When You Can’t Trust the Stories Your Mind Is Telling

The National Institute of Mental Health estimates that nearly one in five adults in America lives with a mental illness. And we have plenty of evidence — from suicide rates to the percentage of Americans on psychopharmaceuticals — that our collective mental health is getting worse. But beyond mental health diagnoses lies a whole, complicated landscape of difficult, often painful, mental states that all of us experience at some point in our lives. Rachel Aviv is a longtime staff writer at The New Yorker and the author of the new book “Strangers to Ourselves: Unsettled Minds and the Stories That Make Us.” Aviv has done some of the best reporting toward answering questions like: How do people cope with their changing — and sometimes truly disturbing — mental states? What can diagnosis capture, and what does it leave out? Why do treatments succeed or fail for different people? And how do all of us tell stories about ourselves — and our minds — that can either trap us in excruciating thought patterns or liberate us? We discuss why children seeking asylum in Sweden suddenly dropped out mentally and physically from their lives, how mental states like depression and anxiety can be socially contagious, how mental illnesses differ from physical ailments like diabetes and high blood pressure, what Aviv’s own experience with childhood anorexia taught her about psychology and diagnosis, how having too much “insight” into our mental states can sometimes hurt us, how social forces like racism and classism can activate psychological distress, the complicated decisions people make around taking medication or refusing it, how hallucinations can be confused with — or might even count as — a form of spiritual connection, what “depressive realism” says about the state of our society, how we can care for one another both within and beyond the medical establishment, and more. This episode contains a brief mention of suicidal ideation. If you are having thoughts of suicide, text 988 to reach the Suicide & Crisis Lifeline. A list of additional resources is available at SpeakingOfSuicide.com/resources. Mentioned: “It’s Not Just You,” a series on mental health in America from New York Times Opinion “The Trauma of Facing Deportation” by Rachel Aviv Ruth Ozeki on The Ezra Klein Show: “What We Gain by Enchanting the Objects in Our Lives” Thomas Insel on The Ezra Klein Show: “A Top Mental Health Expert on Where America Went Wrong” Judson Brewer on The Ezra Klein Show: “That Anxiety You’re Feeling? It’s a Habit You Can Unlearn.” Book Recommendations: Madness and Modernism by Louis Sass Of Two Minds T. M. Luhrmann “Wants” by Grace Paley Thoughts? Email us at [email protected]. (And if you're reaching out to recommend a guest, please write “Guest Suggestion" in the subject line.) You can find transcripts (posted midday) and more episodes of “The Ezra Klein Show” at nytimes.com/ezra-klein-podcast, and you can find Ezra on Twitter @ezraklein. Book recommendations from all our guests are listed at https://www.nytimes.com/article/ezra-klein-show-book-recs. “The Ezra Klein Show” is produced by Annie Galvin and Rogé Karma. Fact-checking by Michelle Harris, Mary Marge Locker and Kate Sinclair. Original music by Isaac Jones. Mixing by Sonia Herrero, Isaac Jones and Carole Sabouraud. Audience strategy by Shannon Busta. Special thanks to Kristin Lin and Kristina Samulewski.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:04Ezra Klein?

  I'm Ezra Klein. This is The Ezra Klein Show.

• 0:23Ezra Klein?

  In "Strangers to Ourselves: Unsettled Minds and the Stories That Make Us," Rachel Aviv considers the philosophical and even the narrative dimensions of mental illness. At its core, this book is about a topic that I'm a little obsessed with. You hear it come up on the show a lot, actually. How do the stories we tell change who we become? How do we know when we're telling a story about ourselves to ourselves that is no longer true? How do we talk ourselves into a new story when that is needed? Aviv's book, as you'll hear, is about this question in its extreme forms. It's about the intersection of story, the ones we tell about ourselves, ones other people tell about

• 1:06Ezra Klein?

  us, and truly severe mental illness. But it raises a question of relevance to everyone. If story can mean so much to a mind that has lost control, how much might it mean, both for good and for ill, for all of us? I want to note that this episode contains a mention of suicidal ideation. If you're having any thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline. As always, my email, [email protected].

• 1:41Ezra Klein?

  Rachel Aviv, welcome to the show.

• 1:43Speaker 01

  Thanks for having me.

• 1:45Ezra Klein?

  I want to begin with a story you mentioned early in the book that seems to maybe have motivated some of the book, but that isn't mainly told there. Tell me about resignation syndrome.

• 1:56Speaker 01

  So in Sweden, there were children, starting in the early 2000s, they would apply for asylum in Sweden. Many of them had come from former Soviet states, and their families applied to asylum in Sweden. And when their families would be denied asylum, the children would stop eating and stop speaking, and the condition would sort of snowball to the point where they would basically be in what looked to be comas. And Swedish doctors didn't really know what to make of the condition, and they called it resignation syndrome.

• 2:36Speaker 01

  And there were investigations to see if this was a phenomenon occurring in other Nordic countries. And basically, it seemed to be an illness specific to Sweden and specific to children from former Soviet states.

• 2:53Ezra Klein?

  And you went to see some of these children, right?

• 2:57Speaker 01

  Yeah, I was interested in to see like the way that biology interacts with a very specific set of social conditions. In this case, like, no one had resignation syndrome unless they had had troubles with the Swedish asylum system. That sort of dynamic felt so confusing to me. And I think there was this desire to see the children as like faking it, like they have to be pretending. Because one of the complicated dynamics was that Sweden, which sort of prides itself on being this charitable, warm place for refugees, started saying that for the families whose children

• 3:40Speaker 01

  have resignation syndrome, they will automatically grant them residency. So it became, there was this like secondary gain component where there was something that the families got out of this illness. But what I was struck by when I met the children was that it didn't feel willed at all. It felt so, I mean, these children were unconscious, like there was no way to access them. So it was some confusing mix of...

• 4:14Speaker 01

  Distress and maybe rewards for expressing a distress in a particular way. And then they kind of lost control over it, like the body took over.

• 4:25Ezra Klein?

  I always wondered, I read this story when you wrote it in The New Yorker and it stayed with me for for years. And one of the things I've always puzzled over with it is if you have ever met any children, it's very hard for them to stay still.

• 4:41Speaker 01

  Yeah.

