When Rachel Aviv, the author of Strangers to Ourselves, was six years old, she simply stopped eating.  She said she got the idea from the Yom Kippur fast.  She was promptly checked into a psychiatric hospital where she became one of the youngest-ever patients to be given the diagnosis of anorexia.  Through associating with older, more seasoned anorexic girls she became a sort of “anorexic-in-training” (p.13). Fortunately, after a few months she snapped out of it, and was discharged.  She never suffered from the same symptoms again.   

As an adult, Aviv began to think about what had happened to her.  The only remnant of her experience was a diary entry from age 8: “I had a diseas called anexexia” (p.231).  Had she even had the disorder, or had the diagnosis been a mistake?  Why had she not gone on to have “an anorexic ‘career’” (ibid.), while one of the girls who had mentored her ultimately died of anorexia-related causes?   In order to answer these questions for herself, Aviv meets with the therapists who treated her more than thirty years ago as well as with the family of her deceased copatient.   

As a result of Aviv’s introspection, she becomes intrigued by people whose psychiatric diagnoses do not fully capture the complexities of their situation.  Strangers to Ourselves presents detailed case histories of several such individuals.  Bapu is an Indian woman whose visions have caused her to be diagnosed with schizophrenia.  Are they delusions, or is she a mystic?  Naomi is a socially disadvantaged black woman who has struggled unsuccessfully to get ahead.  During a manic episode, she jumps into a river with her young twins, one of whom dies. Her claim that “white people are out to get me” (p. 146) is ignored because her doctors insist that “delusions couldn’t on some level make sense” (p. 150). Yet another woman, Laura, bounces from diagnosis to diagnosis, and sleeps fourteen hours a day because of all the medication she is on.  She becomes one of these people who no longer even know if their lack of functioning is “due to their underlying disorder [or] the heavy medications they’d taken for it” (p. 203).      


Strangers to Ourselves provides a fascinating glimpse at people whose psychiatric conditions cannot be fully understood through existing paradigms. As a journalist, and given her own history of being questionably diagnosed, Aviv has a unique perspective.  This is not at all an antipsychiatry book; rather, the author approaches the subject nonjudgmentally so that what the reader is left with is an appreciation for the complexity of the human condition.     

The author suggests that “the stories we tell about [mental illnesses] …can shape their course.  People can feel freed by these stories, but they can also get stuck in them” (p. 22).  In her own case, had she not been yanked out of the hospital by irate parents, she might have copied other patients, and her anorexic behaviors might have become entrenched.  Laura forges an identity based on her diagnosis of bipolar disorder.  When her diagnosis is changed to borderline personality disorder, she takes that to mean she is a “manipulative, fucked-up person” (p. 192).  Yet another patient, Ray, after unsatisfactory results from both psychotherapy and medication, hopes to relieve his depression by writing his memoir.  He works on it obsessively for years, hoping “if he just framed the story right or found the right words…he could ‘finally reach the shore of the land of healing’” (p. 63).  Tragically, he dies suddenly without having completed his book.  

In two of the case studies, a failure to understand a patient’s cultural background leads to misdiagnosis and poor treatment.  Bapu’s Western-trained doctor considers hers to be “one of the worst cases of schizophrenia I’ve seen” (p.94); the neighbors, however, see her as a sort of holy woman. She seems most content when praying but is repeatedly forced into treatment against her will, with dubious results.  Naomi might have been more compliant with treatment if she had felt validated as a black woman: “The doctors’ lack of knowledge about who I am and where I come from pushed me farther and farther away” (p.145).  Indeed, black patients are less often comforted than white ones by being given a biological explanation for their illness.  What may make them feel comforted is an acknowledgement that society has contributed to their problems.   

Some of the most insightful observations in Strangers to Ourselves concern the use of the term “insight.”  Bapu’s doctor says of his patient that “the schizophrenic has no insight…She doesn’t know who she is” (p.77). Naomi’s doctor makes a pronouncement that “her insight is nonexistent” (p.147), whereupon a judge orders her to be forcibly medicated. Laura has “found a kind of solace in surrendering herself to disease” (p. 191) but when her diagnosis changes, she realizes she has “developed insight into the wrong condition” (ibid.). The author cautions us that “a constricted view of insight may…blind doctors…to certain beliefs…that are essential to a person’s identity and self-worth” (p.172). Hopefully, this book will serve as a reminder to mental health professionals that their words carry weight and that all patients deserve to be listened to and emotionally validated.  


Following Bapu’s death, her daughter started an organization called Bapu Trust ( which speaks of “decolonizing the Indian mental health system” and whose purpose is “to see a world where emotional well-being is experienced in a holistic manner, and not just as ‘mental disease.’ We dream of healing environments where every person uses their own capacity to make choices, heal themselves, recover and move on.” 


Farrar, Straus and Giroux

Place Published

New York



Page Count