Strangers to Ourselves

Strangers to Ourselves Plot Summary

Introduction

Mental health is a lens through which we perceive our humanity, yet it remains one of the most enigmatic aspects of our existence. Throughout history, societies have struggled to understand the boundary between normal human suffering and psychiatric illness, often imposing their cultural frameworks on deeply personal experiences. The individuals whose journeys unfold in these pages inhabit what might be called the psychic hinterlands - those liminal spaces where conventional explanations for distress fall short, where language often fails, and where the search for meaning becomes both urgent and elusive. These narratives traverse different eras and cultural contexts, yet they share a common thread: each person finds themselves navigating the complex intersection of biology, personal history, and social environment during periods of crisis. Through their experiences, we witness the profound ways psychiatric frameworks shape identity, sometimes offering illumination and relief, other times imposing limitations that obscure rather than clarify. Their struggles reveal how mental suffering is never merely an individual phenomenon but is sustained and shaped by relationships, communities, and the stories we tell about ourselves. These accounts challenge us to consider how different scales of understanding - chemical, existential, cultural, economic, political - might all be simultaneously true, inviting a more nuanced perspective on what it means to be a stranger to oneself.

Chapter 1: The Diagnosis Dilemma: Finding Identity Through Classification

When Ray Osheroff, a successful nephrologist who had founded several dialysis centers, entered Chestnut Lodge in 1979, he believed he was receiving treatment at one of America's most prestigious psychiatric hospitals. The Lodge was renowned for its psychoanalytic approach, where patients were encouraged to gain insight into their psychological conflicts rather than merely addressing symptoms. Ray had been experiencing profound depression after his business faltered and his marriage collapsed. He paced the halls for eight hours daily, endlessly ruminating on his perceived failures and lost opportunities. Manuel Ross, Ray's psychiatrist at the Lodge, viewed his patient's condition through a distinctly psychoanalytic lens. In staff meetings, Ross described Ray's depression as "a form of melancholia, not mourning" - a reference to Freud's distinction between these states. In this framework, Ray's obsessive regret about his business decisions was interpreted as a way of staying close to a loss he couldn't name: the fantasy of having been "a great man." The Lodge physicians believed that medication would only superficially address Ray's symptoms without providing true insight into his condition. After six months at Chestnut Lodge with minimal improvement, Ray's mother transferred him to Silver Hill, a different facility that embraced the emerging field of psychopharmacology. There, he was immediately prescribed Thorazine to calm his agitation and Elavil, an antidepressant. Within weeks, Ray experienced what felt like an awakening. "Something is happening to me," he told an aide. "Something has changed." He regained his sense of humor, passion for literature and music, and began forming connections with other patients. A nurse noted that a "new human being" had emerged. Ray's experience became the centerpiece of a landmark lawsuit against Chestnut Lodge, which he filed in 1982, arguing that the hospital had negligently withheld effective medical treatment. The case represented a fundamental clash between psychiatry's two dominant paradigms: the psychoanalytic model that sought meaning through understanding unconscious conflicts, and the emerging biomedical model that framed mental illness as a chemical imbalance requiring pharmaceutical intervention. Ray's lawsuit, which eventually settled out of court, was described by one psychiatrist as psychiatry's equivalent to Roe v. Wade - a showdown that would help determine the future direction of mental health care. Yet Ray's story reveals how neither framework fully captured the complexity of his suffering. After being released from Silver Hill, he returned to find his practice and reputation diminished. His life never returned to its former trajectory, and despite taking psychiatric medications for three decades, he still felt rootless and alone. "There is a painful gulf between what is and what should have been," he wrote in his unpublished memoir. Near the end of his life, he lamented being an "unremedied man" - suggesting that neither story about his illness had ultimately made his suffering legible or provided lasting relief.