• 4:41Ezra Klein?

  Ever met a person, right? Ever tried to meditate for 10 minutes? So now imagine not eating, not moving for, for days, weeks, months. That doesn't feel to me like it is typically within the self disciplining power of a person.

• 4:58Speaker 01

  For me, in a way, I think I approached it from a slightly different. That wasn't the question I had. The question I had was, why does that feel so familiar to me? I felt like that had been a form of helplessness and anger that was sort of available to me as a child. But I didn't have like the, maybe that's not quite the way of framing it. But, but in a way, it felt relatable to me. And so like, the more interesting question was, how is it taking such a specific, consistent form among so many children? But even though I agree that that question is really, um, yeah, it is, it is hard

• 5:44Speaker 01

  to have that kind of self discipline. But then I think there's something contagious about self discipline. And once you start, it's really hard to get out of it. It becomes like a psychological and biological, uh, there's just this momentum. And once you're on a track, I, I could really relate to that experience of sort of not being able to pull yourself off of it.

• 6:06Ezra Klein?

  I want to go into what made that relatable. But before we do, one of the things that felt important to me about that story for this book. Is it, in the end, it seemed like what you were describing there was a memetic illness and an illness that almost spreads as a kind of story. Is that right?

• 6:25Speaker 01

  Yeah, I think, you know, eventually I did realize that most of the families with children who had resignation syndrome knew someone who had it. And I was just amazed by the kind of power of, like, I don't think any of these children went into this experience with the desire to have resignation syndrome. But like, to be in a situation where your family's safety is at risk, I felt that there was, you know, a groping for answers. And if you know that another child did this, you know, why not take you to your bed because you are so depressed and then sort of let it go? Like, there's just that mixture of

• 7:09Speaker 01

  sort of following someone else's script, but also feeling like it's really true to you. I mean, I think that was part of what happened. I remember reading, this scholar, Ian Hacking, had studied these Swedish children, and he compared it to Pascal's wager, that if you believe that no one knows whether God exists, but you might as well believe in God, because if he does, what's Pascal's wager? That like, you might as well believe in God, you have nothing to lose. But, but he writes about how when you do believe in God, at first you're pretending, you're kind of willing yourself to believe, but eventually that belief kind of sticks, and something that you had been imitating then becomes

• 7:54Speaker 01

  authentic.

• 7:56Ezra Klein?

  There's this idea that to say an illness is psychosomatic is to say that it is, in some sense, not, not real, or at least not real, in the way that a flu or a tumor is real. How do you think about that?

• 8:14Speaker 01

  I guess I have two slightly conflicting thoughts. Like, one, one thought is that, you know, there is this kind of motto within mental health advocacy that we want to make mental illness just as legitimate and real as any other disease. People often say, I need to take my psychiatric medications, just like someone with diabetes needs to take insulin. And I, I always feel that that is just so simplifying. And like, why do you need to, why do you need to leave out the ways in which, like, psychology is more complicated than sugar in the blood? So like, why do we need to simplify it that way?

• 8:54Speaker 01

  Like, what is so scary about acknowledging some sort of confusing mix of, like, the way we are thinking about things and how our own sort of personality and way of making sense of things actually can influence the course of an illness? But then on the other hand, I think there's this idea that if an intervention is not through a medication or through some sort of medical procedure, then it doesn't count. It's not biological. So like, if praying helps you feel much better in a, in a way that's actually quite

• 9:38Speaker 01

  real, why is praying not seen as acting on, like, your biology? Like, it's seen as a placebo effect? And, and that kind of distinction always felt sort of arbitrary and unfair? And, and maybe a distinction that excludes forms of treatment that really help.

• 9:58Ezra Klein?

  I want to get at something here that you alluded to, which is that resignation syndrome felt familiar to you, relatable to you, because you had had an experience as a six-year-old, which was shocking to me, in reading it with your own kind of illness of self-denial. Can you talk a bit about that?

• 10:19Speaker 01

  Yeah, it related to me because I felt like the early impulse there was the same. There's some sense of like, I can't stand what's happening in my family and in my community. My parents were sort of recently divorced, but it was still very messy. And I don't feel I have any control over the way my life is going. I have control over very few things in my life, but one of those is what I put into my body. So I'll just stop eating. That will be the way to signal that things are not right and that I won't go along with it. And I did that when I was six. My mom, you know, took me to a pediatrician

• 11:01Speaker 01

  and that was the late 80s. And the pediatrician said, okay, this is anorexia. She's not eating. She's lost, I don't know, like it was like 2% of my body weight, which at the time was probably like three pounds. It wasn't much. So then she took me to the hospital in Detroit and I was diagnosed with anorexia there too. And then they had this new anorexia unit for girls. They were all girls then and they were all, you know, in their teens or they were teenagers. And suddenly this sort of impulse to not eat was given a name. And I learned that name and sort of found this social, this circle of other girls who were doing the same thing.

• 11:45Ezra Klein?

  And so there's a way in which that experience for you seems haunted a little bit by the fact that it went in the reverse direction, that you developed your illness here before you had access to a story of it. But there does seem to be a sense in that chapter, in the end of your book, a fear looming over it, that if you had had this story, if you were a little bit older, if you had better understood anorexia, if you had better known how to fit into being an anorexic, that your life could have gone very differently, that something in your impulse could have connected to something in the story. And the intertwining of the two might have been irreversible. Is that right?

• 12:31Speaker 01

  Yeah, no, I think that's a good way of putting it. I got out of the hospital. I went back to school. I didn't tell anyone I had been diagnosed as anorexic and that word would have been meaningless to my peers. It had been meaningless to me like a few weeks earlier. And it just never became.

• 12:48Speaker 01

  Part of my identity. And I guess I wonder if I had, you know, if you get out of this very like altering experience in a hospital and you feel alone and you're trying to immerse yourself in a community and it's a struggle. And I could see how you sort of come back to that diagnosis and feel like, well, those people did understand me. And on the one hand, I think that that can be really comforting. But I wonder, you know, my parents were given an option to like put me in a school for special needs children. And I just think there were these little moments along the way where there were choices

• 13:30Speaker 01

  to define myself as someone who had been mentally ill and choices to define myself as someone who just had this kind of strange experience that I didn't want to talk about. And I think in my case, maybe having a strange experience that I couldn't label or the label just felt ridiculous because I was too young for it. Maybe that helped me sort of find other sources of meaning in that initial transition moment of like feeling alone and weird and like you don't fit in, but trying to find a way.

