Mental health is certainly not a necessity for theOf writers supposed to be “mad,” like Christopher Smart, Koch writes:
Creation of poetic beauty, but a degree of it
Would seem to be, except in rare cases. Schizophrenic poetry
Tends to be loose, disjointed, uncritical of itself, in some ways
Like what is best in our modern practice of the poetic art
But unlike it in others, in its lack of concern
For intensity and nuance.
. . . I wonder how crazy they were,Koch’s poem is often tongue-in-cheek (“To write a poem, perfect physical condition/Is desirable but not necessary”), but here he seems serious. In its extreme forms, “crazy” is incompatible with art, and “schizophrenia” is paradigmatically extreme.
These poets who wrote such contraptions of exigent art?
I wonder what Esmé Wang would think of this. Though she’s been diagnosed with schizoaffective disorder, the essays in The Collected Schizophrenias are also “contraptions of exigent art”: in Koch’s terms, they are intense, nuanced, tightly composed, carefully joined, and powerfully self-aware. Because the essays are mostly written from a place of relative stability, they might seem to confirm the idea that schizophrenia and art are incompatible, that lucidity as we ordinarily understand it is required to construct these “exigent contraptions”—or that Wang is one of the “rare cases” able to construct them. And yet I suspect Wang would refuse Koch’s poetic framing. Her project is more radical, challenging the very assumptions about writers, readers, literature, and illness on which Koch’s lines depend. Essay by essay, she crisscrosses the territory of “the schizophrenias,” driven less by story than inquiry: How should the disorder be named, described, accounted for? If schizophrenia is the question, what sort of writing might constitute an adequate answer?
For Wang, telling a story about a diagnosis means reckoning with diagnostic stories, and throughout her book, analysis and narrative are intertwined. You can see her approach in “Diagnosis,” the book’s first essay, in which the Diagnostic and Statistical Manual functions as a kind of anti-essay, a foil for Wang’s project. The DSM is impersonal where Wang’s book is personal; a “bible” of authoritative classification, where her essays are sinuous and disruptive; a true collection of the schizophrenias, where her book is partial, suggestive, its title ironic. And yet the DSM-5, for all its authority, is an act of naming, culturebound and flawed. It may be a “clinical bible,” but, “like the Judeo-Christian bible. . . [it] warps and mutates as quickly as our culture does.” Riffing on her own religiously inflected language, Wang writes:
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.The DSM-5 is one kind of book, one kind of writing; her book is another, an apostate’s response to medical scripture. Wang sharpens the contrast by quoting, in full, the DSM’s description of her diagnosis, then dissecting the description with metaphor: “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.” The metaphor is both an example of, and rationale for, imaginative writing. It aims at accounts true to the experience of schizophrenia from the inside: descriptions that avoid the “shrink-wrap” of categories, the tidiness of diagnosis, its bloodless objectivity.
Though Wang is eloquent on the limits of psychiatry, her view is far from black and white. She has an essayist’s independence: open to many perspectives, beholden to none. Even as she cites the language of disability rights (“neurotypical,” “ableist”), for example, she also accepts the category of “sick,” and would be glad for a cure. She is a deft anatomist of stigma, but she rejects the idea that stigma is the sole cause of suffering. Quoting the National Institute on Mental Health, she writes that “schizophrenia afflicts 1.1 percent of the American adult population,” then comments:
I am aware of the implications of the word “afflicts,” which supports a neurotypical bias, but I also believe in the suffering of people diagnosed with the schizophrenias and our tormenting minds.That I am aware/I also believe distills Wang’s approach. She interrogates her own assumptions, even as she questions those of others; she is willing to rest in contradiction, in the unresolved. Addressing the controversy over “person-first language,” for example—the idea that someone should be described as “a person with schizophrenia” and not “a schizophrenic”—she offers a sardonic comment: “Our conditions lie over us like smallpox blankets; we are one thing and the illness is another.” The figure includes, and transcends, the debate. A “smallpox blanket” is both separate, in a person-first way, and intimately invasive, but it also implies that “person-first language” is unequal to the experience of the condition. Something more—a metaphor, a narrative, an essay—is required. Wang's metaphor suggests contexts beyond the individual person: a “blanket,” something you might drape over a patient, suggests the damage caring can do, and “smallpox” links medical classification to colonial power.