Chapter 2: Spiritual Seeking: When Devotion Meets Mental Illness

In a stately colonial house in Chennai, South India, a woman known as Bapu began to feel increasingly alienated from her prescribed role as a Brahmin wife. Her marriage had been arranged without the customary exchange of horoscopes, her limp from childhood polio making her a less appealing bride. As she approached middle age in the 1970s, Bapu found herself drawn toward a different path - one of spiritual devotion that would eventually be labeled mental illness by some, and divine inspiration by others. Bapu began attending lectures on the Bhagavad Gita at a local ashram, listening to teachings from a sannyasin named Sri Anjam Madhavan Nambudiri. She converted a small closet-like space in her home into a prayer room, spending hours there daily despite her family's disapproval. Her devotional practices intensified, and she started composing songs about Krishna in medieval Tamil, a language she hadn't formally studied. When these compositions were evaluated by a linguistic scholar, he declared them "divine work" that met all classical standards - puzzling her family, who couldn't understand where this sudden literary talent had emerged from. As her spiritual identification deepened, Bapu grew increasingly detached from domestic duties and family expectations. She began wearing simple cotton saris instead of silk, stopped adorning her hair with flowers, and once gave away her wedding jewelry to a rickshaw driver whose child was ill. Her behavior culminated in her first disappearance in 1970, when she left a letter for her family and traveled to Kanchi monastery, one of South India's most sacred sites. When police eventually returned her home, she seemed to inhabit a different plane of existence, lingering in hallways without fully entering rooms. Her family, alarmed by these changes, took her to a psychiatric clinic run by Peter Fernandez, one of the first generation of Indian psychiatrists trained in Western methods. "We read only the Western books - British and German and American," Fernandez explained. "We didn't have any Indian authors." He immediately diagnosed Bapu with schizophrenia, explaining that "the schizophrenic has no insight - she doesn't know who she is." This diagnosis led to hospitalizations, forced treatments, and electroconvulsive therapy without anesthesia or muscle relaxants. For Bapu, however, her experiences weren't symptoms of illness but manifestations of devotion. She identified with the 16th-century poet Mirabai, who had renounced her marriage because she believed Krishna was her true husband. "Am I Mirabai?" she asked in her journal. In eight hundred pages of journals, Bapu never mentioned her psychiatric diagnosis, instead describing Krishna as a surrogate husband whose body sometimes seemed so close to hers that she could smell the sandalwood paste on his skin. "Who in the 'scientific world,'" she wrote in English, "would believe all this!" This cultural disconnect between Western psychiatric frameworks and Indian spiritual traditions created a profound barrier to understanding Bapu's experience on its own terms. Her daughter Bhargavi later observed that the psychiatric explanation felt like an affront, diminishing what had been celebrated by fellow worshippers. The diagnostic framework imposed on Bapu's life wasn't necessarily more stigmatizing than her reputation as a mystic, but it represented a different story - one that didn't resonate with her sense of meaning or identity.

Chapter 3: Racial Trauma: Social Inequity's Impact on Mental Health

When Naomi Gaines stood on the Wabasha Street Bridge in Saint Paul on July 4, 2003, the twenty-four-year-old Black mother was in the grip of a psychological crisis that cannot be understood apart from America's history of racial injustice. Looking for someone who would smile at her among the predominantly white crowd celebrating Independence Day, Naomi felt increasingly isolated and terrified. She had recently read a conspiracy theory about a government program targeting "undesirable elements of society" and was convinced that she and her children were in imminent danger. Naomi had grown up in the Robert Taylor Homes in Chicago, one of the largest public housing complexes in the world. Twenty-eight identical concrete buildings, wedged between railroad tracks and an interstate highway, housed twenty-seven thousand people, 99 percent of whom were Black and 96 percent unemployed. The complex was known for its violence - "gunfire might just as well be snowfall," wrote one journalist. From her fifteenth-floor apartment in what residents called "the Hole," Naomi rarely saw anything green; the trees and gardens originally surrounding each building had been paved over to reduce maintenance costs. A study published in Environment and Behavior found that residents overlooking trees and grass rated the challenges in their lives as less severe than those living in barren surroundings - suggesting how deeply environment shapes mental health. After moving to Minnesota as a young adult, Naomi began reading extensively about Black history and identity. She was drawn to literature that helped her understand the historical resonances of her own story, including Without Sanctuary, a collection of photographs of lynchings where white spectators watched calmly as Black people were hanged. "I wanted to know why, and then eventually I started thinking, 'What makes my children any different?'" she recalled. As she gained language to describe the kind of pain that had haunted her family for generations, she found it increasingly difficult to get out of bed in the morning. When Naomi began experiencing psychiatric symptoms following the birth of twins in 2002, her concerns about racism were documented in her medical records merely as "bizarre statements." After multiple brief hospitalizations, she was diagnosed with "psychosis not otherwise specified" and later bipolar disorder, but the medications she was prescribed did little to address her fundamental sense of alienation. "Where is the sensitive side of psychiatry?" she asked. "They missed the mark. The doctors' lack of knowledge about who I am and where I come from pushed me farther and farther away." On that July day in 2003, Naomi dropped her fourteen-month-old twin sons into the Mississippi River and jumped in after them. One child survived; the other drowned. During her subsequent treatment and incarceration, Naomi gradually came to accept a diagnosis of mental illness, though she continued to insist that her distress couldn't be separated from her experiences as a Black woman in America. Helena Hansen, a psychiatrist and anthropologist who studies racial stereotypes in medicine, notes that while a biological explanation for mental illness can relieve white patients of moral blame, for Black patients it often "deflects blame away from the societal forces that brought them where they are." Naomi's story illustrates how psychiatric frameworks often fail to account for the trauma of racial oppression, treating social context as peripheral rather than central to understanding mental suffering. Her experience challenges us to consider how racial melancholy - what scholar Joseph Winters describes as grief that cannot be articulated, a loss that becomes internalized and undermines "any notion of self-coherence" - might require different approaches to healing than those offered by conventional psychiatry.

