October 26, 2007

The Center Cannot Hold -- Reflections on a book

By Ellen Saks (Hyperion, 2007)

You know from the dust jacket, even before reading the book, that this memoir about living with schizophrenia tells a most unusual story. The blurbs suggest an exceedingly “happy ending,” littered as they are with phrases like “a beacon of hope” and “the most lucid and hopeful memoir [about schizophrenia] I have ever read.” But it is the briefest bio on the inside, telling us that author Elyn Saks is not only a full law professor and a professor of psychiatry but also an associate at the New Center for Psychoanalysis that begins to paint a fuller picture. Who is this Saks, what was her madness, and how the hell did she get to where she is now in spite of it? When you have schizophrenia, and sometimes even if you do not, you hunger to know more.

I was first alerted to the book’s publication by another website, which wanted me and my twin to review it as a joint endeavor, along the lines of how we did our book, DIVIDED MINDS. This assignment was derailed, alas, by my recent five-week hospitalization. Before Brock Hill interrupted my reading, Saks, a Vanderbilt grad, had left Oxford with an advanced degree, obtained despite a severe active psychosis and concomitant hospitalization. Back in the States, she entered and did exceedingly well at Yale Law School, meanwhile surviving a couple of brief but brutal hospitalizations at Yale’s psychiatric facilities. I was halfway through the book when my own Lyme-induced psychosis forced me to quit.

Now, home again, I finished the book: in California, after Yale, Saks meets with new successes – tenure at USC Law School, publishing several books, qualifying as a psychoanalyst, marriage to a man she loves. These are predictably intertwined with just as many psychotic episodes -- as well as two very serious physical illnesses -- that follow on the heels of every success, as she herself explicitly notes.

Saks claims that the difference between her and the rest of us, besides her stubbornness and the life “lottery” is not so very much. Skills and talents are distributed among the mentally ill as among the general population and it is only that “resources” aren’t (distributed so equally) that apparently keeps the majority of other mentally ill persons from achieving their true potential. To be sure, Saks had parental resources, and thus she had the benefits of psychoanalysis, which is unimaginable for most, who cannot afford even one analytical hour a week, let alone five. She asserts that this did make a difference, the relationship, those uninterrupted decades of non-stop “speaking her [psychotic] mind” to an attentive audience of one.

But was psychoanalysis really the key? What about the reams of research that always said the opposite – we are told Freud himself refused to treat psychotics -- and as a result deprived us of any insight-oriented psychotherapy? If we had individual therapy at all, we were kept at arm’s length with “supportive” measures or else short-term CBT. Not for schizophrenics the long, arduous process of analysis; most were not even capable of forming a true relationship, let alone a therapeutic one. Analysis in such cases would be pointless. That was always the theory, or at least the excuse. Nonetheless, I remember that I did have one, maybe two friends with schizophrenia who were in psychoanalysis, only intermittently on medication, and claimed that the intensive talk therapy alone would cure them. I lost touch with both of them as the years passed and we grew apart. The one I miss the most would be around 65 today. If she is still alive, I wonder how she is doing. It would be fascinating to know whether her prediction did in fact bear fruit. I’d love to know, and hope indeed that she thrives.

Saks, if she is the sole author of the book (she mentions someone’s significant help), is a competent writer; the book moves along well, without the jargon or legalese one might expect from a lawyer. My worst criticism is that it suffers from some repetitiousness, given the unending cycle of success followed by predictable decompensation that characterizes her life. I would not necessarily want to know less information – she chose her life episodes well, clearly had decent editorial assistance in this, as we did not (and did nowhere near as good a job). But I think she might have used indirection rather than dialogue at times. For instance, the dialogue rendition of “disorganized thoughts” soon wearied this reader with its repeated and somewhat “staged” rehearsal on the page. It did not often ring true and hence suffered from its frequent repetition. On the other hand, her oh-so-accurate depiction of MU-10 at Yale New Haven Hospital and the “liberal” use of restraints made me shudder, knowing exactly how she felt.

