Strangers to Ourselves is a non-fiction book published by Rachel Aviv in 2022. The author herself is assumed to be the youngest child ever clinically diagnosed with anorexia when she was admitted to Children’s Hospital of Michigan at the tender age of six. The nightmare that ensued would eventually work its way into this overview of misdiagnosis and the inherent problems associated with correctly diagnosing and treating mental health disorders. A
viv admits that while hospitalized she actually "learned" how to be anorexic from the older girls there also being treated for eating disorders. She adopts the language of Joan Jacobs Brumberg in her writing on the subject, by describing herself as having been "recruited" to become anorexic. Ironically, it would be her very youth that likely saved her from decades of her self-identity being defined by anorexia.
Many people dealing with undiagnosed mental issues or who feel that they have been misdiagnosed can become especially susceptible to external influences. These influences can lead to not just merely taking a tricky path down mistaken self-diagnosis, but creating problems that don't organically exist as a result of twisting behavior so that it adheres more closely to the symptoms of that false self-diagnosis. Strangers to Ourselves takes the form of several case studies that examine such phenomena.
A fairly common example is presented in the case of Laura, a young woman who is initially diagnosed with bipolar depression but is over time reassigned to Borderline Personality Disorder (BPD). The two disorders are hardly interchangeable, require vastly differing treatments, and come with significantly different "baggage." The latter proves especially problematic for Laura who, misinterpreting the disorder by viewing it through the eyes of someone who does not suffer from having BPD, comes to view herself in negative terms as the stereotypical "manipulative bitch" that is the norm for pop culture presentations of the fact that women are overwhelmingly diagnosed with the disorder more than men.
Another case illuminates the degree to which cultural differences can play a major role in the difficult process of correctly diagnosing mental health issues based on behavior. Bapu is an Indian woman who is wildly misdiagnosed as schizophrenic by a physician steeped in western culture and health care. The stimulation for the diagnosis was Bapu's admittedly extreme form of religious practice within her Hindu belief system. On a certain level, the story of Bapu illustrates the great question of religious history: what separates spiritual certainty from delusional insanity? Eventually coming to see herself as a "bride of Krishna" and even she comes to describe herself as crazy in her journals. Which, of course, raises another important question: if one recognizes that they may be divorced from reality can they qualify as insane?
These are the types of questions that permeate the book as the author relates the case histories. The most intense example is probably Naomi, a young African American woman growing up in extreme poverty in Chicago in the 1980s and 1990s. So overcome is she by a relentless cycle of despair fueled by racism and discrimination that she attempts a mercy killing/suicide by throwing herself and her twin sons off a bridge in a desperate attempt to spare them the misery she fully believed would follow them throughout their lives. Aviv dares to present this act as potentially saner than it seems. Naomi's horrific act is unquestionably open to legal debate, but the book asks readers to deeply consider whether or not it is unquestionably a demonstration of mental illness.
This is ultimately the thematic centerpiece uniting the case histories. A diagnosis of mental illness is revealed to often be the machine that drives the explanation for behavior when it should be the other way around. This dissonance is what the title refers to in describing how a young girl acting out the role of anorexic can become anorexic or how a shift from a diagnosis of depression to a personality disorder can severely alter one's self-identity.
