“SCHIZOPHRENIA TERRIFIES. It is the archetypal disorder of lunacy,” Esmé Weijun Wang writes at the outset of her incisive and moving debut collection of essays, and winner of the Graywolf Press Nonfiction Prize, The Collected Schizophrenias. “Craziness scares us because we are creatures who long for structure and sense.” Crazy, lunatic, terrifying, chaotic, dangerous: Wang is keenly aware of the specific host of terms frequently attached to schizophrenia, but also of the ways in which, conversely, the designation can frequently be invoked to mean all manner of things. In “Diagnosis,” the collection’s first and longest essay, Wang cites a 2013 Slate article titled “Schizophrenic Is the New Retarded,” by the neuroscientist Patrick House, who noted that “a stock market can be schizophrenic when volatile, a politician when breaking from party lines, a composer when dissonant, a tax code when contradictory, weather when inclement, or a rapper when headlining as a poet.” While Wang acknowledges that some of the confusion is likely due to literal, etymological readings of the word, coined by Swiss psychiatrist Eugen Bleuler in 1908 — from the Greek schizo, split, + phrene, mind — the cumulative effect is detrimental nonetheless. “In other words,” she summarizes, “schizophrenia is confusing, off-putting, nonsensical, unpredictable, inexplicable and just plain bad.”
I thought of Sontag, of course, who wrote, in Illness as Metaphor, of the mythicization and negative conception of illnesses as engendered by language and literature — both medical and literary — so that an illness becomes at once moniker for and host of cultural fears and anxieties. Sontag’s subject here is cancer, and disease is critically different from mental illness in many ways, but a similar observation rings true through the 13 essays in The Collected Schizophrenias, which write through and against conventional depictions of schizophrenia and the experiences of those who live with it.
Those who live with being key, meaning a person can have or experience rather than be an illness. To be is the most existential of verbs, and as such, the most vulnerable to abuse and imposed definition. For if one is or becomes schizophrenic, what happens to the rest of one’s self? “Sartre claimed, ‘We are our choices,’” writes Wang, “but what has a person become when it’s assumed that said person is innately incapable of choice?” The author was first diagnosed with bipolar disorder in 2001, and then in 2013 with schizoaffective disorder, bipolar type, a disorder that combines symptoms of schizophrenia (such as hallucinations or delusions) and major mood episodes (mania and depression). In “Perdition Days,” an essay about her experience of Cotard’s delusion — a psychosis in which one believes one is dead — Wang describes an anti-stigma talk that she attended in 2013, run by the Mental Health Association of San Francisco:
Part of this training included a lesson on appropriate language usage — to say “person with bipolar disorder,” or “person living with bipolar disorder,” or “person with a diagnosis of bipolar disorder,” instead of “bipolar” as a predicate nominative. We speakers were told that we were not our diseases. We are instead individuals with disorders and malfunctions. Our conditions lie over us like smallpox blankets; we are one thing and the illness is another.
A predicate nominative is a word or a group of words that completes a linking verb and renames a subject. Here, the subject, the person, the individual, would be renamed by the illness, would — to an extent — be replaced by, become one with the illness. Linguistically, the person is no longer singular or specific, but plural and general — a symptom, an iteration of a larger concept. A common description of schizophrenia, Wang writes, is that it takes over or possesses the individual affected and eats away at her until she disappears entirely: she becomes alien, unrecognizable, perhaps even to herself. Wang notes that these portrayals often address not only the person with schizophrenia, but also “the suffering of those who are adjacent to the one who is suffering in the first place,” so that those who live with are also family members, lovers, friends. How effectively they are able to do so will often be determined by their access to key resources like health care, education, and financial aid.
