Rachel Aviv: The Gordian Knot of Mental Illness

You might recognize Rachel Aviv’s name from The New Yorker, where she’s been a staff writer for a decade, covering subjects like medical ethics, psychiatry, criminal justice, and education. She’s been a finalist for the National Magazine Awards twice, and in 2022 she won one for profile writing. In 2022, she also published Strangers to Ourselves: Unsettled Minds and the Stories That Make Us, a recipient of the Whiting Creative Nonfiction Grant and named by The New York Times as one of the ten best books of the year. In It, Aviv tells the story of four people and the treatment they underwent—or not—for their mental illness. It’s a gorgeously told, layered exploration of all that we don’t know about the brain and the mind, and how various treatment modalities restructure our lives—including the stories we tell about who we are. Okay, let’s get to our conversation.

MORE FROM RACHEL AVIV:

Strangers to Ourselves: Unsettled Minds and the Stories That Make Us

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TRANSCRIPT:

(Edited slightly for clarity.)

ELISE LOEHNE: Well, thanks for joining me. It's hard to even know where to start. But I loved the book and sort of trying to get our arms around Something so nebulous, this is a hard topic to take on.

RACHEL AVIV: Yeah. Yeah.

ELISE: How did you choose these four and yourself?

RACHEL: It was a kind of serendipitous process. I think I always knew I wanted to write about Bapu. I'd come across her story when I was researching the global mental health movement. And I originally had thought about writing about her for the New Yorker, but I was struck by how her story felt like like epic family saga involving many generations and there wasn't a clear news hook. I kind of wanted to tell this family story in its entirety. So I had been thinking about her a lot. And then I got into this long correspondence with this man who had been a philosophy PhD student who had become sort of unable to continue his studies and had become homeless and was diagnosed with schizophrenia. And I had this sort of amazing correspondence with him about the experience of kind of moving through the streets and going to the various shelters and understanding like the hierarchy of the system of being homeless and I really had wanted to write about him, actually, and I think... It was that conversation that partly prompted me to write a book also, and in the end, he did not want to participate. So there was, I think, it was just that I had this space or this question that was kind of driving all the research I was doing, and the book felt like a way... To explore that question in a more, like, controlled way.

ELISE: Yeah, you have this great line or two lines: " they have come up against the limits of psychiatric ways of understanding themselves and are searching for the right scale of explanation: chemical, existential, cultural, economic, political. To understand a self in the world, but these different explanations are not mutually exclusive. Sometimes all of them can be true." And I love that you chose four who in some ways represent different lenses for this idea, but it's not so pat, right? Like all of their stories end up being far more complex.

RACHEL: Yeah, I mean, I did end up feeling that each chapter kind of leaves the reader with a certain set of maybe beliefs and assumptions, and then by the end of the next chapter, those assumptions are, like, subtly challenged, so that there is a sense of not being able to rest easy with Just one satisfying explanation.

ELISE: Yeah, there's like a lack of tidiness, which as a reader, I appreciated, even though I so desperately...

RACHEL: yeah.

ELISE: want the world to be tidy and easy to understand. But it's interesting the way that you explore these people's stories, these four stories and your own, and Hava, but part of the problem is like our stories continue, right? Like there's no A B testing someone's life to say, okay, it's not sliding doors, if we do a chemical intervention, this is the outcome and if we proceed with like depth psychology or Trauma exploration, this is the outcome, right? Like often these things are either concurrent or we're just continually evolving along with our whole story which then you write," 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."

RACHEL: I mean, just to go back to what you'd said earlier, I guess, the message of a story depends on when you stop telling that story. And so there are moments in someone's life where their story feels triumphant. And if you end it right there, like with Ray Oshiroff, when he wins his lawsuit against Chestnut Lodge, it would seem as if the answer is, you know, everyone take antidepressants and you'll be cured. And then you keep following the story past that moment of like dramatic conclusion and it leads you to a much different understanding. And I think recovery stories can be like that too. It's sort of, when do you pause the story that you'll have a very different picture of what worked and what didn't.

ELISE: Yeah, no, and the, and it's part of the reason that I think in any recovery story people hold that title so tentatively or carefully, which then, and you don't write about addiction, but it's always that sort of this NAA, this I am an addict, this like active engagement with your diagnosis, rather than ever being able to put it behind you.