• 14:06Ezra Klein?

  There's a quote early in the book that that gets at this, that gets at what I think the book is about in this central, I don't know if I want to call it a tension, a fear, but you write, quote, "There are stories that save us and stories that trap us. And in the midst of an illness, it can be very hard to know which is which." And that quote embeds the other side of this, that for a lot of people, a diagnosis is a relief. For a lot of people, being able to have a story, a name that makes sense of an experience they're having, that takes it off of them and them alone, can be a safety. How do you think about when a story is trapping somebody and when it's saving them?

• 14:52Speaker 01

  I guess like I would emphasize just the sense of unpredictability that we just don't know. And I think maybe we've always assumed that the name is good, the name gives us a community, the name gives us a sort of way of communicating. And I think all that is true. Like, we need names. You know, it's practically impossible, or bureaucratically impossible, not to have diagnoses. But I think there is a sense in which names and labels and, you know, like, the explanation for your illness is just that. Like, we assume that it just captures what we're experiencing, as opposed to thinking that, like, this is

• 15:32Speaker 01

  not neutral, like, this actually acts on us, too. It's not just the diagnosis has described me, it's that I am interacting with this diagnosis somehow, and maybe I kind of subconsciously develop in ways that better embody the way that I feel explains me. So I think it's that sense of just not assuming that this is just about, like, matching person with explanation, but that the explanations do things to us and sort of change the way we think about the future and change our expectations for who we can be and sort of who we can meet.

• 16:18Ezra Klein?

  Have you ever read or come across Lisa Feldman Barrett's work on emotions and how they work?

• 16:22Speaker 01

  No, no.

• 16:23Ezra Klein?

  I know it's, you know, people argue over how emotions work. But her basic theory is that we have certain things inside of us that we can feel, right? Our body's taken sensory data, some amount of that sensory data is available to us, that's interoception. And then we have these concepts that we have to use to decide what it is that that sensory data is revealing. And that depending on what concepts are socially available to us, or individually available to us, you get very different answers. She tells a kind of funny story in the book about being out on a date. That she didn't feel was going well, but she was flushed and her heart was racing a little bit and her stomach, you know, had butterflies in and she's like, you know,

• 17:06Ezra Klein?

  there must be something here. But actually, she just had a stomach flu. And so she was getting the wrong, wrong information, but, but she was trying to attach a cognitive interpretation to, to this data. I had an experience, I mean, still do to some degree. I'm a, have always been an anxious person. Basically, everybody in my family are anxious people, but it got bad for a number of years. And I actually needed to develop an almost identity as somebody who was anxious, just to, to be able to understand what was going on. And then as things got better for me, I realized that that identity was leading me to interpret a pretty huge range of data that in another world, I might have understood as excitement, as anticipation, as anxiety. And I was becoming averse to all kinds of

• 17:50Ezra Klein?

  experiences that were not in the sexual way, just in the nervous system way of rousing.

• 17:56Speaker 01

  Yeah.

• 17:57Ezra Klein?

  And it's just, what you're saying here reminds me a little bit of, of that, that there's some interaction here in a, in a pretty deep way between how we know how to think about what is happening to us. And then over time, then how much of what is happening to us gets read into that way of thinking.

• 18:17Speaker 01

  Yeah.

• 18:18Ezra Klein?

  And so becomes a kind of momentum of that understanding of ourselves. Does that resonate?

• 18:25Speaker 01

  And so I'm curious, what happened then? Would you stop going to things that you wanted to be going to because you assumed that you were an anxious person that wouldn't respond well to it?

• 18:36Ezra Klein?

  I would say it was actually more in my work, that for a period of time, you know, my work has a certain amount of conflict built into it and a certain amount of being willing to make people upset. And as somebody who for a while, like, just didn't want a lot more.

• 18:51Ezra Klein?

  Of that energy in me.

• 18:52Speaker 01

  Yeah.

• 18:53Ezra Klein?

  I became a little more cautious with what I would do, or what I would say, or what I'd be willing to look at in terms of feedback. And then there were things that were happening in my life, too, not so much in terms of where I would go, but just in terms of how I would experience things interpersonally. And it wasn't debilitating. I don't want to overstate anything. But it is a place where, one thing I was thinking, reading throughout your book, is that this is a book, of course, about people with very serious mental illness. But the central question about the stories that we tell ourselves that can trap us, or the stories we tell ourselves that can uplift us, and the difficulty in knowing which is which, and then also the difficulty in the way those stories interact with the stories that are told about us by others or by society.

• 19:38Ezra Klein?

  I mean, that's not simply a question for someone with serious mental illness. In many ways, it's almost a more salient question for people without, partly because they have more control over the stories.

• 19:48Speaker 01

  Yeah. I mean, I've always felt like one of the great things about aging is that I sort of know the situations I can handle and the situations I can't handle. Like, I no longer am this naive 20-year-old who will put myself in situations that make me anxious. But then I think I also wonder if you lean too heavily on that story and make excuses for yourself, and it becomes calcified and limits you. Like, I no longer... You can just become a more limited person. But I think there are times when stories like outlive their usefulness.

• 20:58Ezra Klein?

  One of the first stories you tell in the book is about a man who ends up suing a hospital where he spent some time, Chestnut Lodge in Maryland, for trying to get him to change and alter his stories, for trying to understand his illness as a story rather than medicating him. And at the same time, he becomes very trapped in obsessive storytelling. So tell me a bit about him and about the narrative role he's playing for you.

• 21:22Speaker 01

  So I was interested in Ray Osharoff. I'd seen his story in textbooks as this case that represented the triumph of biology and sort of the triumph of a biological approach to psychiatry. And I was drawn to him because he had been treated at this psychoanalytic hospital called Chestnut Lodge. And it was really the only place in the country that had this kind of utopian idea that it didn't matter what a person's diagnosis was, it didn't matter how sick they were. If you really talked to them, you could see that no person is unreachable. And so he was this doctor who went there because he was depressed.

