“Schizophrenia terrifies” — these are the first words in the first essay in Esmé Weijun Wang’s The Collected Schizophrenias.
Wang is the author of the novel The Border of Paradise and the recipient of a 2018 Whiting Award. She also has schizoaffective disorder, bipolar type, a condition she is used to describing as “the fucked-up offspring of manic depression and schizophrenia.”
“I never intended to be a non-fiction writer and I still primarily consider myself a novelist,” she says. Though primarily called to fiction, Wang wrote The Collected Schizophrenias because schizophrenia and its associated conditions do terrify, and remain so stigmatized, and there is so little writing from people who have the condition. The essays in the collection cover everything from the question of diagnosis to the experience of psychosis to the role of schizophrenia in the Slender Man murder case.
The Verge spoke to Wang about the mental health memes, the question of involuntary hospitalization, and letting people speak for themselves. This interview has been lightly edited for clarity.
I noticed the book is The Collected Schizophrenias, with “schizophrenias” plural. Why is that?
The title has never been anything else. I didn’t want to just talk about schizophrenia as the one singular diagnosis, I also wanted to talk about my diagnosis, schizoaffective disorder bipolar type, and schizotypal disorder. I wanted to talk about all the terms that Eugen Bleuler used. He was one of the biggest names in psychiatric history and the researcher who came up with the idea of the “schizophrenias” as more like a spectrum. He had the idea of it as a range of disorders, not so much one concrete thing.
“Part of what I wanted to do with this book is to bring up a lot of questions.”
I got the perspective of mental health disorders as spectrums from my time as a lab manager and psychology researcher at the Stanford Psychology Department. I spent about three or four years there, and I spent a lot of that time running structured clinical interviews from what was then the DSM-4. We were looking for people who clearly met the criteria for specific diagnoses and ended up throwing out a lot of potential subjects. I realized that so many people who, to me, seemed like they would meet the criteria for major depressive disorder wouldn’t meet that criteria because they’d been depressed most of the day every day for 2.5 weeks instead of, say, four. I started to think of these diagnoses as things that weren’t as cut and dry as I had learned about in abnormal psychology class as an undergraduate.
You write in the first essay that you like diagnoses. Can you tell me more about that, and also how that plays into the political discussions we have about various conditions?
The first essay in the collection talks a lot about where diagnoses come from and the kind of arguments that are going on between the National Institute of Mental Health versus the American Psychiatric Association about how to categorize mental health disorders and mental illness. So many of these criteria for these categorizations are arbitrary. We as humans like to come up with categories and put things in boxes because things are messy.
Still, I like to have things as less messy. We feel less frightened. We have days of the week, for example, because time is scary and if we had a big mess of time without days and weeks we would be much more freaked out by the whole morass of it all. And so that categorization is something I still like. I still like having the diagnosis of schizoaffective disorder, bipolar type. Are there issues with psychiatric diagnosis? Sure. Diagnoses are changing all the time, and for all I know the next version of the DSM might change so that I get knocked out of that diagnosis and I no longer qualify.
But not all diagnoses are equal in stigma, right?
I think that part of the reason I did not receive a diagnosis of schizoaffective disorder until eight years after I experienced my first hallucinations was due to the fact that there is so much stigma surrounding the schizophrenias. My psychiatrists at the time didn’t want me to have to contend with them, both for myself, as well as anybody I have might to tell, including my family, my insurance companies, even themselves. Psychiatrists do have biases. But for me it was a big relief to have my diagnosis officially changed from bipolar to schizoaffective disorder. It felt like schizoaffective was the right diagnosis after I started experiencing psychotic symptoms.
In some ways I think it was scarier to jump from a diagnosis of major depression to bipolar disorder when I was seventeen, though a lot of that has to do with where I was, about to go to college and be away from my family.
What are some of the stigmas the schizophrenias have, even within the world of mental illness?
One of the examples I used in the book is a Facebook meme that I saw going around. It was talking about the “benefits” that can come from different forms of mental illness, something like how depression can make you more empathetic and anxiety can create sensitivity. I don’t remember exactly what it said, but I knew when I started looking at the meme that schizophrenia was not going to be on there.
Schizophrenia is not one of those things that people think about in terms of having benefits. Somebody might think about how “romantic” it might be to have depression or be the tortured artist, but we have a story about schizophrenia as a form of possession akin to Alzheimer’s. The essay “Toward a Pathology of the Possessed” is a lot about that stigma and the metaphor of schizophrenia as a form of possession. People think: you have a person who is fine and good and then they get sick, they have a psychotic break, and all of a sudden they are no longer who they were before, they are taken over by this thing in the manner of something taken over by a demon.
That’s also a kind of theme that runs through the way Andrew Solomon refers to schizophrenia in Far From the Tree. I really admire the way Andrew Solomon writes about depression in The Noonday Demon, which was a big inspiration to me, but I felt that the way he wrote about schizophrenia did tend to really dehumanize people. And that’s a really common way to look at it.
In your essay “On the Ward,” you bring up involuntary hospitalization, which is a hot-button topic. What was the experience of writing that like?
In that essay, I bring up Laura’s Law as well as a couple of other pieces of policy that address involuntary hospitalization and involuntary treatment for people with severe mental illness. I don’t know what the best thing to do is about the involuntary hospitalization question. I ended up having more questions than answers with basically all of the knotty situations that I address. Part of what I wanted to do with this book and what I’d like to happen is to bring up a lot of questions.
I did not find involuntary hospitalization helpful any of the three times I was involuntarily hospitalized. In speaking to a number of people, none of the people I spoke to found it useful. I do think that there are cases in which, for the safety of the person who is being hospitalized, involuntary hospitalization is probably life-saving. However, in those cases, I do want to get across that it is also extremely traumatizing and I think that prior to reading that essay, someone who was pro-involuntary hospitalization might not have thought about that very thoroughly.
There’s been a lot of discussion about how universities are struggling to help students with mental-health issues, specifically regarding leaves of absence versus staying on campus. You were pushed out by Yale because of a mental-health condition. How does that inform your view of the issue?
It’s a really complicated issue and I’ve become more sympathetic to the school side than I was when I was getting pushed out myself. At the same time, I still think schools are doing an awful job. It could be helpful to draw up a set of best practices. I know that different schools have wildly different policies about how to treat their students, so for there to be some kind of unified policy would be good.
How do we begin to eliminate these stigmas?
Listen to people who live with the schizophrenias. That seems to be a good antidote in many cases. I know this is difficult because, often, people living with moderate to severe forms are unable to tell their own stories, but I hope this will help open a conversation in which other people will be given that opportunity to speak.