“Toward a Pathology of the Possessed,” which begins and ends with the killing of a 34-year-old man diagnosed with severe paranoid schizophrenia, Malcoum Tate, by his sister, Lothell, explores how the frustration and fear often felt by those close to a person with schizophrenia can lead to tragic ends. Those charged with primary care can believe the person with schizophrenia has no capacity for insight and must be protected for his or her own good, sometimes leading to involuntary hospitalization. This is an experience Wang describes throughout The Collected Schizophrenias as violating, dehumanizing, and akin to incarceration, not to mention generally unhelpful for the patient who is, contrary to common belief, aware of what is happening to her. Worse, in the extreme example of the Tate family, the relative with schizophrenia can be seen as an untreatable burden: “The burden of care becomes the burden that breaks people. On the stand, Lothell Tate described the crime itself as an act of love: ‘I said to Malcoum, I said, “Malcoum, I love you and I only want what’s best for you, and I’m sorry,” and I shot him.’” Wang’s writing throughout The Collected Schizophrenias is insightful, curious, and never condemnatory, with an eye for revelatory details that embody the complexities of schizophrenia as both illness and metaphor. “Toward a Pathology of the Possessed” ends with characteristic empathy, as Wang considers the particular of the 13 shots:
When I think about the murder, I think about how excessive thirteen shots is. I also think about how a man who loomed over your bed in the middle of the night, a man who claimed to be sent by God to kill your daughter, might seem like a man possessed by evil, and therefore capable of anything, including surviving multiple gunshot wounds — even if you once loved him, or still do.
One of the two epigraphs to The Collected Schizophrenias is taken from Sylvia Nasar’s A Beautiful Mind, a biography of the Nobel Prize–winning economist and mathematician John Nash, whose struggles with schizophrenia were made more famous by the Ron Howard/Russell Crowe film of the same name. “More than any symptom,” Nasar writes, “the defining characteristic of the illness is the profound feeling of incomprehensibility and inaccessibility that sufferers provoke in other people.” There is the sense that a person with schizophrenia simply cannot be understood, her interiority remains inscrutable, thereby eliminating a critical element of her personhood. The Collected Schizophrenias goes a long way to counter and to flesh in the cavernous space around this notion, its attendant implications and misunderstandings. The collection takes its second epigraph from Sontag — not Illness as Metaphor, but the second volume of her diaries, As Consciousness Is Harnessed to Flesh: Journals and Notebooks, 1964-1980:
How can I go on this way?
And how can I not?
Wang’s essays deftly and powerfully occupy the difficult locus between singularity and abstraction, insisting on a distinct subjectivity that is equal in force and import, even while intimately connected to the state of her mental health. Yes, she lives with, but yes, she is. How can I, as Sontag asks, because I am in here, I am all of these things at once, and I continue. One can be singular among the plural and plural among the singular.
In “Diagnosis,” the essay within the collection that most specifically explores the pathologies, clinical definitions, and diagnoses of schizophrenia and schizoaffective disorder, Wang writes,
Some people dislike diagnoses, disagreeably calling them boxes and labels, but I’ve always found comfort in pre-existing conditions; I like to know that I’m not pioneering an inexplicable experience […] To read the DSM-5 definition of my felt experience is to be cast far from the horror of psychosis and an unbridled mood; it shrink-wraps the bloody circumstance with objectivity until the words are colorless.
The DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, a clinical tool created by the American Psychiatric Association, which exhaustively details diagnostic taxonomies, criteria, and codes for use by psychiatric practitioners across the United States and much of the world. “Diagnosis” includes full descriptions from the DSM-5 of both schizophrenia and schizoaffective disorder. It also includes Wang’s own descriptions of her experiences, the chronology and development of her diagnoses, excerpts from correspondence with one of her doctors, what it’s like to be processed by the systems and structures of mental health organizations, the frustration of an illness whose origin remains unspecified, her family history of mental illness, and the use and abuse of language as a means to contain what is uncontainable.