RACHEL: Yeah. Yeah. And I think there are interesting parallels with psychiatric diagnoses and sort of like this confusion around how much is it useful for the diagnosis to be an identity and how do we predict when it's going to be feel useful and liberating and sort of a cure for loneliness and when it's going to feel kind of like trapping and like a self fulfilling prophecy.

ELISE: Mm hmm. Will you tell us the story, briefly, because obviously you do it with so much nuance, but will you tell us about Ray and that, and why that case, why he was such a landmark, or spelled such a moment in psychiatric care?

RACHEL: he was a very successful doctor in the late 70s who became really depressed. And his wife and his business partner basically told him he had to check himself into a hospital. So he went to Chestnut Lodge in Maryland, which at the time was seen as this, like, incredibly elite, idyllic place for psychoanalysis. He had psychoanalysis four days a week. The entire hospital was set up to allow for the ideals of psychoanalysis to like permeate the whole campus. And he was not given medication. It was thought that he needed to kind of talk through his problems and understand where they were coming from and what the source of it was from his family life. And he just deteriorated until he had lost 40 pounds and was pacing and eventually his mom saw him and was horrified and pulled him out of the hospital and put him into a different hospital where he was given medications. And he like, was reborn. He regained a sense of humor. He regained his love of literature. He just was healed in this kind of immediate sense. And so he was full of anger at Chestnut Lodge for withholding the medications. So he sued them and kind of devoted his whole life to like getting revenge on them for What he felt was denying him the cure he was entitled to.

ELISE: Yeah. And it sort of marked a moment, right? .

RACHEL: Right. His case, like, came to represent the triumph of biological psychiatry over Freudian psychoanalysis. And it felt like, you know, the collision between these two frameworks for understanding mental distress. And at that time, it seemed like one had clearly won.

ELISE: But the way that his life evolves is fascinating. And again, like part of this principle of when you're talking about people's lives and minds, there's no tidy...

RACHEL: mm hmm.

ELISE: typically, it seems like.

RACHEL: Yeah. And I mean, yeah, he suffered for the rest of his life, but the way that his life story was written in psychiatric textbooks was, it seemed as if he'd been cured, but the personality issues that he'd struggled with at Chestnut Lodge had identified like really became exacerbated and alienated him from people who loved him.

ELISE: right, and his inability to stop ruminating. And then Bapu, I mean, I thought this was such a beautiful story of clashing cultures, too. And you write about her: "Bapu was not treated as a credible witness to her own experiences, not only because of her status as a patient, but also because of colonial notions about the irrationality of Indian religions. And her story was fascinating, not only because of the mystical or religious fervor, I don't know exactly how you would describe it, that came to Consume her, but also, like, a reasonable escape, right?

RACHEL: Yeah.

ELISE: From her marriage and her in laws. Can you tell us a little bit about her?

RACHEL: she was a wife and a mother living with her in laws in the late 60s in Chennai, and they were a Brahmin family. They adhered to strict traditional rules in the, in terms of the hierarchy of family members. And it was very Lonely and oppressive. And around this time, she discovered she had this incredible talent for mystical poetry. And so her family did recognize that she had this gift. But she kind of Wanted to pursue her relationship with the divine more deeply and so she would run away from home and go to these healing temples where she was celebrated as a poet and as a mystic, and then her family would like send the police to capture her and bring her back, and then she'd be hospitalized and diagnosed with schizophrenia and so she lived in these sort of torn between these two poles for about 10 years or she would be running away and then being forcibly brought home and I think one of the things that made it really complicated is like if she had lived in New York City I think there wouldn't have been a question about whether she was suffering from schizophrenia, like though that level of attention to the divine, just like there's no cultural space for it, but in India, there was, and so she had a sense of self esteem and a sense of belonging when she went to the healing temples. And then when she would be taken to hospitals, it was like that entire sense of self was taken away from her. And so she rejected medical treatment in part because it felt like it represented the loss of a really meaningful identity for her.

ELISE: Yeah. This is really interesting. I don't know much about schizophrenia, but you write: "Some European psychiatrists used to say that they could diagnose schizophrenia intuitively. They sensed an aura of strangeness as if the patient came from another world. A diagnostic principle that came to be known as the doctrine of the abyss, when faced with such people, we feel a gulf which defies description, the philosopher and psychiatrist Karl Jaspers wrote in 1913. We find ourselves astounded and shaken in the presence of alien secrets." Which is so beautiful. I mean, when you think about Bapu, who essentially came to be revered as a saint in some way, right?

