Transcript | Ep. 77: How to Mind Mental Illness with Esmé Weijun Wang

[Stinger]

Esmé: I really wanted to be able to be seen as high functioning, and I wanted to be able to be seen as normal. And, you know, if people found out about my diagnoses, I wanted them to see me as like, yeah, the person who had this serious diagnosis but who also graduated from Stanford with a 3.99 GPA. So it scared me that I had these symptoms that I couldn't control.

[Theme music]

Cristen: Hey y’all, and welcome to Unladylike, the show that finds out what happens when women break the rules. I’m Cristen.

Caroline: I’m Caroline, and that was today’s guest Esmé Weijun Wang, author of the New York Times best-selling essay collection The Collected Schizophrenias.

Cristen: Caroline, I’ve been wanting to talk to Esmé for a while now. I first stumbled across her a couple years back when I was going through a scary mental health period of my own. As I’ve mentioned before on Unladylike, I have generalized anxiety disorder. And at that time, on paper, everything looked good, you know? But I was spiraling on the inside. It was honestly so unsettling that I didn’t know how to talk about it, and I didn’t want to talk about it.

Caroline: Why not?

Cristen: Well, I think I was scared that talking about it would make it even more real. And it felt like a burden that I didn’t want to put on anyone else. Like, I just desperately wanted to figure out how to kind of get myself back together. And that’s actually how I ended up on Esme’s website called the Unexpected Shape, and it’s basically all about getting your creative work done while also living with mental or physical illness. And I was just so struck by how openly she talks about having a serious mental illness.

Caroline: Yeah, in her mid 20s, Esmé was diagnosed with schizoaffective disorder, which she describes as “the fucked up offspring of manic depression and schizophrenia.”

Esmé: It's almost like a demon that takes over a person. The schizophrenias causes a person to no longer be themselves. Whereas depression and anxiety, I think are often considered to be quite awful, but they are more considered to be things that are layered on top of a person. You know, they’re something that somebody is dealing with. They are not something that takes over or empties out a person or replaces the spirit of a person.

Caroline: In The Collected Schizophrenias, Esmé details her journey to what she calls “the inappropriately crazy” end of the mental health spectrum — aka, the most unladylike end.

Cristen: She’s far from alone there. An estimated 1 in 25 Americans live with a serious mental illness, or SMI. The most common ones are schizophrenia spectrum disorders, severe bipolar disorder and severe major depression.

Caroline: But Esmé also occupies a very particular space on that unladylike end of the spectrum. She doesn’t fit what we think schizophrenia looks like — you know, she’s not visibly unhinged or unkempt. She’s a Yale- and Stanford-educated, award-winning writer who’s married to her college sweetheart, has plenty of friends and frankly dresses chic as fuck.

Cristen: Yeah she does, and I was really drawn to this idea of someone who is killing it on the outside while at the same time, her mental illness is sort of escalating on the inside.

Caroline: So today, we’re talking with Esmé about navigating serious mental illness, how it shapes her ambition and why wanting to be seen as “high functioning” is so important to her.

Cristen: And quick note y'all: We’re getting into serious mental health issues in this episode, including psychosis and suicidal ideation, so a heads up if you’re sensitive to those topics.

[Stinger]

Caroline: Esme grew up in Michigan and was raised by her Tawainese immigrant parents. She started reading at 2 and wanted to be a writer by the time most kids are learning to tie their shoes.

Cristen: Yeah, baby Esmé was not messing around. When she was about 6, Esmé sent a letter to the publisher Little Brown asking how she could get her works in print already!

Esmé: And they actually wrote me back. I remember they wrote me back this typed letter, typewritten letter, and they said I needed an agent. So, yeah, I've wanted to be a writer for a very long time.

Caroline: It's funny to tell a child that you need an agent. I would’ve been like, uh ...

Esme: Yeah, I'm imagining some kind of like intern or assistant just thinking like, how should I respond to this kid?

Cristen: But, alongside her big writing dreams, Esmé had to deal with extreme, evolving and often completely mysterious mental health issues. And they also started when she was really young.

Esmé: When I was 4 or 5, I remember having issues where I would be just filled with anxiety and compulsion. I remember this one evening where I was going to get up and get a drink, and then I would go to the bathroom and then I would feel like I needed to go to bed and then get a drink and then go to the bathroom. And I did this over and over again compulsively and ended up standing at the top of the stairs, and I just burst into tears, and my mom said, Why are you crying? And I just said, I can't stop.

Cristen: With puberty came depression, anxiety and insomnia. By the time she was a teenager, Esmé was having suicidal thoughts and started seeing the high school counselor.