• 22:07Speaker 01

  And he was the kind of person, I mean, a number of people have said, like, oh, he reminds me of this uncle that I can't stand being with at Thanksgiving or whatever. Like, he was sort of a certain type that agitated people.

• 22:22Ezra Klein?

  And what is the story that Ray keeps telling and revising so compulsively?

• 22:28Speaker 01

  His story is that he was a successful father and society man.

• 22:36Speaker 01

  He got sick and he could have been treated with medication, but instead, these kind of evil psychoanalysts wanted him to plumb his unconscious. And in the process of doing that, he lost everything in life. He lost his children, he lost his marriage. And if only he'd been treated with medication, he could have been the man that he sort of felt entitled to be. And he kept reworking that story over 30 years. And with time, he became an even greater man, and the hospital did even more evil things. And I think he agitated his doctors and they didn't like him. And so his unlikability kind of got in the way

• 23:18Speaker 01

  of their beautiful theories about how, if you just really understand someone, you can help them become the best version of themselves. And so he asked for medication and they said, "No, you just need more self-awareness, you need more insight." And eventually, he just completely deteriorated and his mother pulled him out of the hospital and put him into a hospital that would give him medication. And very quickly, as if it were like a miracle, like he wrote about this experience and I read it in his medical records. You can just see him become human again. And it's an amazing thing to watch. Like someone who was so depressed and so repetitive, like his depression just took this very repetitive form.

• 24:04Speaker 01

  And suddenly, he didn't need to think about the same things anymore. He could entertain new thoughts. And it was so clear that the medication gave him that. And so then, he had this revenge desire for the hospital that had deprived him of these medications. And he sued them and more or less won. I mean, they settled. But in the way that the case was written about, it was presented as his victory.

• 24:31Ezra Klein?

  I'm surprised you ended the retelling of it there because it seems to me that the point of your telling it is that it wasn't quite a victory in that way. And that's why I ask about the narrative role it's playing because on the one hand, that's a pretty straightforward story that you just told. But maybe we shouldn't be thinking about this in terms of story at all. If something is amenable to medication, then who the hell cares what story you're telling about it? But at least as I read that chapter, that isn't where you feel it ends.

• 25:01Speaker 01

  Yeah, I think I got like really captivated by just that moment of medication working, which is like a dramatic moment. But yes, then the story goes on and he really doesn't recover and he kind of becomes consumed and obsessed with his desire to kind of reclaim his lost status as a father and a figure in society. And he has this idea that what will kind of allow him to re-enter the world as a respectable person is this memoir that he's working on. And he spends like three decades writing drafts and drafts of this memoir. And I think what I wanted, you know, I began the book that way because it felt like this

• 25:46Speaker 01

  is often the story that gets told about psychiatry, that it's this confrontation between these two different paradigms. The paradigm that says that your suffering comes from your family and if you, if you understand it well enough, you can get better. And the paradigm that says, this is about your biology, it's a disease, we can fix it if we just find the right technology.

• 26:09Ezra Klein?

  The reason I ask what role he's playing for you is that for a book about the ways in which the stories we tell maybe trap us, and I think implicitly is about the way in which better stories might free us, he seems like a very complicated case where it's pretty clear in the reading that the storytelling is the pathology for him, that it is a way his pathology is manifesting. He endlessly, endlessly, endlessly repeats himself to his children, alienating all of them. He writes version after version after version after version of these memoirs. There's no version of the memoir that would have worked. And so...

• 26:55Ezra Klein?

  There was a way in which my question with him was, are the stories just orthogonal? Maybe the stories don't trap or free us in these cases. Maybe the problem is believing they have any real power at all when it is this underlying volcanic compulsion that does. When I was younger, I mean, I still have a bit of this, I had quite a bit of OCD and I used to count things repetitively. But there was no count that would have solved it. It wasn't like I didn't have the right number in my head. It was this underlying compulsion. The counting was, you know, it's expression, not its cause nor its solution.

• 27:35Speaker 01

  When you were setting up that question, I mean, I did think that like the story in that chapter is the sort of the story that psychiatry has told, that has sort of trapped psychiatry, this idea that like somehow we have to sort out whether it's psychodynamic or biological. I mean, this is a simplification that I'm saying, but I do feel like that has been a trap, that there's some sort of binary and that it's always one versus the other. And then there's this other binary that's like psychiatry is the solution versus psychiatry is the problem. And that is like this other binary that I think has been a kind of trap.

• 28:14Speaker 01

  But I think, you know, there was something I admired about Ray's, the way he wrote about himself, and there would be these moments of really capturing the experience of what depression feels like or what it feels like to suddenly have it relieved by medications. And I noticed that over the years, as he kept writing his story, it seemed to become less and less honest. It became more of a story about a story about a story and less about like his actual raw experience. I also wondered like, why couldn't he accept the story he was telling? Like, why couldn't he see that as?

• 28:59Speaker 01

  Revealing and meaningful, why did he need an expert to kind of come down from on high and authorize it as like the right thing? I thought that that disconnect was sort of telling, and maybe in all the people I wrote about, like, they had this such elegant, beautiful writing about their own experiences, but they felt like they needed someone to confirm, like, yes, this is true, this is real, there's a sort of reason you're feeling this way. Like, they didn't feel they could trust their own way of describing and seeing it.

• 29:35Ezra Klein?

  I'm curious about your trust in it, though. I don't mean to embarrass you here, but you're a journalist, but more than that, you're a storyteller. A lot of the best journalists I know say you're their favorite journalist because of how good you are at finding and telling stories, where a lot of us just end up going the lazy route and asserting what it is we want to say. And this book felt in many ways like a confrontation that you were having, maybe with the limits or the dark side of the very kind of magic you've devoted yourself to.

• 30:10Speaker 01

  That's a good question. I think one way of kind of hedging that problem was that I told multiple stories in this book. Like, how did I end up writing this book? You know, I had so many of these issues I was thinking about for the last, I think, like, 10 or 12 years. And I recently read, like, the first piece I wrote for The New Yorker, which was also about this issue of insight. I was sort of surprised by how much I was sort of reworking those questions that had been prompted by this piece like 12 years earlier. And I think, like, it was amazing to be able to look at one issue but to tell five stories

• 30:55Speaker 01

  about it and to not...

