The Collected Schizophrenias: Essays

by Esmé Weijun Wang

A diagnosis is comforting because it provides a framework—a community, a lineage—and, if luck is afoot, a treatment or cure.

a loss of feeling toward family, as though they had been replaced by doubles (known as Capgras delusion);

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.

People diagnosed with schizophrenia are more likely to be born in the winter than in the summer,

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.

I wore an organic facial moisturizer that smelled like bananas and almonds, Chanel’s Vitalumière Hydra foundation in 20 Beige (discontinued), and a nubby Tom Ford lipstick in Narcotic Rouge (also discontinued, replaced by the inferior Cherry Lush). My makeup routine is minimal and consistent. I can dress and daub when psychotic and when not psychotic. I do it with zeal when manic. If I’m depressed, I skip everything but the lipstick. If I skip the lipstick, that means I haven’t even made it to the bathroom mirror.

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.

In high school, when I told my mother that I was thinking of suicide, she suggested that we kill ourselves together, which I didn’t fully recognize as the bizarre response it was until I told the story again and again over the following decades of my life.

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.

the clamor in my head soured, becoming what is known in mood disorder parlance as a “mixed episode.” Such episodes occur when a person is experiencing symptoms of both a manic and a depressive phase, such as in episodes of agitated depression. It is considered a dangerous state to be in if that person is suicidal; a severely depressed person will find it hard to summon enough energy to plan and execute a suicide, but a severely depressed person shot through with norepinephrine is reckless enough to do both.

After over a week at YPI, I reached a compromise with the dean and the head of psychiatry: I could stay at Yale if my mother came to stay with me, off-campus, for the rest of the year. (Upon hearing of this plan, a friend who knew of my family history said, “I thought they wanted you to get better.”)

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.

Cotard’s delusion was first described in 1882 by Dr. Jules Cotard, who called it “the negation delirium”; few instances of the disorder have been discovered since. Case reports can be found here and there—the story, for example, of a fifty-three-year-old Filipino woman who had recently immigrated to the United States, who “[complained] that she was dead, smelled like rotting flesh, and wanted to be taken to a morgue so that she could be with dead people.”

Unless I’m catatonic, I do wear red lipstick and Chanel foundation. I do have short platinum hair. I do wear eyelash extensions. I sometimes go for months without showering, but I do not look disheveled. Friends text me for style advice. I have modeled—not professionally, or well, but I have done it. I tend to look superficially good under bad circumstances.

Once I was diagnosed, the new doctor—known in the Lyme community as an LLMD, or a “Lyme-literate medical doctor”—told me that my diagnosis of schizoaffective disorder was likely related to an infection by Borrelia burgdorferi bacteria, and called my illness neuroborreliosis, which implies an infection affecting the brain and central nervous system.

Hung on my bedroom wall is a quote 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 un-spools itself, I was created to bear it.

The belief that DSM-caliber mental illness might be linked to bodily illness, and particularly to autoimmune illness, as my neurologist proposed, is gaining traction. In the Atlantic article “When the Body Attacks the Mind,” journalist Moises Velasquez-Manoff, author of An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases, describes the nightmare experienced by the Egger family when thirteen-year-old Sasha suddenly began to exhibit severe psychotic symptoms. One specialist diagnosed Sasha as having bipolar disorder, subsequently prescribing antipsychotics; Sasha’s mother, who was a pediatric psychiatrist and understood the unlikelihood of a sudden onset of mental illness, persisted until she found a neurologist who suspected something else: an autoimmune variant of encephalitis. Upon infusion with antibodies used to treat autoimmune attacks, Sasha “improved almost immediately.” “If an autoimmune disorder of the brain could so closely resemble psychiatric illnesses,” Velasquez-Manoff asks, “then what, really, were these illnesses?”

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.”

The psychiatric term for inarticulate, babbling speech is “schizophasia,” or “word salad,” and it is one of the more visible symptoms of schizophrenia.