Strangers to ourselves

During the summer of 2025, I read Strangers to Ourselves: Stories of Unstable Minds by Rachel Aviv. As I recently revisited the notes I had written in its margins, I realized that many of the questions raised by this book still accompany my reflections today. Rather than offering conclusions, this newsletter explores why subjectivity, culture, and the diversity of ways we care for one another continue to matter.

"You need to get help."

At some point in life, most of us either hear these words or find ourselves saying them to someone else.

But what kind of help? Help for what? According to which understanding of health? Which culture? Which way of making sense of suffering?

At a time when debates about mental health, medicalization, and the recognition of different forms of care are once again becoming prominent in public institutions and public discourse, these questions remain important to me, not only as a professional, but also when I set aside my role as a therapist and reflect on human nature.

While reading Strangers to Ourselves by Rachel Aviv, I realized how many of our assumptions about mental health are historically recent, culturally situated, and constantly evolving.

Rachel Aviv, a staff writer for The New Yorker, follows over many years the lives of people who have received different psychiatric diagnoses.

The book does not seek, and neither do I, to deny the existence of psychological suffering, nor does it attempt to discredit psychiatry or psychology.

Instead, it asks what happens when a person becomes known primarily through the diagnosis they have received.

Throughout these stories, Aviv shows that suffering does not exist in isolation from culture, history, relationships, politics, religion, or material living conditions.

It was precisely this place of subjectivity that resonated most deeply with me and with the framework of my work as a body-oriented therapist.

Four ideas remained with me after finishing this book:

• subjectivity as an essential part of care;

• the influence of culture on what we call mental illness;

• the importance of integrating different forms of care rather than placing them in opposition.

One of the passages that struck me most describes a transformation that took place in American psychiatry during the 1990s. Rachel Aviv explains that, as health insurance systems changed, rich narratives about patients' lives were gradually replaced by measurable lists of symptoms.

She writes: "The treatment of mental illness came to be viewed as a commodity rather than a partnership."

Later, quoting anthropologist Alistair Donald:

"The real patient is replaced by behavioural descriptions and, in doing so, becomes unknown."

This passage invites an important question: to what extent do our diagnostic categories capture the complexity of human experience? At what point do they stop being tools for care and begin to stand in for the person themselves?

Another section that particularly caught my attention takes place in India.

Aviv shows how many concepts from European psychoanalysis encountered difficulties in a culture where spirituality, devotion, and everyday life remain deeply interconnected.

She quotes Indian psychoanalyst Sudhir Kakar:

"The mystical journey is not separate from everyday life; it permeates and grounds it at its deepest levels."

She also cites N. C. Surya, director of the All India Institute of Mental Health:

"We will become ineffective caricatures of Western psychiatric theory and practice, or reduce our patients to a collection of prestigious foreign jargon."

These passages do not suggest that one approach is superior to another. Rather, they remind us that no theory emerges outside a cultural context, and that no culture exhausts all the possible ways of understanding human suffering.

"I became a historical figure. I'm the man everybody knows, but nobody knows."

It is difficult not to reflect on how a diagnosis can offer belonging while also reducing someone to a single narrative. There is an important difference between receiving a name for one's suffering and becoming known only by that name.

In my own practice, this passage reinforces something I consider fundamental: no technique can replace genuine curiosity about the unique experience of the person sitting in front of us.

Two people may share the same diagnosis and yet live profoundly different realities.

Aviv presents researchers and clinicians who remind us that psychological suffering does not arise from biology alone.

She references bell hooks, Vikram Patel, and several psychiatrists and researchers who show how racism, poverty, violence, migration, discrimination, and social conditions shape both how suffering is experienced and how it is interpreted.

In one of the passages quoted by Aviv, bell hooks writes:

"Many of us Black people fear that speaking about our trauma through the language of mental illness will lead to biased interpretations."

Later, Aviv also presents the criticism of professionals who question the tendency to explain certain forms of suffering exclusively through brain chemistry while leaving social conditions in the background.

These reflections do not diminish the role of medicine; they broaden the conversation.

Medication, psychotherapy, counselling, community, spirituality, material living conditions, and public policies do not necessarily compete with one another. At least, they should not. Each responds to a different dimension of human experience.

After finishing this book, I was left with the impression that Rachel Aviv is not asking us to abandon existing theories or forms of care. Rather, she invites us to recognize that each of them illuminates only part of the human experience.

What stayed with me most was not a discussion about diagnosis, but a reminder that every person experiences suffering through a unique combination of history, relationships, culture, body, language, beliefs, and social conditions. Subjectivity is not a detail to be added after the fact; it is part of how human experience is lived.

This perspective also resonates deeply with my own practice as a body-oriented therapist. My work is to accompany a person as they explore their own experience, remaining curious about the meaning they give to what they are living.

For this reason, I do not see psychiatry, psychotherapy, counselling, body-oriented therapy, community support, spirituality, or public health as competing ways of understanding human suffering. Each responds to different questions and each offers different resources. There are moments when one approach becomes essential; there are moments when several can coexist and complement one another.

Perhaps what this book reminds us most is that preserving a person's subjectivity requires resisting the temptation to reduce a life to a single explanation. The more perspectives we are able to hold in dialogue, the greater our chances of meeting the complexity of another human being with both knowledge and humility.

Written by Juliana Camargo