“God knows where I am” Rachel Aviv on insight and mental illness

If you haven’t read Rachel Aviv’s latest article about mental illness in the New Yorker, you should.

Given the work I do, and the fact that I teach hundreds of young adults entering the helping professions, I encounter many women and men facing mental health concerns. Most of these women and men have difficult or painful experiences, but are able to surmount these obstacles to lead successful and productive lives. Most mental health concerns come to light because the people experiencing painful symptoms and consequences of depression, anxiety, or bipolar disorder actively seek help. In many cases, the hardest people to help are those who do not believe that they have a mental health disorder at all. Almost half of the people diagnosed with a psychotic illness do not believe that they have these disorders. This lack of insight into their own conditions obviously poses huge obstacles to
effective care.

Rachel Aviv’s New Yorker story, “God knows where I am,” is a perceptive and humane account of Linda Bishop, an appealing and intelligent woman who was never able to recognize the basic fact of her severe mental illness. In her comments to others and in her private writing, Bishop combined striking lucidity with an adamant inability “to modify her self-image to acomodate the fact of her illness,” even as she found herself living in a vacant farmhouse subsisting on backyard apples while “awaiting further instructions” from God. Those instructions never came, with catastrophic results.

If you haven’t seen this piece, you definitely should. I don’t agree with everything Aviv has to say about deinistitutionalization and other matters. But it is an amazing, heartbreaking read. If I could only write like that, too.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

2 thoughts on ““God knows where I am” Rachel Aviv on insight and mental illness”

  1. Now if only this woman was not indoctrinated with the superstition and magical thinking of religion and ‘God’ talk growing up. She was right to fear the psychiatrists that had so harmed her in the past. If there was a safe place for her to stay where her expressed wishes around psychiatry were respected, she may have survived. Unfortunately we live in a society that believes not all its citizens are entitled to such basic civil rights as being let alone.

  2. She did find a safe place. It just so happened to be same place where he body was found several days after her death by starvation. Cold and all alone. And I support every persons civil rights to beat their fellow citizens with a side walk brick whether they be a homeless individual or a therapist. Just be sure the therapist gets treated the same way in the judicial system as the homeless person. And please don’t complain or assault my poor brother when he turns up at your front door in his soiled attire demanding a handout. He is only expressing his freedom of assembly and speech.
    As much as we may wish to think that mental illness is easy to address it is far from reality as Ms. Aviv’s story reveals and causes many families grief and sorrow.

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