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The Center Cannot Hold: My Journey Through Madness
Elyn Saks is a success by any measure: she's an endowed professor at the prestigious University of Southern California Gould School of Law. She has managed to achieve this in spite of being diagnosed as schizophrenic and given a "grave" prognosis—and suffering the effects of her illness throughout her life.
Saks was only eight, and living an otherwise idyllic childhood in sunny 1960s Miami, when her first symptoms appeared in the form of obsessions and night terrors. But it was not until she reached Oxford University as a Marshall Scholar that her first full-blown episode, complete with voices in her head and terrifying suicidal fantasies, forced her into a psychiatric hospital.
Saks would later attend Yale Law School where one night, during her first term, she had a breakdown that left her singing on the roof of the law school library at midnight. She was taken to the emergency room, force-fed antipsychotic medication, and tied hand-and-foot to the cold metal of a hospital bed. She spent the next five months in a psychiatric ward.
So began Saks's long war with her own internal demons and the equally powerful forces of stigma. Today she is a chaired professor of law who researches and writes about the rights of the mentally ill. She is married to a wonderful man.
In The Center Cannot Hold, Elyn Saks discusses frankly and movingly the paranoia, the inability to tell imaginary fears from real ones, and the voices in her head insisting she do terrible things, as well as the many obstacles she overcame to become the woman she is today. It is destined to become a classic in the genre.
Saks was only eight, and living an otherwise idyllic childhood in sunny 1960s Miami, when her first symptoms appeared in the form of obsessions and night terrors. But it was not until she reached Oxford University as a Marshall Scholar that her first full-blown episode, complete with voices in her head and terrifying suicidal fantasies, forced her into a psychiatric hospital.
Saks would later attend Yale Law School where one night, during her first term, she had a breakdown that left her singing on the roof of the law school library at midnight. She was taken to the emergency room, force-fed antipsychotic medication, and tied hand-and-foot to the cold metal of a hospital bed. She spent the next five months in a psychiatric ward.
So began Saks's long war with her own internal demons and the equally powerful forces of stigma. Today she is a chaired professor of law who researches and writes about the rights of the mentally ill. She is married to a wonderful man.
In The Center Cannot Hold, Elyn Saks discusses frankly and movingly the paranoia, the inability to tell imaginary fears from real ones, and the voices in her head insisting she do terrible things, as well as the many obstacles she overcame to become the woman she is today. It is destined to become a classic in the genre.
340 pages, Hardcover
First published August 14, 2007
About the author
Elyn R. Saks
9 books285 followersElyn R. Saks, training to be a psychoanalyst, specializes in mental health law, criminal law, and children and the law. Her recent research focused on ethical dimensions of psychiatric research and forced treatment of the mentally ill. She teaches Mental Health Law, Mental Health Law and the Criminal Justice System, and Advanced Family Law: The Rights and Interests of Children. She also teaches at the Institute of Psychiatry and the Law at the Keck School of Medicine at USC and is an adjunct professor of psychiatry at the University of California, San Diego. In her capacity as associate dean, Dean Saks oversees research and grants at USC Law.
Dean Saks recently published The Center Cannot Hold: My Journey Through Madness (Hyperion, 2007), a memoir about her struggles and successes with schizophrenia and acute psychosis. Other publications include Refusing Care: Forced Treatment and the Rights of the Mentally Ill (University of Chicago Press, 2002), Interpreting Interpretation: The Limits of Hermeneutic Psychoanalysis (Yale University Press, 1999), and Jekyll on Trial: Multiple Personality Disorder and Criminal Law (with Stephen H. Behnke, New York University Press, 1997).
Before joining the USC Law faculty in 1989, Dean Saks was an attorney in Connecticut and instructor at the University of Bridgeport School of Law. She graduated summa cum laude from Vanderbilt University before earning her master of letters from Oxford University and her J.D. from Yale Law School, where she also edited the Yale Law Journal. She is a member of Phi Beta Kappa; an affiliate member of the American Psychoanalytic Association; a board member of Mental Health Advocacy Services; and a member of the Los Angeles Psychoanalytic Foundation, Robert J. Stoller Foundation, and American Law Institute. Dean Saks won both the Associate’s Award for Creativity in Research and Scholarship and the Phi Kappa Phi Faculty Recognition Award in 2004.
Dean Saks recently published The Center Cannot Hold: My Journey Through Madness (Hyperion, 2007), a memoir about her struggles and successes with schizophrenia and acute psychosis. Other publications include Refusing Care: Forced Treatment and the Rights of the Mentally Ill (University of Chicago Press, 2002), Interpreting Interpretation: The Limits of Hermeneutic Psychoanalysis (Yale University Press, 1999), and Jekyll on Trial: Multiple Personality Disorder and Criminal Law (with Stephen H. Behnke, New York University Press, 1997).
Before joining the USC Law faculty in 1989, Dean Saks was an attorney in Connecticut and instructor at the University of Bridgeport School of Law. She graduated summa cum laude from Vanderbilt University before earning her master of letters from Oxford University and her J.D. from Yale Law School, where she also edited the Yale Law Journal. She is a member of Phi Beta Kappa; an affiliate member of the American Psychoanalytic Association; a board member of Mental Health Advocacy Services; and a member of the Los Angeles Psychoanalytic Foundation, Robert J. Stoller Foundation, and American Law Institute. Dean Saks won both the Associate’s Award for Creativity in Research and Scholarship and the Phi Kappa Phi Faculty Recognition Award in 2004.
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August 3, 2010
It's a little sad and frustrating when people read this and say things like "whenever she's off her meds, she has an episode, she should just stay on them!".
The most difficult thing in treating mentally ill people is getting them to take and stay on their meds for reasons she details in her book. First, there are usually pretty severe side effects such as permanent nerve damage that causes you to twitch and spasm constantly, have trouble thinking clearly, have no energy and put on a lot of weight. Second, when you're feeling fine for a long period of time it can be hard to believe that you're actually still sick. Third, there's such a strong stigma against mental illness and people who are medicated for mental illness it leads you to feel worthless or inferior when you need meds to control your situation.
She has had far more positive impact with her life with this debilitating, incurable illness than most people will have without such an obstacle.
If you have no empathy this book will frustrate you. That would also make you an asshole.
The most difficult thing in treating mentally ill people is getting them to take and stay on their meds for reasons she details in her book. First, there are usually pretty severe side effects such as permanent nerve damage that causes you to twitch and spasm constantly, have trouble thinking clearly, have no energy and put on a lot of weight. Second, when you're feeling fine for a long period of time it can be hard to believe that you're actually still sick. Third, there's such a strong stigma against mental illness and people who are medicated for mental illness it leads you to feel worthless or inferior when you need meds to control your situation.
She has had far more positive impact with her life with this debilitating, incurable illness than most people will have without such an obstacle.
If you have no empathy this book will frustrate you. That would also make you an asshole.
April 5, 2022
I have this fascination for mental health memoirs. I’ve read about a dozen or so, among them: Zen and the Art of Motorcycle Maintenance, which is brilliant, one of the essential books of my life; Memoirs of My Nervous Illness by Daniel Paul Schreiber; Awakenings by Oliver Sacks, this more of a multi-persona biography than a memoir; William Styron’s Darkness Visible; Kay Redfield Jamison’s An Unquiet Mind; Andrew Solomon’s The Noonday Demon; Frigyes Karinthy’s A Journey Round My Skull; and The Collected Schizophrenias by Esmé Weijun Wang. The last here is a recent publication and completely enthralling. Wang led me to Elyn R. Saks.
Interesting so far is the early collapse of Elyn’s social world. The early adulthood onset of schizophrenia is so brutal. She’s barely 19 and attending Oxford on a Marshal scholarship when she turns resolutely inward, meaning silent. She’s a philosophy major. Saks has a rich emotional memory. She remembers strings of dialogue but also the succession of her emotional states. I have that skill, too. Every humiliation is so readily recalled. Her first experience of any sort of mental health care was in England, where she was never restrained. In England she found affordable psychoanalysis from a talented woman. It saved her. She graduated Oxford with honors, finished her treatment with Mrs. Jones, the analyst, and returned to the U.S. just as she was about to undergo a severe intensification of her illness.
At that time, 1981, psychoanalysis — though it was the only treatment she responded to — was out of favor, and the next generation of antipsychotics had yet to come along. (Oliver Sacks, who blurbs this book enthusiastically, wrote Awakenings which discusses the dreaded side effects of some of the first-generation antipsychotics like L-DOPA.) Author Elyn Saks was finally diagnosed with “chronic paranoid schizophrenia with acute exacerbation.” Her prognosis was termed “grave.” She was now attending Yale law school and spending much time in its mental health facilities. It was Yale-New Haven Hospital that Saks was brutally restrained for the first time. She argues convincingly that such restraints were for the convenience of the staff, not for her own well-being. She suffered inordinately. (Ironically, it was also in a Yale-operated psychiatric hospital that Esmé Weijun Wang, author of The Collected Schizophrenias, would be ruthlessly manhandled more than a generation later.)
It’s when Saks begins to help mentally ill people like herself, that the story becomes doubly interesting. Today she is a professor at USC’s Gould School of Law. Please look for her TED Talk. Astonishing is her achievement when you consider that many with schizophrenia spend their adult lives playing with their feces or babbling or screaming much of the time. An early lesson. Working with a fellow student, she advocates for a young man to be released from some back ward somewhere who then goes on to burn his mother, father and sibling to death in their trailer. So she has herself gone from powerlessness to being the possessor of formidable legal skills that can be used in the interests of the unwell, but which have an unknowable downside as well.
