Yesterday, when I was at the library, I walked over to the “Lucky Day” Shelf. That is the taunt, the bribe for coming into the library. It’s where the staff looks over the books that have long waiting list (I once waited over a year for Piketty’s book Capital) and puts them out for weeklong circulation, instead of the usual three-week checkout period. The books I typically request are so old that they have to be fetched out of storage, or from another library, so this is one of my favorite ways to stay-in-touch with contemporary concerns.
What’s fun about disquiet? I don’t know, but there it was, Rachel Aviv’s book Strangers to Ourselves: Unsettled Minds and the Stories That Make Us. The cover itself looks disquieting, like it has been smudged. Against a white background, the title and subtitle and author name were all printed in the same large sans-serif font, in big letters, equally spaced. But then, it was though a few drops of water had fallen on the book title. It bled the letters together so I could tell what it was supposed to say, but something had gone wrong. The black letters had melted and all of the different colors that they always say make up black shine through, like a distorted prism.
Which is to say, it is a brilliant cover for the topic of the book, which is a deep look at several people as they come into systems and institutions of psychiatry and how they (and we) continue to understand themselves in the course of distress. That sounds so opaque, because it doesn’t really hint at the immediacy of the portraits she manages to paint, beginning with herself.
You see, Aviv was diagnosed at age six as having anorexia nervosa, and she was institutionalized so she could re-learn how to eat. It was considered an unusual diagnosis for a six-year old even then, and to the reader, it doesn’t really sound like she much had the usual and requisite symptoms for the disease. She wasn’t motivated by thinness, not really. She had normal six-year old concerns like why people don’t have tails, and how her wealthy friend Elizabeth had a pool in her house.
She seems to have had the curiosity of a six year old, somewhat enjoyed the way that she could make grownups fuss by refusing food, and thought it was interesting that people fast on Yom Kippur. By contrast, the doctors wanted to talk about messaging about obesity in her family, the pathology that had led her parents to divorce, and her “over-complicated thought process.”
It was hard not to read the account and feel outraged on Aviv’s behalf. As she points out, she couldn’t even read yet, hadn’t encountered a critique of women’s bodies and in any event, wasn’t a woman. Her naïveté and childishness stands out in huge contrast to the pre-teen girls who took her under their wing and predictably, taught her the ways of anorexics: they taught her to pace, to do jumping jacks, and to measure their weight in ounces as well as pounds. It feels so…wrong to have taken her away from her parents, and put her in the 24/7 company of kids who were really sick.
I’ll be book-reviewish for a second and tell you that Aviv’s writing of this episode is so incredibly compelling. She stops short of condemning the path, and puts just enough in our way to make us wonder about the whole thing without beleaguering us with questions, and wow! If this isn’t outstanding writing, I don’t know what is.
Because true to the ambivalent and multilayered way she tells the story, in the end, it sort of worked. The rules of the treatment were that she got to see her parents if she ate, and she wanted to do that, and as lacking in intention at the end as the beginning, she started eating. Some delicious macaroni and cheese, it turns out. Six weeks after her admission, she was discharged. While she initially brought back with her some of the anorexic behaviors she had learned in the hospital, they eventually dropped off and the whole episode became just a little curiosity in her life.
Aviv quotes an anorexic anthropologist, Nonja Peters, in her 1995 essay “The Ascetic Anorexic” who writes a line that may well be the path through the entire book: “Once the ascetic path is taken, ascetic behavior produces ascetic motivations— it is not the other way around.”
This is such an apt description for Aviv’s own case. She sort of wandered into not-eating as a point of curiosity, and once the behavior was in place, it was actually work to create a set of motivations to undergird and explain the actions.
Once, in my twenties, I did the same thing. A family friend was in very serious medical trouble for severe anorexia. I wondered: how does a person not eat? For me, the production of a fast is such a big deal. I fast every year on Yom Kippur, and there is so much chatter about it, I really do find it difficult. I worry a lot about what I will eat beforehand, and often spend the day trying to hydrate so desperately that I end up not sleeping because my body does not actually welcome that much liquid taken in so close to bedtime. And then the whole day of fasting feels like a countdown, and I become more preoccupied by the minutes remaining until food.
