While sitting in my psychiatrist’s office, in the latter half of October 2016, mid-afternoon, amid the glassy glare of sunny Los Angeles, I was shakily, mistakenly, but not surprisingly diagnosed with schizophrenia. I became immediately terrified. Even the doctor seemed scared. Despite the fact that I had no previous history with mental illness, I’d been in the brutal throes of psychosis and post-psychosis for seven long months. I’d been hearing a chorus of voices, some of them frightening, and I’d been seeing things, but the several medications, the anti-psychotics and mood stabilizers, were not working.
My doctor half-stuttered, “I think you have schizophrenia,” as if he was afraid to utter the word. In retrospect, I understand; I was scared to hear it. My symptoms were demonstrably debilitating, and, still, it seemed to me, as if by some malicious magic, the assignment of the diagnosis, the mere mention of the word made everything incalculably worse. It felt like I had crossed some alien border; I was no longer human. That afternoon, when I first became associated with the word — the idea, the cultural trope, the disease — remains, for many complicated reasons, the most frightening moment of my life.
“Schizophrenia terrifies.” That first sentence of Esmé Weijun Wang’s unnervingly excellent essay collection, “The Collected Schizophrenias,” bluntly and perfectly explains that reaction. The disease — the word — conjures up constellations of pop culture archetypes of paranoid violence, the babbling shadow-lives of disabled homeless and the unknowable walking dead of sci-fi TV. “People speak of schizophrenics as if they were dead without being dead, gone in the eyes of those around them,” Wang continues. “[H]uman catastrophes can bear the weight of human narrative — war, kidnapping, death — but schizophrenia’s built-in chaos resists sense.” She explains rather beautifully: “Craziness scares us because we are creatures who long for structure; we divide the interminable days into years, months, and weeks. We hope for ways to corral and control bad fortune, illness, unhappiness, discomfort, and death — all inevitable outcomes that we pretend are anything but. And still, the fight against entropy seems wildly futile in the face of schizophrenia, which shirks reality in favor of its own internal logic.”
After a considerable history of illness, diagnoses, misdiagnoses, hospitalizations and years of working as a lab researcher and manager at the Stanford Department of Psychology, Wang knows well the terror of the word. So too is one’s official diagnostic induction into the schizophrenias, as it turns out there are more than one. Or as my new psychiatrist puts it: “Schizophrenia is no longer considered to be a monolithic concept, but a spectrum. A continuum.” After hearing my particular story, and my lucky success with lithium, my doctor declared I did not, in fact, fit the profile of schizophrenia, but instead had a classic case of schizoaffective disorder, bipolar type. Wang, too, was finally, correctly, officially diagnosed with schizoaffective disorder, bipolar type: “eight years after experiencing my first hallucinations,” she shares, “back when I first suspected fresh hell in my brain. I remain surprised by how long it took. … Some people dislike diagnoses, disagreeably calling them boxes and labels, but I’ve always found comfort in preexisting conditions; I like to know that I’m not pioneering an inexplicable experience.”
But what exactly is the schizoaffective experience?
According to the DSM-5 (Diagnostic and Statistical Manual), schizophrenia is indexed as 295.90, and schizoaffective disorder, bipolar type is indexed as 295.70. Which is not especially illuminating, as Wang notes, but even their closely indexed proximity suggests a spectrum, a familial connection, a collection.
In Wang’s words: “Schizophrenia is the most familiar of the psychotic disorders. Schizoaffective disorder is less familiar to the layperson, and so I have a ready song-and-dance that I use to explain it. I’ve quipped onstage to thousands that schizoaffective disorder is the f—ed-up offspring of manic depression and schizophrenia.” Although she goes on to say this is “not quite accurate,” I’d argue it’s plenty accurate enough. I’ve gone so far as to adopt her “song-and-dance,” since, I’ve found, going into particular detail regarding major mood episodes (manic or depressive), and hallucinations (visual or auditory), tends to, well, freak people out. Wang’s description wonderfully encapsulates one of her strengths as a writer and a thinker. She speaks plainly, directly of her experience, even as she diligently returns again and again to her clinical background, lending each essay a marvelous mix of personality and authority.
The chapter “The Choice of Children” confronts the sobering notion of motherhood and the possibility of passing on a psychotic disorder, while Wang volunteers at a summer camp for bipolar children. Her Essay “Yale Will Not Save You” examines the punishing stigma of mental illness on college and university campuses and Wang’s own endearing love for the school that ultimately asked her to leave because of her disorder. There are fascinating reads of mental illness as possession in “The Exorcist,” of the violence associated with the “Slender Man” phenomenon and the haunting photography of Francesca Woodman. There are chilling accounts of Wang’s psychosis and the psychoses of others — of violence, suicide and murder, tales of death delusion, and moving essays on Wang’s additional fights against late-stage Lyme and PTSD. Her essays are all varied lenses on what it is to be one kind of human, to be schizoaffective, to be her.
As a whole, “The Collected Schizophrenias” provides a new and welcome map for the severe landscapes of schizoaffective disorder, of cerebral disease, diagnosis, recovery, and relapse, of the many human mysteries of the schizophrenias. The essays are resoundingly intelligent, often unexpectedly funny, questioning, fearless and peerless, as Wang makes for brilliant company on 13 difficult walks through largely uncharted territory. I’m reminded of Susan Sontag’s famous take on illness: “Illness is the night side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” She’s half right. Sontag speaks here of physical illness and does not speak for those who’ve traveled in the lands of psychosis, in the unreal realms of the mad, of the mentally ill. Wang does. She speaks for me too, and I thank her for that.
Esmé Weijun Wang
Graywolf Press, 224 pp., $16