Stories We Tell: The Promise and Peril of Mental Illness Narratives

MENTAL HEALTH STORIES are trending, and doctors are worried. The publishing industry has seen a steady flow of books about mental health. A large swath of TikTok is devoted to #awareness influencers with dubious credentials, and Hollywood spotlights dozens of characters with mental illnesses each year. The news media are likewise carving new space to focus on “the mental health beat,” like The Seattle Times’s Mental Health Project and the digital outlet MindSite News, co-founded by former National Institute of Mental Health (NIMH) director Thomas Insel. This boom was preceded by decades of silence—silence that Insel handily critiques. “We should call this what it is: discrimination, fueled by fear and ignorance,” he writes in his 2022 book Healing: Our Path from Mental Illness to Mental Health. But a growing body of narrative nonfiction shows that “destigmatizing” mental illness is not so simple.

The empathy built into storytelling—steeping audiences in circumstances different from their own—is central to art’s power as a social force. “You don’t lead by pointing and telling people some place to go. You lead by going to that place and making a case,” is the oft-quoted dictum from Ken Kesey, whose 1962 novel One Flew Over the Cuckoo’s Nest is perhaps the most famous literary example of the United States’ broken mental health system. Stories that render mental illness on the page, sympathetically and comprehensibly, can shift public opinion toward more open discussion, ideally empowering people to recognize when they are suffering and to seek help without shame.

Yet even though narrative can be a powerful tool to destigmatize, it might also be one of the riskiest. Suicide contagion refers to the idea that suicidal behavior can spread from one vulnerable person to another through direct or indirect exposure within a community or via the media—a concern that shadowed the hit Netflix adaptation 13 Reasons Why (2017–20), which portrays a high school student’s suicide, and which a NIMH-funded study found was “associated with a 28.9 [percent] increase in suicide rates among U.S. youth ages 10–17 in the month (April 2017) following the show’s release.” A Scientific American article published at the time of the series’ release warned that “the role that fiction can play in inspiring suicide is at best unclear,” citing Romeo and Juliet and The Sorrows of Young Werther as other works accused of catalyzing this “copycat effect.” Another metaphor is the peanut allergy. As Victor Schwartz, who serves on the board of Stanford University’s Media & Mental Health Initiative—a think tank that studies how stories can promote (or undercut) public health—explained to me, “For most of us, it’s a pretty healthy lunch. But for a small portion of the population, it’ll kill you.”

September is Suicide Prevention Awareness Month. Last September, Rachel Aviv’s Strangers to Ourselves: Unsettled Minds and the Stories That Make Us leaned into this complexity of writing about mental illness; released earlier this month, Meg Kissinger’s While You Were Out: An Intimate Family Portrait of Mental Illness in an Era of Silence likewise rejects the silence surrounding suicide while at the same time considering the ethics of sharing these stories. Together, these books, each written by a journalist who merges her own experiences with tremendous reporting and research, exemplify best practices for writing about mental illness in a way that does not self-censor or sacrifice the art of their prose. Both shine with a rare honesty, hyperaware of the force of a story.

In While You Were Out, author Meg Kissinger wonders whether speaking openly about mental illness could have saved the lives of two of her seven siblings. Nancy died when Kissinger was 19; Danny hanged himself around 20 years later. “I wanted to show as unflinchingly as possible what the long-term consequences are when you are shamed into silence,” Kissinger writes. “Not to browbeat but to bear witness.” Silence is the foundation of this defiant memoir, which constructs the midcentury Catholic milieu of her Midwestern family, whose “shorthand way of dealing with these situations—by simply not discussing them or making light of it—had an insidious way of fueling shame and blame where none was warranted.”

But her book belies the notion that breaking silence is inherently productive. Not talking can be deadly, yes, but maybe talking can be too. Without self-pity, only a lucid interest in the power of stories and how to wield them, Kissinger recounts a breakdown she has one day in the newsroom. “Your stories aren’t saving people. In fact, they might be making them sicker,” she tells herself after learning that a mother whom she’d followed across the country, while reporting on her search for psychiatric treatment for her son, had ended up in the hospital too. One question Kissinger asks herself motivates much of the memoir: “How had it helped them to have the intimate details of their traumatic trip splayed across the front page of the daily newspaper?”

Meg Kissinger was my professor at Columbia Journalism School, and she recounted this scene to us two years before her book was published. This was the same class in which we read a front-page New York Times story by Megan Twohey and Gabriel J. X. Dance: a 2021 investigation into a website where users could openly encourage each other to go through with suicide. Running the story meant revealing dominant methods of suicide and affording a far larger platform to the site. The class discussed whether shining a light on the truth, unflinchingly, is always helpful, or if there are ever stories that writers should skirt around in the interest of minimizing harm. But, I wondered, how helpful is it to presume to know what’s best for your readers?

