In and Out of Oblivion

Schizophrenia is a strange thing. While statistically uncommon enough to be susceptible to nation-wide medication shortages, it inhabits a prominent niche in the Australian vernacular. From schoolyards to bush doofs, you can go skitzo, skitz out, or even chuck a skitz. On YouTube, you can watch a raver at the hardcore festival ‘Defqon’ inviting fellow dancers to get skitz. Schizo doesn’t translate easily onto the page. Though I must have heard it hurled from the backs of buses to high school corridors a hundred times, the abbreviation remains an orthographic conundrum. It seems like it should be skitz, although that reads too much like skit. If a psychotic episode can appear as a dramatic sketch, it’s more likely to be tragedy than comedy. The word haunts the edges of our everyday consciousness and wanders in from the margins of books, like the schizophrenic itinerant in Rachel Cusk’s first novel, Saving Agnes.

There are many vernacular words used for madness, but we are impoverished when it comes to the lived narratives of people with schizophrenia, bi polar and other psychotic disorders. I am opinionated on this subject. Both of my parents have been diagnosed with schizophrenia, as has my sibling, and my partner has been diagnosed with schizoaffective disorder. I find it hard at times to relate to people who have no relationship to complex mental illness. I don’t think it’s the condition itself that’s the barrier, but the lack of a shared understanding that life is messy – that people can be confusing, frightening, sometimes violent; that histories can shift and stain and leak into the present; that the mind can be an unreliable narrator. 

‘For many of us, the word schizophrenia alone elicits thoughts of a nightmare, a killer, something to be avoided, to run from,’ writes journalist Elfy Scott in The One Thing We’ve Never Spoken About. Refreshingly, her book explores schizophrenia in an inquisitive and compassionate vein. Scott begins the book by introducing her mother with warmth, openness, and humour. Rather than a collection of symptoms, we get a sense of the whole person: a woman who worked as a flight attendant and went on to raise a family on Sydney’s north shore. We learn that she grew up as part of a large family in 1960s Jakarta during an economic downturn and the mass anti-communist killings assisted by Australian and UK intelligence forces (I mention this because when we talk about individuals experiencing disordered or conspiratorial thinking, it’s worth remembering that some of this may not be entirely unwarranted). We learn of the voices that first appeared in the silence while her mother prayed, leading her to believe that outsiders were threatening, watching, insulting her. These intrusions are met with incomprehension from those around her: ‘My siblings and I would hear the same things, see the same things and never be able to express to each other what it was like’. Scott illustrates schizophrenia as an often alienating experience, primarily for the person whose life has been turned inside out, and secondarily for those around them who are tasked with interpreting their erratic signals. In Scott’s case, her mother would interpret smoke machine lights as extraterrestrial activity, or message the family WhatsApp with fears of a microchip being implanted in her brain. This dual perspective has a reassuring effect – being able to see outside the frame of these world-constricting paranoias is what makes them inert.  

The One Thing We’ve Never Spoken About joins a recent upwelling of Australian memoir and fiction that explore women’s experience of schizophrenia directly, or from the perspective of children who have grown up and gone on to write about their mothers. A common point of focus is the sudden change out of once-stable roles. In Paula Keogh’s memoir The Green Bell (2017), two psych ward patients become lovers. In Get Up Mum, Justin Heazlewood’s 2018 memoir, parent and child become enemies, neighbours foes (‘When Mum gets sick she thinks Nan and Pop are bad people and that Barbara [a neighbour] was planted there to spy on her’). Where Get Up Mum employs a diaristic style, collaging school worksheets and doodles from the margins of exercise books in between anecdotes, Sanya Rushdi’s 2023 novel Hospital uses a script-like narrative to record the interactions between the sectioned narrator and those around her, with the small bridges that make events more coherent or navigable noticeably absent. A fellow patient named Shane asks the narrator why she thinks she developed psychosis, if it was the pressure of her PhD: 

The narrator’s ability to study self-conscious emotions in children is juxtaposed alongside the opacity of her own inner experience. In the midst of her self-alienation, the narrator’s ‘I’ begins to feel uncannily like a supporting character – someone being spoken about or observed from the outside – as she is effectively locked out of being able to direct a causal retelling. In this way, the writing illustrates the hyper-reflexivity generally considered to be a core aspect of schizophrenia, a form of ‘exaggerated self-consciousness in which aspects of oneself are experienced as akin to external objects’, in the words of clinical psychologist Luis Sass and psychiatrist Josef Parnas. 

