According to the Encyclopedia of Mental Disorders, involuntary hospitalization “is an extremely controversial course of action.” In her 2019 book The Collected Schizophrenias, Esmé Weijun Wang steps into this controversy. She presents arguments from both sides. And she offers a unique perspective on the issue, having been involuntarily hospitalized herself, three times.

On the pro side of the debate, sometimes people who suffer from mental illness are in danger of harming themselves or others. Wang tells stories about people who wish to help a family member with mental illness and prevent negative outcomes, but feel unable to cope with the situation on their own. She points out that being a loved one of someone with mental illness can be challenging and, in some situations, can result in feelings of terror. She also writes of her personal desire to retain the option to put herself in someone else’s care to avoid committing suicide, if it ever came to that.

On the con side of the debate are, as Wang explains, “crucial issues of autonomy and civil liberties.” She clearly considers these issues of vital importance, as she brings them up not just in the essay on the topic of involuntary hospitalization, “Toward a Pathology of the Possessed,” but in many of the other essays throughout the book. She writes about many aspects of the collected schizophrenias; the issues of autonomy and civil liberties arise again and again.

Wang’s personal experiences in being involuntarily hospitalized were far from positive. She explains the intense fear of being in a small, unfamiliar place and not knowing when she will be allowed to leave. She explains the feelings of despair that arise from not being able to make simple decisions like when and what to eat. Further, it is very difficult, she points out, to say or do anything in a mental hospital and be believed and taken seriously. Here are her words about the situation:

“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.”

And here is what she writes about Julian Plumadore, a speaker and advocate for mental health:

“He’s better now, he tells me, because he was finally told that he himself knows better than anyone else what he needs. For him, that included harm-reduction techniques instead of involuntary rehabilitation, as well as estranging himself from his family.”

This rings true to me. It can be hard to watch someone make their own decisions. You want to reach in and make the decisions yourself, to make sure they are the right ones. The trouble is, your definition of right might not be the same as theirs.

When I was in the worst throes of my bout with physical and mental issues, I did not always know on a conscious level what I needed. I relied on doctors, counselors, family members, and friends to advise me on steps forward. But the advice I received was contradictory and irregular. Much of it did not reliably move me toward recovery. It was only when I began to listen to and trust my gut feelings that I found that I could reliably make decisions that helped, rather than exacerbated, the problems.

I do not claim that I always made the right choices. And I continued to listen to others’ advice, take it seriously, and act on it (if I thought it might help). But if I had not retained the freedom to follow my instincts, I would surely never have found my path to recovery.

It’s admittedly hard to justify letting people make their own decisions when there is reason to believe that they might harm someone (self or others). But it’s also hard to justify taking away someone’s autonomy, without which personal improvement is virtually impossible.

Who makes your decisions?

When I was a kid, for some reason a popular discussion topic around the house was whether appearances, social connections, etc., mattered, or whether the main important things in life were personal grits and smarts and such. Ah, the perennial debate!

Nowadays, this doesn’t seem to me like such a debate. To my adult mind, both of these spheres matter. It matters how you develop yourself personally; and it matters how you present yourself to others. Unless you are a hermit, that is. But barring that, it seems to me that both should be given due heed.

Esmé Weijun Wang has something interesting to say about this non-debate. Her 2019 book The Collected Schizophrenias includes an essay called “High-Functioning.” In it, she describes giving talks about living with schizoaffective disorder, bipolar type. Wang has a desire to share her experiences with others, to foster an understanding of people diagnosed with a serious mental illness. However, as she is well aware, it is difficult to talk about having a serious mental illness without calling into question your validity as a speaker.

So she finds ways of establishing validity and winning her audience’s trust. She is careful to drop that she is a writer who was educated at Yale and Stanford. She wears her wedding ring and talks about her decade-and-a-half-long relationship. And she is careful to dress with impeccable style for all speaking engagements.

