The Collected Schizophrenias: Essays

by Esmé Weijun Wang

Psychoanalyst Christopher Bollas defines “schizophrenic presence” as the psychodynamic experience of “being with [a schizophrenic] who has seemingly crossed over from the human world to the non-human environment,” because other human catastrophes can bear the weight of human narrative—war, kidnapping, death—but schizophrenia’s built-in chaos resists sense.

A diagnosis says that I am crazy, but in a particular way: one that has been experienced and recorded not just in modern times, but also by the ancient Egyptians, who described a condition similar to schizophrenia in the Book of Hearts, and attributed psychosis to the dangerous influence of poison in the heart and uterus. The ancient Egyptians understood the importance of sighting patterns of behavior. Uterus, hysteria; heart, a looseness of association. They saw the utility of giving those patterns names.

Schizophrenia is also conflated with dissociative identity disorder, more commonly known as multiple personality disorder, due to the vernacular use of “split personality” to refer to a disorder unrelated to fractured personalities. And though psychosis is a phenomenon shared by disorders other than schizophrenia, the words “psycho” and “psychotic” are used to refer to everything from obnoxious ex-girlfriends to bloodthirsty serial killers.

Identical twins, according to seminal twin studies in the 1960s, have only a 40 to 50 percent chance of both developing schizophrenia, despite their shared genes. According to the diathesis-stress model of psychiatric illness, a genetic vulnerability to a disorder blooms only if enough stressors cause those vulnerable genes to express themselves.

the debate over AB 1421, as I discovered in San Francisco, touched upon crucial issues of autonomy and civil liberties. The bill makes the assumption that people who display a certain level of mental disorder are no longer capable of choosing their own treatment, including medication, and therefore must be forced into doing so. Sartre claimed, “We are our choices,” but what has a person become when it’s assumed that said person is innately incapable of choice?

The mind has been taken over. The mind has lost the ability to make rational decisions. There’s someone in there, but it’s not whoever it is we formerly believed it to be. Depression is often compared to diabetes—in other words, it’s not your fault if you get it, and you’ll be fine if you just take care of it. Schizophrenia, on the other hand, is compared to Alzheimer’s—it’s still not your fault if you get it, but there’s no fixing it, and though you may not intend to be a burden, you’ll still be one until you die.

A therapist told me in my midtwenties, when my diagnosis was still bipolar disorder, that I was her only client who could hold down a full-time job. Among psychiatric researchers, having a job is considered one of the major characteristics of being a high-functioning person. Most recently, Saks has spearheaded one of the largest extant studies about the nature of high-functioning schizophrenia. In it, employment remains the primary marker of someone who is high-functioning, as having a job is the most reliable sign that you can pass in the world as normal. Most critically, a capitalist society values productivity in its citizens above all else, and those with severe mental illness are much less likely to be productive in ways considered valuable: by adding to the cycle of production and profit. Our society demands what Chinese poet Chuang Tzu (370–287 BCE) describes in his poem “Active Life”: Produce! Get results! Make money! Make friends! Make changes! Or you will die of despair.

If the conversation winds its way to my diagnosis, I emphasize my normalcy. See my ordinary, even superlative appearance! Witness the fact that I am articulate. Rewind our interaction and see if you can spot cracks in the facade. See if you can, in sifting through your memory, find hints of insanity to make sense of what I’ve said about who I am. After all, what kind of lunatic has a fashionable pixie cut, wears red lipstick, dresses in pencil skirts and tucked-in silk blouses? What sort of psychotic wears Loeffler Randall heels without tottering?

Rarely did I experience such a radical and visceral imbalance of power as I did as a psychiatric inpatient amid clinicians who knew me only as illness in human form. During that first hospitalization, I learned that clinicians control when inpatients are granted privileges, such as being able to go downstairs for meals or outside to smoke for ten minutes twice a day. Most important, it was my team of clinicians who decided when I could go home. I became accustomed to playacting for the benefit of doctors: Look! I’m happy! I’m fine! In response to “Are you thinking about hurting yourself or others?” there was only one proper answer, which, regardless of what I said, was always followed by suspicious, persistent questioning. Knowing that it was time for me to talk about being crazy in front of a group of such people, even as a free woman, ratcheted up the rhythm of my already frantic heart.

Yale is the third-oldest university in the country, after Harvard, which is the oldest, and after the College of William and Mary, which was established in 1693. Yale used to be called the Collegiate School, but was renamed for Elihu Yale after a succession of gifts from the English merchant and philanthropist, including books, exotic textiles, and a portrait of George I. These generous donations, the sale of which helped to fund the construction of Yale College in New Haven, were vigorously encouraged by Puritan minister Cotton Mather, who also vigorously encouraged the Salem Witch Trials. In troubled Salem, babbling and odd movements could signify witchcraft. The bewitched Goodwin family children, he said, “would bark at one another like Dogs, and again purr like so many Cats.” We all know what happened to the witches.

