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Esmé Weijung Wang’s The Collected Schizophrenias: Essays (Gray Wolf Press, 2019: 210 pp.) are an articulate and clarion cry to bring empathy to an arena in mental health where it has been missing.
My take on it? Ms Wang seems not to have been one of those survivors whose mental disorder is inextricably entangled with her genius. She was already talented and successful, studying at Yale, before her first breakdown.
The disorder was a major curve ball, delivered at high velocity, and hitting her in
the head – and heart. She gets up, dusts herself off, and, with writing that knocks it out of the park, recovers her own humanity with compelling accounts of her experiences, both humorous and heart-rending, thereby enriching ours and expanding our empathy.
At risk of mixing the metaphor, life handed her lemons. By my estimate, about a bushel. She did not merely make lemonade. She has concocted a kind of electric cool-aide. This is a beverage which perhaps will leave one feeling a tad trippy and vertiginous, but one which expands one’s empathy, not only for survivors of mental illness, but for our humanity at large. The rumor of empathy in Wang’s work is no rumor – empathy lives in Wang’s The Collected Schizophrenias.
The celebrated psychiatrist-philosopher Karl Jaspers (1883–1969) wrote in his seminal two volume psychiatric text General Psychopathology (1913/1959) that lack of empathy was diagnostically significant for a diagnosis of schizophrenia. If one is having trouble empathizing with the other person, the diagnosis of schizophrenia is by no means certain, but belongs on the short list.
The doctor and therapist struggle to have empathy for the often-bizarre constellation of symptoms characteristic of schizophrenia – hallucinations, delusions, incoherent “word salad” speech. The care-takers, from their own perspective, experience a lack of out-bound empathy from the patient, whose suffering is thereby aggravated in being further cut off from human connectivity and isolated.
One thing Ms Wang’s memoir of her disorder makes crystal clear is that her empathy is functioning full throttle. Even if her empathy is sometimes inaccurate (as is everyone’s) or misfires (as does everyone’s), Wang’s empathy lives as a commitment to appreciating the other’s point of view and relating to the other with affinity and appropriate affection. Wang fully experiences the dignity violations, lack of respect, and objectifications on the part of the medical system and professionals trying to help her, leaving her alternatingly in despair and enraged.
Paradoxically a dimension of her reality testing continues to function even as she is fearfully hiding in the closet due to psychotic symptoms that demonstrate to her the break down of her reality testing.
While it is true that most sufferers and survivors of the collected schizophrenias do not present as “high functioning” as Ms Wang, growing evidence is available that, even in the acute phase of the disorder, most psychotic persons appreciate that the hallucinated voices and ideas of reference are somehow subtly and significantly distinct from everyday reality. This awareness, however tentative it may be, can be leveraged and made the target of therapeutic conversation. This has clinical significance for cognitive behavioral and emotional interventions in the acute and the survivor phase. This is the empathic moment of which even so celebrated a shrink as Jaspers missed.
“High Functioning” is itself the title of an chapter in which Ms Wang is in recovery. She is giving presentations on mental health to interested citizens and professionals as part of some gig and good work she has landed after her professional career was ruined by the disorder. The reader gets background on Wang’s earlier career as a fashion journalist. We get a reading list of other “high functioning” individuals who have struggled with mental illness and go on to get PhDs, McArthur “Genius” Grants, and endowed chairs in psychiatry at major universities such as Kay Redfield Jameson, Elyn Saks, and other notable authors of “pathographies.” Pathographies are an emerging but not really new category of biographies and memoirs of survivors of mental illness.
This paradox of reality testing within the breakdown of reality testing has also been pointed out by thinkers whose critical inquiries into mental illness need to be better known. I am thinking especially of the work of Louis A. Sass (1) and Matthew Ratcliffe (2), whose books are cited at the bottom of this review. (See also my related blog reviews of Ratcliffe: https://wp.me/pXkOk-8g and Sass: https://wp.me/pGb20-pp.)
