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

Perhaps you think of the malodorous woman who sits on a park bench mumbling to no one, her grocery cart of worldly possession at her side. Or, something closer to home: a peculiar uncle who never left your grandparents house, kept to himself, who wore a tin foil hat for “protection.” We all have our stereotypes, some reinforced by experience, others by cultural norms and expectations. As a psychiatry resident, I have had the tin-foil-hat-wearing patient, the homeless patients who live under highways. But Elyn Saks has schizophrenia, too, and she wants us to see that it doesn’t always fit the mold.

Saks’s academic pedigree is one to envy. She graduated from Vanderbilt, the went on to be a Marshall Scholar at Oxford and received a Master of Letters before going to law school at Yale. Oh, and she has a doctorate in psychoanalysis, too. Now a professor at USC, she specializes in mental health law, criminal law, and children and the law. And she has schizophrenia. The Center Cannot Hold: My Journey Through Madness is a vivid and starkly honest look at her own mental health.

While most of us will only ever witness schizophrenia from the outside looking in, Saks gives us a clearer window onto her experiences with psychosis. The prologue opens with Saks in the Yale law school library, arduously doing homework with her classmates. But what should be a diligent study session devolves as the psychosis takes hold, and she finds herself out on the rooftop, calling to her now-reluctant partners, “This is the real me! Come to the Florida lemon tree! Come to the Florida sunshine bush! Where they make lemons. Where there are demons.”

Then, still connected enough to reality to realize her classmates do not share in her sentiments: “Hey, what’s the matter with you guys?” Back inside again, and examining her textbooks, Saks remarks, “I don’t know if you’re having the same experience of words jumping around the pages as I am. I think someone’s infiltrated my copies of the cases. We’ve got to case the joint. I don’t believe in joints. But they do hold the body together.” Her mental process races.

Now, in hindsight, Saks pulls us into her vivid world, sharing with us the intensity of her experience. Her writing is crisp, putting us into the moment as we see her taken to the ER, forced to take medication, restrained on a gurney.

“I am like a bug, impaled on a pin,” she writes, “wriggling helplessly while someone contemplates tearing my head off.”

From the riveting opening, Saks moves back in time to her childhood, where we begin to catch glimpses of her mental illness. While much of her youth had the typical ups and downs of growing up, she developed certain obsessions — “a few little quirks” — like needing to align her clothing and organize her books. Then came the night terrors, the feeling that someone was outside her window. Normal child development, or glimpses of the paranoia that would come?

On day, she tells us, her father refuses to let her go swimming, and instead of brushing it aside or becoming angry but then moving on, her mind feels “like a sand castle with all the sand sliding away in the receding surf.”

She writes: “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. If they haven’t felt it themselves, they’ve at least seen a movie, or read a book, or talked to a frightened friend — they can at least imagine it. 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.”

While it is an extremely disturbing experience at the time, young Saks keeps it to herself. “That intuition,” she writes, “that there was a secret I had to keep — as well as the other masking skills that I learned to use to manage my disease, came to be central components of my experience of schizophrenia.”

Yet schizophrenia is a secret that has a way of emerging. That psychotic break at Yale results in five months in an inpatient psychiatric unit, Saks reveals. After that, she writes, her path to recovery is anything but linear as she works to find equilibrium between her autonomy, ambition, and illness.

Well crafted and engaging, Saks’s memoir will change the way you think about schizophrenia. There is that patient with the tin-foil hat: I have seen him myself. But there is a wide range of people who have serious mental illness, and Saks does an excellent job showing us her particular experience.

The Center Cannot Hold: My Journey Through Madness
Hachette Books, August 2008
Paperback, 368 pages

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