Saks claims – and ultimately, don’t we all, we authors of memoirs of madness? -- she wrote the book to give people hope. But she also wrote it to dispel the myth “that people with a significant thought disorder cannot live independently, cannot work at challenging jobs, cannot have true friendships, cannot be in meaningful sexually satisfying love relationships, cannot lead lives of intellectual, spiritual or emotional richness.” Yes, well, fine, I thought upon reading this. That is indeed what we aim for, ALL of us, and good for you that you apparently have it all. You must be the very picture of mental health. I mean, what’s a touch of “significant thought disorder” after all that? (I was, of course, showing myself to be a touch bitter, which is to say, jealous and mean-spirited, as the above shows...but, I mean, really!)

Then I did a Wait a minute, wait a minute! doubletake. What is wrong with this picture? Is this reality? Is this how things really are, that is to say, the usual when a person has schizophrenia? What about all the mothers or siblings or husbands of those with schizophrenia who clearly are not pressing forward with their lives, who are not getting good grades or writing award-winning papers, not earning a living, obtaining bonuses, marrying, or if married, continuing to enjoy mutually satisfying sex and love lives in spite of such a devastating illness? How do they reconcile Saks’ message of hope – for a kind of super success, even as psychosis continues unabated -- with the bleak reality of what they see? It’s not that I’m against hope, as everyone knows perfectly well. But let’s name the ogre first, and go from there. It does no one any good to pretend that you can simply ignore the illness by sheer strength of will (if only you have it), and go on as before...

There have been other schizophrenic high achievers: to name just one, Carole North wrote “Welcome, Silence” several years ago, a memoir of her travels in schizophrenia-land during medical school. She was cured by dialysis – one in a million, she says now -- and became a psychiatrist who nonetheless does not recommend dialysis for anyone else. Cases like Saks and North are too much the exceptions to what is depressingly often the rule: a teenage boy or slightly older young woman gradually deteriorating before the puzzled eyes of family and friends, losing interest in school or work or even in socializing, perhaps becoming interested in new and bizarre subjects no one else can follow, becoming delusional or hallucinatory, and so on, or the sudden psychotic break that cannot be ignored, followed by hospitalization. Sure, there is always the 25-30% who fully recover and never have another episode. Though I am sorry they went through the pain of psychosis at all, I can’t concern myself with them. In some real sense, they do not have the kind of schizophrenia that I’m talking about.

It’s the other 70-75% I speak of, those who are either intermittently or chronically ill. Typically, many and I venture to say the majority of people with chronic/intermittent schizophrenia, do not work, or do so at a level not commensurate with their education or their potential. Many do not live independently, and those who do often have some formal “help” or structure in their day, whether through a partial hospital program or protected work setting, or a visiting nurse or social worker/case manager who comes to see them regularly. Few marry, and those who do, in my experience have trouble with sexuality, with functioning sexually as well, usually due to medication. As for rich emotional, intellectual and spiritual lives, I’d have to say that all are compromised when person is hampered by psychosis and/or chronic schizophrenia; even the obsessive spirituality that affects some psychotic individuals has a certain uncreative rigidity about it that is not truly free, nor as emotionally or spiritually rich as that which is less coerced. Playing tennis with Bible verses, which is the usual form it takes, does not prove a spiritual wealth, not by my lights.

However, if a schizophrenic person is lucky, as I am, as John Nash is, as are several others who have made movies or written recently released memoirs, around age fifty the illness begins to attenuate. Or else the medicines get better, or a little bit of both. Whatever the case, recovery begins to be possible and we start to blossom. No one can predict whether this will happen or not. Some illnesses merely “burn out,” leaving a shell of a person, neither ill, nor truly well, a double tragedy. Some have developed severe tardive dyskinesia from years on the older drugs and this already characterizes and disables their older years, despite improving mental health. No one knows what will happen as they pass into their fifties and sixties. I imagine some people simply stay sick all their lives but I would hope many more do not, or not to the same degree.

