Strangers to Ourselves

What if the stories you tell about your suffering determine not only how others see you—but how you heal, relapse, or recover? In Strangers to Ourselves, journalist Rachel Aviv asks this quietly radical question, exploring how the narratives we inherit—from psychiatry, culture, religion, and family—shape our experience of mental illness.

Aviv contends that mental illness does not exist in a vacuum, nor can it be reduced to biology or behavior. It lives in stories—those told by patients about themselves, and those told about them by others. Across extraordinary case studies, Aviv explores how the frameworks through which we interpret madness—psychoanalytic, biomedical, spiritual, racial, or social—can both save and ensnare us. The result is a book not of medical answers, but of narrative truths: it illuminates how cultural scripts of the ‘sick self’ can organize a life or obliterate it.

The Power of Psychiatric Stories

Aviv opens the book by recounting her own childhood as a six-year-old diagnosed with anorexia—the youngest known case at the time. Her sense of identity was porous, her desires fluid. When she stopped eating, the adults around her interpreted her behavior through the lens of psychiatry: she had a disease, an ‘unusual case of anorexia nervosa.’ Yet she was only beginning to read, unaware of what anorexia even was. Aviv realizes, decades later, that the story told about her at that time—of illness, control, and family dysfunction—might have saved her physiologically but could have invented a new self she never recognized.

She terms this process the looping effect (borrowing from philosopher Ian Hacking): once people are classified, their behaviors start to mirror and reinforce the categories used to describe them. In other words, the diagnosis doesn’t just identify; it transforms. The story of the illness becomes the illness itself.

Lives Defined by Competing Explanations

Through five central stories—Ray, Bapu, Naomi, Laura, and Hava—Aviv explores the consequences of living inside different explanatory systems for mental disorder. Each person’s experience reveals the intersection of personal meaning with institutional power: psychiatry, religion, race, or family structure.

Ray, a doctor treated without medication at the once-prestigious Chestnut Lodge psychiatric hospital, represents the end of the psychoanalytic era. His suffering became the hinge for psychiatry’s historical clash between talk therapy and the biomedical revolution. Meanwhile, Bapu, an Indian housewife considered schizophrenic, was caught between Western psychiatry and Hindu mysticism. She wrote devotional poetry that blurred madness with spiritual transcendence. Naomi, a Black mother in Minnesota, faced the racialized biases of American psychiatry; her postpartum psychosis was reframed as a criminal act, not an illness. Laura, a descendant of Franklin Roosevelt, offers a portrait of the modern psychiatric consumer—overmedicated, overdiagnosed, and alienated by the very system meant to save her. Finally, Hava, an anorexic whom Aviv met as a child, shows what happens when an illness becomes a person’s only identity, dissolving the boundary between recovery and selfhood.

The Larger Question: What Counts as Truth?

Aviv argues that insight—psychiatry’s gold standard for recovery—is itself a culturally loaded concept. To have ‘insight’ means to understand your suffering through the lens psychiatry prescribes (for example, that a voice you hear is a symptom, not a spirit). But what if that interpretive frame doesn’t fit your context or lived experience? Across cultures, the ‘correct attitude’ toward illness varies, and Western psychiatry often punishes those whose stories deviate from its script.

Rather than asserting that one model of truth—psychoanalytic, biomedical, or mystical—is superior, Aviv insists on an ethical humility. She reminds us that scientific explanations are never neutral: they create new ways of being a person. Every diagnostic story, she writes, “changes the space of possibilities for personhood.”

Why This Matters for You

If you’ve ever struggled to articulate your suffering—or felt misunderstood by labels meant to ‘explain’ you—Aviv’s book is a revelation. It invites you to ask not simply whether your story is true, but what truths it allows or forecloses. Whether you find meaning in science, faith, or relationships, the stories you tell about your pain will shape who you become. Mental illness, Aviv shows, is not only a biological fact but also a story-making practice: a way of locating the self amid chaos. We are, inescapably, strangers to ourselves—but through story, we try to find a home.