The anxiety that stories can infect as well as heal pervades Kissinger’s book. “I called my parents at 1:30 a.m., crying that my stomach hurt, when, really, I was worried about them,” she says of her college days, when she used to invent pretenses for confronting her parents’ mental health (and her own). And years later, when she struggles to tell her children, ages 10 and 11, that their uncle, her brother, killed himself, she asks: “How do you talk about suicide without normalizing or vilifying it?” This question pulses at the heart of While You Were Out, in which the author, by raising this question explicitly, deftly separates candor from normalization as she explores what might cause and perpetuate taboo.

Rachel Aviv’s book Strangers to Ourselves likewise confronts the difficulty of narrating mental illness. By deeply reporting the arcs of four psychiatric patients, the collection of case studies argues that medical diagnosis imposes its own story. Within this narrative context, the person—now patient—subconsciously learns behaviors that better fit those outlined in the DSM-5; in other words, receiving a diagnosis can make one sicker. Aviv refers to Ian Hacking’s theory of “the looping effect,” which the Canadian philosopher of science theorized is “[w]hat distinguishes human kinds from ‘natural kinds’ […] By coming into existence through social scientists’ classifications, human kinds change the people thus classified.” One of Aviv’s case studies, Laura, at first finds relief in being diagnosed as “bipolar,” then subconsciously changes her behaviors to better match the identified disorder, descending deeper and deeper into pills and poor health as an undergrad at Harvard. Bapu, an Indian woman who may have had schizophrenia, spirals as a psychiatric patient, but is noticeably happier and healthier when her community regards her as a mystic. And Aviv herself fuzzily remembers being hospitalized at age six for anorexia, though she was too young to understand what it was at the time, and perhaps therefore did not learn the behaviors that would have instantiated being anorexic in her sense of self. “This sense of narrow escape has made me attentive to the windows in the early phases of an illness, when a condition is consuming and disabling but has not yet remade a person’s identity and social world,” Aviv reflects in her prologue. “Mental illnesses are often seen as chronic and intractable forces that take over our lives, but I wonder how much the stories we tell about them, especially in the beginning, can shape their course.”

Aviv frets: “People can feel freed by these stories, but they can also get stuck in them.”

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Telling stories to make sense of illness is ingrained in human nature for a reason—something that Aviv hints at when she frames her book with Hacking’s looping effect. Labeling theory describes how subjects (people) change—their behavior, their sense of identity—when they receive a new label, that is to say, a diagnosis. And medical sociologist Michael Bury goes so far as to declare that a “biographical disruption” necessarily occurs when someone receives a diagnosis of a chronic illness like a mental health disorder. This, he argues, is a “major kind of disruptive experience” because it radically alters the individual’s position in the world. Future plans and expectations hang in the balance; relationships between the individual and their family and friends become suddenly strained, as normal reciprocity gives way to patient-caregiver dynamics. It is instinctual to turn to storytelling to make sense of it all. Narratives deepen understanding, make meaning, share experiences, help heal. (“We tell ourselves stories in order to live,” as Joan Didion put it.)

In a Delacorte Center for Magazine Journalism talk moderated by Keith Gessen at Columbia in March, Aviv offered some guidelines for how to exercise this responsibility in creating narratives. Primarily, writing nonfiction can be a collaborative approach with your characters; those whom she writes about are not “subjects” but rather active participants. “I choose people who I feel like want to understand, and are sort of engaged in that process too, like there’s some alignment,” Aviv said. In Strangers to Ourselves, she ensured that those she was interviewing wanted to discover something about the mental health system, their own illnesses, and their interplay with story and identity. And it is clear that her own quest—to make sense of her early hospitalization for anorexia, to understand her relationship with antidepressants—assisted in that alignment, too.

Schwartz, the Stanford ethicist, says that the key to truthfully portraying suicide is in conveying that mental illness exists outside the binary—that is, the distinction is not between psychotic and healthy, or between chronically sick and “normal.” Rather, mental illness is smudgy, caused by a combination of genetic predisposition and lifestyle, and presenting in a cluster of symptoms that ebb and flow. By emphasizing complexity and engaging nuance—what artists usually do anyway—depictions will be truer, and perhaps safer.

Artists and writers may balk at the idea of guardrails in their creative work, where rules are made to be broken. No one ever said that Romeo and Juliet was realistic, and art is not usually a matter of life or death. But if the relationship between suicide and stories of suicide, between harming and healing, is clouded, at least one precept speaks for itself: as Kissinger’s brother Danny wrote in his suicide note to her, “Only love and understanding can conquer this disease.”

Kissinger peels off labels of illness, just like Aviv does. Nancy, Kissinger’s sister, was described as a “typical” manic-depressive schizophrenic—an amorphous description, unintentionally absurd, that does nothing to communicate her experiences as a human being. The same happened with Danny. And so the author wrote a book about her siblings, about their world, and about the taboos that surrounded them—the taboos that Kissinger, the writer, resists by leaving nothing out. These books aim for fullness. Her dedication: “For Danny, because he wanted us to understand.”

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Isabel Ruehl is an assistant editor at Harper’s Magazine.