Chapter 4: Medicine as Story: The Power of Psychiatric Narratives

At six years old, Rachel was hospitalized for what doctors called "an unusual case of anorexia nervosa." She had stopped eating and drinking for several days, and when her pediatrician examined her, he noted that she had lost four pounds in the previous month. At the children's hospital, she was placed on a unit with older anorexic girls, including a twelve-year-old named Hava who kept a detailed journal about her experiences. "For god's sake the girl's only 6," Hava wrote about Rachel. "Look at her!" While hospitalized, Rachel became fascinated by the older girls, particularly Hava and her roommate Carrie, who seemed to her like mentors. She learned from them that exercise could affect body weight and began doing jumping jacks with them at night. She also adopted their practice of refusing to sit down, standing throughout meals and even while reading. The hospital environment, with its system of privileges tied to food consumption and the threat of feeding tubes for weight loss, created a structure that reinforced eating-disordered behavior. For these young patients, anorexia offered a language for expressing distress when other forms of communication seemed inadequate. But this language was often shaped through what philosopher Ian Hacking calls the "looping effect" - people adjusting their behavior, consciously or unconsciously, to match the way they've been classified. When Rachel later encountered Hava's journals, she was struck by the similarity of their handwriting and expressions, suggesting how closely their identities had become aligned through shared diagnostic frameworks. After seven weeks in the hospital, Rachel returned home and gradually abandoned her anorexic behaviors. Unlike Hava, whose illness became chronic, Rachel never fully internalized the diagnosis as part of her identity. Years later, she wondered if this difference stemmed partly from age - she may have been too young for anorexic behavior to "stick" to her, as she was moving through developmental phases too quickly. The difference between a lifetime of illness and recovery might have been, as she puts it, "a few years." For Laura Delano, who was diagnosed with bipolar disorder at fourteen, psychiatric narratives became central to her sense of self. When her Harvard psychiatrist confirmed the diagnosis, Laura felt relieved rather than distressed: "It was like being told: It's not your fault." The diagnosis offered a concrete explanation for her feelings of alienation and emptiness. Over the next fourteen years, she would take nineteen different psychiatric medications, often in combination, as her doctors continually adjusted her treatment in response to side effects or breakthrough symptoms. By her late twenties, Laura had become what the philosopher Louis Sass calls the "ascetic anorexic" - a patient so versed in psychiatric terminology that she could analyze her own symptoms before her appointments, merely seeking her doctor's confirmation. But this narrative eventually began to feel constraining rather than liberating. After reading critical perspectives on psychopharmacology, Laura gradually tapered off all her medications, experiencing severe withdrawal symptoms but also rediscovering aspects of her identity and sensory experience that had been muted for years. These stories reveal how psychiatric narratives can both illuminate and obscure, providing frameworks that help people make sense of their suffering while sometimes limiting their sense of possibility. The power of these stories lies not merely in their diagnostic accuracy but in how they shape identity, relationships, and one's sense of future potential. For some, like Rachel, brief exposure to a psychiatric framework leaves minimal lasting impact; for others, like Laura, the narrative becomes so deeply internalized that extracting oneself from it requires a profound transformation of identity.

