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Melissa Harris-Perry: Thanks for sticking with us on The Takeaway. I'm Melissa Harris-Perry. Back in 1965, Dr. Martin Luther King Jr. addressed the annual conference of the American Psychological Association. There, he challenged professional psychologists to reconsider the way they use the word maladjusted. Now, King pointed out that psychologists typically describe maladjustment as a personal pathology when a person has trouble functioning in society as it exists.

Dr. King flipped the script and told his audience, "There are some things in the world to which I'm proud to be maladjusted." The King went on to say, "I must honestly say to you, that I never intend to become adjusted to segregation, discrimination, colonialism, and these particular forces." King's call for creative maladjustment is part of a long tradition of challenging the idea of mental illness as exclusively about the brains and minds of individuals by asking, is it the person who is sick, or is it society?

Rachel Aviv: I think it's been hard to hold two truths at the same time, like the truth that she's struggling because of the political and the social obstacles that she had faced in her life and also that she had a mental illness. My name is Rachel Aviv. I'm a staff writer at The New Yorker and the author of Strangers to Ourselves.

Melissa Harris-Perry: Rachel's book tells the stories of six people, including herself, who find themselves in a state of maladjustment that psychiatry's answers could not fully explain. People like Naomi.

Rachel Aviv: Naomi was a young mother. She had four kids before she was 24, and in her 20s became completely overwhelmed by the experience of motherhood.

Melissa Harris-Perry: Just a warning, Naomi's story includes some difficult descriptions of violence.

Rachel Aviv: She felt as if she was suddenly understanding what it means to be a Black mother raising children in America. She felt like she was understanding racism for the first time and understanding the way that discrimination had shaped her life. When she encountered psychiatrists because her behavior did become increasingly troubling and abnormal, she wanted to talk with them about the way that racism had shaped their lives. She became alienated from psychiatrists, because essentially, what they wanted to tell her was, "No, actually I think you have bipolar disorder, and you need to take medications." She felt unseen by that response.

Melissa Harris-Perry: Naomi was unable to cope, and eventually reached a breaking point.

Rachel Aviv: She had thrown both of her twins off a bridge in Minnesota, and one survived and one did not.

Melissa Harris-Perry: Her story bears a resemblance to that of Margaret Garner, a Black woman born into slavery in 1956. Garner and four of her children escaped to freedom in Cincinnati. When she was cornered by men, who come to capture and re-enslave her family, Garner made a choice that it was better for her children to die than to live the rest of their lives in slavery. She took the life of her infant daughter but was discovered before she could take the lives of the rest of her children. Garner's story inspired Toni Morrison's 1987 novel, Beloved. Naomi had not read Beloved, and yet-

Rachel Aviv: Even in this moment of total psychosis, she was also saying, "The reason I threw them off the bridge was because I knew that they were going to live a life of inferiority and ridicule, and I felt like it was my only way to protect them." At the same time, she feared these supernatural forces would hurt them, but it was the same core of feeling like she had done this incredibly destructive thing to protect her children.

Melissa Harris-Perry: In Beloved, Morrison wrote, "Definitions belong to the definers, not the defined."

Rachel Aviv: When her doctors were trying to decide whether she was legally competent to stand trial or whether she could plead insanity, they basically said, "No. She is competent to stand trial because the things she's saying about society are true so actually, what she's articulating is existential and not psychiatric."

Melissa Harris-Perry: Naomi's sickness was defined by her, by a society that often failed to acknowledge its own sickness and thought to criminalize her.

Rachel Aviv: I don't think Naomi would say she was saying in those moments, but I think, for her to accept the idea that everything that was happening to her was a result of her biology is also to diminish what she was experiencing. Going back to psychoanalysis, like in the early days of psychiatry, there was this tendency to blame the family.

Then we shifted away from that model, and we decided, no, it's the brain. I think what Naomi faced was slightly different. To tell her that it was all about her brain, and not her environment, felt dishonest to her because she knew that poverty and the public housing complex that she'd grown up in, and the murders that she'd seen on her block like that really had shaped her mental health. To say it was just biology felt like her own worldview was not being acknowledged.

Melissa Harris-Perry: Part of what you write about is how contemporary psychiatry created this shared language around mental illness. Can you walk us through some of these core developments?

Rachel Aviv: In the '50s '60s '70s, it was pretty common in the cultural imagination to see mental illness as a result of bad mothering. At some point, most prominently in the '90s, I think psychiatrists became increasingly aware of, what a horrible thing that was for mothers to feel like they were responsible for their children's suffering.

Also, as there were developments in neuroscience, I think, we became more aware of how these illnesses are genetically and biologically determined. I think there's a way of going too far, where we stopped being as curious about the webs of human relationships that are part of mental illness. It's not just something that can be localized in the brain, it's something that emerges in our relationship to our community in our society.

Melissa Harris-Perry: As you're talking, I'm thinking here, even about the COVID-19 pandemic, and the tensions between the individualized medical model. COVID is in your lungs, basically, right? Versus a public health model that says COVID is in our communities. The way that you approach everything from prevention to care is quite different. Although, of course, obviously, it is in both places. COVID is both in our communities and in our lungs.

Rachel Aviv: Yes. There was something pure about the idea that mental illnesses is just like diabetes. I think that was a refrain that we often heard. I always wondered why people were drawn to that analogy, because it does then exclude the social aspects of mental illness, which there are social aspects in what create mental illness, but there are also social aspects in terms of why people recover from mental illness.