RACHEL: Yeah. I mean, maybe more than any of the stories I told. I think that her case defies like an easy categorization. And I felt that her daughter said it best, which was one time her daughter went to find her in one of these healing temples and her daughter Saw her she was in this little hotel room and she had covered the entire room with tiny script. Just she had been writing constantly kind of like log aria, like obsessive devotional poetry and you know, her daughter in that moment saw her mother as malnourished, as alone, sort of suffering. And she said, you know, on the one hand, she's this radiant being who kind of like filled our lives with poetry, but then on the other hand, you see her and she's starving and she's not taking care of her body and that is real suffering. And you can't deny that. So there's a way in which her family was trying to hold those Two truths without going off into the space where the real disability was being dismissed or denied

ELISE: Yeah. No. And I thought that the way that you told the story of the children was so fascinating and their own sort of torturous paths through rationalism, atheism, before they find themselves in their mother's shoes, which was also so Interesting.

RACHEL: I mean that element of this story, you know the way that struggles of the previous generation sort of play out In the contemporary lives of a family I found really striking and, you know, I originally had thought about writing the book as individual stories and I kind of felt like that was a fallacy of mine to think that I could do such a thing without like leaving out so much because so much of the individual's sickness and suffering was related to these kind of family dramas that are manifesting in all sorts of Strange ways in future generations.

ELISE: yeah and also I think it's Thomas. I don't know if he was the one who you originally wanted to write about...

RACHEL: mm, mm hmm.

ELISE: about like how he recognized himself as ill because he couldn't completely separate from creature comforts or dislocate himself.

RACHEL: Or did he say, maybe, I can't remember quite either, but it was something related to maybe because he didn't want those or need those, that that was...

ELISE: he said, "he couldn't do what the Buddhists do, like they are able to invest their lives with meaning outside of the normal conventions of ownership, but he couldn't fully divert his attention from the reality that he was suffering. The fact that I was not able to do that for myself was one of the things that showed me I had an illness." that was so interesting. And then also how he complained to you that all of these stories have the same arc with schizophrenia, that there's typically this family setting that then becomes haunted, that there's some outside force that disrupts the internal harmony. That's fascinating. Is that true? It seems true about Bapu, right? Like they're convinced that it's a haunting, but is that true in what else you observed?

RACHEL: I mean, I guess it's a useful way of conceptualizing it for anyone. I think there is a way of thinking everything was just so peaceful and placid until this force from the outside came in. I mean, Thomas was very attentive to stories about mental illness and it would always warn me, like... You shouldn't write about me because I'm not cute and fuzzy, like, find a cute and fuzzy character. He felt aware of how stories about mental illness kind of permeate the culture in particular forms.

ELISE: Yeah. All right, Naomi, the most heartbreaking I think in the book and fascinating story, right? What ultimately was her... postpartum depression, obviously, or PPD?

RACHEL: Postpartum psychosis.

ELISE: postpartum psychosis. And obviously, Like extreme cultural trauma, but brilliant and like, so conscious, right? Of everything that was happening. Can you tell us her story?

RACHEL: Yeah. So she was a young mother with four kids. I think she was 22 and she was kind of walking along on a bridge in St. Paul, Minnesota, and reflecting on how no one was smiling at her and very aware that her children, who are black and she's black, we're sort of the the strangers in this space. And that they would live lives where they were ridiculed. That was sort of how she put it. And she was very aware of forces following her that she needed to escape from. So in this psychotic moment, she jumped off the bridge with her two children. And she survived and one child survived and the other one died. They were both 14 months twins. And so she quickly got like sucked into the criminal justice system that, and the police officers were trying to make sense of why she had done what she had done. And then the doctors in a psychiatric hospital, state hospital, were trying to make sense of what had happened. And there was just this dynamic of, you know, her saying things that felt sociologically true about the observation she had about like how racism and discrimination would shape her children's lives. And but then also saying things that were clearly psychotic and kind of detached from consensual reality. And I think she did want to plead guilty by reason of insanity, but because her delusions were grounded in this kind of real observations about the history of racism in America and what it's like to be a black mother moving through the world, she was seen as sane and so she was put in prison and in the chapter I kind of write about her time in prison, like, coming To understand, you know, that what had happened was the result of a mental illness, but which didn't make her observations about culture less true, like both were operating and causing her distress and interacting with each other. And also earlier on she'd also been quite ill before this sort of tragic event and she really had not been treated, her pain was not seen as rising to the threshold of constituting depression. It was sort of seen as a response to her circumstances. So there were just a lot of moments in which what she was going through medically was not seen in part because she did not trust her white doctors, and in part because her white doctors were not attentive to the different strands of truth that were operating delusions.

