The Center Cannot Hold

Whatever your image of an individual with schizophrenia, I am willing to bet it is not Elyn Saks.

Saks, Elyn R. The Center Cannot Hold: My Journey Through Madness. New York: Hyperion, 2007.

In “The Second Coming,” Irish poet W. B. Yeats wrote: “Things fall apart, the centre cannot hold; mere anarchy is loosed upon the world.” From this evocative poem comes the title of the brave and courageous memoir by Elyn Saks. Saks provides a phenomenological account of her life with schizophrenia as an oscillating experience of excelling academically while trying to keep her mental illness from disabling her.

She begins by detailing her idyllic childhood in a loving and prosperous home. Saks grew up with two parents and two brothers and her family resembled “a Norman Rockwell magazine cover or a gentle fifties sitcom” (p. 8). However, when Saks was only eight years old, she began to experience intense compulsions and phobias. She became convinced that her family home was staked out by a malevolent figure. Around this time she also began having night terrors and her mind began to feel like “a sand castle with all the sand sliding away in the receding surf” (pp. 12-13).

As a teenager, a key life event for Saks was her early experimentation with marijuana and mescaline which led to several years of compelled enrollment in a drug rehabilitation program. During this time, she was taught that all drugs were bad and that any obstacle could be overcome with a sheer force of will. This view would become problematic later on when her psychiatrists would urge her to go on medications and she would fight these prescriptions at every turn.

When she entered Vanderbilt University as an undergraduate, her illness began to deteriorate and she abandoned any interest in personal hygiene and self-care. It was during her undergraduate years when “schizophrenia [rolled] in like a slow fog” becoming “imperceptibly thicker” as time went on (p. 35). Yet, despite her illness, she earned top grades and even took several graduate courses where she developed meaningful friendships with some older students. During this time, she also developed a love for philosophy. She writes:

Philosophy and psychosis have more in common than many people (philosophers especially) might care to admit. The similarity is not what you might think—that philosophy and psychosis don’t have rules, and you’re tossed around the universe willy-nilly. On the contrary, each is governed by very strict rules. The trick is to discover what those rules are, and in both cases, that inquiry takes place almost solely inside one’s head. And while the line between creativity and madness can be razor thin (a fact that has been unfortunately romanticized), examining and experiencing the world in a different way can lead to sharp and fruitful insights. (pp. 40-41)

At Vanderbilt, Saks was granted a Marshall scholarship to study the Classics at Oxford. During her years in England, Saks had intermittent experiences with paranoia and delusional thinking. While in England, she was twice hospitalized for depression (which resulted from her psychosis) and she detailed her experience in talk therapy with a remarkable, if austere, classical analyst. Psychoanalysis would prove to have a huge influence on Saks’ recovery. “While medication kept me alive,” she writes, “it had been psychoanalysis that helped me find a life worth living” (p. 32).

Her studies at Oxford were followed by acceptance to Yale Law School, where Saks again succeeded with distinction despite severe active psychosis and concomitant hospitalization. As a student at Yale, Saks saw various therapists, was institutionalized and physically restrained repeatedly. She also tried many different psychotropic medications, some of which had debilitating side effects. For a long time she believed that her delusional behavior resulted from her self-perceived weaknesses and worthlessness. With a raw honesty, she talks openly about her struggles with her failed attempts at managing schizophrenia without medication, realizing in the end that her disease is a biological one and that medication would be a necessary part of a life of recovery. After graduating from Yale with a law degree, Saks eventually secured tenure at the University of Southern California Law School where she specialized in mental health law and criminal law and published several articles and books. She also obtained a doctorate in psychoanalysis.

Saks is an eloquent writer who allows the reader to share in some of her most personal and painful secrets. One can only imagine how difficult it must have been to reveal so much of oneself after years of maintaining a façade of normalcy to the outside world. Her memoir is a captivating account of psychotic breakdowns, institutionalizations, progress and regression, as well as academic and professional achievements. A less determined individual might have avoided being challenged in any way, but Saks was a serious scholar who’s love for philosophy, psychology, and law kept her going and in such prestigious schools such as Oxford and Yale. She also formed and maintained close relationships and found love in a man who accepted her. Slowly, she prevailed.

My worst criticism of this book is that it suffers from repetitiousness, given the unending cycle of success followed by predictable decompensation that characterizes her life. It’s not necessarily that I would want to know less information, but the dialogue rendition of “disorganized thoughts” soon grew tired. On the other hand, her very accurate depiction of the “liberal” use of mechanical restraints at Yale New Haven Hospital made me shudder, having witnessed exactly what she described during one of my hospitalizations.

There are several great articles about Saks as well as a powerful TED Talk where she talks of overcoming the “grave” prognosis given to her by numerous doctors and provides a powerful inside view of what it is like to live with schizophrenia. In the video, she provides a first hand account of being involuntarily restrained by doctors in the United States despite the fact that she never harmed herself, anyone else, or made any direct threats against anyone. She believes that mechanical restraints are dangerous and demeaning and she does not think that they are acceptable treatment for someone suffering from a terrible illness. She says she is “pro-psychiatry, but anti-force.” She also cites three reasons for her success and high-functioning capability: excellent treatment, a strong support group of friends and family who know her illness, and a supportive workplace. She notes that the most powerful and reliable defense against schizophrenia has been occupying her mind with complex and intellectually stimulating problems. In order to overcome the stigma of mental illness, Saks argues that we need to invest more research into what causes mental illnesses in order to better treat them. She also notes that we need to stop criminalizing mental illness. Lastly, she argues that the press and entertainment industries should continue to include those who suffer from severe mental illness by hiring them or portraying them in a positive light. It’s a short video and worth watching.

There is much to learn from Saks’s brave account of her mental illness. She has spared little in describing deeply personal aspects of her life. She also displays an awareness of her privilege on the mental illness spectrum. She is aware of her position as a middle class woman who has the advantages of managing her recurrent psychotic episodes that other do not have. To be sure, Saks has resources. She benefits from five hours a week of psychoanalysis which is unimaginable for most who cannot afford even one hour a week. She is modest in her hopes for her memoir: “I hope that by writing this book I help others to take some of what they need to lead a life worth living.” Her aim is similar to that of Dr. Marsha Linehan who shares the same goal in her development of dialectical behavioral therapy. The candor and accessibility of The Center Cannot Hold will go a long way to realizing that hope. Anyone with a clinical, academic, or personal interest in mental illness will find this book both compelling and rewarding. This book is written in an engaging manner and is replete with keen observations and first hand accounts of Saks’ experiences which lift the book into the category of notable memoirs on mental illness. But as Saks herself notes, she is one of the exceptions of individuals living with schizophrenia. There are many who suffer who are not pressing forward with their lives. I wonder how they would reconcile Saks’ message of hope—for a kind of super success, even as psychosis continues unabated—with the bleak reality that they see?