The Collected Schizophrenias

By Esmé Weijun Wang

9 min read

Why does it matter? Because the hardest thing about psychosis isn't the hallucinations — it's what happens the moment you report them.

The standard story about mental illness runs like this: a person exists, then illness arrives and takes something from them, and treatment is the project of getting it back. The self is the given; the disorder is the intrusion. Esmé Weijun Wang's essay collection, The Collected Schizophrenias, dismantles this institution by institution — psychiatric hospitals, insurance companies, university administrators, the DSM itself — showing where each one fails and why. What emerges is something more unsettling: the moment you report a hallucination, you forfeit credibility about everything else. Selfhood, for someone with schizoaffective disorder, is not a baseline to be recovered but a daily construction — assembled from clinical precision, silk dresses, Polaroid film, and borrowed spiritual frameworks, because nothing can be assumed and nothing, including the self, can be taken for granted.

A Diagnosis Is a Flowchart, Not a Fact — and the Difference Has Consequences

On a February morning in 2013, Esmé Weijun Wang messaged her psychiatrist through an HMO patient portal. Days had been passing without her existing in them — she could list what she'd done and still have no memory of having done it. By 4 p.m. on Monday, the world felt unreal and so did she. She wrote that she'd been worrying about whether she had a face, and couldn't bring herself to check.

Dr. M's reply came in four sentences. Increase the Seroquel. "I think you may have schizoaffective disorder — a slightly different variant than bipolar I." And by the way, have you read Elyn Saks's memoir?

Wang goes back over that reply word by word. "A slightly different variant" of what? Dr. M never specifies. The Saks recommendation (the most famous schizophrenia memoir of the past thirty years, written by a MacArthur Genius Grant winner) lands at the end of a three-sentence diagnosis like a gift left at the scene of an accident. It signals: you may have a terrifying illness, but here is someone who flourished inside one, which means you could too. Wang notices all of this.

She can catch all of this because she'd sat on the other side of the clipboard. For a year at Stanford's mood disorders lab, she ran clinical interviews, known as SCIDs, that determined which subjects qualified for study. The SCID is a flowchart in a three-inch binder: a weeping, visibly depressed man could be turned away for having four of the required five symptoms, or for arriving at the clinic at day ten instead of day fourteen. The protocol demanded "clean" diagnoses. Hundreds of interviews made clear to Wang that clean diagnoses were rare. A psychiatrist treating patients could bend the criteria (their job was to alleviate suffering, not document pristine symptom clusters) but the underlying categories remained human inventions. No blood test. No genetic marker. Schizophrenia was a pattern that humans noticed, named, and numbered.

She'd run those flowcharts for a year, and she still needed the four-sentence email to mean something.

When We Call Psychosis 'Possession,' We're Granting Permission

Call psychosis "possession" and the logic shifts: you're no longer controlling a person; you're battling something that replaced them. Whatever you do to the dangerous occupant becomes, in this grammar, a form of rescue.

Wang tests this logic against the Lothell Tate case. On December 18, 1988, Lothell shot her brother Malcoum — a man with severe paranoid schizophrenia who had been hospitalized five times and who habitually appeared over family members' beds in the night, laughing before slipping away — thirteen times. The gun held seven rounds. She reloaded. She and their mother checked his pulse, then rolled his body into a roadside gully and drove home. On the stand, Lothell described speaking to Malcoum between shots, saying she loved him, that she was sorry. The jury deliberated for one hour. Newspapers ran headlines like "Family's Nightmare Ends with Slaying of Problem Child." The nightmare, those headlines agreed, was Malcoum himself. Not what had happened to him.

Wang doesn't clean this up. The judge called it "as brutal and dispassionate a murder as I've had a chance to see." Lothell was sentenced to life and died in prison in 1994 after stopping her own diabetes treatment. But Wang also doesn't pretend the possession narrative arrived from nowhere. The psychiatric and legal systems had discharged Malcoum five times, each time determining he posed no threat. When every legitimate path closes, the possession narrative opens a private exit: if the person you loved has been replaced by something dangerous, what you kill isn't a person. The jury spent sixty minutes reaching that conclusion.