ELISE: Yes. And that story is so fascinating, not only for the discrepancies, but for exactly like that exploration of what qualifies someone is insane or does the ability to alternately be sort of a brilliant social critic mean that you're suffering has no value? And I thought that this was, I mean, all the bell hooks that you quote, but also "Helena Hansen, a psychiatrist and an anthropologist at UCLA who studies racial stereotypes in medicine told me, it is woven into the fabric of this country. The black women's role is to do the work, to do the suffering. So why would we, the mainstream mental health field, be chasing them down and asking, can I treat you for your sadness?" And then you write about, and you qualify that it's hard always to know how these deaths are qualified, "but for much of the last hundred years, the suicide rate for African American adults has been roughly half that of white people, a finding that may be complicated by stigma and neglect." it's a very subtle section of the book and it's exploration of when do people break? Like, how much can people endure before they actually break?

RACHEL: Mm hmm. How much is suicide seen as the way to express breaking, I think sometimes people have explained that those statistics, that discrepancy, by saying that, you know, it's one thing to commit suicide. It's another thing to just drink so much or do such risky behavior that it constitutes the same kind of break, but you're expressing it in a different way.

ELISE: Yeah.

RACHEL: Yeah, suicide is a particular script of its own, like there's a way in which it becomes available to particular populations as what to do next when you're feeling this bad and for other populations, maybe there's something else you do next when you're feeling that bad.

ELISE: Are you in touch with her?

RACHEL: Naomi, she makes a lot of music. And so she sends me whenever she has a new video that she's working on.

ELISE: Oh, amazing. Okay. And then Laura who is probably the one who I can just by virtue of sort of following in the same path could very much relate to. Can you tell us about Laura?

RACHEL: So Laura grew up in a really elite community in Greenwich, connecticut and then went to Harvard. And then when she was at Harvard and even a little bit before, like, felt very unhappy and went to a psychiatrist and was diagnosed as bipolar. And when she got that diagnosis, it felt like the explanation for who she was, like the doctor had finally seen her. And she was sort of elated to have this diagnosis and really for 10 years Her identity was as a bipolar patient who was like going to be the best bipolar patient, like always take her medications, always memorize her diagnosis, know her symptoms, know the signs and then like at some point in her late 20s, she realized she wasn't getting any better. She'd been on 19 different medications over the course of that decade and nothing had really helped. And so what was the treatment doing? And she started to wonder like who she was without all these medications and to what degree had her own like growth as a person and her own understanding of her identity been clouded by all the medications she was taking and the lack of clarity about what was a side effect versus what was her... like, she realized she'd not really experienced her own sexuality because a common side effect is blunting of sexuality. And so she became, like, quite angry and decided to taper off of all of her medications. And then found a community of other people who were really struggling with, like, why is it so easy to get on these medications, but there's no... knowledge base about how to get off of them and some of the difficulties of getting off of medications and what it does to your body and your mind, but also like your sense of self and your sense of even like spirituality or romance, they profoundly affect aspects of ourself that go way beyond medicine.

ELISE: And that's a fascinating conversation just because withdrawal is so very real with SSRIs, certainly with benzos, which are very dangerous when it comes to withdrawal. And yet there's very little conversation or explanation of that, I think, when they're prescribed and or like no support, right, for a taper or for people to understand or make sense. So like when you're getting off of something that you feel dependent on but are unclear whether it's serving you and then it fractures you more, at least for a time, it seems like now there's more..

RACHEL: There has been more. Yeah. I think there's always this question of like, Are you returning to your baseline state and this is just always how depressed you felt? Or is it the pulling away of the medication that's actually causing you to be at a level that is lower than what you were before? And if you've been on the medication for so long, you've also changed and your life has changed and it's very hard to figure that out. I think there's not a lot of acknowledgement among psychiatrists of just how prolonged that process can be.

ELISE: right. And then it's all confused also by sort of the strength of the placebo, which is a very hard standard for any medication to beat. And the fact that so many SSRIs seem to help people for six months and then they stop. I mean, it's very confusing. And for some people, they're a life saving intervention.

