The Collected Schizophrenias: Essays

by Esmé Weijun Wang

People speak of schizophrenics as though they were dead without being dead, gone in the eyes of those around them. Schizophrenics are victims of the Russian word гибель (gibel), which is synonymous with “doom” and “catastrophe”—not necessarily death nor suicide, but a ruinous cessation of existence; we deteriorate in a way that is painful for others. 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. Both gibel and “schizophrenic presence” address the suffering of those who are adjacent to the one who is suffering in the first place.

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.

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

Medicine is an inexact science, but psychiatry is particularly so. There is no blood test, no genetic marker to determine beyond a shadow of a doubt that someone is schizophrenic, and schizophrenia itself is nothing more or less than a constellation of symptoms that have frequently been observed as occurring in tandem.

I’ve quipped onstage to thousands that schizoaffective disorder is the fucked-up offspring of manic depression and schizophrenia, though this is not quite accurate; because schizoaffective disorder must include a major mood episode, the disorder may combine mania and schizophrenia, or depression and schizophrenia.

After all, it is easy to forget that psychiatric diagnoses are human constructs, and not handed down from an all-knowing God on stone tablets; to “have schizophrenia” is to fit an assemblage of symptoms, which are listed in a purple book made by humans.

Psychiatry emphasizes a clinician’s judgment as the primary tool for diagnosis.

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.

In these investigations of why and how, I am hoping to uncover an origin story. Pan Gu the giant slept in an egg-shaped cloud; once released, he formed the world with his blood, bones, and flesh. God said, “Let there be light.” Ymir was fed by a cow who came from ice. Because How did this come to be? is another way of asking, Why did this happen?, which is another way of asking, What do I do now? But what on earth do I do now?

The story of schizophrenia is one with a protagonist, “the schizophrenic,” who is first a fine and good vessel with fine and good things inside of it, and then becomes misshapen through the ravages of psychosis; the vessel becomes prone to being filled with nasty things. Finally, the wicked thoughts and behavior that may ensue become inseparable from the person, who is now unrecognizable from what they once were.

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.

We don’t know what happened inside of Malcoum, other than hearsay about some anguished confusion over his mental state, or even what he was reported to have said when the shooting began, which was “Whatcha doing? Whatcha doing?” Instead, we see the nightmares that need to be solved. We see the possessions that have subsumed the sweet girl or the bookish boy, who are understood to be long gone. In the stories of who they were before the illness, or the evil, or the possession—including that of Beth’s family member—there is an expectation of not only normalcy but goodness.

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.

In Blue Nights, Joan Didion remarks, “I have not yet seen that case in which a ‘diagnosis’ led to a ‘cure,’ or in fact to any outcome other than a confirmed, and therefore an enforced, debility.”

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.

Because I am capable of achievement, I find myself uncomfortable around those who are visibly psychotic and audibly disorganized. I’m uncomfortable because I don’t want to be lumped in with the screaming man on the bus, or the woman who claims that she’s the reincarnation of God. I’m uncomfortably uncomfortable because I know that these are my people in ways that those who have never experienced psychosis can’t understand, and to shun them is to shun a large part of myself. In my mind, there is a line between me and those like Jane and Laura; to others, that line is thin, or so negligible as not to be a line at all.

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

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.

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.

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.

What happens if I see my disordered mind as a fundamental part of who I am? It has, in fact, shaped the way I experience life. Should the question be a matter of percentages of my lifetime, I’ve spent enough of this lifetime with schizoaffective disorder to see it as a dominant force. And if 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; this is why I use the word “schizophrenic,” although many mental health advocates don’t.

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.

Then again, mothers act badly all the time. Perhaps the bigger issue is that bad parenting is the problem, schizoaffective disorder or not. I might damage my future children in a way that has nothing to do with mania, depression, or psychosis. Or I might compensate for my neurological defects by being an especially good mother—one who reads stacks of parenting literature and educates her children early on about odd behavior that might come up at home.

