The Center Cannot Hold: My Journey Through Madness by Elyn R. Saks

For anyone, Elyn Saks’s accomplishments would be impressive: multiple degrees from distinguished schools including Vanderbilt, Oxford University, and Yale Law School, plus a PhD in psychoanalysis; four books published and many articles; and important awards, including the MacArthur “genius grant.” Saks did all this while suffering from paranoid schizophrenia. Her story is nothing short of astonishing.

Saks’s descriptions of her delusions and crazy behavior are fascinating and sad. She alarms people by asking “Have you ever killed anyone?” or saying “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.” At times she is floridly psychotic, even forcibly committed and put in restraints. (This leaves such an impression that she’s devoted a good part of her professional life to examining issues of consent with mental patients.)

As Saks explains it, the fundamental characteristic of schizophrenia is confusion between what’s real and what’s not, like the feeling when you wake up from a nightmare and aren’t sure yet if it’s over. As crazy as her delusions sound, it takes many years for Saks to accept that they are delusions, not the same things everyone else thinks but doesn’t say. She figures they just have better self-control than she does.

In fact, Saks is amazingly self-controlled, strong, and self-disciplined. She can maintain order and sanity in her life, and being immersed in the work she loves helps keep her sane. Ironically, though—and to me this is one of the most interesting themes in the book—her refusal to surrender keeps her sicker longer. Even when she can be persuaded to take antipsychotic drugs at all, for years she lowers the dose at the first opportunity, despite many, many experiences of getting better at higher doses. After much she work, she can finally accept that yes, she is schizophrenic, and yes, she needs meds.

Slowly, and with the help of talk therapy, Saks does find balance in her life, even meeting someone to love who loves her back. She’s married now, and has good friends too, and that made me want to stand up and cheer. She’s never going to be not schizophrenic, but she has a way to live with it now, and I’m so glad for her.