What the possession narrative requires, Wang argues, is that Malcoum's selfhood be treated as already gone. Andrew Solomon described schizophrenia as "replacement and deletion": the illness eliminating a person rather than obscuring them. Wang, who endured a seven-month psychotic episode after every available antipsychotic failed her, took those words as a personal threat. She refuses them for herself; she can identify continuity across even her worst episodes. But she won't presume Malcoum's inner life, because that life is accessible only through the record other people made of him. That's what the possession narrative does: it substitutes the record of someone's symptoms for the person, then grants permission to treat those symptoms as the whole story. Lothell called it love. In sixty minutes, twelve jurors agreed.

Reporting Your Symptoms Is the One Thing That Gets You Disqualified as a Witness

What happens when you describe your psychiatric symptoms as accurately as you can? The assumption is that clarity helps. You tell the doctor exactly what you're experiencing, the doctor interprets it correctly, treatment follows. Wang's Louisiana hospitalization shows how that assumption inverts.

She walked into the ER voluntarily. She told intake staff she felt "unsafe" — a free-floating terror with no fixed target, a sensation she recognized and was there to get ahead of. "Unsafe" in psychiatric intake coding means suicidal. The staff flagged it, and the doctor went further: he recorded that Wang believed a conspiracy was targeting her. She hadn't said anything of the kind. He maintained this interpretation for her entire stay. Wang had arrived on her own and was held involuntarily, unable to leave until the doctor permitted it, not because of anything she'd done but because of one word, rewritten at intake into something else entirely.

A note from Wang's Yale Psychiatric Institute records makes the mechanism explicit: "patient shows lack of insight." In clinical usage, "insight" means agreement with your clinician's assessment. Disagree with your diagnosis and the disagreement is filed as further evidence of the disorder itself. Accurate self-report becomes diagnostic evidence; disagreement becomes more of it. There is no position from which your account of your own experience functions as testimony rather than symptom.

David Rosenhan demonstrated from the outside what Wang lived from the inside. In 1973, Rosenhan and seven colleagues gained admission to psychiatric hospitals by reporting auditory hallucinations, then behaved completely normally throughout their stays — an average of nineteen days. All but one were released only on the condition that they accept antipsychotic prescriptions, most carrying schizophrenia diagnoses. Rosenhan was eventually able to reveal his credentials and reclaim his record. Wang observes the asymmetry flatly: he could prove he was a Stanford researcher. She has no equivalent card to play. The illness is real. Nothing reclassifies the chart.

The cumulative effect is that institutions never encounter Wang: they encounter her prior hospitalizations, her intake forms, the phrases she used at 2 a.m. in an ER. The more accurately she reports what's happening to her, the more thoroughly the record confirms the profile. She walked in; the word "unsafe" walked in with her; and once the intake form translated it, she was no longer the one speaking.

High-Functioning Is Real — and Illness Will Eventually Call Its Bluff

Wang walks into the Chinatown Mental Health Clinic in a brown silk Marc Jacobs dress, Chanel foundation in a discontinued shade called 20 Beige, and a Tom Ford lipstick in Narcotic Rouge. She is there to give an antistigma talk about living with schizoaffective disorder. Flat scars cross her bare ankles.

Her makeup tells her what she needs to know. When manic, she applies it eagerly; when depressed, she strips it down to just the lipstick. Skipping the lipstick means she hasn't made it to the bathroom mirror at all. That sequence is more useful than any clinical rating scale.

She borrowed a term from cultural critic Chaédria LaBouvier, who writes on race and aesthetics: "weaponized glamour," meaning the deliberate use of beauty and style to push back against the categories that flatten you into a diagnosis. For Wang, the silk dress and the red lipstick aren't disguise — they're argument. Walking into the Chinatown clinic dressed this way is a claim the room has to reckon with: the category of "schizophrenic" doesn't look the way you picture it. That claim has political weight.