The prose here is very flat, direct, without subtext. Everything is on the surface. The primary objective is communication. One tires of her up and down struggle with her medication, of her refusal to believe she is mentally ill despite the Mt. Everest of evidence. Yet her prescribed medication has the possible side effect of Tardive Dyskinesia, a wretched jerking and plodding manner of walking and bodily movement that is irreversible. She rightly fears her meds because of this. So she keeps going off her them whereupon she has a psychotic break. It’s a dreary repetitive cycle that lasts for years. In the meantime—I love this!—she completes all the publications necessary to be awarded tenure at USC.
Yet her psychiatrist is dismayed at her stubbornness. Finally, he threatens to end treatment with her if she goes off meds again. She has an epiphany about her “maladaptive stubbornness.” Thankfully the new generation of anti-psychotics appears — voila!. It has its downside, too, but it’s minimal compared to the older drugs. She subsequently suffers breast and ovarian cancer in two separate episodes. This woman’s will despite madness and grave illness is astonishing. This is the first story about high-functioning schizophrenics I have ever read. It’s a remarkable document that changes one’s thinking entirely.
Interesting so far is the early collapse of Elyn’s social world. The early adulthood onset of schizophrenia is so brutal. She’s barely 19 and attending Oxford on a Marshal scholarship when she turns resolutely inward, meaning silent. She’s a philosophy major. Saks has a rich emotional memory. She remembers strings of dialogue but also the succession of her emotional states. I have that skill, too. Every humiliation is so readily recalled. Her first experience of any sort of mental health care was in England, where she was never restrained. In England she found affordable psychoanalysis from a talented woman. It saved her. She graduated Oxford with honors, finished her treatment with Mrs. Jones, the analyst, and returned to the U.S. just as she was about to undergo a severe intensification of her illness.
At that time, 1981, psychoanalysis — though it was the only treatment she responded to — was out of favor, and the next generation of antipsychotics had yet to come along. (Oliver Sacks, who blurbs this book enthusiastically, wrote Awakenings which discusses the dreaded side effects of some of the first-generation antipsychotics like L-DOPA.) Author Elyn Saks was finally diagnosed with “chronic paranoid schizophrenia with acute exacerbation.” Her prognosis was termed “grave.” She was now attending Yale law school and spending much time in its mental health facilities. It was Yale-New Haven Hospital that Saks was brutally restrained for the first time. She argues convincingly that such restraints were for the convenience of the staff, not for her own well-being. She suffered inordinately. (Ironically, it was also in a Yale-operated psychiatric hospital that Esmé Weijun Wang, author of The Collected Schizophrenias, would be ruthlessly manhandled more than a generation later.)
It’s when Saks begins to help mentally ill people like herself, that the story becomes doubly interesting. Today she is a professor at USC’s Gould School of Law. Please look for her TED Talk. Astonishing is her achievement when you consider that many with schizophrenia spend their adult lives playing with their feces or babbling or screaming much of the time. An early lesson. Working with a fellow student, she advocates for a young man to be released from some back ward somewhere who then goes on to burn his mother, father and sibling to death in their trailer. So she has herself gone from powerlessness to being the possessor of formidable legal skills that can be used in the interests of the unwell, but which have an unknowable downside as well.
The prose here is very flat, direct, without subtext. Everything is on the surface. The primary objective is communication. One tires of her up and down struggle with her medication, of her refusal to believe she is mentally ill despite the Mt. Everest of evidence. Yet her prescribed medication has the possible side effect of Tardive Dyskinesia, a wretched jerking and plodding manner of walking and bodily movement that is irreversible. She rightly fears her meds because of this. So she keeps going off her them whereupon she has a psychotic break. It’s a dreary repetitive cycle that lasts for years. In the meantime—I love this!—she completes all the publications necessary to be awarded tenure at USC.
Yet her psychiatrist is dismayed at her stubbornness. Finally, he threatens to end treatment with her if she goes off meds again. She has an epiphany about her “maladaptive stubbornness.” Thankfully the new generation of anti-psychotics appears — voila!. It has its downside, too, but it’s minimal compared to the older drugs. She subsequently suffers breast and ovarian cancer in two separate episodes. This woman’s will despite madness and grave illness is astonishing. This is the first story about high-functioning schizophrenics I have ever read. It’s a remarkable document that changes one’s thinking entirely.
June 23, 2017
This is a memoir by a lawyer who has severe schizophrenia and talks about struggling to deal with it while getting through school and then using her unique insight into it to help others with mental illness. If anyone likes TED talks I know the author has one where she discusses it also. I enjoyed the TED talk more than the actual memoir mostly because TED talks force you to cut down to the most important events or ideas but the memoir seemed to drag in a lot of places. It's interesting but at the same time a lot of it felt like it didn't need to be there to help the reader understand Saks and her struggle any better. It's on the higher side of 3 stars or lower side of four stars for me, the writing was really good but again a lot of the book just didn't feel like it imparted much insight. I would suggest checking out her TED talk and if you still want to learn more then reading the memoir as well.
October 9, 2012
Hmmm, this was....interesting. Rather poorly written: emotionally flat all through, often repetitive and very 'cerebral' - the outer sensuous world almost entirely lacking. The middle part, where she describes a full-scale breakdown resulting in restraints and involuntary medication, is harrowing, and should be required reading for medical students, legal students, and indeed psychiatric caregivers. However, her insistence on always having been the best at everything, ever ("I was valedictorian....I wrote the finest exam at Oxford....he said my memo could be a paper...I was in the 99% of the bar exam results...I won tenure" &c &c) becomes annoying after a while. Her decades-long resistance to medication finally ends and it's quite clear she is able to do what she does only while on medication, but she still places all her emphasis on talk therapy (not surprising -- she went on for psychoanalytic training). Given the extreme stigmatization of schizophrenics (think any episode of 'Law and Order,' practically), the writing-off of the mentally ill and the continental shift from therapy to medication, her experiences and viewpoint are important. But it may be a revelation of my venal nature, or just a side effect of over twenty years with bipolar disorder and no insurance, but I was left wondering how she paid for - or who paid for - apparently nearly two decades of intensive, top-drawer, near-daily intensive psychotherapy. This is never hinted at in the book. Given how severely mental illness disables people, and how much of her work was originally with the very poor, very mentally ill, this seems a sizable omission, especially in such an honest and thorough recollection. She makes it clear that she had a large and devoted support network of coworkers, dear friends, doctors, and family members, and makes it equally clear she wouldn't have been able to survive let alone flourish without them, so that makes the invisible money supply even more odd.
- In fine I guess I feel a little bit about this the way I feel about the old Helen Keller question. When you asked people what kind of a loving God would send people into the world blind, deaf, &c (in itself a question that would probably not be asked now, heh) they used to point to Helen Keller. Look at everything she accomplished! and so on, and while she did accomplish amazing things, that doesn't somehow erase the existence of everyone disabled who was not Helen Keller. A friend of mine calls this "the SuperCrip phenomenon" -- like those people who think the legless runner with carbon steel prostheses has an "unfair advantage" over the competition. No, because he doesn't have feet. Obviously, because schizophrenia is severely disabling, because it is so stigmatized and the treatment for it so poor, and the people it attacks are often isolated, broke, and often warehoused or shoved out into the street, it takes someone like Elyn Saks -- someone with extreme intelligence, determination that could probably change planetary orbits, insurance and/or enough money to find and keep good treatment, and all her other advantages -- to write this book, and she knows it. The main thrust of her book is to tell people who are not mentally ill, "Schizophrenic people aren't monsters - I'm just like you." But we should also remember all the others not like her -- the ones not blessed with her gifts, the ones not able to earn her considerable achievements: the ones teetering on the edge, or dead, or so silenced they might as well be dead. Despite her lengthy training and considerable talent at advocacy, Saks can't speak for them; nobody can. Even for 'he that hath ears to hear,' their stories are silent.
(also this book has just a terrible terrible title. Yeats yes yes - still worthy, if terribly overused - but the book makes it clear this isn't a journey through madness (("madness"? WTF?)) - that she has schizophrenia, and she'll always have it. You don't get "through" that.)
- In fine I guess I feel a little bit about this the way I feel about the old Helen Keller question. When you asked people what kind of a loving God would send people into the world blind, deaf, &c (in itself a question that would probably not be asked now, heh) they used to point to Helen Keller. Look at everything she accomplished! and so on, and while she did accomplish amazing things, that doesn't somehow erase the existence of everyone disabled who was not Helen Keller. A friend of mine calls this "the SuperCrip phenomenon" -- like those people who think the legless runner with carbon steel prostheses has an "unfair advantage" over the competition. No, because he doesn't have feet. Obviously, because schizophrenia is severely disabling, because it is so stigmatized and the treatment for it so poor, and the people it attacks are often isolated, broke, and often warehoused or shoved out into the street, it takes someone like Elyn Saks -- someone with extreme intelligence, determination that could probably change planetary orbits, insurance and/or enough money to find and keep good treatment, and all her other advantages -- to write this book, and she knows it. The main thrust of her book is to tell people who are not mentally ill, "Schizophrenic people aren't monsters - I'm just like you." But we should also remember all the others not like her -- the ones not blessed with her gifts, the ones not able to earn her considerable achievements: the ones teetering on the edge, or dead, or so silenced they might as well be dead. Despite her lengthy training and considerable talent at advocacy, Saks can't speak for them; nobody can. Even for 'he that hath ears to hear,' their stories are silent.
(also this book has just a terrible terrible title. Yeats yes yes - still worthy, if terribly overused - but the book makes it clear this isn't a journey through madness (("madness"? WTF?)) - that she has schizophrenia, and she'll always have it. You don't get "through" that.)
August 27, 2018
I recently visited a few high school English classes to introduce Nic Sheff's first novel, Schizo.
