Language doesn’t make people crazy. But language is the tool we use to describe strange behaviors and compile them into a list which makes up a diagnosis of mental illness.
This linguistic exercise transforms a nameless malaise into an official disease—bipolar disorder, schizophrenia, or schizoaffective disorder, say. In that sense, then, language does make people crazy.
Yet without definition and diagnosis, there is also no path toward mental health. “Some people dislike diagnoses, disagreeably calling them boxes and labels, but I’ve always found comfort in preexisting conditions,” writes Esme Weijun Wang in her new book, The Collected Schizophrenias, published by Graywolf Press. “A diagnosis is comforting because it provides a framework—a community, a lineage—and if luck is afoot a treatment or cure.”
With this, she begins a series of essays examining the language of mental illness. Her own quest for diagnoses over decades of psychiatric treatment ends up revealing the fragility of the constructs that all of us rely upon.
In 2001, as a teenager, Wang was diagnosed with bipolar disorder. In 2005, she began experiencing auditory hallucinations. Eight years later, she was diagnosed with schizoaffective disorder, a condition characterized by symptoms of both schizophrenia and mood disorders. ”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,” she writes.
Wang writes about hallucinations, delusions, periods of mania and depression, suicide attempts, and forced institutionalization. She provides a mesmerizing and terrifying glimpse of the mind she cannot trust, but that has also made her a prize-winning writer. Her brain, Wang’s most “valuable asset,” is also a liability. It puts her in danger and is “being damaged by an uncontrollable illness.”
Yet what’s most interesting about the book is that Wang accidentally exposes the madness of sanity. The more she describes her life, the clearer it is that we are all a lot like her—particularly in the ways we seek to reassure ourselves, and others, that we’re fine.
She puts up a facade and takes solace in externalities—the good jobs she’s had, her fancy schools,her branded products that show she’s in the know, culturally speaking, and no slouch. ”‘I went to Yale’ is shorthand for I have schizoaffective disorder but I’m not worthless,” Wang admits, voicing a sentiment few would dare express, though many of us turn to our credentials and connections as proof of our value.
She describes herself as “high-functioning” and proves it to the outside world, and herself, by paying attention to the details of her style. Though she cannot recall long swaths of her life, Wang remembers her impeccable outfits and minimalist makeup, writing, “To the clinic I wore a brown silk Marc Jacobs dress with long sleeves, carefully folded up to the elbows… an organic facial moisturizer that smelled like bananas and almonds, Chanel’s Vitalumiere Hydra foundation (discontinued), and a nubby Tom Ford lipstick in Narcotic Rouge.”
The writer understands that the outfit isn’t really evidence of sanity. But to her and those she meets, signifiers of worth—clothes, wedding ring, job, and the “prestigious university” she attended—all seem reassuring. We understand this instinctually, which is why we rely on status symbols, after all. That’s why we try to make our messy lives look so nice on social media, posting pictures of our achievements more readily than our failings. The same principle applies to everyone—present well, and no one has to know you’re just a struggling human, and somehow that process of putting on a show also may make you feel better.
The difference between Wang and many of the rest of us, however, is that she recognizes that she is creating a facade, and she engages with that notion openly. She knowns she’s hiding something more painful, less presentable. She is acutely aware of the fact that her foundation and lipstick are literally and figuratively cover, writing:
If schizophrenia is the domain of the slovenly, I stand outside its boundaries as a straight-backed ingenue, and there is no telltale smearing beyond the borders of my mouth. To some degree, the brilliant facade of a good face and a good outfit protects me. My sickness is rarely obvious. I don’t have to tell people about it unless I want to.
Like Wang, we all construct ourselves. But we do not all have her piercing insight. Wang knows that her displays create an acceptable version of reality, but she sees that these are fragile constructs. Her life is a show that must go on, and she seeks confirmation from an audience—she admits what few will. “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,” she writes with brutal honesty.
Evaluation is the theme of The Collected Schizophrenias. The book is an exercise in assessment. Wang assesses herself, the state of mental health care in the US, competing theories of disease, and the role that belief plays in diagnosis and treatment. She invites you to evaluate her and the doctors who have offered their diagnoses, hoping you’ll see what she does—that no one knows anything definitive.
After living with schizoaffective disorder for a time, the writer learns from a physician that chronic Lyme disease, causing a brain infection, may explain her psychiatric symptoms. Wang’s psychiatrist dismisses this diagnosis, though the notion that mental illness might be linked to physical causes is increasingly accepted in the medical community.
Medicine, Wang realizes, offers a series of queries more than a set of answers. This epiphany implies a question: “How would a new vocabulary to describe her condition reshape her existence?”
The realization leads her to the “sacred arts,” mysticism, practicing magic and witchcraft. In this context, she reconsiders schizophrenia, entertaining the notion that psychosis might also be seen as an ability, not just an illness. She begins to consider the hallucinations and sense of danger she experienced as messages from herself to herself—what if the voices she heard had a function; what if they were warning her of dangers ahead instead of being threatening themselves?
Wang starts to question the borders drawn between reality and imagination, to allow for the possibility that there are unseen and difficult-to-explain planes that conventional science and medicine won’t contemplate, but that actually influence our operation. She isn’t sure that schizophrenia is an actual psychic ability, but she becomes more willing to consider the possibility that her unquiet mind caused a kind of suffering that had some use. In the four years since then, she’s experienced no delusions.
Wang doesn’t believe in magic, exactly. She’s into rituals, performing certain acts in a certain order, taking a symbolic stand against madness. Ceremonies give her “something to do when nothing can be done.” They’re gestures—and she embraces magical acts like lighting a candle, saying a prayer, dressing up, or wearing lipstick—because they tether her to the world, just like a diagnosis does.
Symbols, the book suggests, whether linguistic or otherwise, are the way we all make reality.