• 30:59Speaker 01

  Expect that the reader leaves story number one with a sense of what is true and what is real and what is the right way to proceed with these complicated questions, or to know that like then they move to story number two and start doubting all the things they felt about story number one. It's not just the telling of different stories, but it's also the fact that I think this form maybe allowed for more like acknowledging that when you write about one story, it's always diminishing like all the stories that would sort of challenge the takeaway from that one story.

• 31:39Ezra Klein?

  A lot of what I read in the stories in the book ended up not being so much about the stories people told about themselves as offering any real path to redemption. It was very hard for me, honestly, to find an instance in the book where I thought the person could have told a different story that would have radically changed what happened to them, maybe with the exception actually of you. But what did seem there was connection, what often seemed to me to have had a possibility of saving someone, or in one case, which we'll talk about with Naomi, maybe did save someone, was connection. And that's actually a little bit more about the stories others tell about us, or maybe tell about themselves

• 32:22Ezra Klein?

  in relation to us, but that there's something about the difference between a story that is told that isolates us and a story that is told, or even a way of telling a story that connects us, which is much less in our control, that seemed really important. But the lifeline here seemed to be other people, not other narratives. The story of Bapu gets into into some of these issues we've been discussing. So, so tell me a bit about who Bapu was and and how she began to change.

• 32:55Speaker 01

  Babu was a Brahmin woman as she became a mother in Chennai. She had an arranged marriage and after having her two kids, she started becoming more and more religious. She wanted to spend all her time in her prayer room. Her family at first kind of respected that she was praying more and that she was writing these beautiful poems about Krishna. But increasingly, they felt like she was neglecting her children and neglecting her duties and it became sort of an unacceptable expression of spirituality. And as Babu became more religious, she started running away from home.

• 33:36Speaker 01

  So she would like slip out in the early morning hours and take a train and go to the south of the country where she could live in healing temples and her family would have no idea where she had gone. So she would run away to these healing temples and the family would be searching for her and they would, sometimes the police would end up bringing her back and she would be bound in rope and she would be sort of mute and just enter the house and no one would look at her, talk to her. It felt so much for her that she couldn't like tolerate being seen as a schizophrenic in her home and then she had to sort of go to a place where that wasn't going to be the way she was described.

• 34:18Ezra Klein?

  She had a story about herself. In some ways, I think the implication, as you say here, is maybe it was even the right one for what she needed, that she was a mystic. And she couldn't get until very late in her life, others to validate that story. And then the deep sadness of that tale to me is that it was in her death that people began to, that more people were willing to see her as a mystic, that the town came out and instead of looking at her as a crazed person, they saw her as, as you said, somebody somewhat in touch with the divine.

• 34:59Ezra Klein?

  And I guess it also raises this kind of obvious question, which is, how do you think about that borderland between mystic and mad woman?

• 35:11Ezra Klein?

  Because the two are not, I mean, there is a sort of matter of perception here on whether or not the rest of the world agrees that you are hearing words from God or not.

• 35:22Speaker 01

  Yeah, I mean, she had two children, a son and a daughter. And her son was really adamant that his mother had been a mystic. And her daughter started a nonprofit organization devoted to people with mental illness. And she clearly saw that her mother was suffering from a mental illness. And something that her daughter said was that she had the sense of her mother as this radiant creature who filled the house with these beautiful songs and prayers. But then there was this time that she saw her at the healing temples and she was hungry and she was so dirty and thin and sort of physically owling.

• 36:04Speaker 01

  And she said, like, you know, that's real suffering and that's real disability. And she was having these moments of ecstasy, but you also can't deny that she was also really suffering. And I wonder if like, maybe one way to think about it is in this pragmatic way of like, if a mystic is able to live her life in a way without that suffering, maybe, maybe she's doing okay as a mystic. But if she's not eating and she's near death, that framework feels very romantic.

• 36:39Ezra Klein?

  Tell me about Bapu's poetry.

• 36:41Speaker 01

  So I was able to read about 800 pages that she had left of her poetry. And it was all, most of it was about Krishna and her like, deep love for Krishna. But some of it was about her children and how angry she was at Krishna for taking her away from her children. And it fit within a very clear tradition of these female poets in India, kind of writing about both the radiance of this sense of being married to a god and like, the tragic nature of never being able to touch God, never being able to kind of, like, you're

• 37:22Speaker 01

  chasing after him and you've had this experience of oneness, but you never can like, hold on to it as long as you want to.

• 37:31Ezra Klein?

  Particularly in this chapter, I was left thinking a bit about a similarly named book by another New Yorker writer, Strangers Drowning by Larissa McFarquhar, which is a book I love, and it's about extreme altruists, people who can't shut themselves to the suffering of the world, and so begin giving everything they have, working crazy hours, having almost nothing for themselves, trying to give all their money to get malaria bednets for children in Africa, or to save farm animals. And it gets at this question of what we think of as normal. And there are certain kinds of, I mean, saying this without judgment, abnormality,

• 38:16Ezra Klein?

  that are very extreme forms of believing things that we tend to believe are normal and good and marks of being a good person to believe. So in Larissa McFarquhar's book, it's very much about this question of, well, we want people to be good people, but we don't want them to be, in a way, too good, too self-sacrificing, in a way that is upending to society, or makes the rest of us feel bad. That if you really believe, what is obvious to believe, that the life of a child somewhere else counts as much as your life has, and begin acting on that, people begin looking at you really, really askance. But it's true religiously, too.

• 38:55Ezra Klein?

  I mean, in the culture Bapu is in, in the culture I'm in, a lot of people, or most people even, are religious, or have been at some point. There are things that one claims to believe in those traditions, books one says the words of aloud. And it's good to believe that to a certain degree, and go to church or go to temple. But if you believe it too much, if you really act the way that might imply you should act, then either you become a monk or an ascetic, and get understood as a higher plane person, or you're really seen as somebody who's gone mad.

• 39:39Ezra Klein?

