Dispatches from the struggle to treat mental illness


Strangers to ourselves. By Raquel Aviv. Farrar, Straus and Giroux; 288 pages; $28. Harvill Secker will publish it in Britain in October; €18.99

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What if the diagnosis of a mental illness does not help the patient? (Pixabay)

What if the diagnosis of a mental illness does not help the patient? What happens if you trap them in a system (therapeutic or pharmaceutical) that, paradoxically, makes them worse? New Yorker writer Rachel Aviv poses these questions at the beginning of “Strangers to Ourselves,” a collection of essays loosely linked by the theme of “restless minds.”

“Strangers to Ourselves” ends with Ms. Aviv’s own psychological struggles. She begins by remembering her hospitalization for anorexia when she was six years old. At that age her diagnosis was too big for her to comprehend, just as the name of her illness was difficult to spell: “she had something that was a siknis, her cald annexea.” In the classroom, she learned to imitate the tics and gestures of the older girls. Shocked by how she and her condition were pigeonholed, her parents rejected doctors’ advice that they should commit her to another psychiatric hospital, which could have saved her from a life defined by her disorder.

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Near the end of his book, Aviv writes about how, as a journalist in New York, he was prescribed an antidepressant. “My first six months on Lexapro were probably the best half-year of my life.” Her anxieties about her job disappeared; She became engaged and subsequently became pregnant. But when she tried to quit the drug, she discovered that she fell into a depression. She’s been doing it for more than a decade now.

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Among these personal experiences, Ms. Aviv describes five people who have struggled with psychological problems and has written about their experiences in memoirs, diaries and unpublished fragments. Through these case studies, she questions the effectiveness of different types of treatments and the parameters of clinical thinking, particularly in the United States, where she tends to dominate a pill-based approach. One in eight Americans takes antidepressants; among white women, that number rises to one in five. But the plight of black people and the poor is often ignored. More than two-thirds of women incarcerated in prisons have a history of mental illness.

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The most striking of these profiles is that of Naomi Gaines. In 2003, when she was 24 years old and a mother of four, she jumped from a bridge into the Mississippi River with her twins, one of whom drowned. Her problems, as a poor black woman, began when she was young. She grew up in a sprawling public housing complex in Chicago that was partially controlled by gangs. Her mother had an abusive boyfriend and the couple used drugs. She never discussed mental illness, her mother tells Ms. Aviv. “In our family, if you’re feeling a little down, you just take a nap. That’s the solution: take a nap.”

Gaines walked in and out of the hospital before jumping off the bridge. But the litany of diagnostic labels he was given was alienating and he didn’t take his medication. “Where is the sensitive side of psychiatry?” she asked. After the jump, she was placed in a secure institution for being “mentally ill and dangerous” and began taking an antipsychotic. She was charged with second-degree murder and sent to prison. Things began to change: she read voraciously and became a clerk in the prison library. She was assigned a therapist. But in 2010 she was taken off the antipsychotic “due to cost” and she was soon placed in solitary confinement for 60 days. She was released 16 years after her crime.

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Ms. Aviv writes sensitively about the limits of diagnosis in a case like this. “Psychiatric knowledge can save a life,” she acknowledges. However, a narrow medical perspective “can also blind doctors and family members to certain beliefs (a relationship with God, a new understanding of society and one’s place in it) that are essential to a person’s identity and self-esteem.” a person”. She discusses the racial biases seemingly inherent in the American healthcare system: According to one study, 40% of second-year medical students think black Americans are less likely to feel pain. She sees the limits of antidepressants, even if some medications can improve life.

The subtlety of Aviv’s book is also its flaw. All five of his profiles feel disparate and disconnected. A chapter set in India is the weakest; the author is better when she is at home. A case study that was originally a New York profile (of a woman named Laura who was prescribed pill after pill) has the greatest sense of purpose. Aviv’s withering assessment of the “biochemical” model of medical care that she overprescribes is powerful, as is her horror at the treatment Gaines received at the hands of doctors and prison guards. More moments of clarity like these would have made a better book.

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© 2023, The Economist Newspaper Limited. All rights reserved. From The Economist, published under license. Original content can be found at www.economist.com



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