Strangers to Ourselves: Unsettled Minds and the Stories That Make Us, is not Rachel Aviv’s case for or against any particular approach to mental health care, no one therapeutic approach. Rather, the book is a sweeping portrait of mental illness, told through case studies.

Some, like Black single mother Naomi, receive too little mental health care, while others, like white heiress Laura, too much. Ray, an American Jewish physician, can’t stop talking about himself and his problems. Bapu, a well-off wife and mother in India, loses herself in a pathological, spiritually-motivated selflessness.    

The American author—a staff writer for The New Yorker since 2013—makes two interconnected points. One is that mental health is complicated, a mess of internal and external definitions, of effective and futile interventions. The other is that it’s dangerous to make a psychiatric condition central to your identity. Fragility can become a self-fulfilling prophecy. Aviv is interested in how some people with mental illnesses go on to lead ordinary or successful lives, while others are held back by a status, either imposed on them or embraced, as mental patient. This becomes their whole thing, crowding out the possibility of a life with other sorts of meaning.  

Rachel Aviv compares her own trajectory, from six-year-old anorexia patient to reasonably well-adjusted, family-having writer, with that of Hava, a fellow child patient, who had made her eating disorder her “career.” Rachel and Hava shared certain demographic details—both Jewish, both children of divorce—except Hava wound up on a path where disordered eating became the main feature of her life, all the way until her untimely death from bulimia-induced injury.    

The autobiographical anecdote as entry point is now standard in non-fiction. The reader expects it as a convention, but also as a credential. Aviv gets to research and report on mental illness not just because she’s an accomplished journalist but because she herself was diagnosed with a serious mental illness.  

The drawback to deriving authority on a general topic from personal experience is that particular cases are, well, particular. But the author comes to the project aware that the mental health experiences of a by-all-accounts thriving professional who as a child dealt with what she herself isn’t even sure was anorexia are not representative. 

And so, Strangers to Ourselves is not primarily about perfectionistic, upper-middle-class white women with histories of anorexia. Aviv’s case studies cover extensive demographic ground.  

To me, Bapu’s chapter was the most compelling. The relationship between madness and spirituality is in some ways an old story, but the day-to-day context of a woman abandoning her husband and children to be a voluntarily impoverished religious pilgrim illustrated the challenges of classifying erratic behaviour as one or the other.   

The broad focus probably does make for a stronger book than if Aviv had chosen to keep the focus inward. But I’d have been interested to hear more about how she understands the relationship between Jewishness and anorexia. By way of explaining her own decision, at age six, to stop eating, she writes:

“I got the idea from Yom Kippur, the day of atonement, which we’d celebrated the week before. It was the first time I realized that it was possible to say no to food. The decision retained the religious energy from the holiday and carried an aura of martyrdom.”  

To this, she adds, “Hava may also have been unduly influenced by the spirit of Yom Kippur.” 

But if Jewish women and girls are disproportionately prone to eating disorders—something data supports—there are several possible interpretations. One would be Holocaust memory, or intergenerational trauma surrounding food. (Think of the images of gaunt Jews that are for obvious reasons a mainstay of Holocaust education.) There’s also kashrut. Jews are more likely than members of the general population to have lists of forbidden foods and food rules.  

But there’s something, I think, in Jewish quasi-whiteness, where many Jewish women and girls are understood as, or understand themselves as, white women who fail to measure up to white beauty standards. A sense that conventional beauty is within reach but elusive may drive some of this.  

Or maybe this wouldn’t have needed to be an entirely different book. Aviv looks at how colonialism impacted Bapu, how racism shaped Naomi’s story, and how expectations on bourgeois men help explain why Ray’s illness played out as it did. There is a Jewish story here, and I’m not just saying that because of the publication I’m writing for here. I don’t fault her for not telling it, but I wish she had.