  And it strikes me as something really interesting. I mean, there are certain kinds of diversion from what we see as normal that are just diversions from what we see as normal. But there's also kinds that are extremities of what we see as normal. And yet, we see them as almost just as abnormal, if not more so. I've just always been fascinated by these spaces where it's like if you if you really listened to what you're told as a kid about being a good person or being in Sunday school, you can pass a point where people think you've listened too much and you have kind of lost like a grip on society.

• 40:15Speaker 01

  It kind of reminds me of something I've thought about, like that if you see the world really clearly, you're actually depressed. Like this idea of depressive realism, like one of the problems with people who are depressed is that they're just seeing things too clearly. Like they're, they realize they're going to die. They realize the world is getting worse every day. Their families are going to get sick. You know, why not be depressed? And so that like to be healthy requires some significant degree of like hiding the reality of your world. And so the people that Larissa writes about, you know, are seeing the world quite clearly, like why not do that? That is the logical response.

• 40:59Speaker 01

  But it's like that clarity feels threatening and extreme and dangerous and problematic in all sorts of ways because they're not like operating according to the illusions that sort of people have agreed to operate according to in order to sort of live in a way that's tolerable.

• 41:48Ezra Klein?

  I think that's a door to what was by far the hardest chapter for me to read in the book and the one I have the most trepidation about talking about. But tell me a bit about Naomi.

• 42:00Speaker 01

  Naomi, she was a young mother with four kids. She was 24 and she became completely overwhelmed by her life. She had grown up in Chicago in a public housing complex where there was an incredible amount of poverty and violence. And at some point, she started reading a lot of books about the history of Black people in America. And suddenly she felt like she was having a series of epiphanies about what it meant to be a Black mother in America raising children. And she reached this point of fear that she felt like

• 42:44Speaker 01

  people were going to harm her children, they were going to lead this awful life. And she went onto a bridge in St. Paul, Minnesota, and jumped off with her two young twins. And one died and one survived. And one of the reasons I decided to write about her is I was reading the interview she'd given in her hospital bed after jumping off. And the police officer was trying to ask her questions and she was, her explanation kept, she said, "I didn't want my children. I see how Brown and Black children are treated in this country.

• 43:25Speaker 01

  And I didn't want them to grow up leading a life of ridicule or inferiority." And she kept, the officer was just so frustrated because the way that Naomi kept explaining what she'd done was through an analysis of the experience of discrimination and racism for her family.

• 43:48Ezra Klein?

  And there was also, it seemed in the way, at least you told the story, a deep sense of paranoia, that she believed that the government was coming to kill her and her children.

• 43:57Speaker 01

  Right. No, there was like a true element of psychosis as well. Like she had thoughts that if she didn't drop off the bridge, she'd be killed another way. And that the other way would be far more, it would, the other way would be a kind of torture.

• 44:15Ezra Klein?

  And the really brutal tension at the core of Naomi's story is this idea that she's somehow too much insight to be seen as fully insane. You write, quote, that, and this is around the question of having an insanity defense, quote, "The evaluator seemed distracted by the truth of her sociological insights. Delusions are not spun from pure fantasy." Tell me about that.

• 44:43Speaker 01

  It was this strange reversal because before she threw off her children from the bridge, before she jumped off the bridge, she had been hospitalized a few times and had tried to talk about the painful realization she was having about how other people were treating her and viewing her. And the doctors said she didn't have insight into the fact that she had bipolar disorder. She was sort of talking about these other things that were unrelated to the medical problem. And then after she committed this crime, they, she was evaluated and they said, like,

• 45:25Speaker 01

  she's actually protesting against the conditions of society. That is a sane thing to do. Therefore, she's not insane enough to not be charged with this crime.

• 45:40Speaker 01

  And I think that was this dilemma for her throughout, you know, her time in prison too, is that like, her delusions were delusions. They departed from reality in a lot of significant ways, but they all connected to her sense of having...

• 46:03Speaker 01

  Been hated by people for because she was black, because she had grown up poor, of feeling like she had been excluded from aspects of society.

• 46:12Ezra Klein?

  That idea that delusions are not spun from pure fantasy, I think, is an important one here. And I guess it raises this question of, I mean, where her story goes is far beyond depressive realism. I think it's like really important to say that and make that clear.

• 46:30Speaker 01

  Yes.

• 46:31Ezra Klein?

  She's not somebody who, I mean, you don't look at injustice in society and throw your kids off of a bridge. But but there is a way here in which I think the question that that is being asked in the chapter is whether other people being able to take her seriously and whether society having a different way of understanding her would have changed things. And so tell me a bit about the role for you that story is playing for her. Is story, do you think if it wasn't injustice of society, it would just have been something else that she has a disease and it was going to find something to latch on to? Or do you think that there was some kind of connection here?

• 47:10Speaker 01

  I think that is a good question, though. Like, you know, I think about that a lot with religious delusions. Like, you have this feeling that people are watching you. And maybe there is something like inherent to certain ways in which the brain can sort of function incorrect. You know, like, why is it so common to feel as if you're being watched? Something about the way consciousness changes in mental illness that I think makes that a common experience. And then it's sort of, it does depend, like, what culture are you in? What metaphor do you reach for to understand that?

• 47:52Speaker 01

  In India, you might say that's because Krishna is, I'm in a relationship with Krishna and he is watching me. And I think for Naomi, it made more sense to say.

• 48:03Speaker 01

  You know, the FBI is watching me and they're going to do what they've done to black people like for the last 100 years, or maybe better way of saying that, that the police are watching me and they're going to treat me the way that they've treated people like me for many years.

• 48:20Ezra Klein?

  I guess I'm asking whether or not there's a counterfactual story here. I mean, this is a book about the way stories interact with mental illness. And there's one version of Seeing Naomi's story where it says her psychosis latched on to a story about racism, and the racism story is true, and it's like, but if she had not latched on to that one, the psychosis would have carried forward no matter what. Do you understand these stories as having a counterfactual? Like, what is, in a book about the ways stories can trap us or free us, is the story relevant to Naomi? Or is really the illness relevant and what we needed was a different social structure where she would have gotten more compassionate help, probably with significantly more treatment from much earlier?