Though Wang is capable of metaphorical fireworks, the essays don’t depend on them. The voice she adopts is typically quiet, unornamented, controlled. (That’s expressive in itself, as if to suggest the effort required to stay balanced.) I was drawn to plain-seeming sentences that were torqued beyond plainness:
Showering became a challenge shortly after I began to hallucinate in college.
I considered myself lucky to have hallucinations I could ignore.
I did all the normal things I could think of.If you held a Lyricism Detector to these sentences, the needle would barely move. They read less like arias, more like deadpan asides. Still, their overtones are complex. They’re funny: the hapless attempt to try and remember what normal people act like, the comic difficulty of showering set against the catastrophic intrusion of the unreal. That comic mismatch suggests the existential problem: how do you navigate a world of normalcy with a breaking brain? How do you “think of” normal things to do, when thinking itself is at issue? How do you perform normalcy, in a world that polices the abnormal?
Some writers’ essays are like crowns or necklaces: key phrases sparkle, like gems in a setting. Wang’s essays are more like an electrical field, in which every sentence, even or especially the seemingly plain ones, is charged. Here, for example, is the opening to “Perdition Days,” an essay about living in the depths of illness:
I write this while experiencing a strain of psychosis known as Cotard’s delusion, in which the patient believes that they are dead.In a stereotypical version of schizophrenia, the disease produces nonsense, and its absence produces clarity. But in these sentences, coherent expression is evidence of cognitive fracture. In the same essay, Wang offers a brief snippet of a journal written in crisis:
11:13 p.m.Nesting a journal entry in an essay is a suggestive move: Wang takes a private assertion of identity, then repurposes it as a public one. Under the pressure of this double context, the list’s meanings multiply. As a journal entry, the list suggests the struggle towards a shared reality. But as part of an essay, the list demonstrates the ability not only to perceive the world others do, but to bear imaginative witness, to reframe one’s past perceptions, to hold them in suspension with the present. To create an exigent contraption of art.
I am Esmé.
I am a writer.
I have been married since 2009.
I have living parents.
I have a brother, who is married.
I am 5 ft. 4.
I was born in Michigan.
My birthday is June 8.
Flowers I love: ranunculus, peonies, sweet peas, jasmine, anemones.
If we had a girl, C. wanted to name her Magnolia.
We had magnolias at our wedding.
Moreover, the very fact of the list is suggestive: even at her worst, Wang’s first impulse is to write. Art looks outward to an audience; the list looks outward, from the indefinite brain-space in which she is lost. The list's structure is also significant. It begins with knowable fact, then trails away into an associative chain about flowers. In other words, it doesn’t just register someone trying to cling to a shared reality; it dramatizes a writer using words to do so, and having the words betray her. There’s a similar gesture in the essay “L’appel du Vide,” where Wang describes taking Polaroid self-portraits in the midst of crisis, just to prove to herself that she exists. In one sense, the act is evidence of profound disturbance. In another, it is only what we do as writers: we externalize what we think and feel, make an object out of it, something another human could hold and assent to; something we can ourselves look at, to understand what we are.