Michelle tried to crawl under her desk. “All of a sudden,” she said, “my neck gets stepped on with a huge boot. And she steps on me and she puts her pepper spray right in front of my face, and she says, ‘Don’t move or I’m gonna spray you.’” Finally, Michelle was handcuffed. Despite the woman’s repeated questioning, she continued to refuse to pull up her sleeve—even as she was pinned up against a wall on the floor—even as she kicked her leg out and booted the UPD officer straight in the face. In the end, the officer took Michelle to a hospital. It was clear, in hearing all of this, that Michelle remains resentful about how she was treated by the officer who came to assess the situation. Without prompting, Michelle gave me the full name of the woman. She said, “It took me about nine years to be able to tell that story.” It isn’t clear whether the officer was given crisis de-escalation training, or any kind of training at all in dealing with mentally ill students. I can easily picture the scenario: a campus cop goes into a dorm, knowing only that a student has cut her wrist. The dormmates are whipped into chaos because of alcohol and a snowstorm and the dramatic, self-destructive behavior of one of their own.

I’m still trying to figure out what “okay” is, particularly whether there exists a normal version of myself beneath the disorder, in the way a person with cancer is a healthy person first and foremost. In the language of cancer, people describe a thing that “invades” them so that they can then “battle” the cancer. No one ever says that a person is cancer, or that they have become cancer, but they do say that a person is manic-depressive or schizophrenic, once those illnesses have taken hold. In my peer education courses I was taught to say that I am a person with schizoaffective disorder. “Person-first language” suggests that there is a person in there somewhere without the delusions and the rambling and the catatonia.

In 2014, Katie J. M. Baker published an article in Newsweek titled “How Colleges Flunk Mental Health.” It was the piece I’d been waiting for—after blogging about my Yale experience, I’d received a flood of emails from students battling to stay in their colleges, students on enforced leave from their colleges, and former college students who, like me, were never allowed to return to school. In her article, Baker makes the case that psychiatric illness is punished by colleges and universities that instead ought to be accommodating students under the Americans with Disabilities Act (ADA). Rather than receiving help, mentally ill students are frequently, as I was, pressured into leaving—or ordered to leave—by the schools that once welcomed them. The underlying expectation is that a student must be mentally healthy to return to school, which is difficult and unlikely to happen to the degree the administration would like. This is saying, essentially, that students should not have severe mental illness.

My younger brother and his wife had a child last year. I am now an aunt, and C. is an uncle. We met our niece on the day she was born, arriving at the luxurious hospital room to take photographs and coo over the newborn. I did not hold her; I still have not held her. She knows who I am and will smile and wave when she sees me, her nose crinkling up as her eyes narrow with pleasure. I love her more as time passes and she grows increasingly autonomous, becomes a person.

This is a trust issue, implied?

I read in the New York Times that a child of a parent who has bipolar disorder is thirteen times more likely to develop the disorder than a child of a parent who does not. A piece on Salon about madness and motherhood, written by a woman with bipolar disorder, evoked the following reader responses: “I grew up with a bipolar mother, and it made my childhood nightmarish”; “I know I’m supposed to say I’m glad I was born but [as a bipolar child of a bipolar mother, I] am not”; “Someone who is mentally unstable enough to require psychotropics should NOT, under any circumstances, even consider having a child.” I read all sixty-eight comments. These I remember.

Though nearly all the statements a psychiatric patient can make are not believed, proclamations of insanity are the exception to the rule. “I want to kill myself” generally holds water, and a therapist who hears those words is legally required to disclose them to prevent client self-harm. In a study hypothesizing that sane people could easily be hospitalized under certain conditions, researcher David Rosenhan and his associates claimed to have auditory hallucinations, and were consequently held in different psychiatric facilities for an average of nineteen days—this, despite being neurotypical and exhibiting no symptoms while hospitalized. All but one of the pseudopatients were released with diagnoses of schizophrenia, and were released only on the condition that they agree to take antipsychotic prescriptions. If not for Rosenhan’s credibility as a scientist and the ensuing publication of his 1973 paper “On Being Sane in Insane Places,” those diagnoses could have dogged Rosenhan and his compatriots for life. Unlike me, Rosenhan ultimately proved to the doctors he had duped that he was, really and truly, a Stanford researcher.