Throughout Strangers to Ourselves, Aviv explores the concept of insight—the psychiatric idea that recovery depends on a patient’s capacity to correctly interpret their own mind. Yet as she shows across cultures and cases, this ideal of ‘correct understanding’ is often a double-edged sword: granting power to some, while erasing others.

What Does “Insight” Really Mean?

In psychiatry, insight means recognizing your symptoms as signs of illness. To be ‘insightful,’ you must agree with your doctor’s explanation. This seems straightforward—until you realize that these explanations, from Freud to modern neuroscience, reflect cultural assumptions about reason, morality, and trust.

Historically, insight meant a moral awakening: becoming conscious of hidden desires or family conflicts (as psychoanalysis demanded). Later, it became biomedical: “I am ill because my brain chemistry is off.” Each version assumes that truth resides in the doctor’s worldview. But Aviv reminds us that agreeing to such an insight often requires surrendering one’s own way of understanding pain.

When Insight Fails or Wounds

Bapu, the Indian woman who experienced divine visions of Lord Krishna, was declared schizophrenic for believing her ecstasies were spiritual. Her psychiatrist, Peter Fernandez, called her “one of the worst cases he had seen.” Yet Bapu herself described feeling illuminated, chosen, and free. She wasn’t seeking diagnosis; she was seeking transcendence. Her society’s mystic traditions offered language for her experience—language psychiatry erased.

Similarly, Naomi Gaines, a Black mother whose postpartum psychosis led to tragedy, was told she ‘lacked insight’ because she believed racism and divine punishment—not chemical imbalance—defined her suffering. In fact, those beliefs reflected her reality: a life shaped by intergenerational trauma and racial abuse. For her, accepting psychiatric insight meant denying the conditions that made her ill in the first place.

When Insight Heals

And yet, insight can also be redemptive. Laura, a young woman from a privileged family overmedicated for years, found healing not by rejecting medicine but by finding new insight into it. Once she realized her ‘biochemical self’ was only one narrative—one that had flattened her complexity—she began to rediscover sensation, sexuality, and creativity. Her recovery required reclaiming authorship of her story, rather than simply absorbing the stories psychiatry gave her.

A Challenge for Every Reader

Aviv argues that genuine insight comes when we stop asking, “Is this interpretation true?” and instead ask, “Who does this truth serve?” When diagnoses feel liberating, they can bring order. When they feel colonizing, they can steal our sense of meaning. To live with illness, then, is to walk a tightrope between knowledge and self-preservation.

“There are stories that save us, and stories that trap us,” Aviv writes. Insight alone isn’t salvation—sometimes, freedom lies in resisting someone else’s version of your mind.

Ray Osheroff, a brilliant and tormented kidney specialist, embodies the twentieth century’s intellectual war within psychiatry: between psychoanalysis—the talk-based model of meaning—and biological psychiatry, the chemical model of cure.

Chestnut Lodge: A Temple of Analysis

In 1979, as his business collapsed and his marriage failed, Ray entered Chestnut Lodge, a famed Maryland asylum that prided itself on psychoanalysis. There, psychiatrists believed patients could be healed only through deep insight into their unconscious conflicts. They banned medication as superficial. Ray’s analyst insisted that he must ‘sit still’ and suffer his pain to grow.

But each day, Ray deteriorated—pacing 18 miles through the halls, losing 40 pounds, begging for antidepressants that never came. When his mother transferred him to Silver Hill Hospital, a medical facility that prescribed drugs, he finally improved. Within weeks, antidepressants restored his vitality. Ray regained the ability to grieve and rebuild his life.

The Lawsuit That Changed Psychiatry

In 1983, Ray sued Chestnut Lodge for medical malpractice, claiming the hospital’s refusal to medicate had ruined his career and family. His case became legendary—the “Scopes Trial of psychiatry.” Expert witnesses clashed over what it meant to treat the mind. Psychoanalysis saw Ray’s despair as moral growth; biological psychiatrists saw it as biochemical deficiency.

The case ended in a settlement, but its impact was seismic. Afterward, psychotherapy yielded to pharmacology. Drugs became the new gospel of progress. Hospitals feared being another Lodge, and soon every patient was medicated. The result, Aviv suggests, was not healing but another totalizing faith: the belief that chemistry alone could explain the psyche.