One of my college roommates was Mormon, and several months into our year living together, I learned with some degree of shock that she would fast the first Sunday of every month, as a way to intensify her prayers. She said it so lightly, as though it were a rather normal thing to do, as though she were saying, “oh yes, we have spaghetti instead of linguini,” as though it essentially made no significant difference to her day whether she were eating or not.
So later on, with my acquaintance being in the loop of anorexia treatment, I thought that I would try it— how long could I not eat?
The first day was actually very hard, just as I remembered. It was not the grueling spin-down of Yom Kippur, because I was drinking water, but I felt inordinately focused on not-eating. I did not wish myself any harm, nor did I have any aspirations for weight-loss, and my only goal was to try to understand: how does a person not eat?
I learned more in the next couple of days. It got easier. Much easier, actually. By the end of the second day, it sounded so very heavy to eat food. And I felt a vague and kind of unexplained feeling of pride and almost euphoria. The idea of overcoming a natural instinct is pretty profound. Yes, I was hungry, most certainly. But there were a lot of other sensations too, like cleansing and purity and lightness, and those stood up decently well to my bodily hunger, which I could see could become somewhat easy to go to war with, to demonize as a wrong path.
On the third day, I met a friend at the coffee shop where she liked to study, so we could do some work together. I explained that I hadn’t eaten in a few days, and with some reluctance, I accepted her view that it was probably time to end the experiment. I could see that to go further would be to normalize behaviors that wouldn’t serve me. I ordered an apple juice, drank it very slowly, and soon after returned to my usual eating habits.
Could I have induced anorexia? I don’t have any doubt that I could have, actually. It was like standing at the edge of a diving board, looking down at a big pool. I think I knew all of the things that would happen inside that pool, so it was easy to turn around and walk back down the ladder. “No thanks, it’s better up here.”
And so I ruminate again on Peters’ observation: “Once the ascetic path is taken, ascetic behavior produces ascetic motivations— it is not the other way around.” Had I gone another couple of days, my own brain would have produced the explanation for why I was acting that way. I would have come under the sway not only of the curiosity I felt that led to the experiment, but to a series of explanations that would have attached to the behaviors themselves. It felt like a thin line and one I could cross at will, had I wanted to.
At the end of her introduction, Aviv writes, “The divide between the psychic hinterlands and a setting we might call normal is permeable, a fact that I find both haunting and promising. It’s startling to realize how narrowly we avoid, or miss, living radically different lives.” (27).
Aviv obviously spent much more time “exploring” anorexia than I did, including very significant run-ins with the treatment infrastructure. There’s a big difference between being six and being twenty-something, as I was. But it was fascinating to feel the way that the path to anorexia is somehow like a beckoning wave that tugs a little, and it’s neither quite a decision nor an accident. And then, once the wave has caught you, it becomes the definition of an entire lifetime, a “career” in psychiatric illness, as Aviv puts it. As she puts it, ”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 I read, it occurred to me that Aviv had wandered in so lightly, wasn’t there a lighter way to have gotten her out? Couldn’t someone have come up with a childlike, playful challenge to get the food back across her lips? I feel almost certain that it could have happened that way, but maybe I’m wrong because the treatment that she had obviously led her to safety.
And that, I suppose, is the disquiet that Aviv feels, that she conveys in her book, that makes the whole wondering thing so satisfying. Couldn’t it have been otherwise? It could, I feel sure. And also: unsure.
Aviv’s reticence in writing is so satisfying. The initial story is hers, but the other chapters focus on other people, the sometimes blurry line between their sanity and illness, and the way that the lives they have led have interacted with that diagnosis. Mental illness is in part a navigation of cultural norms, and some of the stories forced a reckoning with the way that poverty, privilege, and racism can interact with diagnoses.
The stories she narrates are complicated, compelling, haunting, and disturbing. Her writing is too subtle to have an argument of advocacy, but too important not to factor into larger questions of how we treat mental illness. I raced through the book, and today it goes back to the library. It’ll have to be someone else’s lucky day.