In Schizo, the main character, a 16-year old boy, tries to learn how to live with Schizophrenia. After I explained that I felt that it was very important for us to work together to reduce the stigmas often associated with mental health disorders, one of the students enthusiastically recommended Ms. Saks' book.
I have never been disappointed with a book that a student recommends.
In Schizo, the main character, a 16-year old boy, tries to learn how to live with Schizophrenia. After I explained that I felt that it was very important for us to work together to reduce the stigmas often associated with mental health disorders, one of the students enthusiastically recommended Ms. Saks' book.
I have never been disappointed with a book that a student recommends.
September 18, 2007
This book is written by a friend/mentor of mine at USC. It was extremely bizarre to read something so intimate by & about someone I know, so my experience of reading it will be different from the experience of others. That said, I think it's quite powerful. What Elyn is able to pull off is describing, from her currently "sane" place, what it feels like to be severely schizophrenic. Her bridge-building into that experience is rare and worthwhile, and can move a reader's empathy for the mentally ill to a new level (at least it did that for me). It's inspiring to see someone struggle with extreme illness and still somehow create a happy, successful, full life for herself.
For me the main downside was reading it before bed was stressing me out and giving me bad dreams, especially the parts about forced hospitalizations and being in four-point restraints. Maybe don't read it in bed.
For me the main downside was reading it before bed was stressing me out and giving me bad dreams, especially the parts about forced hospitalizations and being in four-point restraints. Maybe don't read it in bed.
June 8, 2018
“There’s days I feel guilty for feeling so good”
Damn, this book left me speechless.
If you or someone you know copes with a mental illness, then read this book. Heck, even if mental illness has played no role in your life, read this book. To me, Elyn R. Saks embodies the epitome of resilience - the ability to bounce back and keep going when things get difficult. She is a TED speaker, ivy league graduate, renowned academic at the University of Southern California Gould Law School, plus a total bad-ass. And she accomplished all this while coping with schizophrenia, a thought disorder characterized by delusions, hallucinations, and disorganized speech.
Throughout the book, though Saks is uncertain about her future, she has a passion for legal studies, philosophy, and as an undergraduate, admires the rigorous and prestigious life of her professors. Her experience with mental illness also enables her to deconstruct problems with a creative and compassionate lens - a skill that will play a critical role in her future career. While not being the best indicator of healthy self-esteem, school work gives her a tangible way to gauge her self-worth and in some ways, academia becomes her saviour.
Given its strong emphasis on academics, impostor syndrome, and mental illness, this book is valuable for students. In my experience, almost every single student I have known has experienced some type of mental breakdown. Academia is rewarding, but it is also competitive, strenuous, and like the Hunger Games IRL - just as gruesome, but less bloody. Yes, Saks is a renowned academic, but her journey did not follow a linear progression. There were even periods she had to take breaks from her academic studies to enter treatment facilities.
Despite her chronic psychotic episodes, she denies having a mental illness for years. Sometimes for people with mental disorders, admitting you need longterm help is just as difficult as the actual illness itself. Without acknowledging a problem exists, nothing remains to be solved, and mental illness go untreated. We want to see ourselves as fighters for coping with these inner demons, and we are, but we cannot fail to acknowledge them as illnesses that need medical attention. As Saks mentions in this book, taking medication is not cheating. If you broke a leg and needed a crutch, would you refuse to take it? I don't think so.
In this book, Saks is nothing but her raw, talented, and honest self. She never sugar coats the debilitating nature of her mental illness. Yes, she has extraordinary grit and access to mental health treatment, but if somebody offered her a magical pill that could get rid of her schizophrenia, she would do it in a heart beat. This passage hit me hard: Writer Tennessee Williams affirmed, “If I got rid of my demons, I'd lose my angels.” But Saks believes her demons are so bad that they make her angels fly away too.
I suspect many will see themselves in Saks. She is awkward, struggles to focus on her work, has trouble forming meaningful friendships, and despite achieving success, continues to doubt herself. It made me feel like I was not alone in my awkwardness. Sometimes when I read books, the popularity and social skills of the people astounds me. Like how can people be so cool? And I'm here struggling to form coherent sentences.
I hope everybody gets the chance to read this book. It helped me come to terms with my own struggles, and how I can continue fighting and moving forward despite them. For me, reading The Center Cannot Hold: My Journey Through Madness was inspiring. As cliché as it sounds, Saks helped me confirm that even in the most dismal circumstances, there can be light and something worth fighting for.
Damn, this book left me speechless.
If you or someone you know copes with a mental illness, then read this book. Heck, even if mental illness has played no role in your life, read this book. To me, Elyn R. Saks embodies the epitome of resilience - the ability to bounce back and keep going when things get difficult. She is a TED speaker, ivy league graduate, renowned academic at the University of Southern California Gould Law School, plus a total bad-ass. And she accomplished all this while coping with schizophrenia, a thought disorder characterized by delusions, hallucinations, and disorganized speech.
Throughout the book, though Saks is uncertain about her future, she has a passion for legal studies, philosophy, and as an undergraduate, admires the rigorous and prestigious life of her professors. Her experience with mental illness also enables her to deconstruct problems with a creative and compassionate lens - a skill that will play a critical role in her future career. While not being the best indicator of healthy self-esteem, school work gives her a tangible way to gauge her self-worth and in some ways, academia becomes her saviour.
Given its strong emphasis on academics, impostor syndrome, and mental illness, this book is valuable for students. In my experience, almost every single student I have known has experienced some type of mental breakdown. Academia is rewarding, but it is also competitive, strenuous, and like the Hunger Games IRL - just as gruesome, but less bloody. Yes, Saks is a renowned academic, but her journey did not follow a linear progression. There were even periods she had to take breaks from her academic studies to enter treatment facilities.
Despite her chronic psychotic episodes, she denies having a mental illness for years. Sometimes for people with mental disorders, admitting you need longterm help is just as difficult as the actual illness itself. Without acknowledging a problem exists, nothing remains to be solved, and mental illness go untreated. We want to see ourselves as fighters for coping with these inner demons, and we are, but we cannot fail to acknowledge them as illnesses that need medical attention. As Saks mentions in this book, taking medication is not cheating. If you broke a leg and needed a crutch, would you refuse to take it? I don't think so.
In this book, Saks is nothing but her raw, talented, and honest self. She never sugar coats the debilitating nature of her mental illness. Yes, she has extraordinary grit and access to mental health treatment, but if somebody offered her a magical pill that could get rid of her schizophrenia, she would do it in a heart beat. This passage hit me hard: Writer Tennessee Williams affirmed, “If I got rid of my demons, I'd lose my angels.” But Saks believes her demons are so bad that they make her angels fly away too.
I suspect many will see themselves in Saks. She is awkward, struggles to focus on her work, has trouble forming meaningful friendships, and despite achieving success, continues to doubt herself. It made me feel like I was not alone in my awkwardness. Sometimes when I read books, the popularity and social skills of the people astounds me. Like how can people be so cool? And I'm here struggling to form coherent sentences.
I hope everybody gets the chance to read this book. It helped me come to terms with my own struggles, and how I can continue fighting and moving forward despite them. For me, reading The Center Cannot Hold: My Journey Through Madness was inspiring. As cliché as it sounds, Saks helped me confirm that even in the most dismal circumstances, there can be light and something worth fighting for.
April 22, 2018
Wow. This was wonderful and terrifying. But mainly it was incredibly eye-opening.
July 21, 2008
The Center Cannot Hold offers a rare peek into the raging mind of a schizophrenic. While the author is anything but a case study (she is brilliant and accomplished even by mentally intact standards, whereas schizophrenia is usually accompanied by low IQ and functional impairment) her uncommon mental clarity enables her to shed light on an otherwise inscrutable disorder.
Of the several memoirs of mental illness I've read, this book offers the most convincing dialogue of psychotic and depressed characters. It also offers an unflinching and disturbing view of the Freudian psychoanalytic tactics used to treat the mentally ill. From a conversation with the author's psychoanalyst, Mrs. Jones:
The author: I am in control. I control the world. The world is at my whim. I control the world and everything in it.
Mrs. Jones: You want to feel in control because in fact you feel so helpless.
The author: I had a dream. I was making golf balls out of fetuses.
Mrs. Jones: You want to kill babies, you see, and then make a game out of it. You are jealous of the other babies. Jealous of your brothers, jealous of other patients. You want to kill them. And then you want to turn them into little balls so you can smack them again.
...
"Are you trying to kill me?" I hissed. "I know about the bombs. I can make a bomb, too. You are the devil. You are trying to kill me. I am evil. I've killed you three times today. I can do it again."
The author’s compassionate treatment of the mentally ill does a great service to readers. She assumes the role of educator and advocate. She convincingly makes a case against the American mental health system, which too often confiscates the autonomy and dignity of its charges, and argues passionately against the use of physical restraints among even violent mental patients. Her push for broader emotional therapies for the mentally ill in tandem with pharmacological treatment (as opposed to the solely pharmacological approach found too often in the US) is powerful and, with luck, will change the minds of medical professionals.
As a book, however, the memoir is imperfect. The author arranges events in strict chronology, and gives every event the same narrative weight: her high school experimentation with mescaline, her major psychotic episodes, her first day at law school, the occasions on which she meets minor characters. She probably intends to imbue each incident with the same emotional value, to showcase her normality along with her abnormality. Unfortunately, it has the effect of diluting the plot (even a memoir must be propelled along some trajectory).
Even more unfortunate, however, is the author’s tendency to reveal her own impoverished capacity for sympathy and insight. Resentment clouds her portrayal of her long-time psychoanalyst. ("He'd rejected me, he'd betrayed me.") She also describes her parents' growing remoteness with the kind of thoughtless confessionalism one might expect from a reality show contestant. It is clear that the author has omitted her role in the deterioration of those relationships, and fails to understand the damage her indiscretion will cause to the people in her life. Worse, neither of these accounts are relevant to the development of the characters or to the progression of the memoir--rather than meaningful revelation, they smack of careless slander.