The author’s extra-clinical narrative structures order a host of clinical information, running alongside to supplement, contour, and complicate, particularly in tonal and stylistic shifts, the official record provided by studies and research: a reminder that experience of mental illness can take multiple forms. Wang shows that it is possible to access the individual with schizoaffective disorder, across registers and disciplines: her existence is not remote or incomprehensible, it can be described in meaningful and evocative terms. This is being able to write of schizophrenia as “a genus rather than a species,” as conceived by Bleuler, who fathered its name, meaning that schizophrenia is a group or a family, composed of myriad iterations, rather than a single, indivisible organism. “As a concept,” Wang writes, “the schizophrenias encompass a range of psychotic disorders, and it is a genus that I choose to identify with as a woman whose diagnosis is unfamiliar to most — the shaggy, sharp-toothed thing, and not the wolf.” In other words, the author can experience or embody a range of diverse iterations and characteristics, without being the animal itself.
Yes, one can be singular among the plural and plural among the singular, as, in fact, the most skilful essayists are. The shaggy, sharp-toothed thing, and not the wolf. And it’s important to note that The Collected Schizophrenias is a collection of essays — not a memoir, a study, a biography, or an autobiography, like the canon of familiar titles Wang cites throughout her essays: Sylvia Nasar’s aforementioned A Beautiful Mind, The Center Cannot Hold: My Journey Through Madness by Elyn R. Saks, Touched with Fire: Manic Depressive Illness and the Artistic Temperament and An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison, and Far From the Tree: Parents, Children and the Search for Identity by Andrew Solomon, whose award-winning memoir, The Noonday Demon: An Atlas of Depression, was a finalist for the 2002 Pulitzer for General Non-Fiction. Wang uses the essay form to do something different, fracturing and evading the expectation of an overarching personal narrative — one with a beginning and an end, a resolution, perhaps, and a series of milestones along the way.
Reading Wang’s collection, I thought of the great essayist Elizabeth Hardwick, who wrote of the form, in a 1986 New York Times Book Review piece entitled “Its Only Defense: Intelligence and Sparkle”:
A collection of essays is a collection of variations. The theme or the plot is not an imaginary construction, as in the novel, but arises from some factuality of history, culture, politics, personal experience, and above all from general ideas. Yet the most interesting will have the self-propelled interior life of imaginative literature, and this is true even when they are responses to an occasion.
Essays, like essayists, are private and personal, as well as public, informed, educative, and far-reaching. Essayistic narratives span the intimate and the impersonal, drawing subtle parallels, yoking unexpected themes or pieces of information, critical readings, anecdotes, and remembrances to generate a logic that is both interior — of the writer’s own world — and exterior — intelligible and accessible to the reader on a number of different levels. So, an essay about acting as a speaker at schizophrenia clinics is also an essay about high fashion as a protection device against stigma, the relationship between capitalist labor and notions of “health,” performing wellness, definitions of normalcy, and what it means to be “high-functioning.” Or, an essay about freshman studies at Yale is also an essay about the paucity of mental health provisions at universities across the United States, new intellectual landscapes, falling in love, class structures, feeling frightened and sick, healing, and moving forward. A piece about Luc Besson’s film Lucy is also about psychosis, imagination, creativity, the relationship between mind and body, and how people with schizophrenia understand “reality checks”; and another, about the author’s interest in Francesca Woodman’s photographs, also considers the camera as an affirmative medium, the vulnerability that can hover around a person’s face — her literal self-image — when experiencing psychosis, and what it means to leave behind a body of work.
Alongside Hardwick, another unparalleled queen of nonfiction came to mind: Vivian Gornick, whose The Situation and the Story: The Art of Personal Narrative endures, for me at least, as one of the best guides to writing nonfiction. Among other poignant maxims, Gornick states, “[W]hat happened to the writer is not what matters; what matters is the larger sense that the writer is able to make of what happened.” Like Wang, the essays in The Collected Schizophrenias contain experiences and episodes of schizoaffective disorder, but are not solely determined by them. Their subject is not only schizoaffective disorder but also writing, creativity, youth, parenthood, relationships with friends and lovers, film, fashion, contemporary culture, personal trauma, political agency, and the world at large, all intricately bound — as are the complex of forces and interests within any individual.
