Updated: Dec 20, 2019
An Experience of Mental Illness
One day in 2013 Esmé Weijun Wang decided to have a garage sale. She gathered up possessions to sell, created an ad on Craigslist, and shared the details with her friends via Twitter. The number of items on sale was enormous; they included her elaborately knit cowl-neck scarf and a lovely red cardigan, but there was something that unnerved the people who came: none of the items had a price tag. “One dollar was the same as ten dollars was the same as nothing.” Some were so confused they left.
Wang, born to Taiwanese parents and living in San Francisco, is a stylish figure. Her face is shaped by a dyed blonde pixie cut with glasses that say educated chic. She wears Chanel’s Vitalumiére Hydra foundation in 20 Beige and a nubby Tom Ford lipstick in Narcotic Rouge. At the time of the garage sale, she had lost thirty pounds from her 5 ft 4 frame and was wearing her “French ingénue” uniform, which consisted of a v-neck white t-shirt and black pants. At certain points, she’s attended Stanford and Yale.
Generally, a “pay-what-you-want” type garage sale, like the one Wang planned to rid herself of her possessions, is considered a red flag for suicide, but Wang’s case was different: she thought she was already dead. Her official diagnosis is schizoaffective disorder, bipolar type, which she describes with great care and generosity in her 2019 book, The Collected Schizophrenias. A series of essays, the work details her unique experience both as a writer with clinical research experience in psychology and as a person living with schizoaffective disorder.
Rock the Boat has interviewed folks managing a range of mental health issues including bipolar disorder as well as depression and anxiety. We have also identified the most helpful websites and organizations for Asian Americans regarding mental health. This piece will explore the themes of The Collected Schizophrenias and Wang’s writing about schizoaffective disorder, which according to the National Institute of Mental Health (NIMH) afflicts as many as two million people in America.
A Culture of Reticence
Schizophrenia was first defined in 1911 by Eugen Bleuler, a Swiss-German psychiatrist. One of his consistent findings was that schizophrenia runs in families. More recent large population studies reveal a strong genetic link between schizophrenia and bipolar disorder. In The Collected Schizophrenias, Wang writes about the possibility of her and her family’s experiences of mental health as stemming from an intergenerational transmission of trauma, passing from immigrant mother to first generation child.
When Wang was first brought to therapy as an adolescent, after having suicidal thoughts, the psychiatrist asked her mother if there was mental illness in the family. "No," her mother said, "there was nothing." Yet, it was a lie. Years later, during a train ride to Taiwan, Wang prompted her mother to explain her family history further, and so, on the small, pull-down lap desk, her mother placed a notebook and drew their family tree placing an X over those who had a known mental illness. By that point, Wang expected to see an X over her own name and two other family members. Instead, she was surprised by how many unknown entities there were with branches “leading to blank spaces on the page.”
Later, in 2017, at a Chinatown Mental Health Clinic in San Francisco, Wang described to a group of patients, in Mandarin, her mother’s explanation for why she lied to her first psychiatrist about her family’s history of mental illness: “We don’t talk about these things.” Reticence is a common theme. Among members of an Asian American performance art group she had joined at Yale, the topic of the Mental Hygiene Department came up. Eyes widened. “Never tell them you’ve thought about killing yourself,” they counseled Wang as a freshman. Doing so would land you in the Yale Psychiatric Institute. It might have been obvious advice to tell your doctor about suicidal thoughts from a health perspective, but not if you wanted to stay at Yale.
The Perception of Mental Illness
In her essay, “Yale Will Not Save You,” Wang writes, “”I went to Yale” is shorthand for I have schizoaffective disorder, but I’m not worthless.” Among racial groups college enrollment is consistently highest for Asian Americans, but the interplay of social mobility, culture, and expectations of friends and family can lead to mental health problems too. Wang, for her part, is highly conscious of how the signifiers of class- where she went to college, her wedding ring and Tom Ford lipstick- are part of the reason she is taken seriously, despite her serious mental illness. She is adamant that her intention is not to glamorize sickness, but it is difficult, even when addressed head on, not to be distracted by those shiny tokens of worth.