One of the things that I found pretty much everyone that I wrote about when they did recover, it felt like it was because they had found a sense of fellowship with someone and not necessarily a doctor, but just like a peer, who had been through a similar experience or understood what they were going through, and in the most stark terms, what seemed to have happened was the person no longer felt alone.

Melissa Harris-Perry: Let's take a short break here. Stay with The Takeaway for more on the stories that shape us with Rachel Aviv.

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Welcome back to The Takeaway. I'm Melissa Harris-Perry. With me, again, is Rachel Aviv, author of the new book, Strangers to Ourselves: Unsettled Minds and the Stories that Make Us. Now, we've heard about Naomi, a young Black woman whose story is told in the book. Rachel also writes about Laura. In some ways, Laura's story couldn't be more different, but in other ways, there's a clear throughline.

Rachel Aviv: Laura was this image of psychiatry's perfect patient. She was wealthy, she grew up in Greenwich, she went to Harvard, she was an excellent squash player. In college, she went to a psychiatrist and explained how unhappy she felt and she was very quickly diagnosed with bipolar and put on medications, and the number and types of medications that she took, just kept growing.

By the time she was in her late 20s, she realized she'd been on 19 different medications over the course of the last decade. She also realized she just didn't feel any better. She'd taken all these medications and they just weren't working. I think for so long she had been really drawn to this idea that medication is a precision instrument that will target the precise part of your brain that is not functioning.

Something that I found interesting was her doctors, I think, seemed to see her life as perfect and to not really interrogate what aspects of-- Because she was this ideal type that they could recognize, I think they didn't examine why the life she was living felt uncomfortable to her and false to her, and why that was causing her so much distress. At the time that she reaches her late 20s, she basically realizes she no longer knows who she is. She's been so shaped by this idea of herself as bipolar and by all the medications she was taking, that she has lost access to who she was before or who she would have been.

Melissa Harris-Perry: In your study of these cases, are there times when diagnosis really does feel like a relief, like a pathway to a life that someone wants to be leading, versus for folks who that diagnosis doesn't do that?

Rachel Aviv: Yes, definitely. With Laura, when she got the bipolar diagnosis, she described feeling elated. She called her father and said, "They figured out what's wrong with me. There's a solution," and she felt really validated and also that it wasn't her fault. I think that is a common experience; if it works, that's amazing. The issue that I wanted to draw attention to is that we don't-- That it's just unpredictable. Yes, that experience does happen a lot, but I think there's also this other side where someone gets a diagnosis, and suddenly it feels like a self-fulfilling prophecy.

It changes their sense of who they are, and who they can associate with, and who they can become. There's this kind of looping effect, where, the way that someone is classified, then shapes their behavior, almost as if they turn into someone who better fits that classification.

Melissa Harris-Perry: Now, these ideas on diagnosis and classification, these are ones Rachael has been ruminating on ever since her own early interactions with the field of psychiatry.

Rachel Aviv: When I was six, and my parents were getting divorced, I stopped eating, and after three days, my mom took me to a pediatrician. The pediatrician-- This was the late '80s, and anorexia was really in the cultural atmosphere and the pediatrician diagnosed me with anorexia. I was then hospitalized on this unit with older anorexic girls, they were like a decade older than me. I had never heard of anorexia and I had no idea what it meant, but these older girls taught me what it meant to be anorexic, and what an anorexic does, and I felt like I adopted a new value system by watching, modeling myself after these older girls.

Melissa Harris-Perry: Do you think the diagnosis was right?

Rachel Aviv: It's hard to say. Because, in the end, whatever treatment happened, I moved on, and it really wasn't-- It didn't shape my life. It's hard to go back and say that what happened was wrong. What I guess I did realize was, I'd always felt uneasy with the way that I was classified, and I'd always wondered how that classification then changed my own behavior. I almost felt like it's irrelevant whether I was anorexic or not because I just had this core sense of unhappiness and helplessness, and I channeled it into a form and that form was anorexia. That's the way I've come to see it.

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Melissa Harris-Perry: Rachel continued to search for understanding of her own mental health, as she dealt with feelings of depression and anxiety. She writes-

Rachel Aviv: I worried that my baseline self was not who I'd been in the years before taking Lexapro, but the more dysfunctional self had occasionally resurfaced, most visibly when I was six and hospitalized, or perhaps the medications had changed me so much, that my baseline self was no longer mine to reclaim. This sociologist, Alain Ehrenberg writes that long-term treatment with antidepressants has become a cure for people who feel inadequate. The drugs create a paradoxical situation in which the medication is invested with magical powers, while the pathology becomes chronic.

Helen, who stayed off Lexapro, believed there could have been something phony about her sudden desire while medicated to be part of the world. I too found it foreign, but it also felt true. "It is a joy to be hidden," the British psychoanalyst DW Winnicott wrote, "But disaster not to be found."

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Melissa Harris-Perry: If you were the editor for the field of psychiatry, how would you edit the story? How would you alter the story that psychiatry is telling right now?

Rachel Aviv: I think knowing the story is important. Knowing that truth has subtly shifted, and that we shouldn't necessarily take it for granted and internalize it. I think, there needs to be diagnoses, there needs to be definitions, it helps us communicate. I think, if anything, if there were more space and time for more attention and more of a sense of humility. I can't apply the general rule to the individual, and therefore, I need to understand the way that this individual is describing their life and making sense of these really difficult experiences.

Melissa Harris-Perry: Rachel Aviv is staff writer for The New Yorker, and author of the new book, Strangers to Ourselves: Unsettled Minds and the Stories That Make Us. Rachel, thank you so much for joining us.

Rachel Aviv: Thank you.

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