patients, but Aviv takes things in a very different direction here. She includes a woman with a privileged upbringing who grew up in Greenwich, Connecticut, but also a working class black woman whose mental issues and disastrous choices lead to her incarceration and an Indian woman who uses her Hindu faith to better deal with her mental health issues. The author also describes her own experiences in the mental health system -- she was once the youngest anorexic on record -- and traces the experiences of another patient she met while institutionalized. While I found "Strangers to Ourselves" generally interesting, the author's decision to tell these stories struck me as genuinely brave. It's hard not to feel that something's wrong when, as she puts it, a psychological diagnosis can lead to a "career" in mental illness.

The author also provides a historically interesting recounting of how traditional, long-term psychotherapy fell out of favor, describing a court case that marked the beginning of the end of the school of thought that believed that you'd need a comfortable couch and a decade in therapy to resolve your inner conflicts. This case is justly famous in mental health circles, but I'd never heard of it. While many of these stories are genuinely inspiring -- since they show how people with difficult psychological issues adopted unconventional methods in order to live with their genuinely difficult psychological issues -- this chapter serves as a warning. Even the best care won't solve your problems for you. Recommended to professionals and hobbyists alike. ( )

Jan 8, 2023. Strangers to Ourselves: Unsettled Minds and the Stories That Make Us
by Rachel Avi

Why I picked this book up: a Christmas present from my son Hanse.

Thoughts: this book drew me in from the beginning. The author was able to share an in-depth view of a young girl’s battle with anorexia, her deep battle, identity and exposure of psychiatry.

Why I finished this read: I felt as though I was reading a diary and watching professional attempts at work. I wanted to see how it ended.

Stars rating: 4 of 5 stars. ( )

Rachel Aviv's Strangers to Ourselves: Unsettled Minds and the Stories That Make Us (2022) is a thought-provoking and profound study of how lives are defined by stories, perceptions, and choices. The author examines the lives of six families defined by mental illness. The stories that unfold are complex and multi-generational. However, the bigger picture here describes a history of psychiatry in the late 20th century as psychoanalytic concepts of personality gave way to pharmacological explanations for understanding and treating mental illness.

Readers learn about an influential malpractice lawsuit that changed psychiatry and the spread of Western psychiatry to India, how loneliness and despair lead mothers to seek protection for their children, and how relationships with food and society provide comfort. This is also a book about acceptance and finding one's way. While I learned and thought about defining mental illness, sometimes finding myself back in the early stages of my career, I reflected on the importance of seeing people as they see themselves.

Early career mental health professionals are well-trained to recognize mental illness and provide treatments that promise relief to their clients. They are trained that the working relationship between therapist and client is of utmost importance. With some practice, they often learn how to sit with a client and experience both the subjective and the objective experiences of both client and therapist--the place is where a Buddhist-influenced psychology points. But it is not easy. Quiet observation of ourselves takes time.

Aviv takes us on her journey as she observes herself and her context. She challenges the question, "is mental illness a personality flaw or a brain imbalance?". This book is a good read for counseling students and practitioners or anyone interested in examining the assumptions underlying how they approach people with mental illness. ( )