The One Thing We’ve Never Spoken About is also attuned to self-consciousness, but quickly expands from a personal viewpoint into an ambitious explainer-type piece of longform journalism on psychosis and its stigma. The anticipation of outsiders’ reactions to schizophrenia is a recurring theme. Reading her mother’s journal, Scott realises the ‘weight of the secrets’ that her mother never shared with her children, and further outlines the difficulty of explaining a condition that comprises such a broad umbrella of symptoms and definitions that can shift depending on the context. ‘Diagnoses’, as Scott writes, ‘can change from professional to professional, as well as over time’. Accounts such as Monique Grbec’s essay on her mother’s schizophrenia, ‘Confronting the Stolen Tears’ (2018), chart the trajectory of mental illness through endless treatments and diagnoses:  

Importantly, Grbec writes context into the diagnoses: her mother’s experience of being separated from her family and raised as a ward of the state from only eight months of age, being made to work for no pay from the age of fourteen. But enforced treatment tends to delete this context, creating in patients a ‘numbness’, an inability to express feeling that arises in response to such world-altering dispossessions, including, for Grbec’s mother, the loss of custody of her own children. Changing diagnoses have a tumultuous effect on the person experiencing psychosis, adding further instability to the lives of sufferers whose illnesses can then intensify rather than recede in severity. But even more radically, the language of diagnosis prises apart the mind from its external conditions, personal from collective histories. Terms like ‘complex ill health’ or ‘mental illness’ medicalise and isolate symptoms that are the outcomes of abuse and intergenerational trauma. 

There is a popular story about psychosis that represents the experience as a kind of psychic evacuation, emptying the person of any history or identity preceding the initial episode. As Esmé Weijun Wang puts it in The Collected Schizophrenias (2019): 

This ‘unrecognizability’ is a trope that’s familiar in not only writing about schizophrenia but also representations of old age; and, as Scott notes, ‘Up until [1908], schizophrenia had been known as “dementia praecox”, a kind of early onset dementia.’ Here, the ravages of time are replaced by the ravages of psychosis, but Wang challenges the idea that the overwriting of one’s identity can ever be total. In sardonic riposte to a psychologist’s suggestion that schizophrenia, like Alzheimer’s disease, ‘to some degree eliminates that person’, Wang asks, ‘Is everyone the same as they were ten years ago?’ Both Weijun-Wang and Scott acknowledge that the effects of antipsychotic treatment itself can be transformative. Over time, the side-effects of antipsychotic medications take a heavy toll: intense fatigue, weight gain, suppressed immunity, cardiac arrythmia, tardive dyskinesia (uncontrollable shaking). Drugs like lithium can induce toxification of the kidneys, while overly high doses of sedative can induce catatonia. Medication is supposed to make you healthier, but antipsychotics can cause damage to physical health in the long term. In this way the recovery narrative is turned back on itself. The diagnosis becomes a kind of self-fulfilling prophecy, as the sufferer becomes the evacuated subject of the medical diagnosis (‘the schizophrenic’) at the end of the course of treatment, rather than at the beginning.  

Timelines are interrupted and upended by psychotic illness, which common terminology would segment into episodes, as if there were a neat way to draw the line between where reality ends and where hallucination begins. This is one of the central concerns in The One Thing We’ve Never Spoken About. In searching for the source of hallucinations, Scott reveals a dissolving partition between the self and the ‘outside’. One of Elfy Scott’s interview subjects, Joe, describes auditory hallucinations as being akin to music: 

Music is a thread that runs through the book, popping up again in the metaphor of ‘discord’ as Scott explores the triggers for psychotic disorders. Bringing to mind a dissonance, a wrong note, a signal confirming a sense of disconnection or hostility, it’s a potent word for expressing the paranoia that so often underscores psychosis. Where psychosis is often seen as a loss of the capacity for meaning-making, it can be more accurately thought of as a need to rearrange or look for meaning in the noise of precarious signals. In this way, psychosis may not be an aberrant experience so much as a window into a fundamental human drive to maintain a sense of order. As Sarah Krasnostein writes in The Believer (2021), citing an article in Science on the correlations between pattern perception and wellbeing, ‘The need to be in control is so strong that “individuals will produce a pattern from noise to return the world to a predictable state”.’ Krasnostein is writing about faith rather than madness, but the cognitive desire is similar: noise, discord, mixed signals – a jarring uncertainty arises from the static, waiting to be tuned into a guiding chorus, however unreliable such voices may ultimately be. They both share a drive to make music from discord. 

The One Thing We’ve Never Spoken About is most interesting when opening up new ways of understanding psychosis through analogies with not only music but also other creative processes. Early on Scott interviews a psychology professor, Dr Jayashri Kulkarni, who compares hallucination to learning a new language in the way that we might repeat a phrase until it seems more natural, or more logical as the circuit of meaning is strengthened by the increasing cluster of references around it. If a rave can be schizo, music a metaphor for paranoia, language acquisition a parallel for hallucinatory reinforcement, then schizophrenia would appear to require diverse storytelling modes. The root of the word schizophrenia comes from the Greek word for ‘split mind’, which opens up rich literary possibilities. In his 2024 essay ‘A Story-Shaped Life’, Gan Ainm writes of a kind of splitting of the self that occurs when psychotic illness takes hold: 

What Ainm helps characterise is the expansive disorientation that sets in with psychosis, a feeling of atemporality and ungroundedness. Nonlinear timelines take root in such experiences, inviting new narratives about illness and recovery. This is something that Scott’s book touches upon in its interest in the way people with schizophrenia structure their stories of recovery and the places they publish, from Facebook groups to subreddits, where ‘[p]eople share images of their tattoos and writing created during manic periods.’ There is a distinctive rhythm and logic to the way mania contours speech, unfurling into the disjointed verses of word salad or the fast-moving jumps between conclusions popularly known as flights of ideas. But these patterns are not explored in any depth. 