Even in the depths of psychosis, Wang frames her identity to herself in social terms, reminding herself that she is a writer, spouse, daughter, and sister. The Collected Schizophrenias is haunted by a paradox: an ultimately isolating disorder is negotiated in public, and its meaning occurs at the intersection of the damaged brain and the world. It’s possible to imagine a very different book, one which dwells on interior experience, which describes, at length, the terrifying hallucinations that Wang mentions in passing: the threatening voice, the locomotive suddenly appearing in the street, the corpse in the back seat of the car. But Wang’s accounts of unreality are spare and deliberate. Instead, she narrates herself experiencing the worst of her illness in the presence of others. Believing herself to be dead, she talks with her husband, who calmly offers evidence for the fact that she is alive. Answering a nurse’s query in an institution, she asserts that she feels fine, but is disbelieved; watching a movie with friends—one of whom shares her diagnosis—she begins to panic, as the movie’s world becomes more real than her own, and asks her friend if he feels the same; walking down the street with another friend, she starts at demons in the shadows, then pretends nothing happened; hallucinating a menacing voice in a dorm shower, she asks her roommate afterward if she heard anything. (“You’re crazy,” her roommate tells her.) Schizophrenia is negotiated among others, a fact that entails hope and pain: some rare souls lift her up and sustain her, while others—most—condescend, exclude, or edge away.
For Wang, schizophrenia is unavoidably social, a frame suggested by one of the book’s epigraphs (from Sylvia Nasar’s A Beautiful Mind): “More than any symptom, the defining characteristic of the illness is the profound feeling of incomprehensibility and inaccessibility that sufferers provoke in other people.” For Wang, this means that life involves performance: fabricating a persona, someone comprehensible, accessible, recognizable as sane. Wang explores the meaning of performance throughout the book, but particularly in the essay “High-Functioning,” where she suggests that the performance is less to express the self than protect it. Words are only part of the performance: appearance is key as well. The adversarial nature of the act is suggested by metaphors of war. “When I browse the virtual aisles of La Garconne,” she writes, “I am considering a uniform for a battle with multiple fronts.” Fashion is “armor”; her put-together appearance is a “weaponized glamour.”
But “weaponized glamour” could describe Wang’s prose style as well: a polished, deliberate, carefully assembled version of the self. The essay is a different kind of performance, a display of identity on the author’s terms. But unlike the performances narrated in the book, the essays fully and publicly embrace the fact of illness. They are public gestures in which schizophrenia is neither hidden or normalized. Rather than contrive a perfected, capable persona, Wang is willing to question perfectionism itself: to expose her uncertainties, to show the damage the category “high-functioning” does, to confess that she nonetheless clings to the idea. She has a self-scorching honesty: “Because I am capable of achievement, I find myself uncomfortable around those who are visibly psychotic and audibly disorganized.” Here, as throughout the book, her preference is for the truth of the unresolved.
In Wang’s radical openness is a subtle challenge to the reader. Wang doesn’t just demonstrate the lucid self-awareness that tends to be equated with normalcy and credibility; she questions our devotion to lucid self-awareness, to normalcy, to credibility itself. The performer questions the terms by which the performance is understood:
If the conversation winds its way to my diagnosis, I emphasize my normalcy. See my ordinary, even superlative appearance! Witness the fact that I am articulate. Rewind our interaction and see if you can spot cracks in the façade. See if you can, in sifting through your memory, find hints of insanity to make sense of what I’ve said about who I am. After all, what kind of lunatic has a fashionable pixie cut, wears red lipstick, dresses in pencil skirts and tucked-in silk blouses? What sort of psychotic wears Loeffler Randall heels without tottering?In this narrative, Wang addresses an imagined interlocutor. But with the turn to the imperative mood, she is also, I think, addressing the reader.
Throughout the book, her meditation on writing is intertwined with a meditation on reading. Even as we sink into the imaginative world she creates, she asks what it means to sink into an imagined world. For Wang personally, this is a serious issue: in “Reality, On-Screen,” she recounts carefully choosing which movies to see, lest she begin to believe that what she sees is real. (She avoids seeing The Hunger Games for a long time.) She explicitly links the dawn of psychosis with the experience of art: for her, the growing sense of delusion, when it comes, “feels like breaking through a thin barrier to another world.” In “The Slender Man, The Nothing, and Me,” Wang remembers her childhood absorption in The Never-Ending Story, from which she created, with friends, an elaborate, ritual-filled imaginative world; eventually her intensity drove her friends away. As an adult, her therapist advises her “to avoid consuming fiction while delusional”: “This, after listening to the audiobook of The Yonahlossee Riding Camp for Girls . . . had me disoriented and believing that I rode horses and was at a boarding school.” She reads Marilynne Robinson’s Home, “knowing that I would likely become merged with the fictional world there, and I did.” And yet storytelling can lead her back to reality as well. In “Perdition Days,” she writes: “Like a child asking for a bedtime story, I left my studio and crawled into bed with C. at six in the morning. I said, ‘Tell me about what is real.’” Her husband does: he tells her about their house, their lives together, her parents, and so on. She writes, “None of this solved the problem, but it did help. It was as comforting as a bedtime story would have been.” To write is to create alternate worlds; to read is to enter them. Both, then, are kin to schizophrenia.
