The Center Cannot Hold: My Journey Through Madness

The Center Cannot Hold: My Journey Through Madness (2007) is an award-winning, best-selling memoir by Elyn R. Saks about her life with schizophrenia. It recounts Saks’s mental health journey from the beginnings of her illness through its progression and eventual management, as she finds personal and professional success along the way.

Elyn Saks is a professor, lawyer, psychoanalyst, and academic, currently serving as the associate dean and the Orrin B. Evans Professor of Law, Psychology, Psychiatry, and the Behavioral Sciences at the University of Southern California Law School. She has authored a number of academic articles and books in the area of mental health and law, including on the rights of psychiatric patents, and the application of criminal law to patients with Dissociative Identity Disorder (DID). The Center Cannot Hold is her first autobiographical work. This guide, which contains mentions of self-harm and suicide, is based on the Hachette Kindle edition.

Summary

In the prologue, Elyn Saks recounts a psychotic episode she experienced as a law student at Yale which eventually landed her in the ER. She recounts her childhood growing up in Miami in the fifties and early sixties where she leads an idyllic, suburban life but begins to display symptoms of mental illness which go unaddressed.

As a teenager, Elyn experiments with drugs and an experience leaves her with extended, unpleasant hallucinations. In response, her parents admit her to a rehab center called Operation Re-Entry. Elyn spends the next two years developing a strong negative attitude towards all kinds of drugs and medication, and a belief that any illness or weakness can be overcome by force of will.

In the 70s, Elyn attends Vanderbilt University and does her undergraduate studies in philosophy. Early signs of schizophrenia begin to emerge, and Elyn has multiple experiences of psychosis, including delusions and hallucinations. However, her small but strong circle of friends act as a stabilizing influence, and she completes her degree with a stellar academic record. Elyn goes on to study Aristotle in the original Greek at Oxford via the Marshall Grant.

The change in academic routine and lack of social support at Oxford are stressful, and Elyn experiences psychosis with suicidal ideation. She enters Warneford Hospital as an in-patient. Elyn is given antidepressants and her therapy sessions focus on day-to-day coping; however, after she leaves the hospital, her condition worsens, and she is re-hospitalized again eight months later. Elyn is referred to Dr. Storr, a consultant psychiatrist, who recommends she continue her studies at Oxford but also begin intensive talk therapy. Elyn begins seeing Mrs. Jones, a psychoanalyst. Sessions with Mrs. Jones help Elyn manage her symptoms, and she eventually earns her MLitt from Oxford. Elyn stays on in England for another year, continuing therapy with Mrs. Jones and volunteering at Littlemore Hospital, a psychiatric institution.

Elyn eventually moves back to the United States to attend Yale Law School. She experiences psychosis again, arriving full circle to the events of the prologue. She is forcibly restrained and given medication, and the doctor issues a Physician’s Emergency Certificate, allowing the hospital to hold her for fifteen days. In this time Elyn continues to be forcibly given medication and kept in restraints. Her parents are notified of her condition despite her protests, and she is withdrawn from Yale by the hospital without her knowledge or consent. Elyn eventually receives an official diagnosis of schizophrenia.

Elyn remains in hospital for the next few months; she eventually goes home and reapplies to Yale and is accepted. Before classes begin, Elyn begins therapy with Dr. White, a Yale faculty psychiatrist. He treats her with a combination of psychoanalysis and medication, which proves effective. Elyn’s second time at Yale sees her making a valuable and lifelong friend, Steve Behnke, who is the first non-medical professional to whom Elyn discloses her psychiatric history. Steve and Elyn work at the Yale mental health law clinic together to represent psychiatric patients and children.

After graduation, Elyn works at Connecticut Legal Services (CLS) for a short while, before moving on to a teaching position at a local law school; she continues working with Dr. White all the while. During this time, she also suffers a brain hemorrhage which she eventually recovers from, but is initially ignored by doctors owing to her psychiatric history. Elyn goes on to accept a tenure-track position at University of Southern California (USC). She moves to Los Angeles, and begins therapy with a new analyst, Kaplan.

Elyn settles well into USC, making friends and becoming a well-liked professor. She writes and publishes multiple academic articles and books during her time here, and ultimately achieves tenure. Elyn also trains in and practice psychoanalysis herself, and even finds love. She eventually marries her husband, Will, who stands by her throughout her illness and a two-time battle with cancer.

Throughout this time, Kaplan helps Elyn navigate and manage her illness. Eventually, however, the relationship sours, and Elyn moves on to other therapists, continuing to receive psychoanalysis and medication. She reconciles herself to the fact of her illness, and her experience of living a fulfilling and satisfying life despite it.