Ray’s Tragic Afterlife

Ray spent decades trying to understand which story—psychological, biochemical, or moral—defined him. He wrote an unpublished memoir for 30 years, revising his explanation as psychiatry itself evolved. By his death, he felt he had lost not just his career, but his framework for identity. Even after decades on antidepressants, he lamented that he was “an unremedied man.”

Aviv’s portrayal of Ray mirrors psychiatry’s own existential crisis: every ‘cure’ produces new blind spots. When one paradigm—insight or medication—claims total authority, it risks turning the patient’s story into proof of its own correctness. In this sense, Ray’s madness was never just chemical or emotional—it was emblematic of an entire profession becoming a stranger to itself.

Can faith heal—or break—the mind? In the story of Bapu, a South Indian housewife and poet, Aviv examines what happens when spiritual experience collides with psychiatric authority. Bapu’s journey—from suburban wife to saintlike wanderer—shows how culture defines the line between revelation and disorder.

A Woman Who Spoke to Gods

Born into a high Brahmin family, Bapu felt suffocated by domestic expectations. When she began composing ecstatic devotional songs to Krishna, neighbors whispered that she was blessed. Her words appeared in perfect medieval Tamil, a language she’d never studied. Religious scholars called it divine inspiration. Soon, she left home to seek holiness in temples and ashrams.

To her family, this devotion looked like insanity. When she wandered away, police detained her as a ‘mentally ill offender.’ Doctors diagnosed her with schizophrenia. She was forcibly medicated, tied to a hospital bed, and shocked with electroconvulsive therapy. Her visions of Krishna—once venerated—became symptoms of delusion. “She could not even reason,” her psychiatrist said. “She cannot be a normal person.”

The Colonial Legacy of Psychiatry

Aviv situates Bapu’s story in India’s colonial history. Western psychiatry had long cast non-Western belief systems as backward or primitive. Indian mystics who saw unity between body, mind, and spirit were recoded as irrational. Psychiatrists like Peter Fernandez believed that “too much religion is not good.” Yet traditional healing systems—Ayurveda and temple therapy—often viewed madness as a spiritual imbalance, not disease.

Bapu’s case exposes how medical authority can erase indigenous knowledge. Her daughter Bhargavi, who later became a philosopher and feminist, realized that her mother’s ‘madness’ could also be read as resistance—a refusal of patriarchal and colonial definitions of sanity. Bhargavi founded the Bapu Trust for research on mental health and healing, arguing that people like her mother needed empathy and cultural context, not erasure.

A Legacy of Lost Meaning

Bapu lived and died between diagnoses and divinity. To her doctors she was a schizophrenic; to her followers, a guru. Her poetry, written on scrap paper and hymnals, is her only testimony. She called herself “a fruit that will not ripen”—forever caught between worlds. In telling her story, Aviv restores the humanity psychiatry could not see: that madness, at times, is another form of worship, another way of surviving the unbearable.

Naomi Gaines’ tragedy—dropping her twin sons from a bridge during a psychotic episode—is perhaps the book’s most devastating portrait of how social injustice compounds mental illness. Through Naomi, Aviv exposes the racial and economic double standards that shape psychiatric care in America.

A Mother No One Believed

Naomi grew up in Chicago’s infamous Robert Taylor Homes, raised by her mother in poverty and violence. As a young poet in Minnesota, she sought to write about single Black motherhood, racism, and despair. When postpartum psychosis struck after the birth of her twins, cultural scripts about ‘strong Black womanhood’ left no room for her collapse.

White psychiatrists labeled her delusional for saying “white people are out to get me”—even though systemic hatred had marked her life. Rather than seeing social reality in her visions of persecution, doctors saw only chemical imbalance. Naomi was hospitalized, restrained, medicated, and criminalized. Her crisis became a case study not in healing, but in punishment.

Race, Religion, and Madness

Aviv weaves Naomi’s story into a haunting genealogy of race and psychiatry. For centuries, medicine pathologized Black emotion: enslaved people who resisted were said to suffer from ‘drapetomania.’ Later, schizophrenia was recast as a ‘Black disease’ associated with rebellion. Even in the 21st century, Naomi’s plea for help was met with suspicion, not empathy.