This is perhaps the book’s greatest weakness: it employs a very broad brush, glossing over details in an explanatory manner that tends towards a generality with sanitising effect. Scott eschews the word ‘patient’ and replaces it with ‘consumer’ (though, as anyone who has flipped through a mental health clinic brochure knows, she is not alone in this); instead of ‘poor’ there is ‘socioeconomically disadvantaged’. Such polite, abstract phrases facilitate oversimplification at times. For example, when explaining the lack of community-based services available to people with schizophrenia, Scott writes, in the manner of a retail report: ‘Consumers have been left without places to go where they can chat to people who live like them and their families do, where they can relate to others, work on their goals, plan their futures.’ This appears in the context of a three-page summary of the history of deinstitutionalisation, about which Scott generalises: ‘People living with the condition were turfed out of institutions without the comprehensive mental health support they needed, with no places to live and no prospects’. These absolutes ring hollow in the absence of more in-depth research into long running community-based supports, including, for example, the Richmond Fellowship, an organisation that provides housing services specifically to patients discharged after long-term hospitalisation for psychosis without the means to secure accommodation. In Australia such supports also include halfway houses, hospital re-provision, residential recovery programs, and satellite housing. Scott does mention the Richmond report of 1983 that recommended a ‘system of integrated community based networks, backed up by specialist hospital or other services as required’, though she goes on to make the point that deinstitutionalisation has been used as a political means to cut mental health funding. As compelling as this broader point is, the outrage that this argument is intended to provoke comes across as shallow when the research doesn’t seem particularly nuanced. Among other things, a proper assessment of deinstitutionalisation would delve further into the history of Australian mental hospitals, noting the carceral function of many institutions operating as asylums. 

Perhaps the most frustrating of Scott’s explanations is the repeated equivalence she draws between schizophrenia and other illnesses, including diabetes. This makes sense in the first instance, insofar as those with either condition need to keep on top of a medication regime. But then she references a quote from a media commentator that juxtaposes news representations of murder committed by people with schizophrenia with those committed by people with diabetes. It’s easy to appreciate Scott’s implicit aim here of distancing mental illness from its immediate association with violence by showing that those with physiological illnesses can be just as prone to such outbursts. But such an argument only seems to stigmatise more people, while overlooking the mental element unique to schizophrenia – an element that courts, for instance, weigh up very carefully in sentencing decisions where psychiatric illness is involved.  

Scott is right that language heavily contours the lives of people with schizophrenia, and the courtroom is one such place where narratives become material. The narrativisation of mental dysfunction is nowhere more formulaic than in sentencing hearings. After the prosecution has read out the ‘facts’ detailed on the indictment, there is a ‘plea in mitigation’ from the defence. This is the point where we rewind to hear a bit of the accused person’s story, usually a fleeting snapshot of the health conditions or trauma or family responsibilities they carry – something to mitigate the sentence. Often the plea will mention some form of treatment involving antipsychotic medication. 

While, on the one hand, we have a surplus of terms around psychotic illness, there is, on the other, a language deficit around the experience of psychosis that can capture its far-fetchedness and intensity. Books like Scott’s are in a difficult position, forced into a PR-type advocacy role that constricts the possibility of being intellectually unrestrained – and truthful about the condition. The One Thing We’ve Never Spoken About illustrates this awkward palatability in its handling, and quick dismissal, of depictions of schizophrenia in popular culture. I am perturbed when Scott characterises the presence of psychotic illness in films – ‘like […] a roommate with schizophrenia who becomes so obsessed with the person they’ve living with that they kill their cat and then attempt to murder them’ – as ‘explicitly offensive’. Real-life parallels aren’t actually hard to find; I read this passage after a recent murder case concerning a man with schizophrenia and his neighbour, also involving a cat. Concerningly, the book positions such incidents as outlandish, framing their worst outcome to be what other people will say or think about people with schizophrenia. Instead of exploring these ingrained tropes, Scott simply blots out confronting representations as being in poor taste when they are, in fact, some people’s realities. At one point, Scott asks a professor whether putting teenagers through an early psychosis prevention program could be ‘stigmatising and damaging’ – as if it were far worse to be identified as psychotic than having to endure a debilitating experience that necessitates early intervention.  

From courtrooms to hospitals, people’s life trajectories can so often depend on the hinges between words, or unravel over something in the fine print. A seemingly tiny snag in the elastic can cause the sheltering structure to come undone. Or it might reveal a secret that was too big to bury. In any case, The One Thing We’ve Never Spoken About makes the burden lighter by removing the weight of silence.