• 49:06Speaker 01

  Yeah, I think, you know, if her story was, there are aliens invading my body. I do think that story would have, there would have been less reinforcement for that story everywhere she looked. So I guess I think if I play out that counterfactual, it's hard when you have a story that is reinforced. Like, there are signs everywhere and you suddenly see them, and so you don't know if you're suddenly seeing the world clearly. She felt like she was suddenly noticing all the pieces of evidence for her story. And so I, you know, the counterfactual that I sometimes think about is when she was walking

• 49:46Speaker 01

  on the bridge, right before she jumped off, she kept saying, like, I was just looking for someone who would smile back at me. And I did wonder, like, what would have happened if someone smiled at her? And is, you know, are our lives, like, so arbitrary that if some random, if a different person had, like, gone to the grocery store and walked along that way and smiled at her, her entire life wouldn't have happened the way it had?

• 50:12Ezra Klein?

  One thing the chapter circles, and again, her story is very, is distinctive and ends in, well, moves through a true horror.

• 50:22Ezra Klein?

  But I did think one thing that the chapter was circling was this question I hear much more often now, which is whether living, and I mean this here for mentally well people too, living within the truth and totality of historical crimes and sins is psychologically destabilizing. And so there's this kind of analysis of what we are as a country, or where we are as a society, or climate change, or racism, or all kinds of things that are very real, but that to fully absorb their realness and their size, and how far they reach back, and what they might mean going forward, is such a psychological kind of self-harm, that whatever

• 51:04Ezra Klein?

  the truth content, it should be discouraged on exactly that ground. Like, if you read the book The Coddling of the American Mind by Hyden Lukanoff, they sort of make this argument that you have cognitive behavioral therapy, which teaches you, in a healthy way, to tell better stories about the world, more generous ones, you know, and that has a tension with this way of looking at injustice, which teaches you to tell a much grimmer story about the world, and a much more suspicious one. And I'm curious how you thought about that after the reporting, but also reporting with her family, where this seems to come up a lot.

• 51:40Speaker 01

  I sometimes think about mental illness, like, in terms of porousness, like, you know, there are some mental illnesses where one of the major problems is you're, like, too porous, you're letting the world in, and it's, you can't resist it, like, for Naomi, like, every, you know, you can't live if, like, every single slight is affecting her identity so deeply. And then I think there are other illnesses where you're so closed off from the world, like, you're not letting the world in. I mean, I think resignation syndrome would be something like that.

• 52:20Speaker 01

  And it was almost like Naomi couldn't calibrate, like, her receptivity to all this injustice that she was reading about and that she was seeing, and she wanted more and more of it. Like, even that impulse to know more, instead of to protect herself from it, contributed to what happened to her. I remember her mom saying, you know, she learned too much about her history too quickly.

• 52:46Speaker 01

  But I just can't imagine any world in which like denies, I mean, yes, maybe like young children shouldn't be taught every aspect of the history too soon, but like the idea of denying a person their own history to protect their mental health, I don't know where that would lead people.

• 53:09Ezra Klein?

  But you can imagine versions of it that aren't full on denial. You can imagine versions of it, which I think are the contested ones today, that are more about a question of believing yourself to have an independence from the past, right? Believing in that we, you know, have a land to some degree of opportunity, that quite a lot is up to our individual agency, and believing that systems bear down on us with such force that there is little we can do, given that we are within their grasp. And I do think it is contested. I think you can understand a lot of the fights over curriculums and even in politics is a fight between these narratives. And I think that both can include some similar facts, but with very, very, very

• 53:53Ezra Klein?

  different interpretations.

• 53:57Speaker 01

  It's hard because I think that, you know, for Naomi, like, once she was in prison, she started reading about black mothers and the grief and the melancholy of black mothers. And then she did find a way into that history that made her sort of unmanageable experiences feel like quantifiable in some ways.

• 54:23Speaker 01

  She, yeah, maybe, maybe it was not, you know, it was not the book that she read on lynching that was helpful, but it was the sense of like, oh, I was being placed in the position that so many black mothers have been placed in where There's sort of no option to be depressed because we've always been told to carry these burdens. And if we have any trouble, we just sort of pray about it or take a nap. And we aren't entitled to feel sad about this. So I do think there was a version of that story of the history that was actually very productive for her because it made her aware of why, for so long, she had kind of resisted

• 55:07Speaker 01

  the idea of being mentally ill or depressed and felt like she had to live up this, be this very strong, indestructible figure who couldn't ask for help.

• 55:22Ezra Klein?

  I think that's really interesting and then gets to this, I think, other social concern that I see pretty often now. There's been this very sharp rise in mental illness and suffering among teenagers. You're seeing more self-harm, more kids ending up in the hospital. And one of the reasons I sometimes hear suggested is that there's been this mainstreaming of narratives of mental illness, of identities of being depressed, of being anxious, of having bipolar disorder, where for a long time, there was much more stigma around these. And there's been a sense that reducing the stigma would help. I think there's also

• 56:06Ezra Klein?

  people who now feel that reducing the stigma has made them, to go back to a word I used earlier in the conversation, more memetic. They've become more common stories. And as such, more people are beginning to understand their experience in those terms. And then with some of the dynamics we've discussed, that's developing a momentum in their own lives. Having done all this work on stories of mental illness, at this point, are you more or less concerned about that? Do you think part of the rise in mental suffering we're seeing is a result of stories that are becoming too widely told or too widely believed?

• 56:45Speaker 01

  I thought a lot about that with suicide. I, you know, I do wonder. I think early on, I remember I was writing a story about the Sandy Hook shootings. And I remember reading that Adam Lanza, who had shot all those children at Sandy Hook in his bedroom, had a lot of cut out magazine articles of other people who had shot people at schools. And that did really scare me about writing about Sandy Hook. Like, I, for the first time, felt I can't write about this person because I'm like

• 57:30Speaker 01

  putting a piece of information to the world that might make it feel more possible for some other, like, very lonely, unhappy, young male teenager to start thinking this is a way of, like, expressing solidarity with other men like this, or sort of communicating the same thing that Adam Lanza had been communicating. So that's with, you know, mass shootings in schools. But I worry about something similar with suicide, that a lot of people are going to get depressed.