In the end, books like Saks’ make me feel bad about what I was never able to accomplish. And I worry that they suggest to the wider world – as does a recent review in the Hartford Courant -- that it should expect equal from the rest of us, from me. But don’t you see, I want to cry out, I’ve already done the very best I could! And I really believe that that is true of most people, especially those with schizophrenia. We are not lazy, we are not stupid or dull or willful, we fight to get through each and every day, no matter how hard that is. Saks’ “proof,” her massive achievements to the contrary, we have an illness that makes it devastatingly difficult for us to access, much less live up to, the potential we know, and yes, we know, is there inside us. We achieve by simply getting up each day and facing our many demons and pressing on. Do not count our achievements – however humble by comparison -- as nothing, just because they are not Saks’ or North’s.


PS I probably will cut this down by 3/4 if I actually submit it somewhere, as it is MUCH much too long and long-winded. But I indulge myself here and allow myself the bull-headed luxury of giving you everything, every stupid little thing I think and thought about this book. Relevant and important, or not! Feel free to discard or discount everything that you think unworthy of me or just plain disagreeable. I felt downright disagreeable at times! In point of fact, the book really irked me in places, I think because it just plain made me jealous...How come I couldn't do all that myself??? I berated myself. A useless preoccupation, singularly! I couldn't and I didn't, and that's just how it is.

So take it all with a grain of celery salt or sel de mer, and if I seem sour, take it with a spoonful of sugar. I will be sweeter tomorrow. Anyone else read this book yet? If you feel like sending me your own reviews or opinions, I will put them up on my next blog page if you give me permission. Or you can post them yourselves in the comments page if you prefer. (If you want them put up on the blog, publicly, send them to me at my gmail address above).



Posted by pamwagg at October 26, 2007 08:25 PM | TrackBack


I haven't read the book but a friend who owns the facility that I am brought to when I have "episodes" told me about Elyn Sak's book. I sarched on the 'Net and found this blog.

I was born and raised in a third-world Asian country, and still reside in it. If you're complaining about the rest of the world not really knowing what it's like, try being schizophrenic here. People lump everyone with mental illness under the general heading "crazy" which means homeless, grease-covered vagrants roaming the polluted streets with all their worldly possessions in a plastic bag. If you don't fit into that category (you're well off and have a family that can afford to keep you fed, housed, and looking clean), you're simply weird. Either way, you're met with derision, shunned, avoided, lied to, or at best, patronized. Treatment which makes us go ballistic and/or psychotic.

To make it in the real world (hold a real job, have a real relationship, enjoy real sex), it is impossible to wear the schizophrenia badge of courage on your chest. You will have to slug it out like the rest and not expect special treatment because of your condition. If you do, it automatically disqualifies you from "reaching your true potential."

Which I think is just fair. In a country where poeple have to deal with potential-limiting factors far graver than mental illness (poverty comes to mind instantly), I cannot find the moral energy to whine about the unfairness of it all, nor am I possessed by a zealous desire to educate others and make them see the light. All I can do is be thankful that I wasn't born poor, and had parents who had the resources to see me through my early years of psychosis.

I've been taking care of myself for five years now. Effectively self medicating, although the prescriptions are provided by my psyciatrist but I don't have psychoanalysis nor do I feel that this is the best way for me to go.

I found out that freely expressing myself doesn't work for me. I'm not really sure if what I'm saying or writing is what I really feel or think, or is just done to fulfill the expectations of my audience, or echoing someone else's ideas that I might like at that particular moment but may not be in alignment with my fundamental beliefs.

I used to write for a living, cheap trashy stuff because I worked in public relations and had no choice, or really commercial stuff as an ad copywriter. I know I wasn't fulfilling my potential but I was resigned to the fact that I couldn't aspire for more because my history of mental illness effectively created a glass ceiling. You see, I wanted to make my mark in the corporate world. With all its intrigues and backstabbings and normal office stuff that drives schizophrenics really crazy. The creative world wasn't offering that challenge. There, craziness was celebrated, encouraged even, and romanticized.

