Tyler Jager
Rachel Aviv is a staff writer at The New Yorker, and the author of Strangers to Ourselves: Unsettled Minds and the Stories That Make Us (Farrar, Strauss, and Giroux, September 2022). The book, her début, explores how personal and institutional narratives shape what Aviv terms the “psychic hinterlands,” accounts of mental distress that are less distinct from “a setting which we might call normal” than we might believe.
Aviv tells the stories of four very different people and their encounters with psychiatric explanations for their illnesses: Ray, who sues a famed psychoanalytic institution in the 1960s for failing to cure him; Bapu, who abandons life in an elite Brahmin family to devote herself to ascetic mysticism; Naomi, a Black woman who is incarcerated in Minnesota for throwing herself and her two children off a bridge; and Laura, a wealthy Harvard graduate who decides to go off her prescribed psychiatric medications to discover a new identity for herself. Aviv closes the book with Hava, whom she met as a young girl in an anorexic ward, and whose story ends up veering far from where Aviv herself ends up.
I spoke with Aviv in September over the phone to discuss Strangers to Ourselves, her magazine writing, and her singular approach to narrative nonfiction. As she describes in this interview, edited for length and clarity, “There’s the hope that if you get close enough to someone’s own point of view, their behavior no longer seems alien and unattractive, but feels to some degree legible.”
In Strangers to Ourselves, you mention how you felt self-conscious about your choice of career after reading your psychiatrist’s notes as an adult, which said that when you were in medical intake as a child, you ‘could control the interview.’ Was this related to your first interest in a career in journalism?
Not totally. I think I just really wanted to write. I didn’t know what form it would take. I assumed I wanted to write fiction, so I would write short stories, and something that I noticed was that I was good at describing. The idea of creating my own plot—it just seemed like an act of true genius, that people are able to do that. Right after graduating from college, I started reading a lot of nonfiction, people like Adrian Nicole Leblanc, or Tracy Kidder, and I discovered for the first time that there really was a genre of writing that could develop the characters in a way that felt novelistic but that was true. So I think I approached journalism more from that angle. If I wanted to be writing this kind of story, I needed to figure out how to find a story and how to collect the acts, and how to interview people. It stemmed more from finding a form that I found incredible as a reader and wanting to be able to do that.
Are there ways of getting your audience—for lack of a better word—just, to care? To approach something that might already have a turn-off effect because the very subject is stigmatized?
Right, like when I write about Naomi, she is a mother who kills her child. That, for most people, is it. You’re done. You don’t feel anything for her. Actually, my editor originally said that’s too much. But I approached it as, ‘here is this woman in pain, who’s having all these really complicated thoughts about the community in which she’s moving around, and if we can understand the way she’s being in the world, and how she’s tried to articulate for herself what she just did—this unthinkable thing she just did—the challenge is to get the reader in a space where the unthinkable thing she just did feels legible, because of all these thoughts she’d been having up to it.’ There’s the hope that if you get close enough to someone’s own point of view, their behavior no longer seems alien and unattractive, but feels to some degree legible.
Another theme in your magazine writing is that you’re often following one character, say, through a journey or reacting to some institution. But a lot of the stories in this book felt really multivocal.
I’m glad you felt that way, because I felt like that was one of the freedoms of having more space. I could enter more people’s perspectives. I did like the experience of having a conversation with one person and coming away with a certain view of the situation, and then I would have a conversation with her sister, and come away with a very different view, and come away with the mother, and then I’d have a third view. I think in the writing I wanted to be able to preserve that experience so that a reader also feels their perspective shifting, and feels the possibility of seeing the same set of events through different frameworks.
I’d like to ask you about Naomi specifically—because it is a story wrought with emotion in so many ways. There are so many documents involved, and also the challenges of people knowing you’re interviewing many members of your family, who may say things that are outside their control. What was building that relationship like?
I just started by sending her a Facebook message, and then we talked on the phone. She was very open. I was like, ‘I’d love to read your unpublished memoir,’ and then she sent it to me, and I read it and responded. From there, I planned a meeting with her in person. It might have been after our first meeting in Minnesota when I asked if I could read some of the documents related to her case. But it was a very slow process. It wasn’t until I had been talking to her for more than half a year that I finally met her in Chicago, and her sister gave me these garbage bags full of her letters from prison.
I think for Naomi, something that she’d faced was that she had gotten the worst media coverage possible. ‘Mother of children kills child.’ I think she rightly understood that there was a way of telling her story that was far more compassionate, and nuanced, and true to the experience. She wanted to participate in that, and felt actively passionate about that. So I think she was quite open because the work I wanted to do was very much aligned with work she wanted to do in her own life.
Is that how you came across her story? Through this rotten media coverage?