Ultimately, the book reads not as a cohesive memoir but as a diary, circumscribed by the author's own very limited perspective, occasionally muddled, but extraordinary nonetheless.
Of the several memoirs of mental illness I've read, this book offers the most convincing dialogue of psychotic and depressed characters. It also offers an unflinching and disturbing view of the Freudian psychoanalytic tactics used to treat the mentally ill. From a conversation with the author's psychoanalyst, Mrs. Jones:
The author: I am in control. I control the world. The world is at my whim. I control the world and everything in it.
Mrs. Jones: You want to feel in control because in fact you feel so helpless.
The author: I had a dream. I was making golf balls out of fetuses.
Mrs. Jones: You want to kill babies, you see, and then make a game out of it. You are jealous of the other babies. Jealous of your brothers, jealous of other patients. You want to kill them. And then you want to turn them into little balls so you can smack them again.
...
"Are you trying to kill me?" I hissed. "I know about the bombs. I can make a bomb, too. You are the devil. You are trying to kill me. I am evil. I've killed you three times today. I can do it again."
The author’s compassionate treatment of the mentally ill does a great service to readers. She assumes the role of educator and advocate. She convincingly makes a case against the American mental health system, which too often confiscates the autonomy and dignity of its charges, and argues passionately against the use of physical restraints among even violent mental patients. Her push for broader emotional therapies for the mentally ill in tandem with pharmacological treatment (as opposed to the solely pharmacological approach found too often in the US) is powerful and, with luck, will change the minds of medical professionals.
As a book, however, the memoir is imperfect. The author arranges events in strict chronology, and gives every event the same narrative weight: her high school experimentation with mescaline, her major psychotic episodes, her first day at law school, the occasions on which she meets minor characters. She probably intends to imbue each incident with the same emotional value, to showcase her normality along with her abnormality. Unfortunately, it has the effect of diluting the plot (even a memoir must be propelled along some trajectory).
Even more unfortunate, however, is the author’s tendency to reveal her own impoverished capacity for sympathy and insight. Resentment clouds her portrayal of her long-time psychoanalyst. ("He'd rejected me, he'd betrayed me.") She also describes her parents' growing remoteness with the kind of thoughtless confessionalism one might expect from a reality show contestant. It is clear that the author has omitted her role in the deterioration of those relationships, and fails to understand the damage her indiscretion will cause to the people in her life. Worse, neither of these accounts are relevant to the development of the characters or to the progression of the memoir--rather than meaningful revelation, they smack of careless slander.
Ultimately, the book reads not as a cohesive memoir but as a diary, circumscribed by the author's own very limited perspective, occasionally muddled, but extraordinary nonetheless.
February 26, 2020
(الجو رائع الليلة، لونه أخضر. عسل بطل نخل. هل قتلت طفلاً من قبل؟ الجامعة تخاف من القافلة. أنهم يذهبون يحبون أكل غناء الأحجار السائلة)
هذه العبارات والكلمات المبعثرة، أو ما يُعرف بـ"سلطة الكلمات"، هي إحدى علامات السكيزوفرينيا –أو الشيزوفرينيا كما تُعرف على نطاق واسع. وخلافًا لما هو معروف، فالسيكزوفرينيا ليس انفصامًا للشخصية بل انفصالاً عن الواقع. هو اضطراب ذهني ودماغي له العديد من الأعراض منها الأوهام والوساوس، الإنكفاء على النفس، الخوف المرضي والعديد من الأعراض المخيفة الأخرى.
(هناك أشخاص سينزلون من السماء، أنهم على وشك احتلال الأرض. أنهم يبحثون عني، يريدون قتلي، أريد أن اختبأ في الخزانة حتى لا يروني)
الاعتلالات النفسية هي سمة العصر، وليس صحيحًا أنها نادرة. قد تجد بعض أعراضها في أصدقاءك أو أقاربك، أو ربما في نفسك.كل ما في الأمر هو أننا نخطئ في تصنيف المرض على أنه (طباع شخصية) أو ربما (نظرة حسد) أو (سحر أسود). ياصديقي، كلنا لنا مزاجاتنا ولكن أن يكون الشخص في قمة المرح والسعادة دون سبب ثم تجده فاتر الطاقة لا يرغب حتى في الأكل، فالأمر قد يتعدى كونه (تقلباً في المزاج).
أرى أنه من الضرورة أن يتعلم المرء شيئًا أو اثنين عن الأمراض النفسية وذلك لسببيّن: التعرف على الأعراض والتعامل معها بشكل صحيح سواءً وجدت في النفس أو في الغير. كما أن تلك المعرفة قد تفيد الإنسان في تفادي تلك الأمراض والوقاية منها. لا ترفع حاجبك فتلك الأمراض أقرب لنا مما نتوقع. لا أتحدث عن الاعتلالات الكبرى بل الأقل من ذلك مثل الاكتئاب المزمن، التوتر المرضي، الوسواس القهري وغير ذلك.
(أنا شرير...شخص لا يستحق الحياة...لا أحد يحبني. مالفائدة من حياتي أساسًا. إنني أقتل الناس بأفكاري. لا أريد أن أعيش)
هذه الكتاب هو سيرة ذاتية عن درب وعر مضت فيه المؤلفة لتغلب – أو بالأحرى لتقاوم- الشيزوفرينيا وتحقق أهدافها في الحياة. الدكتورة إلين ليست شخصية عادية، بل أكاديمية مجتهدة من الطراز الأول. تفوقت في دراستها وهي تنتقل من جامعة إلى أخرى في مسيرتها الأكاديمية في أرقى الجامعات، من بينها أكسفورد الإنجليزية. بل إنها تبحرت في العديد من المجالات من بينها القانون وعلم النفس، إلى درجة أنها من الحالات النادرة التي تحول فيها المريض النفسي إلى مستشار نفسي.
تصور الكاتبة رحلتها بهدف إلهام الآخرين ممن يعانون من ذات المرض، لتعطيهم أملاً ونموذجًا ملهما وتقدم لهم بعض الدروس. في طيات حكايتها نتعلم الكثير عن أعراض السكيزوفرينيا، عن أنماط العلاج النفسي، عن المصحات النفسية، والكثير الكثير عن معاناة المريض النفسي سواء في المستشفيات أو مع المجتمع أو –وهذا الأكثر مشقة- مع الذات. الأسلوب سهل جدًا جدًا إذا أخذنا بعين الاعتبار أن كاتبته متخصصة أكاديمية. النقطة فقط هي أنها إنسان محبة للدراسة منذ سني مراهقتها، لذا لم يكن هناك الكثير من المغامرات أو الظروف الاستثنائية، بل انقسم الكتاب مابين أروقة الجامعات ودهاليز المستشفيات.
عن نفسي تعلمت الكثير من هذا الكتاب، عن الأدوية والتشخيص والأعراض، عن التحدي والأمل والهزيمة والإصرار، عن المعاناة الداخلية والغربة والعزلة، وعن غرابة هذه الكائن المسمى بالإنسان.
إضافة: وجدت هذا المقطع التمثيلي عن مراحل معاناة المصاب بالشيزوفرينيا، وعن مراحل علاجه. أعجبتني دقة المعلومات وجودة التنفيذ، وأعتقد أن يوصل الكثير من أفكار هذا الكتاب:
https://youtu.be/ni7rXAfEUd4
هذه العبارات والكلمات المبعثرة، أو ما يُعرف بـ"سلطة الكلمات"، هي إحدى علامات السكيزوفرينيا –أو الشيزوفرينيا كما تُعرف على نطاق واسع. وخلافًا لما هو معروف، فالسيكزوفرينيا ليس انفصامًا للشخصية بل انفصالاً عن الواقع. هو اضطراب ذهني ودماغي له العديد من الأعراض منها الأوهام والوساوس، الإنكفاء على النفس، الخوف المرضي والعديد من الأعراض المخيفة الأخرى.
(هناك أشخاص سينزلون من السماء، أنهم على وشك احتلال الأرض. أنهم يبحثون عني، يريدون قتلي، أريد أن اختبأ في الخزانة حتى لا يروني)
الاعتلالات النفسية هي سمة العصر، وليس صحيحًا أنها نادرة. قد تجد بعض أعراضها في أصدقاءك أو أقاربك، أو ربما في نفسك.كل ما في الأمر هو أننا نخطئ في تصنيف المرض على أنه (طباع شخصية) أو ربما (نظرة حسد) أو (سحر أسود). ياصديقي، كلنا لنا مزاجاتنا ولكن أن يكون الشخص في قمة المرح والسعادة دون سبب ثم تجده فاتر الطاقة لا يرغب حتى في الأكل، فالأمر قد يتعدى كونه (تقلباً في المزاج).
أرى أنه من الضرورة أن يتعلم المرء شيئًا أو اثنين عن الأمراض النفسية وذلك لسببيّن: التعرف على الأعراض والتعامل معها بشكل صحيح سواءً وجدت في النفس أو في الغير. كما أن تلك المعرفة قد تفيد الإنسان في تفادي تلك الأمراض والوقاية منها. لا ترفع حاجبك فتلك الأمراض أقرب لنا مما نتوقع. لا أتحدث عن الاعتلالات الكبرى بل الأقل من ذلك مثل الاكتئاب المزمن، التوتر المرضي، الوسواس القهري وغير ذلك.