Chapter 5: The Chemical Path: Psychopharmacology's Promise and Limits

The introduction of psychopharmacology in the mid-twentieth century transformed psychiatry, offering new hope for conditions previously considered untreatable. This revolution began with the tuberculosis drug iproniazid, which had the unexpected side effect of making patients feel unusually cheerful. Nathan Kline, a prominent psychiatrist who would later briefly treat Ray Osheroff, observed patients at a sanitarium on Long Island who felt so lighthearted while taking iproniazid that they danced in the corridors. One woman later told her psychiatrist that she had experienced happiness only once before - during a religious conversion while recovering from tuberculosis. When Kline began prescribing iproniazid to his depressed patients, he observed remarkable transformations. A young married woman started "caring for her household efficiently and doing full time graduate work." An artist who hadn't painted for over a year produced "a profusion of oil paintings, water colors, and sketches totaling more than a hundred." The drug seemed to restore what Roland Kuhn, another pioneer in psychopharmacology, called "the power to experience." Yet the theoretical foundation for these medications remained uncertain. Joseph Schildkraut's influential 1965 paper in The American Journal of Psychiatry proposed that depression might be caused by deficiencies in certain neurotransmitters, since antidepressants appeared to increase their availability. However, Schildkraut himself described this chemical-imbalance theory as "at best a reductionistic oversimplification of a very complex biological state." Despite decades of research and billions spent, scientists have not located specific biological or genetic markers associated with any psychiatric diagnosis, and it remains unclear exactly how antidepressants work. For patients like Laura Delano, medications initially offered relief but eventually created new problems. The Prozac prescribed for her depression made her drowsy, so her doctor added Provigil, a stimulant used for narcolepsy. When that made it difficult to sleep, she was given Ambien. This "prescription cascade" - where side effects of one medication are treated with additional drugs - led to her taking multiple psychiatric medications simultaneously, a common pattern in contemporary psychiatry. Laura's experience with withdrawal when she decided to stop her medications reveals another limitation of the chemical approach. She experienced sweating, dizziness, and extreme sensitivity to sounds and colors. Her emotional reactions felt disproportionate and artificial - "like you feel possessed," she explained. "The emotions are occupying you, and you're at their mercy, and yet, on one level, you know they are not you." Online communities of people withdrawing from psychiatric medications have developed terms for these experiences: "neuro-emotion," "dystalgia," and other words attempting to describe sensations that exist beyond conventional language. Naomi Gaines faced different challenges with medication. While antipsychotics helped stabilize her acute symptoms, they did little to address the social and historical contexts of her distress. When she complained that "white people are out to get me," this was documented as one of her "bizarre statements" rather than recognized as reflecting her lived experience as a Black woman. Helena Hansen, a psychiatrist and anthropologist, observes that her Black and brown patients are less responsive to the idea that "your biology is deficient and you can fix that with technology" - a framework that can deflect attention from the social forces that contribute to mental suffering. The chemical approach to mental health has undeniably helped millions of people function better in their daily lives. However, its limitations become apparent when medications are presented as complete solutions rather than tools within a broader understanding of human suffering. As Thomas Insel, who directed the National Institute of Mental Health for thirteen years, wrote in 2022: "Nothing my colleagues and I were doing addressed the ever-increasing urgency or magnitude of the suffering millions of Americans were living through - and dying from."