In this light, the book’s title is extraordinarily suggestive. If the essays are in some sense “schizophrenias,” then to read them is not just to enter the author’s world of perception vicariously. It’s to be reminded that reading itself, like schizophrenia, is a liminal, boundary-crossing experience. The title calls attention to the book in the reader’s hands.
By implicating the reader, Wang brings the book’s paradox close to home: schizophrenia is both alien and familiar. It is as strange as believing that poison is in your tea, and as ordinary as reading. For readers unaffected by the schizophrenias, Wang’s achievement is to make this paradox plausible, to make schizophrenia seem at once familiar and utterly other; and by moving toward this perspective, the reader moves towards greater understanding of Wang herself, who inhabits this duality. As such, reading becomes a bridge, and writing is an answer to the isolation, both personal and social, that the condition brings. If schizophrenia is defined by “the profound feeling of incomprehensibility and inaccessibility that sufferers provoke in other people,” then Wang’s essays combat that feeling with art. They are comprehensible, accessible. And yet they keep an honest distance: they open a window on Wang’s experience, but they don’t angle for pity or empathy. We are never far from the fact that we are reading words, a construct, a version, and that much of the experience is beyond words to convey.
It’s that combination of openness and distance that I found compelling. The voice is credible, in what is revealed and what isn’t. That credibility is itself a theme of the book, and its achievement. In a book about a doubly isolating condition—one that impairs cognition, and is deeply stigmatized—an act of communication is moving in itself; in a book about a fractured self, the reconstitution of an intact persona is significant; in a book about the loss of a shared reality, the essay becomes a room both the reader and writer can enter. But the reader enters on the writer’s terms, guided by prose both expository and dreamlike. It is more than clear; it questions the idea of clarity itself, and the reader’s assumptions about brains supposed to possess it.
Which brings us back to Koch’s “The Art of Poetry.” Brilliant and funny as it is, that poem nonetheless is grounded in a different view of writers, readers, and the value of art. I’ve used that poem as a foil here, less to criticize its framing of mental illness than to illuminate what Wang is after. She is as aesthetically exacting as any writer in poetry or prose, but she is clearly after something more disruptive, useful, and politically engaged than “poetic beauty.” As her riffing on fashion demonstrates, beauty is more than a goal: it’s a tool, a means to an end. The essays, as I’ve tried to suggest, are an answer to schizophrenia, an attempt to both contain and express a deadly subject. But they also answer to the question: Why do so, and for whom? If we grant that the essays are beautiful, what is the beauty for?
In “Diagnosis,” Wang writes: “A diagnosis is comforting because it provides a framework—a community, a lineage—and, if luck is afoot, a treatment or cure.” Note the word comforting, which points to Wang’s primary concern: not only what is true or beautiful, but what heals—or, absent healing, consoles. As accounts of illness, the essays begin where the diagnosis ends: they’re a fuller act of naming. Even an accurate diagnosis is only a starting point. The patient needs meds; the person needs meaning, a framework built from everything available, a shared reality, something less like an institution and more like a home.
George Estreich is the author of a poetry collection, Textbook Illustrations of the Human Body, the Oregon Book Award-winning memoir The Shape of the Eye, and Fables and Futures: Biotechnology, Disability, and the Stories We Tell Ourselves. His essays and articles have appeared in The New York Times, Aeon, The American Medical Association Journal of Ethics, and McSweeney’s Internet Tendency.