(أنا شرير...شخص لا يستحق الحياة...لا أحد يحبني. مالفائدة من حياتي أساسًا. إنني أقتل الناس بأفكاري. لا أريد أن أعيش)
هذه الكتاب هو سيرة ذاتية عن درب وعر مضت فيه المؤلفة لتغلب – أو بالأحرى لتقاوم- الشيزوفرينيا وتحقق أهدافها في الحياة. الدكتورة إلين ليست شخصية عادية، بل أكاديمية مجتهدة من الطراز الأول. تفوقت في دراستها وهي تنتقل من جامعة إلى أخرى في مسيرتها الأكاديمية في أرقى الجامعات، من بينها أكسفورد الإنجليزية. بل إنها تبحرت في العديد من المجالات من بينها القانون وعلم النفس، إلى درجة أنها من الحالات النادرة التي تحول فيها المريض النفسي إلى مستشار نفسي.
تصور الكاتبة رحلتها بهدف إلهام الآخرين ممن يعانون من ذات المرض، لتعطيهم أملاً ونموذجًا ملهما وتقدم لهم بعض الدروس. في طيات حكايتها نتعلم الكثير عن أعراض السكيزوفرينيا، عن أنماط العلاج النفسي، عن المصحات النفسية، والكثير الكثير عن معاناة المريض النفسي سواء في المستشفيات أو مع المجتمع أو –وهذا الأكثر مشقة- مع الذات. الأسلوب سهل جدًا جدًا إذا أخذنا بعين الاعتبار أن كاتبته متخصصة أكاديمية. النقطة فقط هي أنها إنسان محبة للدراسة منذ سني مراهقتها، لذا لم يكن هناك الكثير من المغامرات أو الظروف الاستثنائية، بل انقسم الكتاب مابين أروقة الجامعات ودهاليز المستشفيات.
عن نفسي تعلمت الكثير من هذا الكتاب، عن الأدوية والتشخيص والأعراض، عن التحدي والأمل والهزيمة والإصرار، عن المعاناة الداخلية والغربة والعزلة، وعن غرابة هذه الكائن المسمى بالإنسان.
إضافة: وجدت هذا المقطع التمثيلي عن مراحل معاناة المصاب بالشيزوفرينيا، وعن مراحل علاجه. أعجبتني دقة المعلومات وجودة التنفيذ، وأعتقد أن يوصل الكثير من أفكار هذا الكتاب:
https://youtu.be/ni7rXAfEUd4
April 4, 2013
I'm going to totally and consciously cop out on this review. Yes, the book was maddening to read at times given the "one step forward, five steps back" nature of her journey. And I beat myself up throughout most of it, as my impatience with Saks's actions grew. She takes the meds. She feels better on the meds. She insists on abandoning the meds. She goes "floridly psychotic," gets hospitalized and has a horrific time of it. Multiply that sequence by 20-25 and you get the first 300 pages of the book. As I chafed against the repetition of this vicious cycle, I thought "Could I really be this cold and lacking in empathy? Compassion is what's called for here!" And then I realized: *this* inability to see things as they are is the essence of her disease process, and the crux of all types of insanity: doing the same things over and over again and expecting different results. I can't say I loved this book, but it was an important and revealing look into the mind of a person who is both brilliant and tortured... and very brave.
August 6, 2016
Elyn Saks is an unusual figure to say the least. An academic superstar: Vanderbilt valedictorian, Marshall scholar to Oxford for graduate study in philosophy (Aristotle's metaphysics in the Greek no less), Yale Law School, tenured faculty at U South California, MacArthur "Genius" Fellow. And since her late teens, battling with schizophrenia: disabling and terrifying bouts of delusions and hallucinations.
High-functioning people with mood disorders like depression or bipolar disorder are all around; many of them manage to hide their illness very effectively. Perhaps they are even your colleagues, your doctor or your lawyer. High-functioning people with schizophrenia are vanishingly rare. (The only other example that comes to mind is the mathematician John Nash). This is the disease of those people you try to ignore on public transport, who mutter and shout to themselves or apparently at random, who drift down the social ladder to homelessness and addiction, who appear unable to care for themselves or to hold down any kind of employment.
Saks' memoirs should remind us that this outcome is not inevitable, that people with psychotic disorders can lead fulfilling lives. Of course she had well-off parents and access to excellent care. Again unusually for psychotic disorders, she has found psychoanalysis greatly beneficial. But the lesson stands. Anti-psychotic medication - for all its flaws, side-effects and problems - has helped her remain functional. She has brought her personal and professional experience to bear on the ethico-legal problems of psychiatry: competence, restraint, right to refuse treatment etc.
The most interesting parts of the book are the first-person descriptions of how psychosis disintegrates one's relationship to reality. To describe this is a waking nightmare would be almost literal. Recommended for anyone with an interest in mental illness.
High-functioning people with mood disorders like depression or bipolar disorder are all around; many of them manage to hide their illness very effectively. Perhaps they are even your colleagues, your doctor or your lawyer. High-functioning people with schizophrenia are vanishingly rare. (The only other example that comes to mind is the mathematician John Nash). This is the disease of those people you try to ignore on public transport, who mutter and shout to themselves or apparently at random, who drift down the social ladder to homelessness and addiction, who appear unable to care for themselves or to hold down any kind of employment.
Saks' memoirs should remind us that this outcome is not inevitable, that people with psychotic disorders can lead fulfilling lives. Of course she had well-off parents and access to excellent care. Again unusually for psychotic disorders, she has found psychoanalysis greatly beneficial. But the lesson stands. Anti-psychotic medication - for all its flaws, side-effects and problems - has helped her remain functional. She has brought her personal and professional experience to bear on the ethico-legal problems of psychiatry: competence, restraint, right to refuse treatment etc.
The most interesting parts of the book are the first-person descriptions of how psychosis disintegrates one's relationship to reality. To describe this is a waking nightmare would be almost literal. Recommended for anyone with an interest in mental illness.
March 22, 2016
4.5 stars!
This is an eye-opening memoir by a fascinating woman. Elyn R. Saks is a highly functioning intelligent woman with multiple higher degrees from places like Oxford and Yale and she just happens to have Schizophrenia. In this memoir she does battle with her demons and for the most part she wins. I found this to be extremely inspiring.
It is also a look into the way we treat mental health especially in the US. It's pretty bad.
This is an eye-opening memoir by a fascinating woman. Elyn R. Saks is a highly functioning intelligent woman with multiple higher degrees from places like Oxford and Yale and she just happens to have Schizophrenia. In this memoir she does battle with her demons and for the most part she wins. I found this to be extremely inspiring.
It is also a look into the way we treat mental health especially in the US. It's pretty bad.
March 14, 2019
Apparently on a roll with reading memoirs related to my diagnosis.
Can't believe my psychiatrist recommended I read this. This book left me utterly cold.
Her experience in the psych ward was moving (I cried) but her pull yourself up by your bootstraps mentality is frustrating, as is the fact that her self-worth revolves around her being the best, the smartest, etc., etc. When the author's psychoanalyst describes her as "a republican" when it comes to the mentally ill they are not kidding. Her lack of generosity towards those who 'give up' by going on disability—to people who don't have parents that can bankroll seeing a psychoanalyst daily and who can basically pop in to said psychoanalyst whenever a crisis happens—is damning.
Also, it's John Nash all over again. A genius who has schizophrenia accomplishes major things, people point to them as "what you could do if you tried harder." "Why don't you write a book?"
Can't believe my psychiatrist recommended I read this. This book left me utterly cold.
Her experience in the psych ward was moving (I cried) but her pull yourself up by your bootstraps mentality is frustrating, as is the fact that her self-worth revolves around her being the best, the smartest, etc., etc. When the author's psychoanalyst describes her as "a republican" when it comes to the mentally ill they are not kidding. Her lack of generosity towards those who 'give up' by going on disability—to people who don't have parents that can bankroll seeing a psychoanalyst daily and who can basically pop in to said psychoanalyst whenever a crisis happens—is damning.
Also, it's John Nash all over again. A genius who has schizophrenia accomplishes major things, people point to them as "what you could do if you tried harder." "Why don't you write a book?"
February 15, 2021
I will be thinking about Elyn and her book for a long time. For the last nine years, I've worked on an inpatient psychiatric unit, first as a nurse intern, and eventually as a nurse.
I dearly love my patients with all of my heart, and believe there is no group that is more discriminated against in most of the world. At least, truly, in America, there is little to no discrimination left culturally- EXCEPT for mental illness. Fight me on this. But no one can unless they've seen it first hand, which I have. For nine years.
I've had patients tell me they would rather be diagnosed with cancer. At least then people won't tell you to "just go for a walk and you'll feel better." At least then, they buy you flowers. Patients of every color, creed, and religion come together in solidarity in our unit because they know they are the remaining unfortunate few who truly know what discrimination is.
Elyn's story is heart-wrenching as the reader watches her wrestle from beginning to end with fear of accepting her mental illness, uncertainty about sharing it with others, and decades of battling over taking her meds because doing so is to acknowledge the illness.
My only sticking point with this story is Elyn's relationship with one of her psychoanalytic therapists, Mrs. Jones. I'm pissed at Mrs. Jones. Not only is the Freudian preoccupation bizarre, but she knowingly allowed her client to develop a codependent relationship with her, encouraging her to wallow in her psychosis during their sessions, and never directed her to take much needed medications. Elyn's brain was on fire the entire time they met. I do not like Mrs. Jones.
The juxtaposition in Elyn's treatment in the 80s versus the care we give now was horrifying. While some of the inpatient treatment she received was appropriate, there is a REASON we've moved away from some of the old methods of treatment, including extreme requirements for use of restraints. That hurt my heart to read.
If you are interested in a mind's eye view of the schizophrenia experience, I highly recommend this book.
I'd rate this book an PG-13 for scary situations, adult content, some swearing, some discrete sexual encounters, and mild drug use.
I dearly love my patients with all of my heart, and believe there is no group that is more discriminated against in most of the world. At least, truly, in America, there is little to no discrimination left culturally- EXCEPT for mental illness. Fight me on this. But no one can unless they've seen it first hand, which I have. For nine years.