Esmé: And at some point she told me, “You know, you're going to have to see a psychiatrist. This is getting really serious.” And so one morning I told my mom before school, I've been seeing a counselor and she's thinks that I need to see a psychiatrist. And my mom yelled at me. She was so upset, so angry. She said, “We've always given you everything you've needed. You have clothes to wear, you have food, you have a roof over your head. How could you do this to us?” And I - I remember crying in the car on the way to school and crying. I skipped first period and I was just crying in the art room

Caroline: Eventually, Esmé and her mom went to see the psychiatrist together.

Esmé: He was a white man. And he asked my mom in front of me, “Is there any history of mental illness in the family?” Which is a very ordinary question to ask in this kind of like diagnostic meeting. And my mom said, no, there's no history. And I learned years later that there was quite a strong history of mental illness in my family. And I asked my mom, “Why did you tell that first doctor that there was no history of mental illness?” And she said in Chinese, essentially, “Well, it wasn't his business.” And I think that kind of cultural stigma was a lingering factor throughout all of my diagnoses.

Cristen: Her diagnoses, plural, started with clinical depression and anxiety. Then, the summer after Esmé graduated from high school, she was exhibiting enough signs of mania that her psychiatrist diagnosed her with bipolar disorder.

Esmé: And my mom was just like, OK. She didn't know what it meant, really. She told me years later that if she had a really understood what it meant, she wouldn't have let me go to school, especially not across the country and not by myself.

Caroline: Esmé was 18, and a couple months later, she left home in California to start her freshman year at Yale.

Cristen: Now, Esmé’s psychiatrist recommended that she wait to start taking her new bipolar medication until she got settled at Yale and could start working with someone there. This meant that there was a stretch of months where Esmé was dealing with the stress of starting college and experiencing bipolar symptoms.

Caroline: That delay was the first domino to fall that ultimately resulted in Esmé being hospitalized at the Yale Psychiatric Institute twice her first year there. After the second time, Yale sent her packing.

Cristen: Then in her early 20s, after she’d restarted her college career at Stanford, Esmé began experiencing intermittent symptoms of psychosis

Esmé: Psychosis is either hallucinations, so false sensory experiences, hearing things, seeing things, feeling things physically — and they're actually hearing things, like you hear them as though they're actually there. And then delusions are false beliefs. So you believe something like the FBI is after me or I am Jesus, and you believe them as strongly as you would believe anything else.

Cristen: Remember — at this point, Esme’s schizoaffective disorder was undiagnosed. And that psychosis she started experiencing is what we colloquially call having a “psychotic break.” But as this was happening, Esme was at Stanford, making the grades, and planning to pursue a PhD in clinical psychology.

Caroline: And after completing her undergrad, she started working in the school’s Mood and Anxiety Disorder Lab

Esmé: My therapist told me that I was the only person with a diagnosis of bipolar disorder that she had as a client who had a regular job. I felt so out of control as someone like that. And it gave me a sense of control to be able to be as - a girl scientist and to study the brain and to be able to kind of look at statistics and to be able to, you know, look at fMRI images and to kind of feel like I could distill it down to these kind of images and numbers and information.

Caroline: In what ways were you feeling sort of out of control at the time?

Esmé: I think a lot of it had to do with my psychotic symptoms, which in the end turned out to not so much be from bipolar disorder, but to be more from the schizoaffective disorder, which wasn't diagnosed at the time. But what scared me the most were the psychotic symptoms that I couldn't hide from people. There were, you know, things that I would see. I would call them kind of shadowy demons. They were just these dark, flying things that would just fly at my head. I would see them flying at my head, I would duck instinctively, and then I would realize I looked insane because that's what an insane person looks like. And there was nothing that scared me more than not being able to control my response to my symptoms.

Caroline: Esmé decided to change what she could control, though. A few years into studying clinical psychology, she left her PhD program to focus on writing, and in 2010, she got her MFA.

Cristen: Her mental health, however, continued deteriorating. In 2013, 10 years after she’d been forced out of Yale, an excruciating seven-month-long psychotic episode culminated with Esmé getting diagnosed with schizoaffective disorder.

Esmé: I was so relieved. It was such a relief. A lot of people don't like diagnoses, they - they don't like to be put in a box. But I like to know that I'm not pioneering an inexplicable experience. I - I like to know that other people have experienced the thing that I am experiencing.

Cristen: When we get back, we’ll learn exactly what that diagnosis of schizoaffective disorder means, and Esmé talks to us about trying to out-achieve the mental illness stigma.

Caroline: Don’t go anywhere

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Cristen: We’re back, and when we left off, Esmé Wang had been diagnosed with a schizophrenia spectrum disorder. So Caroline, what are we talking about when we say schizophrenia?

