Rachel Aviv on Writing About Sensitive Topics and Character-driven Reporting

Could you tell us about your current Fellows Program-supported project as well as your latest article in the New Yorker, “The Challenge of Going off Psychiatric Drugs,” why you chose it, and why did you became interested in the subject?

As for “The Challenge of Going off Psychiatric Drugs,” I became interested in the subject because I’d had close friends go through very difficult experiences of withdrawal from SSRIs. I wanted to find medical literature about this problem, and I was amazed that there was almost nothing. I was also troubled by what seemed to be two separate streams of conversations: the conversation among patients, who felt that withdrawing from medications was a dilemma and source of anguish; and the conversation among doctors, who were not engaged in questions related to “de-prescription” and were inclined to say that if patients were having trouble coming off drugs, it was because their underlying illness was resurfacing. This is the kind of logic that can’t be tested—if you’re feeling ill, it’s because you were always destined to be ill—and so it seemed to me a neglected corner of medical thinking—one that could potentially affect millions of people’s lives.

My Fellows project revolves around an idea developed by the historian of science Ian Hacking, who describes how diagnoses create kinds of people that in a certain sense did not exist before. They give us “a way to be a person, to live in society,” he writes, affecting “our idea of what it is to be an individual.” Hacking describes this as the “looping effect.” Classifications don’t just describe experiences—they also generate new forms of experience. The story about Laura Delano in “The Challenge of Going off Psychiatric Drugs” felt relevant in the sense that her diagnosis became a kind of career. She began to organize her sense of self—and her expectations for what kind of life she should live—around it.

When it comes to writing about sensitive topics such as an individual’s mental health, what steps do you take to help others feel comfortable talking to you and also to protect their privacy? What are those conversations like?

To take Laura Delano as an example, we had a number of informal conversations before I began reporting in any sort of formal way. We also talked a lot about her concerns in advance, before almost every conversation. One of the things that was important to her was to feel like she wasn’t completely surrendering control of her own story. One way of alleviating this fear was that, in the process of writing the story, I would read her paragraphs or sections of the piece verbatim—at a stage when I was not particularly attached to it—and she would pick out a particular sentence and then reflect on it—sometimes for an hour or more—in order to help me convey, more precisely, her state of mind at that time. This process ended up feeling less like fact-checking and more like reporting and it gave us both peace of mind that we’d accurately captured the experience.

How do you balance skepticism about the ideas or trends you are reporting on with what you’re discovering and experiencing as a journalist who is deeply embedded with the characters you’re writing about?

I was wary of writing about this topic from the beginning because in some ways it felt like a no-win situation: I would anger people on either side—there are many who fear (understandably) that any sort of public skepticism about the use of psychiatric drugs could discourage people from taking drugs that can save their lives. There would be others, I knew, who would say that I didn’t go far enough in challenging conventional models of mental illness. It was a challenge to find the right balance in telling a story about someone who had been failed by our current treatment methods while also allowing for the fact that psychiatry is essential and life-saving for many people. There’s also the additional challenge that when you’re writing about medications that probably about a fifth of readers take—if we extrapolate from the C.D.C. statistics—it can be more difficult for them to make imaginative leaps: so many people take these drugs that if they haven’t had any difficulty withdrawing, they automatically assume that no one else could have either.

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