The Collected Schizophrenias: Essays

by Esmé Weijun Wang

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.

Schizophrenia and its ilk are not seen by society as conditions that coexist with the potential for being high-functioning, and are therefore terrifying.

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.

RAISE (Recovery After an Initial Schizophrenia Episode), designed to explore the efficacy of certain kinds of early-intervention treatments.

Feeling some degree of control over their lives is particularly important for a population of people who are vulnerable to having none.

“I went to Yale” is shorthand for I have schizoaffective disorder, but I’m not worthless.

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.

My friends with anxiety disorders, for example, tend to speak of anxiety as a component of their personalities.

There might be something comforting about the notion that there is, deep down, an impeccable self without disorder, and that if I try hard enough, I can reach that unblemished self. But there may be no impeccable self to reach, and if I continue to struggle toward one, I might go mad in the pursuit.

I left Yale for good in early 2003, although I did not know at the time that it was the end. I’d been hospitalized for the second time at the institute—two times in one year, was the way the head of psychiatry put it, although it was two times in two school years—and because of this breach of etiquette, they asked me to leave.

was told to be at JFK on the same night that I left the hospital—so urgent was Yale’s desire for me to leave.

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.

institutions of higher education fear liability, because no school wants to be sued over a student’s suicide, or held responsible for a mass shooting.

Well the truth is,’ he says, ‘we don’t necessarily think you’ll be safer at home. But we just can’t have you here.’”

Bipolar disorder has yet to be fully understood in adults, and it is even more mysterious in children.

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.

primary feature of the experience of staying in a psychiatric hospital is that you will not be believed about anything. A corollary to this feature: things will be believed about you that are not at all true.

The doctor told me in one of our rare meetings that I’d said, upon emergency room intake, that I believed in “a conspiracy of people” who were determined to hurt me. “I didn’t say that,” I said. “I said that I was feeling unsafe.” But “feeling unsafe”—as in, feeling terror about everything and nothing in particular—was an unfortunate phrase for me to use during the intake. “Unsafe” is a psychiatric code word for “suicidal,” which I was not, although I was many other things. I hadn’t said anything about a conspiracy. “Unsafe” might have triggered the hospital’s belief—its own delusion—that I felt unsafe due to a paranoid belief: a conspiracy of people out to do me harm. The hospital maintained for the remainder of my stay that I had come in feeling “unsafe,” with delusions of persecution. Because “unsafe” doubled as “suicidal,” I was considered a danger to myself. Even though I had voluntarily walked into the ER for help, “unsafe” meant that I was considered to be “involuntarily hospitalized,” which also meant that I was locked down in the rural Louisiana hospital, on the north shore of Lake Pontchartrain, until the doctor gave me permission to leave. I did not know how long that would be.

according to the Department of Justice, “nearly 1.3 million people with mental illness are incarcerated in state and federal jails and prisons.”

I maintain, years later, that not one of my three involuntary hospitalizations helped me. I believe that being held in a psychiatric ward against my will remains among the most scarring of my traumas.

In this way I have become, and have remained, delusional for months at a time, which feels like breaking through a thin barrier to another world that sways and bucks and won’t throw me back through again, no matter how many pills I swallow or how much I struggle to return. What’s true is whatever I believe, although I know enough to parrot back what I know is supposed to be true:these are real people and not robots; I am alive, not dead. The idea of “believing” something turns porous as I repeat the tenets of reality like a good girl. When hallucinating, the idea of “seeing” or “hearing” something is similarly untrustworthy. I’ll see a thing well enough to duck or jump to avoid it. Still, I know what is supposed to be true, and that includes a reality without shadowy demons or sudden trapdoors.

Forgiveness, as it turns out, is not a linear prospect. Neither is healing. Both flare up and die down; so do my symptoms of schizoaffective disorder. I have tried to control these “oscillations,” as my psychiatrist calls them, but what, if anything, can truly be controlled?

There are still nights when I feel myself on a knife-edge, when the terror of PTSD mingles with the trickiness of unreality. It spreads through me like ink-blotting paper, and then I am unpredictably vulnerable to all kinds of stimuli—movie trailers that both rub up against where I am raw, shocking me with adrenaline, and pull fiction into my sense of what is real.

The normal emotion that I would feel looking at a loved one’s face is absent. The person afflicted with Cotard’s is unable to feel emotions about familiar faces. It is thought that with Capgras this lack leads to a conclusion that the person’s loved ones have been replaced by doubles, and with Cotard’s that the person experiencing the delusion is herself dead. In

It was true that I was dead, but I believed that it made sense to playact normalcy, or rather, an improved version of normalcy, because of the additional belief that I was in an afterlife. According to the logic of my delusion, this afterlife was given to me because I hadn’t done enough to show compassion in my “real” life, and though I was now dead, my death was also an optimistic opportunity.

Other questions: if 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?

Whereas I’d once believed that I’d been gifted an optimistic afterlife, this shimmering notion was quickly replaced by the idea that I was in perdition. In this scenario, I was doomed to wander forever in a world that was not mine, in a body that was not mine; I was doomed to be surrounded by creatures and so-called people who mimicked the lovely world that I’d once known, but who were now fictions and could evoke no emotion in me. I spent much of my time in catatonic psychosis, a form of agitation characterized by overactive movement or no movement at all, and I lay in my bed feeling psychic agony more excruciating than any personal experience of physical pain.

The attractive, curly-headed one turned his head as he passed. Yes, I thought, our eyes meeting, you may think I’m hot, but I’m also a rotting corpse. Sucks to be you, sir.

was already dead, so suicide never came to mind, but the idea of having meaningless possessions did.

Why do any of these things? Why did I behave in the manner of someone who was alive when I believed, to differing levels of absolutism, that I was dead? The notion of perdition never left me when I was suffering from Cotard’s delusion, but the degree to which I despaired about it did.

To take a photograph, in other words, is to participate in one’s own reality, to be a true member of the world of things.

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.”

Lyme disease might have escalated my existing psychiatric condition by triggering an immune reaction. Or, as my LLMD believes, Lyme might have directly infected my brain, causing the symptoms that led to a diagnosis of schizoaffective disorder.

When I began to hallucinate, in 2005—first hearing a voice, and then seeing what wasn’t there—my mother suggested that these symptoms might not be pathologies but rather spiritual gifts. According to Chinese superstition, initial hallucinatory experiences may be indications that one is meant to become a “soul reader,” a skill akin to a fortune-teller or medium. “People use it as a career,” she told me, “so don’t be scared.” No one else had tried to give me a perspective on my symptoms beyond that of mental illness.

I tell myself that if I must live with a slippery mind, I want to know how to tether it too.