RACHEL: And even like a placebo could be life saving too. It's just very confusing.

ELISE: exactly. Like the placebo certainly could be. And the power of the mind in its ability to write stories or create stories. But Laura, to me, seemed like the strongest case of someone whose story about herself, particularly because this intervention was so early, and then the cascading effect. Like how her story of herself and her desire for a diagnosis to just explain her angst and you write, "often prescription cascades are a feature of neglect, a way for overburdened psychiatrists to quickly manage their caseloads. But in Laura's case, her psychiatrist seemed to feel a duty to preserve her capacity to function at the highest levels. Almost treating subpar performance as a symptom of its own. They kept tinkering with her drugs as if they could eventually bring her to an emotional state that corresponded with all the advantages she'd been given."

I struggled with depression when I was in college and I felt I had what I think is seasonal affective disorder. It wasn't significant, but used to be a skier from Montana. I had spent a lot of time outside and being inside, I just felt so down. Consequently, so ashamed, like I had no reason to be sad. How dare I be sad? And like, it was an unacceptable response to all that I had.

RACHEL: Yeah, and I think, yeah, probably that sense of it being unacceptable, like, makes it more painful. And I think because Laura couldn't identify the cause, she felt, well, first she felt like, oh, this is so wonderful, there's a biochemical cause, like, now I don't have to feel so guilty. But then once there's a biochemical cause, she had this sense of herself as Permanently ill and nothing about her environment could change that.

ELISE: yeah you right, "in some sense, being the perfect patients had been a form of avoidance, a way of attending to a narrow set of symptoms rather than to discontents about her social world, the goals for which she was supposed to be competing, the pristine persona she was expected to cultivate." And you talk about how she, even in her conversations with you, did not want to talk about her childhood because she didn't want to offend her family.

RACHEL: Yeah, yeah, right, she knew it was important to them to kind of maintain the sense of, like, happy, privileged life.

ELISE: Yeah. And, you know, thinking of Bapu, for example, this instinct that we have, rightly or wrongly, and in Naomi's case, this is true, Papu's case, certainly in all of these instances, there's some cultural forces that shape who we are, that become intolerable on a spectrum. But you either are sort of comfortable with that, or it's clear, or it feels like, how could I possibly criticize or blame or find any exterior source for my own malaise? Like, it has to be me.

RACHEL: Right. And I think that's interesting that we think about Bapu's world as culture. We think about Naomi's world as culture, but, like, Laura's world, because it's the world of the doctors, the sort of elite white, medically literate world. We don't think of his culture, so we don't sort of attribute whatever is going on to culture to environment. We see it as within the genes or the biology.

ELISE: Right. And it's interesting, that even Ray, for example, theoretically, who is of the culture, he's a doctor.

RACHEL: His was like a culture clash between 2 cultures and medicine in a way, and he was believing that he'd been subjected to the wrong medical culture.

ELISE: Right. Right. And that there is a cause. That there is a version of dialysis for his mind, right? That he could have been cured or set right. Right. Is this stat, do you know, still accurate now more than one in five white women in America takes antidepressants? Is that accurate?

RACHEL: I haven't checked in the last year, but it was as of last year.

ELISE: That counts, that's amazing.

RACHEL: Yeah, it's like disorienting.

ELISE: I mean, clearly this is your childhood, there's a personal story in this book, which we can leave to people to discover as they read it. But is this the focus of all of your work? You think your life's work, understanding the way that all of these forces Venn diagram in the body?

RACHEL: I think it has been a lot of like what has driven my writing since I started writing, I don't know that that will be the focus like of the next 15 years. But I do think the thing that motivates me to write is often like the sense that we're having all these internal psychological experiences that are so misconstrued by whatever like institution or policy or human theory of human behavior is supposed to capture those experiences. So I'm just, I feel like in my writing, I'm always wanting to get as close as I can to the inner workings of someone's mind, basically.

ELISE: yeah, well, and I think it comes down to that line from the beginning of the book, which is that sometimes, you know, we're story making creatures, right? We need to take our experiences and create a coherent narrative for ourselves in order to make meaning and understand our actions. And those stories can liberate us or they can trap us, right? We can carry them around Like Ray in sort of an endless loop that we can't escape.