I've had patients tell me they would rather be diagnosed with cancer. At least then people won't tell you to "just go for a walk and you'll feel better." At least then, they buy you flowers. Patients of every color, creed, and religion come together in solidarity in our unit because they know they are the remaining unfortunate few who truly know what discrimination is.
Elyn's story is heart-wrenching as the reader watches her wrestle from beginning to end with fear of accepting her mental illness, uncertainty about sharing it with others, and decades of battling over taking her meds because doing so is to acknowledge the illness.
My only sticking point with this story is Elyn's relationship with one of her psychoanalytic therapists, Mrs. Jones. I'm pissed at Mrs. Jones. Not only is the Freudian preoccupation bizarre, but she knowingly allowed her client to develop a codependent relationship with her, encouraging her to wallow in her psychosis during their sessions, and never directed her to take much needed medications. Elyn's brain was on fire the entire time they met. I do not like Mrs. Jones.
The juxtaposition in Elyn's treatment in the 80s versus the care we give now was horrifying. While some of the inpatient treatment she received was appropriate, there is a REASON we've moved away from some of the old methods of treatment, including extreme requirements for use of restraints. That hurt my heart to read.
If you are interested in a mind's eye view of the schizophrenia experience, I highly recommend this book.
I'd rate this book an PG-13 for scary situations, adult content, some swearing, some discrete sexual encounters, and mild drug use.
April 21, 2022
Elyn Saks takes us intimately into her lengthy experience of being diagnosed with schizophrenia in this eye-opening and compelling memoir of, as she describes it, 'madness.'
This was suggested to me by my friend Nathan (@schizophrenicreads on Tiktok), as an example of a book with good representation of schizophrenia. Obviously every diagnosis of mental illness is varied and complex, but Saks does an excellent job of sharing her specific experience discovering she has mental illness, exploring its potential origins or the moments she began to uncover it, and how it shaped her life as she pursued an academic career.
My biggest takeaways from this book were not only the vast misconceptions of what schizophrenia is, but the harmful narratives that permeate conversations around mental illnesses. Additionally, Saks reveals some of the stark contrasts between how the US treats patients with mental illness versus other countries, which was both illuminating and horrifying. Hopefully things have changed since her experiences in the 70s and 80s, but I suspect there are still many hurdles to overcome in this fight.
I cannot recommend this memoir highly enough! Whether you are looking for a book specifically about schizophrenia or just enjoy reading memoirs, The Center Cannot Hold will keep you engaged and hopefully teach you something you didn't know about someone else's lived experience, which is the least we can hope for from a book like this.
This was suggested to me by my friend Nathan (@schizophrenicreads on Tiktok), as an example of a book with good representation of schizophrenia. Obviously every diagnosis of mental illness is varied and complex, but Saks does an excellent job of sharing her specific experience discovering she has mental illness, exploring its potential origins or the moments she began to uncover it, and how it shaped her life as she pursued an academic career.
My biggest takeaways from this book were not only the vast misconceptions of what schizophrenia is, but the harmful narratives that permeate conversations around mental illnesses. Additionally, Saks reveals some of the stark contrasts between how the US treats patients with mental illness versus other countries, which was both illuminating and horrifying. Hopefully things have changed since her experiences in the 70s and 80s, but I suspect there are still many hurdles to overcome in this fight.
I cannot recommend this memoir highly enough! Whether you are looking for a book specifically about schizophrenia or just enjoy reading memoirs, The Center Cannot Hold will keep you engaged and hopefully teach you something you didn't know about someone else's lived experience, which is the least we can hope for from a book like this.
November 29, 2014
Elyn Saks suffers from schizophrenia and says she wrote this book to demonstrate that people with this illness can lead rich and successful lives. She herself teaches at a top law school, has had psychoanalytic training, has written a number of scholarly articles and is married to a kind and understanding man. As a psychiatrist, I found her infuriating, and I imagine her doctors over the years did, too. She takes forever to realize that she absolutely must take antipsychotic medication and, despite all her own evidence to the contrary she attributes her success in controlling her illness to psychoanalysis, buying into the, to my mind, untestable and fanciful notion that psychosis serves to "protect" her from her strong negative emotions, and that exploring this notion four to five times a week in analysis is in some way helpful. She never says how she manages to finance this treatment. I assume some of it was financed by her parents; she is pretty hard on them. I can only imagine how exhausted they were by her psychosis and refusal to accept medical advice and take medication regularly.
I found the writing rather flat-footed for someone so apparently talented (as she repeatedly tells us) and also oddly lacking in introspection. I actually think this memoir may have been ghost written, as in the acknowledgements Saks thanks Larkin Warren who "helped bring the book to light, in a way that will allow me to 'speak' to more people in these pages." I notice that Larkin Warren is the coauthor of several "memoirs" of people with troubled pasts.
I found the writing rather flat-footed for someone so apparently talented (as she repeatedly tells us) and also oddly lacking in introspection. I actually think this memoir may have been ghost written, as in the acknowledgements Saks thanks Larkin Warren who "helped bring the book to light, in a way that will allow me to 'speak' to more people in these pages." I notice that Larkin Warren is the coauthor of several "memoirs" of people with troubled pasts.
November 25, 2007
Saks presents an articulate and honest portrayal of her life with schizophrenia, from its early days to the present. She doesn't deny the severity of her symptoms, while also acknowledging that the life she's built for herself is atypical -- she is a married, tenured law professor at USC with degrees from Vanderbilt, Oxford, and Yale. The most devastating part for me was Saks' account of her days in the Yale psychiatric centers, acting out and recognizing that the staff didn't particularly care if she got better; they just wanted her to behave. This book makes a good case for the necessity of mental health reform in the US, particularly because Saks' first full psychotic break occurred in Great Britain and she spent years in treatment there before being treated in the US. It also nuances the many ways that stigma against mental illness persists, even among those who claim to be healers, and how that can make it difficult for those with illness to admit to themselves that they are ill. And it presents an eloquent case for the power of psychoanalysis as a tool for determining the functions of psychosis and for allowing Saks to eventually focus on all of the aspects of her life, not just the illness or the work that served as her salvation from the illness for so long. What this account does best in many ways is present the power of a fighting spirit, the places where that fight can cause problems, and the power of friendship in the darkest of days.
August 10, 2016
Elyn was an amazing individual, with schizophrenia, under the best possible circumstances. She acknowledges that her supportive upbringing, affluence, opportunity for psychoanalysis, extreme intelligence and sheer determination are valid factors contributing towards academic success, not being homeless or institutionalized indefinitely and having the ability to form friendships and meaningful relationships. While a struggle to incorporate the three indwelling entities (her as a doctor, her as the 'Lady of the Charts', and her as a person) that made up Elyn Saks, she manages her symptoms finally after years of denial, with submission to medication. Through her experience during hospitalization, she rightfully challenges and changes laws such as forcible confinement with use of restraints, and, more confusingly so, fighting for the rights of people with severe mental health issues to refuse being medicated. This book was an eye-opener for those in the helping industry, if one ever wanted to understand better, by reading a frightening and detailed account of the torment someone with schizophrenia goes through while in a psychotic state. You will also learn more about post Freud psychoanalyst Melanie Klein. http://www.melanie-klein-trust.org.uk...
July 18, 2019
This seems to be the schizophrenia memoir, and it comes as no surprise that it’s written by a very accomplished, successful person: going public with an account of one’s psychosis and delusions could be career-ending for many people, but when you’re a tenured professor at a prestigious law school, with a stack of degrees and publications, you can basically do what you want. Still, it’s a gutsy thing to publish.
This is an account of the author’s life from childhood up to probably her 50s, though the bulk of it takes place while she’s doing her graduate and law studies, which is when her mental health problems cause the greatest crises. Fortunately for her, she’s in England on a Marshall scholarship when she’s first hospitalized, in an environment where patients’ personhood and wishes are respected – unfortunately, a sharp contrast to her hospitalization during law school back in the States, which is harrowing, as these stories tend to be. She is a tough lady though, and a strong sense of purpose in her studies and her work – as well as a few close friendships and a lot of psychoanalysis – gets her through.
I was surprised that Freudian psychoanalysis could actually do somebody with a serious mental illness much good, but it makes sense that having one-on-one time 4-5 times a week with someone who would listen nonjudgmentally to all her bizarre thoughts would help. She does eventually wind up having to be on medication long-term, and her discussion of all the reasons she resists this is really interesting. She doesn’t want to be “dependent on drugs,” the side effects of the antipsychotics available at the time were quite bad (including the risk of permanent, very visible nerve damage for those who took them long-term), but she also doesn’t want to view herself as damaged enough to need this. It doesn’t make logical sense and yet this seems to be a thing with the most stigmatized illnesses, that people often view taking medication for them as a symbolic capitulation, as if acknowledging the disease enough to treat it means turning over control of their lives to it.
Overall this is definitely an interesting memoir, though not a particularly artistic one; it’s told in a straightforward, chronological manner, albeit with a lot of dialogue that is probably not exact. Given how much the author has studied mental illness, I would have liked to see her broaden the scope of the book a little more, comment on how her experience of schizophrenia compares to that of others. That said, it works well as is, it’s accessible and engaging, and it’s a great window into a dreaded disease that’s generally discussed as if people who have it are incapable of contributing to the conversation themselves. Saks is living proof that people with schizophrenia are as capable as anyone else of living a full life, under the right circumstances: despite grave prognoses early on, and various crises along the way, she has a great career, is happily married and has a lot of strong friendships. At any rate, this is an eye-opening book and I recommend it.