It's also true. The psychiatric hierarchy Wang first encountered as an inpatient — depressives at the top, because many were Yalies who'd already demonstrated their potential; schizophrenics at the bottom, excluded from group therapy, assigned no future beyond low-grade stability — rewards exactly the signals she has learned to emit. Being perceived as high-functioning gets you better care, a different cadence from nurses, the tacit assumption that you might still have a future.

But the illness doesn't run on the same schedule as the performance. During one period of active psychosis, Wang was watching shadowy demons dart at her from every angle, and her body kept giving her away — she flinched, ducked, startled visibly at things no one else could see. No silk dress concealed the flinching. She knew exactly how she looked.

At the end of the Chinatown visit, a clinician says she starts out hopeful with every new patient, then watches them relapse and return until they stop seeming like people who can dream. Wang is touching the fabric of her dress. She had either fooled this woman or convinced her — she uses both words and refuses to choose. Fooled means the performance was a lie. Convinced means it was true. Wang's position is that neither word alone settles it, and deciding which one applies is exactly the work that remains undone.

When You Can't Trust Your Own Mind, Selfhood Becomes Something You Build, Not Find

Most of us navigate identity the way we navigate a familiar room in the dark: you don't need to see the furniture to know it's there. You feel it from the inside. The problem Wang runs into is that psychosis doesn't knock you unconscious and leave a gap in the record. It operates from inside your perception, which means you can't step outside it to check whether what you're experiencing is real. When the instrument you'd use to measure your own mind is the instrument that's broken, introspection doesn't produce selfhood. It produces more uncertainty.

Wang's solution, developed not as theory but out of desperation, is to treat selfhood as something assembled from external evidence rather than felt from within. During a psychotic episode, she began shooting self-portraits with two film cameras: a Contax T2 and an SX-70 Polaroid. Physical film was essential. Digital images exist on a screen; instant film produces a tangible object. She needed the object.

One photograph showed the back of her head. In it she spotted a birthmark she had entirely forgotten, a dark smudgy mark on her neck. She'd been avoiding her own face; here was a detail that proved continuity. A birthmark means you were born; it means you haven't always been here. In a Grimm fairy tale she references, a mark on a son's shoulder convinces his parents their child has truly returned. Wang uses it the same way: proof that the person she'd been before the illness had actually existed.

She calls these photographs a mizpah (a Hebrew word of parting, the wish to be watched over across a divide you cannot bridge), except the two people separated are versions of herself. One self shoots during the episode without knowing why; the other surfaces later and reads them like letters sent across that gap. The camera is the only witness that isn't inside the delusion.

The same logic governs what she does when a form of psychosis called Cotard's delusion — in which the patient becomes convinced they have died — takes hold. She crawls into bed with her husband at six in the morning and asks him to tell her what is real: her parents, the furniture, what city they live in, where the farm table came from. He walks through all of it, then offers the one argument that feels most like evidence — when people die, you don't see them anymore. He doesn't see his grandfather anymore. But he sees her. This doesn't dissolve the delusion. It helps the way a bedtime story helps: not by solving anything but by providing a structure you can rest inside.

Wang doesn't land on recovery. The essay that closes the book leaves her with a ribbon anointed with oil, tied around her ankle when she feels herself beginning to slip, not a cure but a tether. The self she maintains this way is assembled from photographs she doesn't remember taking, from her husband's inventory of their furniture, from a cord around her ankle. When you cannot trust the mind that generates the self from inside, you build it from whatever can be held in the hand.

The Ribbon Around the Ankle

The ribbon around the ankle is such a small thing. But Wang's entire book has been an argument that small things — a Polaroid with a birthmark, a husband listing furniture, a lipstick applied or skipped — are what selfhood actually runs on when the bigger machinery fails. What you take from this book isn't a theory of mental illness or a framework for compassion. It's something more disquieting: the recognition that the self you assume you inhabit continuously is, for most of us, less verified than you'd like to think. Wang just has more reason than most to verify it daily. The ribbon says she intends to be here tomorrow. That's not recovery. That's something harder — the work of remaining herself, done without guarantee, one small piece of evidence at a time.