The National Institute of Mental Health estimates that nearly one in five adults in America lives with a mental illness. And we have plenty of evidence — from suicide rates to the percentage of Americans on psychopharmaceuticals — that our collective mental health is getting worse. But beyond mental health diagnoses lies a whole, complicated landscape of difficult, often painful, mental states that all of us experience at some point in our lives.

Rachel Aviv is a longtime staff writer at The New Yorker and the author of the new book “Strangers to Ourselves: Unsettled Minds and the Stories That Make Us.” Aviv has done some of the best reporting toward answering questions like: How do people cope with their changing — and sometimes truly disturbing — mental states? What can diagnosis capture, and what does it leave out? Why do treatments succeed or fail for different people? And how do all of us tell stories about ourselves — and our minds — that can either trap us in excruciating thought patterns or liberate us?

We discuss why children seeking asylum in Sweden suddenly dropped out mentally and physically from their lives, how mental states like depression and anxiety can be socially contagious, how mental illnesses differ from physical ailments like diabetes and high blood pressure, what Aviv’s own experience with childhood anorexia taught her about psychology and diagnosis, how having too much “insight” into our mental states can sometimes hurt us, how social forces like racism and classism can activate psychological distress, the complicated decisions people make around taking medication or refusing it, how hallucinations can be confused with — or might even count as — a form of spiritual connection, what “depressive realism” says about the state of our society, how we can care for one another both within and beyond the medical establishment, and more.

This episode contains a brief mention of suicidal ideation. If you are having thoughts of suicide, text 988 to reach the Suicide & Crisis Lifeline. A list of additional resources is available at SpeakingOfSuicide.com/resources.

Mentioned:

“It’s Not Just You,” a series on mental health in America from New York Times Opinion

“The Trauma of Facing Deportation” by Rachel Aviv

Ruth Ozeki on The Ezra Klein Show: “What We Gain by Enchanting the Objects in Our Lives”

Thomas Insel on The Ezra Klein Show: “A Top Mental Health Expert on Where America Went Wrong”

Judson Brewer on The Ezra Klein Show: “That Anxiety You’re Feeling? It’s a Habit You Can Unlearn.”

Book Recommendations:

Madness and Modernism by Louis Sass

Of Two Minds T.M. Luhrmann

“Wants” by Grace Paley

Thoughts? Email us at ezrakleinshow@nytimes.com. (And if you're reaching out to recommend a guest, please write “Guest Suggestion" in the subject line.)

You can find transcripts (posted midday) and more episodes of “The Ezra Klein Show” at nytimes.com/ezra-klein-podcast, and you can find Ezra on Twitter @ezraklein. Book recommendations from all our guests are listed at https://www.nytimes.com/article/ezra-klein-show-book-recs.

“The Ezra Klein Show” is produced by Annie Galvin and Rogé Karma. Fact-checking by Michelle Harris, Mary Marge Locker and Kate Sinclair. Original music by Isaac Jones. Mixing by Sonia Herrero, Isaac Jones and Carole Sabouraud. Audience strategy by Shannon Busta. Special thanks to Kristin Lin and Kristina Samulewski.

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When You Can’t Trust the Stories Your Mind Is Telling

The Ezra Klein Show