The Center Cannot Hold

1. Elyn Saks' journey with schizophrenia: From denial to acceptance

"I am a woman with chronic schizophrenia. I have spent the majority of my life in the grip of delusions, paranoia, and hallucinations."

Early struggles: Elyn Saks' battle with schizophrenia began in her teenage years, marked by intense delusions and paranoia. She initially denied her illness, believing her thoughts were normal and that she simply lacked the willpower to control them. This denial led to multiple hospitalizations and setbacks in her personal and academic life.

Path to acceptance: Over time, Saks gradually came to terms with her diagnosis. This acceptance was facilitated by:

• Consistent psychoanalytic treatment
• Supportive relationships with friends and mentors
• Professional accomplishments that challenged her self-perception as "defective"
• The dramatic improvement in her symptoms with newer medications like Zyprexa

Saks' journey illustrates the complex process of accepting a mental illness diagnosis and the profound impact this acceptance can have on one's ability to manage the condition effectively.

2. The power of psychoanalysis in managing mental illness

"While medication had kept me alive, it had been psychoanalysis that had helped me find a life worth living."

Therapeutic alliance: Saks found tremendous value in her psychoanalytic relationships, particularly with Mrs. Jones and Dr. White. These therapists provided:

• A safe space to explore her thoughts and feelings
• Consistent support and understanding
• Insights into the meanings behind her symptoms

Analytical approach: Psychoanalysis helped Saks by:

• Encouraging her to express her thoughts freely, including psychotic ones
• Providing interpretations that helped her understand her experiences
• Offering a containing relationship that helped her feel less alone with her struggles

Saks' experience demonstrates that while medication can be crucial for symptom management, intensive psychotherapy can play a vital role in helping individuals with severe mental illness build meaningful lives and develop coping strategies.

3. Stigma and secrecy: Navigating academia with schizophrenia

"To admit to any of it was to admit that my brain was profoundly broken, and I just couldn't do that."

Fear of disclosure: Throughout her academic career, Saks grappled with whether to reveal her diagnosis. She feared:

• Being seen as incompetent or unfit for her profession
• Losing opportunities for advancement
• Facing discrimination from colleagues and students

Strategies for success: To navigate this challenge, Saks:

• Carefully managed information about her condition
• Worked diligently to prove her capabilities
• Sought support from trusted mentors and friends
• Gradually opened up to select colleagues as she became more established

Saks' experience highlights the pervasive stigma surrounding mental illness in professional settings and the complex decisions individuals must make regarding disclosure.

4. The role of medication in treating schizophrenia

"The clarity that Zyprexa gave me knocked down my last remaining argument."

Medication struggles: For years, Saks resisted taking medication consistently, viewing it as:

• A crutch that indicated weakness
• Something that dulled her intellect and creativity
• Proof that she was fundamentally flawed

Breakthrough with Zyprexa: When Saks finally found an effective medication:

• Her psychotic symptoms dramatically decreased
• She experienced long periods without any psychotic thoughts
• Her ability to focus and function improved significantly
• She gained a new perspective on the reality of her illness

This experience underscores the potential of appropriate medication to dramatically improve quality of life for individuals with schizophrenia, while also highlighting the challenges of finding the right treatment.

5. Balancing personal relationships and mental health challenges

"If Steve's friendship had made me feel human, Will was making me feel like a woman."

Interpersonal difficulties: Saks' schizophrenia posed significant challenges to forming and maintaining relationships:

• Fear of intimacy and vulnerability
• Difficulty trusting others
• Concerns about burdening potential partners with her illness

Growth and connection: Despite these obstacles, Saks developed meaningful relationships:

• Deep friendships, particularly with Steve, who provided unwavering support
• A romantic relationship with Will, which helped her experience new aspects of herself
• Professional connections with colleagues and mentors who respected her work

Saks' journey illustrates that while mental illness can complicate relationships, it does not preclude the possibility of forming deep and meaningful connections with others.

6. Achieving professional success despite mental illness

"I was a lawyer, a scholar, with multiple academic degrees and honors, the promising beginnings of both a publishing career and a teaching career."

Academic achievements: Despite her struggles, Saks:

• Graduated from Vanderbilt University as valedictorian
• Earned a scholarship to Oxford University
• Completed a law degree at Yale
• Became a tenured professor at USC Law School
• Published numerous articles and books on mental health law

Strategies for success:

• Intense focus on work as a coping mechanism
• Careful management of her illness to minimize disruptions
• Support from mentors and colleagues
• Leveraging her unique perspective to contribute to her field

Saks' accomplishments demonstrate that individuals with severe mental illness can achieve at the highest levels of academia and professional life with appropriate support and treatment.

7. Legal and ethical considerations in mental health treatment

"There's a powerful urge in each of us to talk about our traumas. A psychotic episode is like experiencing trauma."

Patient rights: Saks' work in mental health law focuses on:

• The right to refuse treatment, including medication
• Ethical considerations in forced hospitalization
• The use of restraints and seclusion in psychiatric settings

Personal experience informing professional work: Saks draws on her own experiences to advocate for:

• More humane treatment of psychiatric patients
• Greater respect for patient autonomy
• Balancing safety concerns with individual rights

Her work highlights the complex ethical and legal issues surrounding mental health treatment and the importance of incorporating the perspectives of individuals with lived experience of mental illness.

8. The importance of support systems in managing schizophrenia

"Take courage, Elyn, take courage."

Critical support network: Saks' ability to manage her illness and achieve success was greatly aided by:

• Consistent, long-term psychoanalytic treatment
• Supportive friends like Steve who provided emotional and practical help
• Understanding colleagues who accommodated her needs
• Family members who, despite initial struggles, learned to support her

Professional support: In addition to personal relationships, Saks benefited from:

• Mentors who believed in her capabilities
• Supervisors who provided reasonable accommodations
• Mental health professionals who respected her autonomy

Saks' experience underscores the crucial role that a strong support system plays in helping individuals with severe mental illness lead fulfilling lives and reach their potential.

Last updated: January 22, 2025