Caroline: OK, well in general, schizophrenia means that someone has ‘psychotic’ symptoms and sometimes loses touch with reality. Y’know, they hear things that aren’t real. Or, believe things that aren’t true. Now, schizoaffective disorder — which is Esmé’s diagnosis — is a little different. It’s like a blend of those schizophrenia symptoms plus symptoms of a mood disorder like the depression and mania associated with bipolar disorder.

Cristen: And the schizophrenias have been around since forever. It’s also taken practically forever for doctors and scientists to figure that out. In the early 1800s, for instance, the closest diagnosis was “broken brain,” which … talk about phoning it in.

Caroline: Yeah, and it took another 70 years for it to be classified as a unique type of mental illness, initially called dementia praecox, or premature madness.

Cristen: Then, in 1911, a Swiss psychiatrist named Eugen Bleuler coined “schizophrenia” from the Greek roots for split mind. Our Swiss mister also defined the schizophrenias as a spectrum — aka a range of disorders, not just one thing.

Caroline: People tend to mislabel and stigmatize folks on that schizophrenia spectrum as having split personalities, being “psycho” and possibly even dangerous. But, in reality, the schizophrenias are much more varied and complicated. Here’s Esme again.

Esmé: I think often the appropriate type of crazy is the kind of crazy that people have accepted to this point. I mean, even in the mid to late 90s, people were just starting to accept clinical depression and anxiety. Whereas I think schizophrenia or the schizophrenias or psychotic disorders are still seen as more stigmatized than depression and anxiety.

Cristen: And because SMIs, or serious mental illnesses, are so stigmatized, going out of your way to look “normal” — or even exceptional — is a common coping strategy.

Esme: Like I know that because I dress well and I can speak eloquently that I am treated more well than people with the same diagnosis who may not be as high functioning, who can't say they went to a fancy school or that they can pass as somebody who doesn't have a really serious mental health diagnosis. I'm always really cognizant of passing as high functioning, and at the same time I wrestle with whether that's something that I, you know, should take advantage of and how I use that. How much do I use that privilege of being high functioning? The phrase high functioning is really looked at with a lot of caution in the disability rights community, which makes a lot of sense because it does not make sense to treat people who are so-called high functioning better than it is to treat people who are not. And yet that's very much the case.

Cristen: It seems like so much of being considered “high functioning” boils down to appearance. Like, do you look crazy? For Esmé, she writes: “Unless I’m catatonic, I do wear red lipstick and Chanel foundation. I do have short platinum hair. I do wear eyelash extensions. I sometimes go for months without showering, but I do not look disheveled.”

Caroline: But more than anything, maintaining a paying job is the gold standard of being “high functioning.”

Esmé: If you can make money, if you can contribute to the, you know, the capitalist machine, then you are high functioning. If you spend your days smelling flowers and lying around and watching TV, then you are not high functioning, and you are perhaps worthless or lazy or any of these other words that people may fling at people who are not, quote unquote, high functioning. So much of the idea of being high functioning is linked to money and whether one can make money or be part of that world.

Caroline: That’s why quitting her full-time editing job in 2013 felt like a crack in her high-functioning armor. Like, as long as Esmé could hold down a jobby job, like surely she couldn’t be that crazy

Cristen: But that stressful jobby job had been triggering psychotic episodes. The year Esmé left stable employment, she’d also experienced what’s called Cotard delusion, also known as walking corpse syndrome. For nearly two terrifying months, Esmé was convinced that she was literally a dead woman walking.

Caroline: By then, Esmé had also been involuntarily committed to psychiatric hospitals three times. As she wrote, "For those of us living with severe mental illness, the world is full of cages where we can be locked in.”

Cristen: Also, things like psychiatric emergency hold laws mean that people who are experiencing psychotic symptoms may be involuntarily committed. And while the point of those laws, sure, is to stop people from hurting themselves or others, when you’re living with a very unpredictable mental illness, they can feel terrifying.

Esmé: People ask like, well, how likely is it that you will have another psychotic episode or like, how do you know when you might have another psychotic episode? And the answer is really, I don't know. I could have another psychotic episode as soon as I leave this studio. I could have another psychotic episode tonight or I could have one tomorrow. Or I mean, these things are so unpredictable. You know, I take it not just day by day, but hour by hour and minute by minute. And yeah. Who knows?

