Review: The Center Cannot Hold by Elyn R. Saks

The Center Cannot Hold: My Journey Through Madness by Elyn R. Saks (Hachette Books 2007)

Reviewed by Patricia Steckler

Horrifying delusions and auditory hallucinations did not deter Elyn Saks from her Oxford University Master’s degree studies. Compassionate psychiatric care in England squired her through. But, later, as a law student at Yale University and in a psychotic state, Yale psychiatrists “bound both legs and both arms to a metal bed with thick leather straps” and forced medication down her throat. Multiple times. She plummeted into despair.

“A sound comes out of me that I’ve never heard before—half groan, half scream, marginally human, and all terror. Then the sound comes out of me again, forced from somewhere deep in my belly and scraping my throat raw. Moments later, I’m choking and gagging on some kind of bitter liquid that I try to lock my teeth against but cannot. They make me swallow it. They make me.” (4)

Haunted and rattled to her core by this and other hospital-induced traumas, Saks’s grit and determination propelled her through her law studies, despite how shattered she’d felt. She prevailed, graduated from Yale, and embarked on a mission to legally safeguard the rights of Americans with severe psychiatric illnesses. (England had outlawed the use of restraints two hundred years ago.)

Saks’s memoir, The Center Cannot Hold: My Journey Through Madness, is the draconian life story of an intellectually gifted woman, wrenched out of a normal life by the turbulence of severe mental illness. Voices demeaned her. Disordered thoughts confused her. Words tumbled out of her mouth in stream-of-consciousness word salads that plagued this otherwise thoughtful, gentle, and fragile woman.

Saks captures her wobbly, dissolving thoughts in poignant passages throughout the book. From memos to lemons to demons, Saks’s mind makes these wild free associations, symptoms of schizophrenic thinking: “Come to the Florida lemon tree! Come to the Florida sunshine bush! Where they make lemons. Where there are demons.” (2)

Saks is afflicted with schizophrenia. She is the Orrin B. Evans Distinguished Professor of law, psychology, and psychiatry at the University of Southern California Gould Law School and the director of the Saks Institute of Mental Health Law, Policy, and Ethics. Saks is a passionate fighter for the rights of people with severe mental illnesses. She shows us that mental illness does not have to be a life sentence.

Yet, doctors, universities, employers, and the public routinely shun and reject people with psychiatric diagnoses. While working in New Haven after law school Saks was hit by a hammering headache and became, uncharacteristically, confused of her whereabouts. Concerned friends, who’d known her through psychotic episodes, believed that she was ill, medically, not psychiatrically. They took her to the emergency room. But once the ER doctor learned her psychiatric history, he dismissed her without a medical work-up. “Stigma against mental illness is a scourge with many faces, and the medical community wears a number of those faces,” explains Saks. (232)

The doctor assumed that “I was ‘just’ having a psychotic episode,” said Saks, and dismissed her from the ER. Her friends, deeply worried for her life, contacted her mother who flew up from Florida to intercede. Again, Saks went to the ER. This time “I was diagnosed with a subarachnoid hemorrhage — my brain was bleeding. The mortality rate from this kind of hemorrhage is about 50 percent.” (232-234)

Fear and aversion typify the public’s reaction to mental illness. Common reactions include crossing to the other side of the street, whispering about that crazy person, and spouting beliefs that those folks should be locked away. In fact, it’s the people with schizophrenia, suffering from disorganized thoughts, perceiving that the world is dissolving, and hearing voices shout derogatory words who are the legitimately frightened souls. “Psychotic people…do scary things because they are scared.” (97)

Here’s how Saks describes her psychotic states:

Place yourself in the middle of the room. Turn on the stereo, the television, and a beeping video game, and then invite into the room several small children with ice cream cones. Crank up the volume on each piece of electrical equipment, then take away the children’s ice cream. Imagine these circumstances existing every day and night of your life. (229)

Elyn Saks makes my heart throb and sing. Courageous in her drive to overcome serious mental illness and heroic in the face of screaming demons that inwardly blare “I am evil. I’ve killed you three times today…I’ve killed hundreds of thousands of people with my thoughts.” (97) She puts readers inside her psyche. She captures the overwhelming experience of her mind as it crumbles during psychotic episodes.

“Consciousness gradually loses its coherence. One’s center gives way. The center cannot hold.” (13)

But Saks did get hold of her center. Saks found caring psychotherapists who interpreted her psychotic symptoms in ways that made them comprehensible to her. “Often, I’m navigating my life through uncertain, even threatening, waters—I need the people in my life to tell me what’s safe, what’s real, and what’s worth holding onto.”(331)

Her therapists were steadfast in their care. They respected her fervent wish not to be re-hospitalized. Saks also took anti-psychotic medication that helped stabilize her, though not without side effects and lapses in effectiveness.

Compassionate, calmly delivered collaborative care, is the mainstay of good psychotherapy. With thoughtfully prescribed psychotropic medication and an unflinching commitment by mental health professionals, people with schizophrenia and other major psychiatric illnesses can be guided into a life of meaningful work and loving relationships.

The Center Cannot Hold was an overnight sensation in mental health circles, a best seller, and it won Dr. Saks a $500,000 MacArthur Genius award from which she founded her institute. For Saks, “the real payoff was discovering a fellowship of fans, high-functioning people with the same diagnosis as herself, some of whom would stand up and self-disclose.” (NYT, 2011) The Center Cannot Hold was and, is still, a lodestar for people with serious mental illness.

Saks’s story epitomizes ascendancy over severe illness, driven by steely resolve and succored by the support of loving friends and committed professionals. I wish she were my friend. She is surely my inspiration.

Buy this book: Indiebound / Amazon

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