Wang admits that she has had a longtime passion for fashionable clothes—and for good reason. I love this passage about how she feels about fashion:

“The way I clothe myself is not merely camouflage. It is an intimidation tactic, as with the porcupine who shows its quills, or the owl that puffs its body in a defensive offensive: dress like everyone should be terrified of you.”

This makes a lot of sense to me. If who you are, as a person, is liable to provoke mistrust in others, why wouldn’t you do everything you could to appear powerful and in control? On the flip side, if who you are, as a person, is liable to provoke trust in others, why would you waste your time attending to every minute detail of your appearance?

“Dress for success” is a great mantra, in my opinion. Just don’t neglect to also put in the hard work of developing your personal strengths—as Wang has clearly done. Her book is fabulous. It’s well written, extensively researched, and thought provoking. I trusted her completely to give me all the facts: the good, the bad, and the ugly. And the chic.

What are you wearing today?

Schizophrenia runs in my family. To learn more about this mental illness is, for me, a way of trying to understand a piece of my family history. So when I saw a book called The Collected Schizophrenias featured at my local indie bookstore, cute cover and all, I had to buy and devour it.

The Collected Schizophrenias is a collection of essays by Esmé Weijun Wang. Each of the essays puts a different focus on her experiences as a woman living with schizoaffective disorder, bipolar type. The writing is fabulously direct, concise, and honest. This book, like A Mind Unraveled by Kurt Eichenwald (which I previewed earlier this year), does a great job of dispelling common myths about the illness at hand (Eichenwald writes about epilepsy), while offering insights into how to thrive in the face of the illness’s difficulties.

I admire Wang’s strength in writing and speaking about her experiences. Mental illness is still, despite great strides forward in this area, stigmatized. One of the first and most important steps in fighting stigma is to hear and to understand. What is it like to live with schizoaffective disorder, bipolar type? Wang endeavors, in this book, to explain.

It’s important to hear her. Wang points out that most information about the collected schizophrenias is presented from the perspective of an observer witnessing the words and behavior of someone else. For example, referring to a statement as a delusion implies that one does not believe the statement oneself. But the helpfulness of the outsider perspective goes only so far.

What does it feel like to be the person herself? Wang shares a few of her worst times in this passage:

“I’ve seen myself forget to feed my dog. I’ve seen myself remember, and then not care enough to do it. Sometimes I can’t even say more than two words or move. There are periods when I know that my husband has been replaced by an identical robot.”

To fully understand this passage, it’s important take into account the rest of the essay. For the essay is about some of Wang’s worst times . . . and best times. She tells a touching story about serving as a camp counselor for children with bipolar disorder. She was instrumental in helping a boy transform from hating the camp to loving it—from feeling all alone to feeling that he had friends. Here’s a passage about one of Wang’s best times. A camper was feeling sick:

“I told him to try and relax. I stroked his bangs with the palm of my hand. I hummed Chinese lullabies, and the longer I stood and stroked and hummed and whispered, the stiller he became, until he was asleep.”

It is important to remember, about oneself and others, that we all have our good and bad days. A diagnosis is not a life sentence. I don’t think it should be one, anyway. A diagnosis is, or should be, a tool to help people understand some of their personal roadblocks and look for ways to move forward.

I can personally identify with the worst-times and best-times passages. I know what it’s like to have terrifying thoughts along the identical robot theme. I also know what it’s like to sometimes want to reach out and help others, but other times feel removed from any reality except what’s in my head. It is unclear to me whether almost everyone has such thoughts and feelings, or whether it’s in my blood. That second possibility would not surprise me one bit!

On the other hand, reading this book drove home to me the seriousness of this illness. A recurrence of philosophical musings and doubts, even when they become obsessions, is a very different beast than a persistent feeling of utter certainty. Wang notes that on her bad days—which can last for months—she is incapable of doing things that others can easily do on their bad days. She also notes that powerful psychiatric drugs have given her a stability that she would otherwise lack.

But to return to the original hand . . . I suspect that we human beings are a lot more alike than we usually admit.

What are you like at your worst and best?