Insiders: “The Center Cannot Hold” by Elyn R. Saks

Elyn Saks is a professor at the University of California Gould School Law and and adjunct professor of psychiatry at the University of California at San Diego School of Medicine. She is extremely accomplished by any measure. That she has done this while managing serious mental illness is remarkable. In a piece she wrote for the New York Times in 2013, she said,

“Although I fought my diagnosis for many years, I came to accept that I have schizophrenia and will be in treatment for the rest of my life. Indeed, excellent psychoanalytic treatment and medication have been critical to my success. What I refused to accept was my prognosis. Conventional psychiatric thinking and its diagnostic categories say that people like me don’t exist. Either I don’t have schizophrenia (please tell that to the delusions crowding my mind), or I couldn’t have accomplished what I have (please tell that to USC’s committee on faculty affairs). But I do have and I have. I am not alone. There are others with schizophrenia and such active symptoms as delusions and hallucinations who have significant academic and professional achievements.”

Saks provides some of the best descriptions of what living with schizophrenia has been like in her best selling book, “The Center Cannot Hold” (2007).

“This experience is much harder, and weirder, to describe than extreme fear or terror. Most people know what it is like to be seriously afraid. But explaining what I’ve come to call ‘disorganization’ is a different challenge altogether. Consciousness gradually loses its coherence. One’s center gives way. The center cannot hold. The ‘me’ becomes a haze, and the solid center from which one experiences reality breaks up like a bad radio signal” “No organizing principle takes successive moments in time and puts them together in a coherent way from which sense can made. And it’s all taking place in slow motion.” (p13).

Saks has become a significant spokesperson for combining medication and talk therapy for managing schizophrenia.

“Medication has no doubt played a central role in helping me to manage my psychosis, but what has allowed me to see the meaning in my struggles – to make sense of everything that happened before and during the course of my illness, and to mobilize what strengths I may possess into a rich and productive life- is talk therapy. People like me with a thought disorder are not supposed to benefit much from this kind of treatment, a talk therapy oriented toward insight and based upon a relationship. But I have. There may be a substitute for the human connection – for two people sitting together in a room, one of them with the freedom to speak her mind, knowing the other is paying careful and thoughtful attention – but I don’t know what that substitute might be. It is, at the heart of things, a relationship, and for me it has been the key to every other relationship I hold precious. Often, I’m navigating my life through uncertain, even threatening waters – I need the people in my life to tell me what’s safe, what’s real, and what’s worth holding on to.” (p.331).

Saks may be considered the ideal spokesperson for those who may believe one can overcome schizophrenia, but she honestly confronts that notion with her own experiences of both success in managing her illness and constant reminders of the limits and challenges she must deal with.

“My life today is not without it’s troubles. I have a major mental illness. I will never fully recover from schizophrenia. I will always need to be on antipsychotic medication and in talk therapy. I will always have good days and bad, and I will get sick.” (p.335).

A friend of Saks asked her if there were a pill that would instantly cure her, would she take it. She thought of the poet, Ranier Maria Rilke, who would decline psychoanalysis saying, ” don’t take my devils away, because my angles may flee too”. And she responds, “My psychosis is a waking nightmare , in which my demons are so terrifying that all my angels have already fled. So would I take the pill? In a heartbeat.” (p.336).