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Hephzibah Anderson (2022) reviews Rachel Aviv’s first book, Strangers to Ourselves: Stories of Unsettled Minds. The book, according to Anderson, is a subtle and penetrating investigation into how ‘mental illness’ is diagnosed. It brings to attention the ways in which the diagnostic language used is far from neutral. Rather, Aviv suggests, such language, “moulds a patient’s innermost self, promising to explain who they are by weaving narratives that free and entrap” (Anderson, 2022). “There are stories that save us, and stories that trap us,” in the words of Aviv (cited by Kisner, 2022)
Aviv’s book also brings to attention two competing approaches to ‘mental illness’: the Freudian, which endorses introspective therapy to promote ‘understanding’ of the fundamental personal and social maladjustments producing the distress; and the pharmaceutical, which proposes that, for example, depression is a natural, biochemical phenomenon that requires psychopharmacology (Kisner, 2022).
Although not addressed in this snippet, Aviv also discusses the roles that injustice and inequality play in mental distress.
Discourse provocation: The key notions here are ‘language’, ‘innermost self’, ‘to promise’, ‘to explain’, ‘to narrate’, ‘to free’, ‘to save’ and ‘to entrap’. Two shifts are made here: from the register of ‘mental illness’ to that of psycho-dynamics more generally; and from psychiatric practice to design practice as a form of intervention.
One question might be: In so far as designs may be interpreted narratively, that is, acknowledging that they are interwoven with language and that they provide a path of progression for thought and action, what is the relationship between the notion of a ‘promise’ and that of an ‘affordance’, a much-used term in the context of design practice?
While ‘affordances’ might be said to ‘free’, and perhaps to ‘save’, in that they offer a path or at least a next step, can they also be said to ‘entrap’ or ‘ensnare’? Not in themselves perhaps, but only in so far as their offer of a lead may, after having followed it, prove to be misleading. An ‘affordance’ is not a ‘destination’ nor a ‘resolution’. Nor does it provide an explanation. It takes part, nonetheless, in defining possible destinations/resolutions and possible explanations. Designs, however, because they interweave or implicate language and make offers, even if they are not overtly diagnostic nor as strong or consequential as promises, also shape a person’s ‘innermost self’ defined psycho-dynamically, a dynamics which, as Aviv asserts, includes our relationships and communities.
Jordan Kisner’s discussion of Aviv’s book follows her into the realm of disorientation that emerges when a person experiences the trauma of having their agency ripped from them, for example, by an external authority or by an imposed narrative. In this process, we become, as Aviv’s book title indicates, ‘strangers to ourselves’, a condition that leads us, as Kisner states, following Aviv’s lead, to narrativise.
However, as Aviv argues, our self-narrating does not lead to self-determination. Once we have created a story, “we need to know what others make of that story, how they understand us, so that we can understand ourselves. The question “Who am I now?,” while directed at the self, cannot be answered only by the self. It requires traversing between the meaning we make inside ourselves and the meaning we encounter in community” (Kisner, 2022). So while those about whom Aviv writes, “described their psychological experiences with deep self-awareness, … they also needed others to confirm whether what they were feeling was real” (Aviv, quoted by Kisner, 2022).
Kisner (2022) concludes that all of Aviv’s subjects, even including herself, having been diagnosed as having anorexia at the age of 6 years, “live at the mercy of social and medical constructions, and yet strive to shape and reshape their irreducible, protean selves”. It is, Kisner says, the most human drama.
It is in the use of the word ‘drama’ that an opening appears, an affordance perhaps, through which the operation of ‘design’ may be perceived. We might alter Aviv’s ‘insight’ so that it reads: When we become strangers to ourselves, we are compelled ‘to design’. That is, we are compelled to un-throw or throw-off that into which we have been thrown, which includes narrative discourses, social situations, institutional settings and socio-cultural, socio-economic places. Narrativising, in other words, always ‘takes place’ for someone, or group of someones, somewhere in some capacity.