There was one good article in the Star-Tribune, after [Naomi] had gotten out of prison where she was just reflecting on her life, and a friend had sent me the link. There was something about the way she spoke that was just arresting. She spoke with such detail, and is just a beautiful thinker and speaker and I was drawn to that. She seemed like someone who was really actively trying to make sense of her experience on a number of different registers. Medical, sociological, political—she was just trying to grapple with it all. Someone could have gone through the same experience as she did, and maybe all those same factors would have been at play, but she had this unique capacity to reflect on them and write about them. That was something I pointed out in our first conversation, and it became the root of our relationship, talking about those multiple registers.
I was also curious about your relationship with Laura, because that was a story you’d written already for The New Yorker [“Bitter Pill,” April 8, 2019 Issue]. Was that an example of coming back to someone and re-evaluating, or were there other aspects of the story that changed when writing for a magazine versus a book?
When I wrote the magazine story, I was thinking a lot about how there just wasn’t enough attention to problems of withdrawing from medications. It felt like it was this underexplored, under-discussed area. I approached Laura’s story through that framework: why are people talking about this? Why is this such a feature of people’s lives, getting off these drugs?
For the book, that question no longer felt as prominent to me. It was more about how Laura had really embraced one story about herself: she was bipolar, she needed to take medications for the rest of her life. And then there was this 180-degree shift to ‘no, it’s been medications that have caused all these problems.’ The chapter was a little less aligned with her argument than the magazine piece had been. In the book, I was looking more into how the new view she had— the view that seemed to have saved her—also had a lot in common with the previous story she had, that psychiatry was this precision instrument that could solve her problems.
Was that a reaction to your own personal reevaluation of her story?
It was just doing more thinking and research on these questions, and having more space. I think I was kind of angry about the lack of knowledge about why all these people were on these medications for so long, and why we don't know enough about getting off them. When I wrote the book chapter, I think some of that anger had cooled. In the context of, ‘ what is this evolving story of what psychiatry has been telling to people,’ it felt like I was in a space of more critical distance.
I think one reason your reporting is really fascinating because there’s this sort of seamless way that you’ve weaved in academic research into your writing. For example, you cite Miranda Fricker in the book—epistemic injustice is really her concept—and I know you’ve written on the philosopher Martha Nussbaum in the past. At what stage does that research enter your reporting? Is it more of an ideation stage of what you might want to write about, or does it present different ways to think about the subject?
I’m glad you like that. I think it comes in earlier. Sometimes, if I’m thinking, ‘is this a worthwhile story?’ I will read academic work on the subject—just to understand if there’s a rich discussion about this idea. Then, I’ll often read academic work as a way of thinking about the most important questions to ask people. I love reading anthropology, because in a way it’s a version of journalism—a more rigorous version—and you can see what other people are saying about the subject.
Sometimes I’ll introduce work in conversations, and it’s always nice when someone has read it —like if Naomi said, ‘yes! I’ve read this piece by Miranda Fricker,’ that would have been a really organic way to talk about her ideas. So I love when someone I’m writing about is reading something; then I can read it too, and we can build off that. When it comes to integrating the actual academic work into the writing, I try to only do it unless I can’t otherwise make the point, or there’s the question of giving credit to an idea that I wouldn’t have otherwise been able to articulate. But I am wary of putting it in for any reason other than because it thickens or advances a reader’s understanding of the narrative. I try not to do a dump of research, where I’d be horizontally explaining the situation without moving the narrative forward.
In other interviews, I’ve heard you describe how having a narrative that exists—either if it’s in psychiatry, or if it’s in media—can help people give meaning to their own sense of illness or crisis, by giving it language. That’s a big theme in the book. I’m wondering if you have thought that your own writing has done that. Say someone that’s struggling with one of these conditions picks up a copy of Strangers to Ourselves and it changes the way they think about it.
I mean, that would be the dream. To make someone less lonely. My best reading experiences are like that: “oh my god, someone articulated this shape of experience that I wasn’t totally aware of, and now I am, and I feel this relief from a loneliness that I didn’t totally know I had” — that’s, to me, an amazing thing that reading does. So I would love it if someone had that experience.
That’s one other reason I loved the themes of the book. There are, for these individual people—for Hava, for example, it’s her partner—people they rely on who make them feel less alone. Was loneliness always a theme you anticipated in advance?
No, no. That was something I noticed after I finished writing, that people’s sense of recovery seemed to hinge on their sense of isolation. I was really interested in Frieda Fromm-Reichmann’s essay about loneliness, about how it’s this experience that’s so terrifying that people really don’t want to talk about it. It’s not seen as a phenomenon within psychiatry’s purview. So that emerged in part because I was seeing the moments of commonality in the lives of the people I was writing about.
It’s interesting because it seems like what makes that special could disappear if you tried to remedy it through policy—the spontaneity of personal relationships.
Right. But I do think there could be more of an emphasis on peer care, if other people have had similar experiences. There are more programs like that today, where people who have experiences with mental illness mentor and visit other people who are deeper in a crisis. I think that seems like a really important and financially viable method, rather than expecting that everyone’s going to have a deep relationship with their doctor.