Chapter 6: Healing Communities: Finding Connection Beyond Diagnosis

When Naomi Gaines was incarcerated at Shakopee Correctional Facility in Minnesota following her tragic actions on the Wabasha Street Bridge, she found herself isolated not only physically but socially. Other incarcerated mothers, many of whom were also Black, "completely shunned me," she recalled. "They looked at me like, 'How dare you break down and do that to your kid?'" This rejection reinforced her sense of being fundamentally alone in her suffering. Then, unexpectedly, Naomi met Khoua Her, a Hmong woman who had also been convicted of killing her children while in a state of psychological distress. Khoua approached Naomi and said, "I don't know if you know me, but if you ever need someone to talk to, I'm here. I know what you are going through. I understand." This simple act of recognition - the acknowledgment that someone else could comprehend her experience - created what Frieda Fromm-Reichmann, once called the "queen of Chestnut Lodge," described as the opposite of loneliness: the sense that one's inner life can be shared and understood. For Bapu, the spiritual seeker in Chennai who was diagnosed with schizophrenia, a different kind of community emerged around her. Despite her family's initial rejection of her devotional practices, neighbors began to see her as a holy woman with healing powers. Word circulated that if she touched the forehead of a sick baby, the baby's fever would dissipate. Mothers sought her counsel when their sons struggled in school, and fishermen asked her to pray for their ill children. "The neighborhood ladies thought she was a saint, just like Mirabai," her nephew observed. This community validation offered Bapu a framework for understanding her experiences that differed radically from the psychiatric explanation imposed on her. Laura Delano found her healing community online, among people who were also struggling to withdraw from psychiatric medications. These forums - with names like Surviving Antidepressants, the International Antidepressant Withdrawal Project, and Benzo Buddies - offered practical advice about tapering medications and a space to communicate about emotional experiences that lacked conventional names. Unlike the anti-psychiatry movement of the 1970s, which questioned whether mental illness existed at all, these communities acknowledged suffering while challenging dominant narratives about its causes and treatments. For Ray Osheroff, meaningful connection remained elusive throughout his life. After his experience at Chestnut Lodge and Silver Hill, he returned to a diminished medical practice and strained relationships with his children. He continued revising his memoir for over thirty years, hoping that if he could just frame his story correctly, he might "finally reach the shore of the land of healing." But the manuscript became increasingly oppressive and dishonest over time, focused on revenge rather than understanding. The absence of a community that could validate both his suffering and his potential for growth left him isolated within his own narrative. In her memoir "The Center Cannot Hold," law professor Elyn Saks describes her diagnosis of schizophrenia as being told that whatever had gone wrong inside her head was "permanent and, from all indications, unfixable." This sense of permanent alienation is what healing communities often work to counteract. The psychologist Pat Deegan, who was diagnosed with schizophrenia as a teenager, argues that recovery is not about returning to a previous state but about transformation - "an ever-deepening acceptance of our limitations" combined with the discovery of new possibilities. These diverse examples suggest that healing often emerges not from the perfect diagnostic framework or medication regimen, but from connections that make suffering communicable rather than isolating. In these spaces, people can develop what the philosopher Ian Hacking calls "kinds of people" - new ways of being that incorporate aspects of diagnosis without being reduced to them. The most effective communities seem to be those that can hold multiple explanations simultaneously, acknowledging the biological dimensions of distress while also honoring its social, cultural, and existential meanings.