Taking into account Aviv’s understanding that the self extends into relationships and communities, it can be argued that it is not simply ‘the self’ that people strive to shape and re-shape. Rather, it is the world in which the self is suspended or immersed that the striving seeks to shape and re-shape, in other words, the discourses, the people, the situations and the places, by whom and by which that self was initially shaped and continues to be shaped. This is already implicit in Aviv’s recognition that when we become strangers to ourselves, we are compelled to narrativise but we need to know what others make of that story, how they understand us, so that we can understand ourselves. The question of who one is cannot be answered only by the self.
That process of finding out what others make of one’s story, however, always ‘takes place’. The ‘taking place’ involves specific settings, which, it is argued, are filled with existing designs at many levels, from the clothing that establishes the personas of those involved through to the architectural and interior design of the institutional setting.
The narrating and the presenting of those narratives are situated. Social and medical constructions are not simply verbal, not simply discursive, not simply narrative discourses. Narrative discourses take place as part of particular settings or ‘stages’, to use the theatrical metaphor with which this passage of thought began, without which their authority may be questioned and destabilised. Such settings or stagings act as part of the discursive and narrative framing. They are not simply surrounds. Rather, they are equally discursive and equally narrativising as the verbal or written narratives. They tell, sometimes didactically, sometimes implicitly, the participants in the ‘human drama’ who they are, who has what role, and what is the dramatic issue at stake. They distribute differential knowledges about how the space is organised and how the inter-relationships among the participants and the ’supporting cast’ work: who supports whom in the achievement of what, in what institutional setting. The institution is understood as a compound narrative discourse-constructed environment. It matters where, and to whom, one tells one’s narrative.
On the issue of the different approaches to psycho-dynamics, Freudian and pharmaceutical, they suggest two different approaches to design practice, or more properly two approaches to designing. One approach focuses on the psycho-dynamic effects generated through the language use and discourse patterns of specific designs. Such designs might be characterised as ‘media’ products and services, including the ‘digital’ media and services. The other approach focuses on how designs operate at the level of the physical and the biochemical. Such designs may be characterised as ‘product’ design, a category that is extended to include the design of pharmaceutical drugs (See Snippets 3. Narratives of willpower; narratives of disease).
Each approach leads to very different kinds of design intervention, one at the level of language, which has often been associated with ‘mind’, especially in recent philosophy of language, the other at the level of body, which, given the interpenetration of mind and body, represent two different ways of effecting psycho-somato-dynamic change. In each case here, we are talking about interventions that require further interventions. We are not talking ‘cure’, as salvation. Design, as pedagogy, is not soteriological (Parsons, 2015).
Design, therefore, may have a strong interest in working at the interface between the psycho-linguistic and the bio-chemical. If these were reformulated in terms of semiosis – or is this semiotic imperialism? – as psycho-semiosis and bio-semiosis, could their interactions, as intercalating sign-action processes, fall within the remit of design practices?
References
Anderson, H. (2022) Strangers to Ourselves by Rachel Aviv review – rewriting the language of mental illness, Observer, 9 October. Available at: https://www.theguardian.com/books/2022/oct/11/strangers-to-ourselves-stories-of-unsettled-minds-rachel-aviv-review-rewriting-the-language-of-mental-illness (Accessed: 19 October 2022).
Aviv, R. (2022) Strangers to Ourselves: Stories of Unsettled Mind. London: Harvill Secker.
Kisner, J. (2022) ‘The Diagnosis trap’, Atlantic, (October). Available at: https://www.theatlantic.com/magazine/archive/2022/10/mental-illness-diagnosis-strangers-to-ourselves-aviv-book/671247/ (Accessed: 19 October 2022).
Parsons, A. (2015) Non-magisterial, non-charismatic, non-soteriological, non-dogmatic pedagogical practices; and the question of ‘the book’, Poiesis and Prolepsis [Blog]. Available at: http://prolepsis-ap.blogspot.com/2015/08/non-magisterial-non-charismatic-non.html (Accessed: 20 October 2022).
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