A cousin to my mother’s remorse and guilt is an invisible, additional question that I have for her, that being: would it have been better if I’d never been born? Even though I’ve made my parents proud, I can’t help but wonder if that outweighs watching me break down over the years.

As Bly’s anecdotes, and my own, indicate, a 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.

Though the experience of being 5150’d is not the same as being arrested (“You are not under criminal arrest”), there are inevitable parallels between involuntary hospitalization and incarceration. In both circumstances, a confined person’s ability to control their life and their body is dramatically reduced; they are at the mercy of those in control; they must behave in prescribed ways to acquire privileges and eventually, perhaps, to be released. And then there is the wide swath of people for whom mental illness and imprisonment overlap: according to the Department of Justice, “nearly 1.3 million people with mental illness are incarcerated in state and federal jails and prisons.”

Imagination has a power in childhood that it lacks in older years. How much more rooted in my childhood delusions would I have been had I—like Anissa and Morgan—had access to scores of documents that testified to the reality of my daydreams? What if I’d been able to open YouTube and watch other children being swept away by the power of the Nothing? Would I have become increasingly absorbed by the narrative, and stuck to the story to dangerous ends, if I had spent hours reading hundreds of forum posts about its veracity?

Before the psychosis properly begins, as I experienced during Lucy, I experience an agitated sense of something being wrong. The wrongness isn’t limited to the grotesqueries mutating inside, but is also true of the world at large: how did it get this way, and what am I supposed to do with it? I mean this not only of dailiness, which is full of restless hours that must somehow be spent, but also the sky, the walls, the trees, my dog, the windows, the curtains, the floor—all of which are but a small portion of everything that needs my attention, including everything abstract and concrete, even as my ability to deal with them is at first dwindling and then absent. The more I consider the world, the more I realize that it’s supposed to have a cohesion that no longer exists, or that it is swiftly losing—either because it is pulling itself apart, because it has never been cohesive, because my mind is no longer able to hold the pieces together, or, most likely, some jumbled combination of the above. I can understand only one piece or the other, even though the sky is supposed to belong to the same world as the curtains, and the dog that enters the room draws my attention as an entirely new object to contend with. People write about the so-called comfort of being insane in the same way they cavalierly refer to the happy ease of being developmentally disabled, but in this liminal space I am aware enough to know that something’s wrong. Something’s wrong; then it is completely wrong....

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.

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

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?

I write this while experiencing a strain of psychosis known as Cotard’s delusion, in which the patient believes that they are dead. What the writer’s confused state means is not beside the point, because it is the point. I am in here, somewhere: cogito ergo sum.

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.

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? When the self has been swallowed by illness, isn’t it cruel to insist on a self that is not illness? Is this why so many people insist on believing in a soul?

Suicide demands a narrative, but rarely, if ever, gives one.

In exercises designed to discern my primary values, recognition, to my dismay, appears again and again. I care about recognition as much as I care about my own self-regard, in large part because I don’t trust my self-evaluation.

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.

During the worst episodes of psychosis, photography is a tool my sick self uses to believe in what exists. The photographs become tools for my well self to reexperience the loss. They are a bridge, or a mizpah—a Hebrew noun referring to the emotional ties between people, and especially between people separated by distance or death—between one self and the other. The well person has the job of translating the images that the sick person has left behind as evidence.

Beautiful things can be destroyed because they’re obliterated by something else: the ordinariness of an artist’s life is eclipsed by their manner of death. The obliteration can also be gradual.

I am still ambitious, but I must be careful about my ambition; illness has distorted my life such that it’s become hard to recognize it as my own.

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.

Hope is a cast line in search of fish; faith is the belief that you won’t starve to death, or that if you do, God’s plan could account for the tragedy.

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.

I originally went to Bri because psychosis had made me fear my own mind. Since then, the sacred arts have given me some solace not so much through the beliefs they provide as through the actions they recommend. 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.

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.