After one of my milder episodes and just as I hit forty, I decided to reinvent myself. I applied for an entry-level position in an industry different from those that I used to work in (although I soon found out that writing software is not all that different from writing ad copy - it's still a highly creative process and the proportion of loons is just about the same)

I'm surviving pretty well, and I've been promoted thrice in five years. But I harbor no illusions at all that once the ugly face of schizophrenia shows, management will not have anything to with me. I'll get fired on the spot (as I've been four times in past jobs), but with always with compassion (after all, I always manage to turn out excellent work and my departure is always viewed as a waste of talent).

Maybe I'm doing better now because I'm approaching the age when the illness is supposed to "attenuate." Most probably I won't be achieving anything as spectacular as John Nash's (although the most convenient way for colleagues to come to terms with my condition is to explain it away by saying that a thin line separates genius from madness). But I like the way my life has turned out so far, and I have no regrets (HONESTLY!) that I have this illness. It has made me a better person, wiser to human frailty and thus more forgiving of it. Which is why I do not understand the lashing out about this illness preventing people from achieving their true potential. I think the illness comes with package, and it's part of the equation for calculating potential. =) You can't discount it and say, what if? You might as well discount any other factor.

I can better understand the gripes about the unfulfilling sex life. Because I knew how it was before I started taking medications. But I'd rather not be occupied by thoughts of sex for the greater part of my waking hours.

Really, the realization of potential is the least of a 3rd-world schizophrenic's worries. Here, we need to be sane to survive. I've walked the streets for days on end, plastered in grime and grease, with a big plastic bag. I could have been run over by a car, killed by policemen, knifed by drug-crazed trippers. I could have died from hunger. Always, I found a way to cheat disaster. Now I'm working in a job that pays more than what 95% of salaried workers in my country receive. Maybe that's the fulfillment of my true potential?

Posted by: Alya at December 31, 2007 11:23 PM

Like Ellen Saks, I am endeavoring to write a book about how I helped my son recover from schizophrenia. I am only too aware of invoking the bittersweet feelings of those people who haven't fully recovered in the way they would like. I attribute the key to my son's recovery to intense therapy undergone by parents and child while simultaneously working very hard to get my son off medication. The two go hand in hand. Sadly, this kind of therapy is available to few people (and distrusted by many!) and the prevailing wisdom over the past 40 years is that getting off drugs is foolhardy indeed. I also believe that schizophrenics who recover have engaged symbolically and metaphysically with a person or philosophy that has explored their core concerns. Most "talk therapy" (correct me if I'm wrong) doesn't do this.

Posted by: Jung Frau at December 19, 2007 08:35 AM

I have just read Elyn Saks book. I am a mom with an adult son who may be schizophrenic. His psychiatrist has not given us a final diagnosis. I read the book hoping to understand the illness and to discover what if anything I can do to support my son. I am devastated and feel my life is on hold until we know one way or the other. I was completely unaware of what this illness means to those coping with it and the impact it has on families. Elyn's story seems exceptional and while it does give hope to those looking for me it was close to horrifying in it's description of the worst aspects of the illness and various treatments. I just found your blog via NAMI...and hope to learn more from you. Thank you for your generous sharing of such personal feelings and thoughts. My son is an artist and writing poetry and painting have been life-lines for him as well. I am also an artist and I think I know exactly what you mean when you say that you live to write and write to live. Many blessings to you.

Posted by: Susan Jonsson at October 31, 2007 07:01 PM

I understand your reservations about the book, which I truly enjoyed. Your points are valid.

I have always thought psychotherapy would be helpful, though unavailable to me at this point, and Saks' book reinforced that opinion.

Congratulations on the upcoming poetry book.