I was so wedded to my notebook that one of the other patients was convinced that I was an undercover journalist, and nicknamed me Lois Lane; Lois Lane, and not Nellie Bly, whose asylum exposé instigated an $850,000 increase in the budget of the New York City Department of Public Charities and Correction. I never learned the diagnosis of the young man who called me Lois, and he claimed that he had no idea why he was in the hospital. I couldn’t tell if there was anything wrong with him. In Ten Days, Bly writes: “The insane asylum on Blackwell’s Island is a human rat-trap. It is easy to get in, but once there it is impossible to get out.”

Section 5150 of the California Welfare and Institutions Code states that “a person, as a result of a mental health disorder, [who] is a danger to others, or to himself or herself, or gravely disabled” is allowed to be taken “into custody for a period of up to 72 hours for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment in a facility designated by the county for evaluation and treatment and approved by the State Department of Health Care Services.” Although all states have some form of this law, “5150” has slipped into the cultural vernacular as a catchall term for involuntary psychiatric hospitalization. A friend of mine, a veteran of the mental health care system, once confessed to me that his ATM card’s PIN code was 5150. We both laughed, uneasily.

For me, a popular 1984 film called The NeverEnding Story stood in place of the Slender Man’s well-wrought wiki. I was in second grade when the film was released. An expensive West German production full of fantastic creatures, the film follows Bastian, a bookish and bullied boy, and his absorption into an alternate universe called Fantasia, which happens via a mysterious book snatched from a dusty bookstore. In Fantasia, the mystical Childlike Empress has fallen ill, and a young hero, Atreyu, is sent on a quest to find a cure. Meanwhile, a terrible force called the Nothing is destroying their world. If the Childlike Empress survives, it is thought, so will Fantasia. By the end of the film, Bastian’s and Atreyu’s worlds intersect. It is up to Bastian to save Fantasia by giving the Childlike Empress a new name, which he does by screaming out of a window during a violent storm.

I wonder if Everett Percival’s Dr No owes anything to this film?

In Jen Percy’s book Demon Camp, her chronicle of a soldier’s life after war, an unnamed neuropsychologist tells her about the neurological consequences of trauma: “Sometimes the amygdala enlarges, the hippocampus shrinks. Trauma can cause inflammation, atrophy, neuron death, and shrinkage. Parts of the brain can wither, rearrange, and die.” It’s also commonly believed that the brain suffers physiological damage because of schizophrenia; according to one 2013 study, the highest tissue loss occurs in the first two years after the initial episode, and though it may slow after that, the loss does continue.

It is impressive, and horrifying, how many authors choose to employ the trope of discovering a woman’s body in pieces, scattered, or in garbage bags, unrecognizable. I wondered if bookstores, instead of having sections for Mysteries or African American Literature, ought to cordon off a section for Girls in Trouble.

away. A fictional narrative is considered nuanced when it includes contradictions, but a narrative of trauma is ill-advised to do the same.

We speakers were told that we are 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.

“If an autoimmune disorder of the brain could so closely resemble psychiatric illnesses,” Velasquez-Manoff asks, “then what, really, were these illnesses?” According to the growing field of autoimmune neurology, the immune system can wage a misguided attack on a person’s central or peripheral nervous system. My previously suspected diagnosis of anti-NMDA receptor encephalitis is one such example—the disorder occurs when the immune system attacks the brain’s NMDA receptors, resulting in a chaotic array of symptoms such as speech dysfunction, hallucinations, delusions, and cognitive and behavioral disturbances—symptoms, in other words, that look like schizophrenia. In a 2006 study by William W. Eaton et al., which links three existing Danish data sets, the researchers concluded that “a history of any autoimmune disease was associated with a 45% increase in risk for schizophrenia.”

In seeking her out, I was intrigued by the idea of finding a way to make sense of my idiosyncrasies and anxieties. When I mentioned this to Bri, she laughed and said, “I’m sorry to tell you this, but belief does not simplify life.”

Belief

The class description for Beyond the Hedge: Foundational Techniques for Embracing the Liminal explains the titular phrase as follows: “In older times one way of talking about someone who could travel into the liminal realms was to say that they went ‘beyond the hedge,’ an old idiom meaning that they could travel beyond what was safe and known into territory that held mystery, magic, and great promise.” The course covers three foundational techniques: using the body’s intuition, working with talismanic cords, and building relationships with allies and spirit guides.

The second-century Gnostics claimed that among ordinary Christians lived the pneumatikoi, elite believers who possessed spiritual wisdom beyond that of their peers. The pneumatikoi could speak in tongues—a phenomenon called glossolalia—as evidence of being possessed by the Spirit; though occasionally intelligible, glossolalia “for the most part … consisted of frenzied, inarticulate, incoherent, ecstatic speech.” The psychiatric term for inarticulate, babbling speech is “schizophasia,” or “word salad,” and it is one of the more visible symptoms of schizophrenia. Incoherent speech may indicate truths too profound to be understood by the lowly; it may also indicate a deterioration of the mind.