Esme Weijun Wang’s book is a collection of essays. As such it is different from most other memoirs about schizophrenia. The essays do not necessarily form a cohesive picture of the collected schizophrenias or of Ms Wang’s experiences as a person with a diagnosis of schizoaffective disorder. Her first essay, “Diagnosis”, does, however lay the groundwork for both an understanding of the background and context of various diagnostic categories and her own experience with her particular diagnosis (es). The other essays provide a combination of her ongoing struggles with her disorder and commentary of the psychiatric and psychopharmacological cultures.
To provide for context here, I will share just the first part of the Diagnostic and Statistical Manual (DSM 5) description of symptoms for schizophrenia, indicated on page 8 of Wang’s book:
A. Two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
- Disorganized Speech (e.g. frequent derailment or incoherence)
- Grossly Disorganized or Catatonic Behavior
- Negative Symptoms (i.e. diminished emotional expression of avolition).”
Wang distinguishes the diagnosis of schizophrenia from her own diagnosis of schizoaffective disorder:
” Schizophrenia is the most familiar of the psychotic disorders. Schizoaffective disorder is less familiar to the layperson and so I have a ready song -and- dance that I use to explain it. Ive 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.”(p.10).
I will have plenty to say about the DSM as a political/economic “sacred text” later, but for now, Wang’s description of her diagnosis in the context of her own felt experience is wonderfully expressed in the following passage:
” To read the DSM-5 definition of my felt experience is to be cast far from the horror of psychosis and an unbridled mood; it shrink-wraps the bloody circumstance with objectivity until the words are colorless. I received the new diagnosis of schizoaffective disorder after twelve years of being considered bipolar, in the middle of a psychiatric crisis that went on for ten months. By then, the trees had long shed their dead leaves. But in the beginning of 2013, the psychosis was young. I had months to go of a frequent erasure of time; the loss of feeling toward family, as though they had been replaced by doubles (known as Capgras delusion); the inability to read a page of words, and so forth, which meant that the agitation I felt at realizing something was badly wrong would only go on and on and on and on.” (p.11)
In her essay, “On the Ward”, Wang addresses the issue of involuntary hospitalizations and her assessment of the effects of her own involuntary hospitalizations:
“For those of us living with severe mental illness, the world is full of cages where we can be locked in. My hope is that I’ll stay out of those cages for the rest of my life, although I allow myself the option of checking into a psychiatric ward if suicide feels like the only other option. 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.”(p.110)
Wang’s last two essays, “Chimayo” and “Beyond the Hedge”, report her somewhat flailing attempts to identify a diagnosis she can fit on for size, such as the possibility that she may have “neuroborreliosis” (late stage Lyme disease) rather than schizoaffective disorder, and her attempts to align her experiences with spirituality- that her illness might be a “spiritual gift”. Wanting to have her illness have some meaning, she expresses what many others with any illness likely feel, “In my illness I became hungry to understand suffering; if I could understand it, I could perhaps suffer less, and even find comfort in the understanding. What I have found difficult is not seeking an escape hatch out of pain, whether that be pills, alcohol, or the dogged pursuit of a cure. In suffering, I am always looking for a way out.”(183).