Posted by: ky perraun at October 29, 2007 09:17 PM

I want to second everything that Kate said. I am very glad you are back. I hope to read Elyn Saks book sometime. I expect I will say the same thing that Kate said: "Ms. Saks will remain the author of a good book.... But you, you are flesh and blood to me, vital, real, valuable." I couldn't say it any better.

I appreciate so much that "You are gracious enough to let people into your life through this blog.....and don't forget, you, too, are a very accomplished person."

Yes, you have done the best you could, and you are succeeding in enriching our lives. I am very excited that you will have another book coming out. I want to get it as soon as it is available.

And just like Kate,
"I'll always be a fan and a friend."

I count it a great privilege that I got to meet you last year. I hope I will get to see you again sometime.


Posted by: Stuart at October 29, 2007 04:22 PM

First things first: I want to congratulate you that Cavankerry Press is going to publish your manuscript of schizophrenia poems. I'm so excited about this. I knew your poems would get published! I'm eager to own a copy. You, despite your ongoing struggle with schizophrenia, are a success story. You may look to Elyn Saks with some jealousy but I look to you with more admiration than I do to her. Why? Because you are an artist in a way that she is not. I am drawn to your honesty and to your skillful use of language. And I am grateful that you have had the courage to put yourself out there not only in your poems but in your blog. Ms. Saks will remain the author of a good book on her struggles with schizophrenia, but she will always be too removed from my life. Her impression is passing. But you, you are flesh and blood to me, vital, real, valuable. You are gracious enough to let people into your life through this blog. I can't help but value you much more than her. Your blog is filled with personal wisdom. I hope someday you will edit down this blog and create another book. I read The Center Cannot Hold and I thought it was a good book and yes, her accomplishments are impressive, but you have given me and your readers so much more and don't forget, you, too, are a very accomplished person. I'll always be a fan and a friend.

Posted by: Kate K. at October 27, 2007 10:15 PM

I haven't read Saks' book, but I atill agree with what you say about it.

In my opinion, society as a whole doesn't understand Schizophrenia or even know what it truly is. Although "A Beautiful Mind" tried to show people what it was, it still sent out the message that people with Schizophrenia can "get over it" and live a "normal life" (whatever that is.) Unfortunately, it sounds like Saks' book will help reinforce that same message.

Posted by: Laurie B. at October 27, 2007 01:26 PM

Hello Pam,

Welcome back!

I'll start off by saying that I respect and admire all you've done and continue to do, in your life and with the blog. Feel free to call me out on what I'm about to say. No disrespect is intended; however, I wanted to give you my perception in response to your blog entry re: Elyn Saks.

With all due respect, I believe most people with schizophrenia could hold some kind of job, whether a traditional one or not. Most people I know with schizophrenia do work, and the one person I know who doesn't, leads a full, happy life aware of his limits yet not caving in to them.

While Elyn Saks has a hopeful story, I don't think one should trade success like that with having ongoing symptoms. A person can be successful and not be burdened with paranoia; she just might not have a job like Elyn does.

I would rather have a low-stress job and virtually no symptoms than to be a law professor and be dogged by psychiatric problems. In that regard I don't envy Elyn, who still has a hard time of it.

And though it's hard for me now, I choose not to talk about that because I refuse to resort to self-pity. My commnent here will skirt the issue, as I did indeed interview Elyn Saks for the SchizophreniaConnection blog I write. However, I'll say this much: sometimes success comes at a cost. I admire Elyn, don't envy her. I wouldn't want her life, but if someone else reads her book and says, "Wow, maybe I can try for that," more power to him or her!

Again, Pam, welcome back. I value your opinion and though we've "crossed" here re: Elyn's book, I look forward to hear from you.


Posted by: Christina Bruni at October 27, 2007 10:14 AM

This was a pleasure to read! I haven't read Saks's book: the news that psychoanalysis had been her salvation made me suspicious. I would love to see your response to her book get a wider readership.

Posted by: Debbie at October 27, 2007 10:11 AM

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