• 58:08Speaker 01

  But the idea that suicide is what depression leads to, or is a way out of depression, I do think that there's a social influence for sort of when that idea comes to people. Not that it's not, like, built into people's... I do think, like, that's real, and that, and some people will say, like, suicide feels like its own kind of disease. But I think, especially for young people who make these really impulsive decisions, it does seem scary to be in an environment in which, like, suicide feels like domesticated or something, like, other people are talking about it.

• 58:49Speaker 01

  If I'm feeling like A, B, and C, then I'll start thinking about suicide, because that's what people do when they feel these things.

• 58:58Ezra Klein?

  I think suicide is a really tough and interesting example here. I think back to, there was a Netflix show called Thirteen Reasons Why, and it's about a suicide among a teenager. And it was criticized pretty partially by researchers because they felt that it could have this memetic force. And then there were studies, or at least a study that came out, finding an otherwise very hard to explain increase in suicide among the predicted group of teenagers in the month that the show came out, a real spike. And you hear this a lot, that suicide is contagious. And I've never known what to do with this because presumably it's not just suicide.

• 59:43Speaker 01

  I actually had a conversation with one of the people who made that series. And I think it's just so frustrating because the logic is that if we talk about this, it de-stigmatizes it. And we want people to talk about suicidal impulses that will help them ask for help. I guess I have this impulse toward telling the truth about something. Speaking openly is always a force for good. But I think suicide is just so impulsive. And so if the idea is available to someone, it's hard to know what they'll do with that idea. And so it's really hard to know.

• 1:00:23Speaker 01

  I know that in my own, when I think of what stories to write, I do tend to think I should avoid something that will plant an idea for something. I guess I'm respectful enough of, or I kind of fear the reality of that memetic process.

• 1:00:52Ezra Klein?

  And let me end on this, which is a question that's related to something I asked you in the beginning. You've now done years of work on this book about the ways the stories people tell can trap or free them. Has it changed the way you think about the stories you tell yourself, even if that's hard to change? Does it make you, you know, is there any way this changed the way you want to approach your own process of self-narrativization?

• 1:01:21Speaker 01

  I mean, I think I mentioned this before a little bit, like I am, as I get older and like certain stories about myself become more like successful in a way, like I can rely on them. Like I'm a self-disciplined person who cares about these certain things. Yeah, I do get scared that it's like limiting and that it sort of, it will close me off and that it will not allow me to change in the way that I like need to change to, like, yeah, there's a risk of a story working too well. And you sort of, you lack of flexibility

• 1:02:06Speaker 01

  that you need or that you want.

• 1:02:09Ezra Klein?

  Did anything come to you in reporting these stories about what dislodges a story somebody is otherwise telling?

• 1:02:16Speaker 01

  I think it's like a person so much, finding a person who you feel that sense of connection with and who challenges your way of understanding yourself or sees your way of understanding yourself. Like with Naomi, she developed this incredible relationship with the librarian at her prison and the librarian.

• 1:02:43Speaker 01

  Could kind of say, like, you know, you think you don't need these medications, but I know what you care about. And I know that when you're not taking these medications, you're not able to do the things you care about. And I think that challenged like this easier story Naomi had about being free from the influence of these like white doctors imposing their, you know, newfangled treatments on them. So, yeah, I mean, I do think it's like those deep connections. And this kind of goes back to Chestnut Lodge, like that there was something so powerful about the ideas there that like if you, if someone understands you well enough and really listens, they might be able to challenge

• 1:03:28Speaker 01

  your self conception in a way that is healing for you.

• 1:03:34Ezra Klein?

  And then always our final question. What are three books that have influenced you that you would recommend to the audience?

• 1:03:41Speaker 01

  I loved Madness and Modernism by Lewis Sase. Like, I think that that was one of the books that made me want to write about psychosis. He kind of compares modernist literature to the schizophrenic experience as a way of saying, like, we've misunderstood schizophrenia. It's not this kind of romantic genius going against the grain of society. It's this intense self consciousness and the sense of sort of dissolving of boundaries between self and other, and that all these ideas are showing up in modernist literature. And he kind of maps like quotes from Kafka onto clinical records.

• 1:04:23Speaker 01

  And it really made me think I had no understanding of what psychosis was until I read that book. Another book related to psychiatry is T. M. Lerman's Of Two Minds. She kind of, she's an anthropologist, and she looks at the way

• 1:04:44Speaker 01

  That psychiatrists are trained and sort of how the training has created these divide in psychiatry between these two different ways of seeing the mind. And I guess I would recommend anything by Grace Paley. I was recently reading her story, "Once," because I remember that it had been my favorite story when I was like 18. And I reread it and felt like my understanding of it had completely changed and it wasn't about like ex-boyfriends anymore. It was about aging and, you know, trying to figure out what you want in life. So that story, among all of her stories, I would recommend.

• 1:05:23Ezra Klein?

  Rachel Aviv, your new book is "Strangers to Ourselves: Unsettled Minds and the Stories That Make Us." Thank you very much.

• 1:05:31Speaker 01

  Thank you.

• 1:05:39Ezra Klein?

  Thank you for listening to the show. I got a couple of recommendations here for you at the end. If you like this conversation with Rachel Aviv, if you want to go deeper into some of these ideas, we did a show a few months ago with Tom Insell about psychiatric treatment. This show was very much about stories, about narratives. That one, from one of the nation's top mental health doctors and policymakers, is about what we know about where psychiatric treatment works, how to embed it more in social and policy fabric, and how to build a much stronger mental health care system. We also have a past show with Judd Brewer on anxiety, and one of my favorites with Riva Zeki, which is also very much about story from a more fictional lens, but about stories and schizophrenia and objects.

• 1:06:23Ezra Klein?

  And it's just a really cool, beautiful episode. We will put links to all of those in the show description here. In addition, Time's Opinion has been publishing a series exploring America's mental health crisis called "It's Not Just You." You can check out the series at nytimes.com/itsnotjustyou. The Ezra Klein Show is produced by Annie Galvin and Raja Karma, fact checking by Michelle Harris, Mary March Locker, and Kate Sinclair. Original music by Isaac Jones, mixing by Sonia Herrera, Isaac Jones, and Carol Sabra. Audience strategy by Shannon Busta. And special thanks to Kristen Lynn and Christina Samueluski.