RACHEL: I think what one of the things that's interesting to me is like when we think about what causes distress and a life that goes awry, there's so much attention to different causes, but the way that the story, or the diagnosis, or the treatment interacts with our identity, I think, is not thought about as much. Like, the way that the very intervention itself changes our sense of who we are feels like it gets neglected. There's this sense that, you know, the diagnosis is describing something that is always solid and real and less thought given to like, well, how does that diagnosis interact with a mind? And how does the mind change knowing that the mind has been characterized this way?

ELISE: Well, or, you know, dipping into your story, you write about how as the youngest or theoretically the youngest patient to ever be diagnosed with anorexia, right, but you write about the historian Joan Jacobs Brumberg and the genesis of eating disorders where you were recruited for anorexia, but the illness never became a career. And sort of that seems like there's this genesis or this moment, right, that moment of recruitment where you started eating again and quickly exited the hospital and then others, it became their entire formation of identity, right?

RACHEL: Why does it stick? Or why doesn't it stick? And I think it was just really interesting reading back over my medical records from that time, I think, you know, there were theories about maybe family dysfunction causing it or some sort of personality trait of mine, but no, none of the doctors were thinking, like, well, how does the fact that we've given the six year old this, like, Really alarming diagnosis and then put her in a hospital surrounded by other girls with this fairly alarming diagnosis, How is that changing her behavior? There was no analysis of the very actions that they had just taken and how that was sort of changing the course of My life.

ELISE: Yeah. Well, it was like such a beautiful snapshot of the way that then culture takes over, right? Because in the hospital, you sort of narrowly escape a different, potentially a different fate or dealing with this in a lifelong way. But these older girls are sort of teaching you how to be anorexic, actually.

RACHEL: right, right. I was like studying under them. Yeah

ELISE: yes. In a way that we recognize all over culture. And it's interesting to think about that, maybe that's most recognized with anorexia because of our unrealistic beauty standards and the culture of thinness, but for all of these other forms, these other mental diseases, you can also understand how they become reinforcing. You certainly saw that with Laura and bipolar, right?

RACHEL: Yeah, everything she did could be reinterpreted, like if she felt sad, rather than like sitting with that sadness for a moment and Wondering where it came from, it was immediately like rerouted to, oh, this is a symptom of bipolar. I must take more meds. I think that's what I meant by it can be its own form of evasion because you're not really like living, you know, really even having the experience before you like immediately get rid of them by saying like, that's a symptom of this illness that I have that I'm going to treat right now.

ELISE: Yeah, there's like a dislocation from our experience. This idea somehow that baseline means permanent equilibrium, you know, which can be distorted, I think, at times, and I'm not suggesting that it's not, doesn't become disease for some people, but somehow that, like, our goal in life is to make any dysregulation vanish, or that we should live like that somehow. That's the dream.

RACHEL: Right. Yeah, I understand the dream, but yeah.

ELISE: Well, thank you for the book. It's beautiful,

RACHEL: you so much for your great questions.

ELISE: and have fun with your daughter.

RACHEL: Thank you. Okay, take care.

ELISE: Alright, bye.

Strangers to Ourselves is a beautiful book, as mentioned Rachel is bookended with another girl who she encounters when she is hospitalized for anorexia as a six-year-old and she goes back to understand what happened to her. Really, it’s a book about these moments of demarkation, when some of our behavior becomes pathologized because it is, potentially, pathologized, but how do we even understand that in a wider context and what are the appropriate interventions and then how do we, in those interventions, put ourself on a different path. This is the hard part of any mental illness, is that it can dramatically shape, not only the stories we tell about our selves, but the outcomes, our life trajectory, where we can or cannot go, in a way that’s the most high-stakes intervention of all, potentially. She writes about this woman who was one of the primary therapists at the Lodge, which is where Ray went, where they did this intensive psycho-analysis, no medication, psychiatric intervention, the one who was sued; Fromm-Reichmann reassures her patient, “You have gathered during these eyars a tremendous amount of human experience, having had the opportunity to observe practically all types of emotional experience in your fellow patients and in yourself. And what are these emotional experiences of the mentally disturbed other than human experiences of the kind we all go through, seen as if under a magnifying glass?” That was a note to her fellow physicians, but I think it stands for all of us as well: When does the normal perturbations of being human evolve into something more dramatic, where action needs to be taken and where do we naturally evolve and move out of it on our own? Rachel’s book attempts to answer some of these questions and she is a beautiful writer, so it's a worthy read for that alone.