Caroline: I'm kind of asking this question as - to you as someone who's both studied psychology and is dealing with some of these issues herself. Is it weird to you that, like some of these things aren't able to be better predicted. Like I'm thinking of a thing that can't really be compared. But like, for instance, migraines, you know, it makes me so upset that, you know, so many women experience terrible migraines all the time. And yet science is like, man, that's confusing, right, guys? Does it ever feel weird to you that some of these things can be so hard to predict?

Esmé : No, I mean, I think it is so frustrating. I think that especially when I was much more likely to be physically ill on a regular basis, it was so hard for me to make plans with people or make, you know, work plans because I didn't know if I would be really sick at any given moment. So I could make an appointment, say, to have a phone call with a potential client for something. And I had no idea if I would just be like horribly ill in the next hour or at that time of that phone call. And so it is frustrating, and it's so confusing, and it's so hard to know how to live your life.

Cristen: We’re gonna take a quick break. When we come back, Esmé tells us what happens when chronic illness meets hustle culture — and how disability has changed her approach to ambition.

Caroline: Stick around.

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Esmé: Getting work done without destroying one's self is something that I've been trying to figure out and trying to learn. And that’s been really important to me. Especially as somebody who grew up really ambitious and really type A.

Cristen: We’re back with critically acclaimed writer Esmé Wang.

Caroline: In 2015, after a few years of some really scary physical symptoms like extreme weight loss, weakness and fainting, Esmé was diagnosed with Lyme disease — on top of her schizoaffective disorder.

Esmé: So often I'm like, am I just making this up? Like, can I just will myself to be better? Is this - is this nothing, like is - maybe all of this is nothing.

Cristen: But this wasn’t a case of mind over matter. Those Lyme symptoms left her constantly fatigued and essentially forced Esmé to rest.

Caroline: So, when her primary work became taking care of herself, she had to make some adjustments.

Cristen: What does ambition look like to you through a disability lens?

Esmé: So one way that ambition has kind of had to change through a disability lens is that I've had to both change the things that I'm working toward, and I've had to find workarounds for how I work. So I'm no longer able to work in an office, so like a 9-to-5 kind of thing. But I am able to write. I'm still able to write. I can't work at a laptop at my desk for six to eight hours a day the way I used to. But I wrote basically the entirety of The Collective Schizophrenias on my phone or on an iPad while lying in bed. So I've just found workarounds to do the things that I feel I need to or want to do. And I think some, you know, some people or some things that really inspired me are say Frida Kahlo and how she painted in bed because of her injuries and yeah just things like that have been so incredibly inspirational to me. Not in a disability porn kind of way, but just in a like, yeah, workarounds. Like I - I can still do the things that I want to do, I'm just going to do them in a way that looks a little bit different.

Cristen: We did want to ask you about someone that I would call a real MVP of The Collected Schizophrenias, and that’s your partner, who you refer to as C. And I'm so curious to know, how have you managed your mental health journey alongside a long-term relationship?

Esmé: It has not been easy. Something that really bothers me is sometimes I'll be looking through reviews of my book and I'll see comments like, oh, I feel so sorry for the author's husband. And it really breaks my heart because it speaks to my biggest fears because it speaks to my fears of being a burden and of not being worth loving you know? But, yeah. He's - he is really wonderful. But he's not a saint. And we have gone through really rough times. We, you know, we've been to couples counseling. We had to find a way to get through the really tough times. But we're also, I think, really lucky to have one another, and we love each other a lot.

Cristen: So I've been talking to you this whole time with my dog in my lap. I also had to ask you, who is Daphne and what does she mean to you?

Esmé: Oh, my gosh. Daphne. Daphne is our little dog. She's, I think, about 7 now. She's a rescue. She's the best dog. She's so good. And I love her so much.

Cristen: Now, I want to say that I heard an interview with you where you mention that a psychic once told you that Daphne would be a great spiritual teacher to you.

Esmé: Yes, it's true. Yeah, you know, like, for example, we both have trauma issues. And so if you're cuddling with her and you move, she will freak out and jump away. And I used to be really hurt when she did that. And then I would try to coax her back. But then after a while, I realized like, no. Like she's having a trauma reaction and she needs her space. And that - that really taught me something, I was like, no, it's OK. Like, when she's having a little a little thing, you know, she just needs to be alone for a little bit. When she's scared, it's OK.

Cristen: As do so many of us.

Caroline: We just need some snuggles and then we need our space.

Cristen: For listeners who might be experiencing their own mental health struggles, is there any, I don't know, advice or any parting words in particular that you would give to them?

Esmé: Yeah, I think it's important to hold onto and to remember the things about you that are just you that are not your illness or your diagnosis or like all these things that have kind of like taken over your definition of yourself. I mean, I think it's important to remember that like you hate broccoli or that you are really good at painting your nails or that you think that Velveeta tastes really good or something. Like I think it's really important to remember the things that make you you that have nothing to do with mental illness or illness or yeah. Just any of those things, diagnoses or anything like that. So that would be my advice.