One of the most profound topics that recurs throughout The Collected Schizophrenias is the difficulty, for the person with schizophrenia, of self-determination. One is told that, clinically, one lacks insight and therefore the ability to determine not only one’s own reality, but reality in general. Wang writes incisively of the philosophical implications this has with regards to Western-based ideas of selfhood. “[I]f it’s true that I think, therefore I am, perhaps the fact that my thoughts have been so heavily mottled with confusion means that those confused thoughts make up the gestalt of my self,” Wang writes in “Yale Will Not Save You”; and in “Perdition Days”:
[I]f I am psychotic 98 percent of the time, who am I? If I believe that I don’t exist, or that I am dead, does that not impact who I am? Who is this alleged “person” who is a “person living with psychosis,” once the psychosis has set in to the point that there is nothing on the table save acceptance? When the self has been swallowed by illness, isn’t it cruel to insist on a self that is not an illness? Is this why so many people insist on believing in a soul?
Wang questions and questions, and we question along with her, see versions of ourselves in her struggles and queries. There are, of course, no answers, though in the final two essays of Wang’s collection — “Chimayó” and “Beyond the Hedge” — there is some balm as she considers alternative spiritual, psychological, and occult ways of thinking about illness that she can practice alongside her medical treatment. “Chimayó” tells of Wang’s 2015 diagnosis of chronic Lyme disease, and her time at an intensive treatment clinic in Santa Fe, New Mexico. While there, she and fellow writer and patient Porochista Khakpour, of 2018’s excellent Sick: A Memoir, which chronicles her struggles with late-stage Lyme disease, visit the early 19th-century pilgrimage site of El Santuario de Chimayó, where visitors travel to collect a small amount of “holy dirt” that they will keep or sometimes rub on their bodies in the hopes of a miraculous cure for whatever they suffer. Wang considers the differences between hope and faith, resilience and suffering, citing a quotation attributed to Joan of Arc: “‘I am not afraid. I was born to do this.’ However my life unfolds, goes my thinking, is how I am meant to live it; however my life unspools itself, I was created to bear it.”
The final essay in the collection, “Beyond the Hedge,” continues this sense of the self as a divine or spiritual channel, as Wang explains her interest in clairvoyance and her introduction to “the liminal” as a space in which “thin-skinned” individuals — those who “have perceptions that are wide-open; they perceive what is happening in the other realm” — can access the numinous and the non-rational, that which lies beyond the surface of the apprehensible. This might sound hokey or implausible to the alternative-spiritual-faint-of-heart, but Wang delivers it with calm surety; she reminds us that she is an adherent of science and has lived carefully, has survived by diagnosis and medical advice (a reminder that is also the seasoned stance of the individual who is continually asked to account for herself). It is the actions and not necessarily the beliefs that provide the most sustenance, “To say this prayer — burn this candle — perform this ritual — create this salt or honey jar — is to have something to do when it seems that nothing can be done.” At the end of this essay, at the end of the collection, Wang describes the use of “talismanic cords,” which offer protection to the liminal person: as she travels, sometimes slips and falls between realms, it keeps her grounded and makes sure that she returns:
When a certain kind of psychic detachment occurs, I retrieve my ribbon; I tie it around my ankle. I tell myself that should delusion come to call, or hallucinations crowd my senses again, I might be able to wrangle sense out of the senseless. I tell myself that if I must live with a slippery mind, I want to know how to tether it too.
The essays of The Collected Schizophrenias continue this intuitive chain of connections, and tether Wang tenderly, intelligently, insistently to us. May she return again and again, for she has much to impart, in her brilliant prose, about how to write the shaggy, sharp-toothed thing and not the wolf.
Read more LARB pieces related to mental health and illness here.