The DO Book Club, April 2026: ‘Strangers to Ourselves: Unsettled Minds and the Stories That Make Us’

Toward the end of the 20th century, a profound shift happened in how we understand human suffering. Biomedical explanations of mental illness effectively eclipsed psychoanalytic theories that had long dominated our understanding.

We traded the couch for the clinic; the narrative for the neurochemical. Yet, as Rachel Aviv brilliantly illustrates in her book, “Strangers to Ourselves: Unsettled Minds and the Stories That Make Us,” our diagnostic frameworks, while necessary, often become rigid, cutting us off from our own complex humanity.

Aviv, an investigative journalist and staff writer for The New Yorker, does not offer a polemic against modern psychiatry. Nor does she advocate a return to Freudian, Lacanian dogmatism. Instead, she asks a much more profound, unsettling question: How do the stories we tell about mental illness shape the course of the illness? Drawing on philosophy, Aviv explores how people classified with a psychiatric label often unconsciously change their behaviors and identities in order to fit the very mold of their diagnosis; the label creates a self-fulfilling prophecy.

The stories in the book, published in 2022, and her investigation into them are intimately personal. At just 6 years old, Aviv stopped eating and drinking. She landed in an anorexia unit. Because she was too young to fully comprehend the term anorexia, she escaped by not letting the illness remake her identity. It is from her own childhood trauma that Aviv branches outward, constructing a series of deeply empathetic and extensively researched portraits of individuals whose experiences defy straightforward categorization.

“A strange sense of abyss opens up when I think about the life I have now, and how easily it might have gone another way, as it did for others,” Aviv says in her prologue. “The divide between the psychic hinterland and a setting we might call normal is permeable, a fact that I find both haunting and promising. It is startling to realize how narrowly we avoid, or miss, living radically different lives.” (p. 27)

Among the most fascinating is Ray Osheroff, a successful doctor who became the battleground for the war between psychoanalysis and psychopharmacology. Suffering from severe depression, Osheroff admitted himself to Chestnut Lodge, an elite psychiatric facility that abhorred medication and insisted that insight-driven talk therapy was the only cure.

When months of pacing and agonizing yielded no progress, he transferred to Silver Hill, where doctors prescribed antidepressants that rapidly restored his functionality. Ray sued Chestnut Lodge for malpractice, a landmark case that coincided with the publication of the “DSM-III” in 1980 and heralded the triumph of biological psychiatry over psychoanalysis. Yet, as Aviv deftly points out, even with his chemical imbalance corrected, Ray remained unremedied, still searching for an overarching story to explain his fractured life.

A master class in psychological portraiture

Aviv is fiercely attentive to how cultural, racial and socioeconomic forces dictate stories. We meet Naomi Gaines, a Black mother from Minnesota who, in the grips of psychosis, jumped off a bridge with her infant twins, resulting in the death of one of the children. Through Gaines, Aviv exposes how racism and systemic poverty frame mental illness, highlighting how the prison system has become a de facto mental health institution for marginalized people. In contrast is Laura Delano, a privileged, Harvard-educated white woman who accumulated a litany of diagnoses and was prescribed 19 different medications over 14 years. While Gaines was underserved and criminalized, Delano was overserviced, illustrating how ambitious white women are frequently overmedicated in the pursuit of having it all, ultimately leaving them numb emotionally.

“Strangers to Ourselves” is a masterclass in psychological portraiture. Aviv discusses her own ongoing use of the SSRI escitalopram (Lexapro), admitting that while she doesn’t fully buy into the biochemical model of her own loneliness, the medication helps her function as a better family member and person in society. In doing so, she refuses to neatly resolve the tension between the biological and the psychological.

Aviv’s intimate discussion of her and her friends’ use of medication required her to be very reflective. She lived better within the structure of pharmacotherapy; others appear to manage well with only short courses of treatment. Aviv’s personal account details the struggle that comes with the stigma around mental health and personal fears of being marginalized and different. Many of us miss this aspect of mental health.

Aviv eloquently outlines how mental health narratives can liberate us, giving us a community, agency and vocabulary for our pain and trauma, but also explores how these narratives can just as easily bind and trap us. Aviv’s indispensable book reminds us that while we desperately need solutions to mental anguish, we must not become dogmatically attached to the categorical truths of any single era. The mind is far too mysterious to be flattened into a checklist of symptoms. Even at the height of scientific advancement, we remain wonderfully, terrifyingly strangers to ourselves.

The book shares heartfelt stories that are an essential read for patients and physicians because they challenge assumptions around mental health and its care. Within these stories, the factors of race, culture, religion, family customs, idiosyncratic experience, dreams and expectations all shape the patients’ lives and illnesses. Aviv’s stories are animated and gripping and allow caregivers to have shared empathy for those whose minds and identities are in flux. More importantly, Aviv’s book is a testament to the resilience of the human condition.

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