This is an account of the author’s life from childhood up to probably her 50s, though the bulk of it takes place while she’s doing her graduate and law studies, which is when her mental health problems cause the greatest crises. Fortunately for her, she’s in England on a Marshall scholarship when she’s first hospitalized, in an environment where patients’ personhood and wishes are respected – unfortunately, a sharp contrast to her hospitalization during law school back in the States, which is harrowing, as these stories tend to be. She is a tough lady though, and a strong sense of purpose in her studies and her work – as well as a few close friendships and a lot of psychoanalysis – gets her through.
I was surprised that Freudian psychoanalysis could actually do somebody with a serious mental illness much good, but it makes sense that having one-on-one time 4-5 times a week with someone who would listen nonjudgmentally to all her bizarre thoughts would help. She does eventually wind up having to be on medication long-term, and her discussion of all the reasons she resists this is really interesting. She doesn’t want to be “dependent on drugs,” the side effects of the antipsychotics available at the time were quite bad (including the risk of permanent, very visible nerve damage for those who took them long-term), but she also doesn’t want to view herself as damaged enough to need this. It doesn’t make logical sense and yet this seems to be a thing with the most stigmatized illnesses, that people often view taking medication for them as a symbolic capitulation, as if acknowledging the disease enough to treat it means turning over control of their lives to it.
Overall this is definitely an interesting memoir, though not a particularly artistic one; it’s told in a straightforward, chronological manner, albeit with a lot of dialogue that is probably not exact. Given how much the author has studied mental illness, I would have liked to see her broaden the scope of the book a little more, comment on how her experience of schizophrenia compares to that of others. That said, it works well as is, it’s accessible and engaging, and it’s a great window into a dreaded disease that’s generally discussed as if people who have it are incapable of contributing to the conversation themselves. Saks is living proof that people with schizophrenia are as capable as anyone else of living a full life, under the right circumstances: despite grave prognoses early on, and various crises along the way, she has a great career, is happily married and has a lot of strong friendships. At any rate, this is an eye-opening book and I recommend it.
November 1, 2012
The more I study the issue of schizophrenia, the more I realize what tremendous courage it takes for anyone to talk about living with it -- let alone a professor at a major university.
In this gripping, literate memoir, Elyn Saks talks about her lifelong struggle with paranoid schizophrenia, from the time she was a young woman to the present, working as a tenured law professor at the University of Southern California. Growing up in Miami, she was always a talented student. Then, as a teenager, her parents discovered her with some marijuana and insisted she go into a strict anti-drug facility, where she heard over and over again the mantra that drug dependency could be overcome by willpower and determination and never giving in to any excuses.
This intense focus on believing you have control over your behavior would go on to give Elyn enormous problems when she began to experience psychotic breaks. For years, she resisted using any drugs, and even after she relented, she kept trying to scale back on her anti-psychotics, believing they were somehow a crutch or an admission of failure.
Despite her sometimes severe symptoms -- and one of the book's best features is its ability to recreate her disordered, paranoid thoughts of having killed people or being able to kill them with her mind -- Elyn made it through Oxford as a classical philosophy scholar, even though it took her twice as long because of stays in mental hospitals. She had a similar struggle getting through Yale Law School, and in America, suffered her first experience of forcible restraints and forced medication.
Eventually, against enormous odds, she obtained a teaching position at Southern Cal and got tenure after publishing academic papers on the rights of mentally ill patients to refuse treatment, and whether people with multiple personality disorder should bear responsibility for crimes committed by one of their personalities.
The book is also a testament to the friends who stuck by her through all the chaotic years, when so many did not know she had mental illness, and to the man who finally brought love into her life.
And she has always had her work -- her safest haven, just as school libraries were the places she always sought out when she felt most fragile. “Occupying my mind with complex problems has been my best and most powerful and most reliable defense against my mental illness,” she has said.
This sometimes grim but enormously moving memoir is so literate that it reads like a novel, and like a good novel, it has you rooting throughout for the heroine in spite of her struggles.
March 5, 2018
A truly eye-opening book. I thought I had a basic understanding of what schizophrenia was, but Saks really proved me wrong. She describes her experiences eloquently and expresses both her feelings and delusions well, resulting in a powerful memoir that gives you a short glimpse into what it's like for her living with schizophrenia.
Her accomplishments are extraordinary, regardless of her diagnosis. I can only hope to be as successful as she in the academic world one day, as it takes a lot of ambition and drive to get to where she is even with a "neurotypical" brain. It is remarkable that she was able to go through her battles with mental illness while still holding on to that essential part of herself, her intellect and her need to keep learning and pushing herself. To say her story is inspiring would be an understatement.
I was angry and confused with her throughout a large portion of the book. I was not alive in the 1980s and even though I was aware that mental health treatment has come a long way, I was shocked by how she was treated in the United States. Restraints, tricks, threats, and even doctors denying that what she was experiencing was real at all! I was also disappointed that the first professionals she saw simply diagnosed her with depression and encouraged her to eat more. I know that medical professionals at that time were not evil, and many of them probably had only good intentions, but her experiences were inhumane and appalling. My heart breaks for her and other mentally ill patients who had to go through anything even remotely similar.
Psychoanalysis is something I'd learned about in college psych but not something I'd ever given much credit to. It was interesting to see how it works for her, and how central it is to her treatment. I wonder if it is still popular today?
I learned so much while reading this book, from her delusions to her traumatic experiences in hospitals and emergency rooms. There were two central things I took away from her writing: one, that people battling with schizophrenia may be acting strangely or violently because they are scared themselves; and two, that mentally ill patients are always being told what they need to do, and that sometimes what they need is to be asked what they want to do. (I wish I could provide the two quotes for these, but I've already returned the book to the library. They were fantastic quotes though.) I highly recommend this to anyone who wants to understand more about schizophrenia or really any severe mental illness.
Her accomplishments are extraordinary, regardless of her diagnosis. I can only hope to be as successful as she in the academic world one day, as it takes a lot of ambition and drive to get to where she is even with a "neurotypical" brain. It is remarkable that she was able to go through her battles with mental illness while still holding on to that essential part of herself, her intellect and her need to keep learning and pushing herself. To say her story is inspiring would be an understatement.
I was angry and confused with her throughout a large portion of the book. I was not alive in the 1980s and even though I was aware that mental health treatment has come a long way, I was shocked by how she was treated in the United States. Restraints, tricks, threats, and even doctors denying that what she was experiencing was real at all! I was also disappointed that the first professionals she saw simply diagnosed her with depression and encouraged her to eat more. I know that medical professionals at that time were not evil, and many of them probably had only good intentions, but her experiences were inhumane and appalling. My heart breaks for her and other mentally ill patients who had to go through anything even remotely similar.
Psychoanalysis is something I'd learned about in college psych but not something I'd ever given much credit to. It was interesting to see how it works for her, and how central it is to her treatment. I wonder if it is still popular today?
I learned so much while reading this book, from her delusions to her traumatic experiences in hospitals and emergency rooms. There were two central things I took away from her writing: one, that people battling with schizophrenia may be acting strangely or violently because they are scared themselves; and two, that mentally ill patients are always being told what they need to do, and that sometimes what they need is to be asked what they want to do. (I wish I could provide the two quotes for these, but I've already returned the book to the library. They were fantastic quotes though.) I highly recommend this to anyone who wants to understand more about schizophrenia or really any severe mental illness.
January 20, 2014
Unfortunately, schizophrenia as a health condition is often misunderstood. People tend to make assumptions based off of out dated notions of what mental illness is and is not and in turn feed into the stigma of mental health disorders. Elyn Saks tells her story with incredible honesty and vulnerability. In "The Center Cannot Hold" Dr. Saks shares a deeply personal account of her life. As a second year master's student, majoring in Mental Health Counseling, I am so grateful for her courage to share her story. Her unique and personal struggle with schizophrenia allowed for me to really empathize with her as she gave me a glimpse into her world. It is a beautifully told narrative that took me into the mind of a woman struggling to live her life in a meaningful way. This is a book that I would highly recommend to anyone seeking to more fully understand the challenges of living with a mental illness. Dr. Saks discusses the debate over medication as well as the continual struggle to not be defined by the stigma.
August 31, 2021
A very compelling read, and does much to battle the stigma against thought disorders.
The book, written by a brilliant USC law professor with schizophrenia, is a real page turner, as she is locked up in institutions, chained to tables, and ignored when she’s genuinely dying from a brain hemorrhage. The whole story is harrowing til it’s not. Suddenly a bright future emerges and she is powerful and free. I loved following her. I was also impressed with the economy of the text. She never uses three words when two will do, nor works things out in front of us. The result is a balanced, composed text that lacks floweriness, mostly to its benefit.
It’s a bit dated (a lot of her hospitalization stories are from the 70s) and biased toward Freudian psychoanalysis, but she also makes it clear that medication is a necessary part of her ongoing success. I did start to worry that she was essentially guru-hopping between her different analysts, and falling into psychosis whenever one died or moved. But perhaps that’s a pitfall of any human relationship on some level; it sustains you until it doesn’t. I just would have liked to see more reference to behavioral research and less to her analysts’ idiosyncratic theories along the lines of, “you are projecting on me that which your father said about you as a toddler.”
I also would have liked more vivid descriptions of her hallucinations and delusions. As a person without a thought disorder, it’s hard for me to get in her head when she vaguely refers to, say, “the evil beings I sensed in the sky.” But I’m sure there are good arguments to be made for not fleshing them out too fully.
This won’t give you an overview of schizophrenia, its treatments, or modern theories thereof. But it will give you a peek into the much-lauded barrier between genius and madness.