Chapter 7: Recovery as Transformation: Redefining the Self After Crisis

Recovery from mental illness has traditionally been framed as a return to normal functioning - what Pat Deegan calls the "restitution storyline." Yet for many who have experienced profound psychological crises, this narrative proves inadequate. "For those of us who have struggled for years," Deegan writes, "the restitution storyline does not hold true." Instead, recovery often involves a fundamental transformation of identity, a process of discovering who one might become rather than reclaiming who one was before. Hava, the twelve-year-old girl who had befriended six-year-old Rachel in the hospital, struggled with anorexia for decades. Her journals reveal how the illness gradually became central to her identity - "Labels aren't so bad," she wrote. "They at least give you a title to live up to... and an identity!!!!" Her recovery didn't begin until her forties, when she met Tim, a financial analyst who approached her with an attitude of acceptance rather than judgment. When she purged after meals, he didn't criticize her but understood it as her way of managing anxiety. His compassion created space for gradual change - "You're never going to have a big breakthrough," he told her. "But there are a lot of tiny breakthroughs, and they add up." For Naomi Gaines, transformation came partly through discovering frameworks that could accommodate both her psychiatric symptoms and her awareness of racial injustice. In prison, she spent hours in the library reading works by bell hooks, Fox Butterfield, and other writers who explored the intersections of race, trauma, and healing. The prison librarian observed that for Naomi, "these ideas were already playing in her mind: that she came from a history of enslavement, from a family whose roots were not recognized." Finding these perspectives validated in literature helped Naomi develop what psychologists call "insight" - not just accepting her diagnosis, but understanding how it related to her complete identity and history. Laura Delano's recovery involved reclaiming aspects of herself that had been muted by years of medication. After tapering off nineteen psychiatric drugs, she experienced physical sensations and emotions with new intensity. At thirty-one, she learned how to give herself an orgasm for the first time - an achievement that left her in tears of joy. She also discovered a capacity for intimate relationships that had previously seemed impossible. "On this very sensory, somatic level, I couldn't bond with another human being," she explained. "It never felt real. It felt synthetic." Her transformation wasn't about returning to a pre-medication self but about discovering who she might be beyond diagnostic categories. Bhargavi, the daughter of Bapu (the spiritual seeker diagnosed with schizophrenia), underwent her own transformation after her mother's death. For years, she had rejected her "haunted childhood" by becoming "a total rationalist," gravitating toward European philosophers and dismissing the spiritual frameworks that had defined her mother's life. After losing her own baby daughter and experiencing a mental health crisis, Bhargavi began to reconsider her mother's story. She founded Bapu Trust, a nonprofit organization in Pune, India, that helps families find explanations for mental distress that resonate with their own cultural and spiritual perspectives rather than imposing Western psychiatric frameworks. These diverse paths to recovery challenge the notion that mental illness has a single trajectory or endpoint. They suggest that healing often involves integrating crisis experiences into a more complex understanding of the self rather than overcoming or erasing them. As the philosopher and psychiatrist Karl Jaspers wrote, mental illness can be viewed as "a mode of failure which represents not a loss of value but on the contrary a revelation of being." This transformative view of recovery acknowledges that people may never fully return to their pre-crisis selves, nor should that necessarily be the goal. Instead, as Fromm-Reichmann told a patient anxious about leaving Chestnut Lodge, the experience of mental illness provides "a tremendous amount of human experience" - a capacity to observe "practically all types of emotional experience" in oneself and others. These experiences, she suggested, are not alien to humanity but rather intensified versions of universal human struggles - "seen as if under a magnifying glass."

Summary

At its core, the journey through mental illness reveals how our understanding of the mind is never purely objective but always filtered through cultural, historical, and personal lenses. Each individual in these narratives confronts the inadequacy of a single explanatory framework to capture their complex reality. Whether it's Ray Osheroff caught between psychoanalytic and neurochemical explanations, Bapu navigating the collision of Western psychiatry with Indian mysticism, Naomi struggling to have her racial trauma recognized within clinical settings, or Laura finding that diagnostic categories both illuminated and constrained her sense of self - all demonstrate how the stories we tell about mental suffering profoundly shape its course and meaning. Perhaps the most valuable insight these experiences offer is the necessity of holding multiple truths simultaneously. Mental distress may indeed involve biological mechanisms, but it is also inseparable from one's social world, cultural context, and personal history. Recovery rarely follows a linear path back to some idealized "normal" state but instead often involves transformation - discovering new ways of being that incorporate rather than erase difficult experiences. As we continue to evolve our understanding of mental health, these narratives remind us that the most healing approach may be one that maintains curiosity about the full complexity of human suffering, that respects the power of both medication and meaning, and that recognizes how profoundly we are shaped by the communities and frameworks through which we understand ourselves.

About Author

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Rachel Aviv

Rachel Aviv joined The New Yorker as a staff writer in 2013. She has written for the magazine about a range of subjects including medical ethics, criminal justice, education, and homelessness. She was a finalist for the 2018 National Magazine Award for Public Interest for “The Takeover,” a story about elderly people being stripped of their legal rights, and she won the 2015 Scripps Howard Award for “Your Son Is Deceased,” a story on police shootings in Albuquerque. Her writing on mental health was awarded a Rosalynn Carter Fellowship, an Erikson Institute Prize for Excellence in Mental Health Media, and an American Psychoanalytic Association Award for Excellence in Journalism. She has taught courses in narrative medicine at Columbia University Medical Center and the City College of New York. In 2010, she received a Rona Jaffe Foundation Writers’ Award. She was a 2019 national fellow at New America.

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