Cristen: Well, Caroline, I'm once again sitting here with Brewster, my rescue dog, in my lap, and since I started this episode talking about like my own - my own darkness, a mental space that I had spiraled into, and I feel like I should also report that I have been what sometimes feels like clawing my way out of that space.

Caroline: Yeah. Relatable.

Cristen: But I'm definitely in a much healthier place, in large part because I finally forced myself to start talking about it. A.K.A. I started seeing not one but two therapists, which is another story for another time. I also take Esme’s parting advice really to heart. I actually had just a really down day after we had talked to her and her advice of like, remember the things about you that like make you you beyond your mental health. And it just came back to me and it was so grounding in that moment and very reassuring. And I mean, I'll be honest, like mental health is like a day-by-day kind of thing, but it's also comforting to know that other people are dealing with it.

Caroline: And it's nice to hear her advice to remember that you are not your mental health or mental illness.

Cristen: Yes. Yes. And like, oh, my God. Like that. The whole part about like the productivity fears really resonate. And another thing that I took away from Esme is just also allowing myself to kind of create little systems that kind of adapt to my anxious tendencies of like if I need to like pace up and down the hall, like with my phone while editing, like, that's OK. So I hope that listeners have found her as like helpful as - as I have, because I really am not only astonished just by like the gift of her like talent and writing, but I truly appreciate her openness about a serious mental illness and one that specifically just isn't talked about. I mean, I never really talked to anyone about schizophrenia.

Caroline: And ultimately, it seems like a lot of people don't want to.

Cristen: Right. Right. Because it feels scary. But as I've learned from firsthand experience, talking about things is so important.

Caroline: Yeah, it is.

Cristen: Hashtag everybody go therapy.

[Stinger]

Cristen: You can find more writing from Esme on her website esmewang.com. There you’ll find tons of advice for creatives and folks dealing with mental illness.

Caroline: And we want to hear your thoughts about this. Do you have a serious mental illness? How do you handle it and what about our convo with Esme resonated with you? Tell us all about it. Email us at hello@unladylike.co, hit us up on social @unladylikemedia or join our private facebook group and find the thread for this episode.

Cristen: You can also head over to our site, unladylike.co, to find this episode’s sources and transcript. Plus, while you’re there, you can pick up some sweet Unladylike merch AND sign up for our newsletter to get a weekly update on actually good news about women in the world.

Caroline: Y’all can now support us by subscribing to our Extra Unladylike Patreon! We’ve started an ad-free bonus feed of episodes over at patreon.com/unladylikemedia.

Cristen: And for more bonus goodness, you can find bonus Unladylike PEP TALKS over at stitcherpremium.com. Use the code UNLADYLIKE over there to get 30 days of free listening.

Caroline: Nora Ritchie and Sam Lee are the producers of Unladylike. Abigail Keel is our senior producer. Gianna Palmer is our story editor. Shruti Marathe transcribes our tape. Our music is by Flamingo Shadow, Amit May Cohen and Sarah Tudzin. Mixing, sound design and additional music is by Casey Holford. Executive producers are Chris Bannon, Daisy Rosario and Unladylike Media. This podcast was created by your hosts, Cristen Conger and Caroline Ervin of Unladylike Media.

Cristen: Special thanks to the folks over at KQED for recording Esme. And a super special thanks to my dog and Unladylike’s unpaid intern Brewster, who sits on my lap for each and every recording of this podcast.

Caroline: Next week ...

Nicole Ellis: I know that I want to have a family that involves children. Ideally, I want to have kids that are genetically related to me and biologically related to me. And there's a lot of emotion in that, right? There's a lot of emotion in forcing yourself to think through the possibility that that might not happen. And you just want to stave off that fear as much as you can. And that's why egg freezing is popular.

Cristen: We’re talking to Nicole Ellis from The Washington Post about her journey to find out if she should freeze her eggs. Make sure you’re subscribed to Unladylike so you don’t miss this episode. Find us in stitcher, spotify, apple podcasts or wherever you listen to podcasts.

Caroline: And remember, got a problem?

Cristen: Get unladylike.

[Stinger]

Caroline: Don’t go anywhere

Cristen: I actually have to go somewhere because my battery’s about to run out, brb

Caroline: [Singing] Takin’ an intermission … let’s all go to the lobby!

Nora: I’ll be right back myself!

Caroline: All right! I’ll just —

Cristen: Caroline, you wanna get outta here?

Caroline: I’ll just be here!