There is something for everyone in Ms Wang’s collection.
She acknowledges that she takes her anti-psychotic medications on schedule, and, moreover, the medications that work for her right now are so-called first generation, haloperidol and quetiapine (Seroquel). She argues that the National Alliance on Mental Illness (NAMI) takes positions dear to the heart of the families of the mentally ill (take your meds, allow for involuntary incarceration in an emergency (5150: code for involuntary commitment), be a good “mental patient” conforming to the hierarchy in which psychiatrists are I authority).
At the same time, Wang is an evangelist and a strong advocate for RAISE (Recovery After an Initial Schizophrenia Episode) and the need for autonomy for the mentally ill: “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 (p. 57).
The anti-psychiatry movement will find comfort and is well-represented in Wang’s work. Not only do the mentally ill have to survive the illness, they also have to survive the system that is supposed to help them: “Though nearly all the statements a psychiatric patient can make are not believed, proclamations of insanity are the exception to the rule” (p. 101). Crazy making rules and treatments. If that is not a double bind, I would not know one.
Wang takes a position: “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). A bold statement of the obvious: That is tragic – and an outrage.
The honest broker, Wang then reports on individuals who committed violent crimes and/or killed themselves while in the grips of psychotic episodes. No easy answers here.
The social justice dimension is not pervasive in Wang’s memoir – perhaps because Wang’s family and husband were able to be supportive enough to arrest her slide into the abyss of insanity just short of the edge – but explicitly surfaces periodically and powerfully: “nearly 1.3 million people with mental illness are incarcerated in state and federals jails and prisons” (Department of Justice) (p. 110). Wang does not say what percentage is getting the treatment they need in accordance with professional diagnostic guidelines. I am going to be optimistic: 25%?
Since this is not a softball review, a point occurred at which I was about to put down the book with the admittedly devaluing, objectifying judgment: This individual is a walking laboratory of psychiatric (and medical) curiosities.
Wang endorses the Cotard delusion, in which the person claims that I part of his
body does not belong to him or that he as a total person is dead and should be disposed of properly. My empathic understanding of this disorder – and this is not the truth with a capital T but consider the possibility – is that the person’s emotional life has been short-circuited. The person is emotionally “dead,” for without emotions and affects we lack vitality and aliveness. Wang’s credibility (with this review) is restored as she reports she was so desperate she was considering ECT (electro shock therapy), but did not go through with it. The disorder spontaneously remits.
In an ongoing and increasingly desperate search to regain her power over the seemingly endless series of (un)related disorders, Wang suspects she may have an autoimmune disorder. Whether late stage Lyme disease is one of those, I do not know.
By this time, Wang is a relatively well-informed professional patient with limited but apparently sufficient resources, and she manages to go on a kinda of new age medical retreat to Santa Fe, New Mexico, for the treatments with a “lyme literate” medical doctor (LLMD).
Always the honest broker, Wang reports the writings of Leslie Jamison, author of The Empathy Exams, in which Wang compares Lyme is to the problematic, hard-to-pin-down, possibly delusional disorder, called having “Morgellons.” Jameson gives an account of the person who has Morgellons, in which the individual experiences worms or worm-like sensations, crawling beneath his flesh, which, apparently, sometimes pops out. Yikes.
At this point, I abandon any skepticism I might have about Wang’s suffering as a medical patient as my own limitations or arrogance. I decide to acknowledge once again there are more things in heaven and earth than are dreamt of in our philosophies (note: “philosophy” meant “natural science” in Shakespeare’s time).
(1) Louis A. Sass, (1994), The Paradoxes of Delusion: Wittgenstein, Schreber, and the Schizophrenic Mind, Ithaca, NY: Cornell University Press.
(2) Matthew Ratcliffe, (2017), Real Hallucinations: Psychiatric Illness, Intentionality, and the Interpersonal World, Cambridge, MA: MIT Press, 290 pp.
(c) Lou Agosta, PhD and the Chicago Empathy Project