Stories That Trap Us
Rachel Aviv on the stories we tell about mental illness
One of the most damning failures of contemporary psychiatry has been the profession’s inability to promote diagnostic narratives that do justice to the complexity, diversity, and richness of psychopathology, are conducive to psychological self-understanding, facilitate recovery, and take the ethical responsibility of “looping effects” seriously. This is not simply a conceptual or scientific failure, as the profession has had the conceptual and scientific resources to offer such narratives, but it seems to me to be a failure rooted in a distinct lack of epistemic humility and a lack of attention to how stories shape our lives. Rachel Aviv, a staff writer for The New Yorker, homes in on this issue really well in her recent book Strangers to Ourselves, and shares her own experience of an eating disorder at a very early age:
“I also wonder if I ever had anorexia in the first place. Maybe my limited exposure to the ideal of thinness prevented me from wanting it badly enough. To use the terms of the historian Joan Jacobs Brumberg, who has written eloquently about the genesis of eating disorders, I was “recruited” for anorexia, but the illness never became a “career.” It didn’t provide the language with which I came to understand myself.
This sense of narrow escape has made me attentive to the windows in the early phases of an illness, when a condition is consuming and disabling but has not yet remade a person’s identity and social world. Mental illnesses are often seen as chronic and intractable forces that take over our lives, but I wonder how much the stories we tell about them, especially in the beginning, can shape their course. People can feel freed by these stories, but they can also get stuck in them. […]
There are stories that save us, and stories that trap us, and in the midst of an illness it can be very hard to know which is which.
Psychiatrists know remarkably little about why some people with mental illnesses recover and others with the same diagnosis go on to have an illness “career.” Answering the question, I think, requires paying more attention to the distance between the psychiatric models that explain illness and the stories through which people find meaning themselves. Even if questions of interpretation are secondary to finding effective medical treatment, these stories alter people’s lives, sometimes in unpredictable ways, and bear heavily on a person’s sense of self—and the desire to be treated at all.”
Rachel Aviv. Strangers to Ourselves. Farrar, Straus and Giroux. (pp. 21-24) (emphasis mine)
See also:
Psychiatry wars: the lawsuit that put psychoanalysis on trial — chapter from Strangers to Ourselves on the conflicted legacy of the Ray Osheroff vs Chestnut Lodge case adapted for The Guardian (we confront new forms of polarization in mental health discourse today, but the conceptual lessons of humility and pluralism remain the same)
[I will occasionally share quotes/passages from books or articles that I find to be interesting and thought-provoking. For such posts, my goal would be to focus on material that the average reader of this newsletter is unlikely to have come across on their own, but would find to be relevant.]