The book, written by a brilliant USC law professor with schizophrenia, is a real page turner, as she is locked up in institutions, chained to tables, and ignored when she’s genuinely dying from a brain hemorrhage. The whole story is harrowing til it’s not. Suddenly a bright future emerges and she is powerful and free. I loved following her. I was also impressed with the economy of the text. She never uses three words when two will do, nor works things out in front of us. The result is a balanced, composed text that lacks floweriness, mostly to its benefit.
It’s a bit dated (a lot of her hospitalization stories are from the 70s) and biased toward Freudian psychoanalysis, but she also makes it clear that medication is a necessary part of her ongoing success. I did start to worry that she was essentially guru-hopping between her different analysts, and falling into psychosis whenever one died or moved. But perhaps that’s a pitfall of any human relationship on some level; it sustains you until it doesn’t. I just would have liked to see more reference to behavioral research and less to her analysts’ idiosyncratic theories along the lines of, “you are projecting on me that which your father said about you as a toddler.”
I also would have liked more vivid descriptions of her hallucinations and delusions. As a person without a thought disorder, it’s hard for me to get in her head when she vaguely refers to, say, “the evil beings I sensed in the sky.” But I’m sure there are good arguments to be made for not fleshing them out too fully.
This won’t give you an overview of schizophrenia, its treatments, or modern theories thereof. But it will give you a peek into the much-lauded barrier between genius and madness.
March 1, 2019
I picked up this book because it seemed interesting. I was halfway through it when I realized it was the life of a scholar I know! I knew that this scholar did mental health law, but I didn't connect until later. The book is an excellent perspective on mental health and the thesis (if there is one) is to stop stigmatizing the mentally ill. Saks is an excellent and honest writer. I learned a lot
March 25, 2024
The humanity we all share is more important than the mental illness we may not
I enjoyed this book, despite sometimes feeling like I was reading a textbook, it was a vivid depiction of what it’s like to live with schizophrenia. I applaud the author’s bravery for publishing such an honest depiction of an Illness still dogged by stigma and misunderstanding.
I enjoyed this book, despite sometimes feeling like I was reading a textbook, it was a vivid depiction of what it’s like to live with schizophrenia. I applaud the author’s bravery for publishing such an honest depiction of an Illness still dogged by stigma and misunderstanding.
September 27, 2017
Fascinating story told by a schizophrenic woman who managed to graduate Yale Law and then become a tenured professor, all the while struggling against delusions and other symptoms. Not a poetic book but it felt very honest and it was a way to get a bit of a clue to what psychosis must feel like.
October 11, 2018
Wow.
Okay, let's get the not-so-great over with first. The writing isn't always great; it's sometimes a bit repetitive and the author's high-achieving academic history is mentioned a bit too often. And there was a bit near the end when I got a bit bored - I'm not really that interested in the details of anyone's wedding cake, to be honest.
But the good bits? They are fabulous. This is honest, insightful and raw. As someone with secondary personal (i.e. not me but about as close as otherwise possible) experience of schizoaffective disorder, I was blown away. I could not put this down. I started to read at about 4 a.m. (couldn't sleep - story of my life - reading puts me back to sleep faster than lying there with my brain awhirl), didn't stop reading until I had to do a school-run, then came home and read until I'd finished.
There is a fairly heavy emphasis on psychoanalysis which is now widely agreed to be an inadequate, if not ineffective, management tool for schizophrenia. However until relatively recently, we did not have effective pharmaceutical treatments, and the choice was between psychoanalysis, drugs with fairly horrific side-effects, or nothing. Reading this, I found myself frequently reminded of how grateful I am that we now have better medications - not cures, but drugs that give many people their lives back. Saks is hugely impressive in what she has managed to achieve *despite* the lack of availability of appropriate treatment throughout most of her life, and although this book does wander at times, it provides an excellent insight into what living with psychosis (or the threat of psychosis) is actually like. For that reason, I'm calling this at 4.8*.
Okay, let's get the not-so-great over with first. The writing isn't always great; it's sometimes a bit repetitive and the author's high-achieving academic history is mentioned a bit too often. And there was a bit near the end when I got a bit bored - I'm not really that interested in the details of anyone's wedding cake, to be honest.
But the good bits? They are fabulous. This is honest, insightful and raw. As someone with secondary personal (i.e. not me but about as close as otherwise possible) experience of schizoaffective disorder, I was blown away. I could not put this down. I started to read at about 4 a.m. (couldn't sleep - story of my life - reading puts me back to sleep faster than lying there with my brain awhirl), didn't stop reading until I had to do a school-run, then came home and read until I'd finished.
There is a fairly heavy emphasis on psychoanalysis which is now widely agreed to be an inadequate, if not ineffective, management tool for schizophrenia. However until relatively recently, we did not have effective pharmaceutical treatments, and the choice was between psychoanalysis, drugs with fairly horrific side-effects, or nothing. Reading this, I found myself frequently reminded of how grateful I am that we now have better medications - not cures, but drugs that give many people their lives back. Saks is hugely impressive in what she has managed to achieve *despite* the lack of availability of appropriate treatment throughout most of her life, and although this book does wander at times, it provides an excellent insight into what living with psychosis (or the threat of psychosis) is actually like. For that reason, I'm calling this at 4.8*.
May 19, 2014
This book added new depth to my ability to think about mental illness. It gave a fullness to my understanding of word salad and psychosis. Getting a firsthand, experiential account of how restraints feel when having a breakdown is invaluable. I now think more critically about what it means to force medicate someone. I have a new humility when considering someone dependent on medication who is struggling with taking it. It's not fair for me to think of it as simple to take the medication and be better, when I have never struggled with serious mental illness. At its core, this memoir is about the importance of autonomy and human dignity for everyone. I am so glad I read it and it was so hard to put it down!
April 19, 2016
To be succinct, I think this is a very moving book. Though it's obviously hard for me to say, I felt like The Center Cannot Hold does a great job of conveying what it's like to live with Schizophrenia". That's a very general statement, though, so I figured I would talk a bit about some more specific details of her book which stuck out to me.
In particular, I found her descriptions of the onsets of her psychotic episodes very chilling. Going from fully professional to incoherent and free-associating in the span of an hour must be terrifying and disorienting, and the way these transitions were often described very briefly (a paragraph at most) meant they kind of "snuck up" on me, kind of yanking me away from thinking about whatever professional issues were being discussed. While I don't mean to imply that these small surprises are comparable to an actual psychotic break, the lack of any longer build-up or foreshadowing gave me some idea of how disruptive a psychotic episode must be.
Further, the book gave me an appreciation of why someone with a mental illness might want to get off their medication. I guess the way I felt about this before could be summarized by the comparison Saks makes to physical disease - "if your leg is broken, why wouldn't you use a crutch?" - so whenever I saw someone in a movie or whatever not take their medication, it always felt more like a plot device than something a real person might reasonably do.
Saks' constant fighting to lower her dosage with the goal of getting off medication gave me some idea of why it might be different with mental disease, though. Leaving aside the significant side effects of many anti-psychotics, I hadn't really thought about how accepting that you need medication on some level means surrendering to the disease.
For Saks, trying to get off medication seems to be a means of resisting her disease - a way of refusing to be defined as merely a crazy person. I was very impressed by her ability to make me appreciate how difficult it must have been to give up her goal of getting off medication, and found her ultimate acceptance of her need for medication very touching.
(Just to be clear, I don't mean to romanticize not taking medication or anything. It's just that but before reading The Center Cannot Hold, I hadn't really thought about why you might not feel happy about taking your medication even in the absence of side effects.)
One last thing which stuck out to me was just how good a job Elyn Saks the author does of writing Elyn Saks the main character. While I understand that the book is a memoir and so the two are actually the same person, The Center Cannot Hold made me feel like I had spent some time with its author more than most other memoirs I have read. Saks doesn't just recount events, she goes out of her way to make you understand what she was thinking and feeling at the time, and how she feels about it looking back. I just found it really well written, I guess.
So in short, I think this is a book well worth reading.
In particular, I found her descriptions of the onsets of her psychotic episodes very chilling. Going from fully professional to incoherent and free-associating in the span of an hour must be terrifying and disorienting, and the way these transitions were often described very briefly (a paragraph at most) meant they kind of "snuck up" on me, kind of yanking me away from thinking about whatever professional issues were being discussed. While I don't mean to imply that these small surprises are comparable to an actual psychotic break, the lack of any longer build-up or foreshadowing gave me some idea of how disruptive a psychotic episode must be.
Further, the book gave me an appreciation of why someone with a mental illness might want to get off their medication. I guess the way I felt about this before could be summarized by the comparison Saks makes to physical disease - "if your leg is broken, why wouldn't you use a crutch?" - so whenever I saw someone in a movie or whatever not take their medication, it always felt more like a plot device than something a real person might reasonably do.
Saks' constant fighting to lower her dosage with the goal of getting off medication gave me some idea of why it might be different with mental disease, though. Leaving aside the significant side effects of many anti-psychotics, I hadn't really thought about how accepting that you need medication on some level means surrendering to the disease.
For Saks, trying to get off medication seems to be a means of resisting her disease - a way of refusing to be defined as merely a crazy person. I was very impressed by her ability to make me appreciate how difficult it must have been to give up her goal of getting off medication, and found her ultimate acceptance of her need for medication very touching.
(Just to be clear, I don't mean to romanticize not taking medication or anything. It's just that but before reading The Center Cannot Hold, I hadn't really thought about why you might not feel happy about taking your medication even in the absence of side effects.)
One last thing which stuck out to me was just how good a job Elyn Saks the author does of writing Elyn Saks the main character. While I understand that the book is a memoir and so the two are actually the same person, The Center Cannot Hold made me feel like I had spent some time with its author more than most other memoirs I have read. Saks doesn't just recount events, she goes out of her way to make you understand what she was thinking and feeling at the time, and how she feels about it looking back. I just found it really well written, I guess.
So in short, I think this is a book well worth reading.
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