When Naomi was imprisoned, she found her first real listener in another mother who had killed her children—the Hmong immigrant Khoua Her. In their prison friendship, Naomi discovered that different cultural languages of suffering could coexist: faith, trauma, and illness were not enemies but translations of the same grief. She began writing again, turning guilt into testimony.

Redemption and Reentry

After years in prison, Naomi learned to narrate her illness as both personal and political. When released, she became an advocate for mental health and racial equity. Her story asks readers: When do we stop calling pain madness and start calling it meaning? Aviv’s answer is quiet but revolutionary—healing begins when someone finally listens not to symptoms, but to story.

If Ray showed the rise of biological psychiatry, Laura Delano reveals its lasting cost. A descendant of Roosevelt and Harvard graduate, Laura was diagnosed with bipolar disorder at fourteen. In an era of faith in brain chemistry, she became the perfect patient: compliant, articulate, high-achieving—and profoundly lost.

The Promise of Chemical Salvation

Each new psychiatrist fine-tuned Laura’s neurotransmitters, prescribing Prozac, Ambien, Lamictal, Seroquel—the ‘polished machinery’ of modern medicine. Her life became a laboratory of moods. Every feeling was a symptom, every hesitation a sign to adjust the dose. For years, she believed her destiny lay in finding the perfect pharmacological balance. But instead of joy, she felt flat, detached from her body, and sexually numb. The drugs dulled her suffering—and everything else.

Questioning the Chemistry of the Soul

After a near-fatal overdose, Laura entered a borderline personality disorder program, where she began reading Robert Whitaker’s Anatomy of an Epidemic. There she learned that the chemical-imbalance theory had never been scientifically proven—only believed. She realized her entire identity as ‘bipolar’ was a story psychiatry had told her to make sense of unhappiness within privilege. Her real problem, she saw, was existential: she had outsourced her humanity to a diagnosis.

Laura slowly tapered off her medications, enduring months of withdrawal—what she and others online called “neuro-emotions”: fear, rage, shame experienced at unbearable volume. The process was excruciating, yet it returned to her what years of treatment had erased: desire, creativity, and embodiment.

Reclaiming the Right to Feel

Laura’s recovery wasn’t freedom from illness but from psychiatry’s total narrative. She now helps others disengage from overmedication, not as dogma but as solidarity. By reclaiming suffering as part of being alive, Laura—and later, Aviv herself—challenge the reader: maybe the goal isn’t to eradicate pain, but to live truthfully inside it. “Normal people cry,” one psychiatrist tells his patient; Laura finally allows herself to join them.

The book’s epilogue returns to Hava, the older girl Rachel Aviv once idolized in the hospital ward. Hava’s story reveals what happens when illness outlives the hope of recovery—when it becomes the organizing principle of a life.

A Friendship and Its Ghost

As a child, Aviv thought Hava, with her feathered hair and fatal elegance, possessed secret knowledge about purity and perfection. Decades later, Aviv finds her obituary. Hava had spent 30 years oscillating between anorexia and bulimia, hospitalization and partial recovery. In letters to politicians, she begged for mental-health funding. In her journals, she chronicled endless cycles of eating and self-hate. What began as a search for holiness became a slow suicide of definition: anorexia wasn’t her disease—it was her name.

Love, Care, and the Hope of Being Seen

Yet even in decline, Hava longed for connection. She adopted an infant son but later relinquished him for adoption, fearing she couldn’t raise him safely. She found love in middle age with Tim, who accepted her compulsions without judgment. For the first time, she said, she felt “better than ever”—living proof that recovery doesn’t always mean cure. Two weeks before they moved in together, she died in her sleep, likely from complications of her illness.

Aviv closes her book by suggesting that recovery is not restoration but transformation. Like psychologist Pat Deegan writes about schizophrenia, lasting healing comes from “acceptance of our limitations,” not erasing them. Hava’s life—and her death—become a mirror for Aviv’s own survival. The difference between them, she realizes, may have been nothing more than time, luck, and the stories they were given to believe.