Science / Genetics
Schizophrenia is typically diagnosed in the late teens to early thirties, but the exact point when a person’s brain starts to veer toward psychosis is unknown. According to the diathesis-stress model of psychiatric illness, mental illness becomes a reality only if enough stressors cause vulnerable genes to express themselves. It is also possible for symptoms to form later in adulthood after periods of stress or isolation.
Other stressors could be prenatal and build on the idea of an intergenerational transmission of trauma. Wang’s mother had recently immigrated to the United States from Taiwan, when she became pregnant. She was a newly married young mother with her own psychiatric issues. During birth, Wang’s head became lodged behind a bone in her mother’s pelvis causing a flood of cortisol and other chemicals to inundate her brain. It is possible, Wang wonders, that this could have affected her genetic expressions and brain development including her mental health.
One Indian-American physician and Pulitzer Prize winning author studying the possible connection between gene development and schizophrenia is Siddhartha Mukherjee. Similar to Wang, who has clinical research experience in psychology as well as a personal connection with schizophrenia, Mukherjee has the technical knowledge of a medical doctor along with personal experience of being related to people with severe mental illness including schizophrenia. He writes about these personal and scientific understandings in the 2016 book, The Gene: An Intimate History. In particular, he identifies the gene variant C4A as powerfully correlated with the risk of schizophrenia. C4A is most significant in the parts of the brain involved in “cognition, planning, and thinking,” which are the brain functions most impaired in people with schizophrenia.
Treatment and Civil Liberties
What do you do when a loved one shows signs of mental illness? Of course, it is possible that not every situation may require treatment, or that loved one could agree that he needs support and might work together with you to create a treatment plan. But what if that person fears the stigma of saying he has mental illness? What if you disagree about how extreme the symptoms are? Is the involuntary treatment of a person with severe symptoms of mental illness, like schizophrenia, ever justified?
In her 2002 book, Refusing Care, Elyn Saks, a professor of law and psychology at the University of Southern California, who also has schizophrenia, says that, “Alleviating suffering is not a legitimate reason for taking away people’s rights.” She calls for “self-paternalism” laws that would allow people to identify in advance the medical care they wish to receive should they become ill, and, as a person with mental illness, she says that there are few other scenarios where treatment should be imposed.
On the other hand, organizations like the National Alliance of Mental Illness (NAMI) tend to be composed of family members of the mentally ill who advocate for less patient autonomy. Their policy platform declares, “(9.2.7) States should adopt broader, more flexible standards that would provide for involuntary commitment and/or court ordered treatment when an individual, due to mental illness… lacks capacity.” Similarly, E. Fuller Torrey, a psychiatrist whose sister suffered from schizophrenia, was also an advisor to NAMI and helped found the Treatment Advocacy Center (TAC). He is an advocate of involuntary treatment, including hospitalization, and claims that the recovery movement gives false hope to the severely ill.
The topic of treatment is a hot button issue in the mental health community. In her book, Wang writes, “Involuntary commitment may sometimes be warranted, but it has never felt useful to me.” Yet, she takes a journalistic approach to understanding the arguments for and against involuntary treatment. As a result, her writing comes off as ambivalent. In interviews, Wang is usually asked to clarify her view of the subject, but her final opinion remains elusive. Ultimately, she says, her research only led to more questions than answers.
The best personal writing happens when an author is able to create a connection with the reader by diving deep into a real complexity or struggle in her life. Wang's well-paced book is valuable because she is able to set aside the potential shame of her mental illness and instead explore it in a thoughtful and considered way. Part of her writing process is also about setting boundaries. She writes that she was raped but is selective in the details. She is careful in narrowing the descriptions of her marriage. The book also contains stories and research that are not about her, but Wang's best writing is personal.
In an interview earlier this year, at the Asian American Writer's Workshop in New York, Wang spoke to a packed house about a note she received from her editor. It said, “Why do you not describe the rape in the book?” Instead of describing it in depth, she revised her passage to explain why people might want to know more about the rape and why she does not want to talk about it. At a time when everyone has access to sharing pieces of themselves with others, it is a practical lesson for Wang to share. And it just might affect your mental health.