The Center Cannot Hold: My Journey Through Madness Paperback – August 12, 2008

Rossa Forbes is a contributor to Goddess Shift: Women Leading for a ChangeIn schizophrenia memoirs I am always looking to see what things that I can emulate in order to help my son get through his own particular version of schizophrenia. This kind of guidance is virtually non-existent unless you read about it from people who have been there themselves.It is easy to dismiss Elyn Saks as an over-achieving drama queen. Many people think that hers must be a mild case of schizophrenia since she is such a high achiever. I am amazed that she racked up all the credentials that she has while clearly psychotic much of the time. However, by doing this she has also demonstrated the elasticity of this diagnosis, and she has anecdotally pointed out some valuable insights for the rest of us. Her story will be disappointing for people who see getting off medications as a pathway to recovery because she finally admitted to herself, after years of refusing to take them, that she needed the medication to function. It just goes to show that there is no one size fits all solution.When I read these first person narratives, I always ask what information is available now that wasn't available then or what did the person not do that might have helped? None of this guarantees, of course, that the outcome would have been any different. Elyn Saks did not explore vitamin therapy. Vitamins in large doses such as vitamin B3 (niacin) act like drugs and there are no negative side effects. Energy medicine, which has also helped my son, was not widely known back then, and so there is no mention in this book of therapies that could correct an energy imbalanceI have learned enough through my own investigations to see that certain factors were in her favor outside of just being female. One is that her family let her do her thing. It is sometimes said that the family has to be involved but not over-involved. This is what is called Expressed Emotion (EE). Patients with families exhibiting low EE are found to have better outcomes when it comes to schizophrenia. When I first was trying to find out some useful information about what to do for my son, I was intrigued to read that many doctors feel that people do best whose families don't seem to notice that their relative is ill. Elyn Sak's parents win top prize in that category, though it probably wasn't a deliberate strategy on their part. Once I caught on to this simple but elegant idea, I began practicing it with my son. It seems to work because it thrusts a certain responsibility on the person while they remain clueless about how really worried you are. They are less anxious this way. You will eventually be less anxious, too, by practicing low EE.People who get labelled schizophrenic are often overly attached to their family. They can be the dutiful, thoughtful, "good as gold", achieving child. This almost guarantees that their passage into adulthood will be troublesome in really weird ways. Becoming an adult and leaving the framework of the family frightens them. Rather than get angry and openly rebel (a time-honored method of achieving independence), many go psychotic. Highly sensitive to begin with, they simply freak when it becomes apparent that soon they will soon be venturing further into the world or that the world is putting more demands on them. They are, of course, way too "considerate" of their parents. German theologian and counsellor Bert Hellinger says that individuals with schizophrenia are particularly sensitive to (though consciously unaware of) family trauma often originating four generations in the past. They "self-sacrifice" for a parent as a way of atoning for past family trauma. In this case, Elyn Saks is no exception. Early on, she told a therapist that she no longer wanted to see her (Karen) because her parents were upset that the therapist hadn't figured this out and come up with a plan, and that it cost them too much money to continue to see her. "It never occurred to me back then (and if it occurred to Karen, she didn't say so) that I was taking better care of my parents than I was of myself."The drug rehab program that she was forced into in high school by her parents left her no time to think for herself beyond the confines of what she was told to do and how to act. This may have worked to her advantage, not because she was abusing drugs (she wasn't) but because it gave her a framework of hard work and structure to her day that she was able to use throughout her psychosis. She always reached out for someone to hang onto, like clinging to a doorframe in a high wind, using that person as a frame of reference for her day. In her Oxford years she allowed time for herself to be clearly psycho within a framework of rigorous Kleinian psychotherapy, and then sobered up somehow during the rest of the day and went back and racked up more academic credentials. It was astonishing to me that the analysis that she underwent on a daily basis for three years in England didn't seem to lift her psychosis. She literally clung to the analyst right up until the day she left to go back to the United States, weeping and being her usual psychotic self. She had unknowingly done what psychiatrist Thomas Szasz advises. She found herself a contractual psychiatrist unconnected to an institution. She paid out of pocket for the privilege and she got what she wanted, rather than having the State force its one size fits all approach on her.The high school drug rehab program also gave her a lifelong aversion to taking any drugs, whether legal or illegal. If you read Robert Whitaker's new book, Anatomy of an Epidemic, you will see that her success, messy as it is, may be in large part because she continually refused to take the antipsychotics that were offered her. Whitaker's book extensively documents that long term use of psychiatric drugs leads to poorer outcomes. Psychiatrist Daniel Carlat says: "We often talk about neuro-transmitters like serotonin and noroepharin. But that really ends up being neurobabble. It sounds impressive to patients and it makes them think we know what we're doing when we're prescribing the medications. But we don't really know how these meds work." Side effects, said Carlat, can be serious or in some cases, unknown. "We don't know enough about the side effects to know how many people we're putting at risk."Elyn Sak's very messy psychotic life almost tempts me to say that an antipsychotic introduced earlier would have helped get her life together, and I am someone who is not at all in favour of relying on drugs to solve personal problems in living. Reading this book I am tempted to think "oh, please, just try an antipsychotic," but I am only too aware that psychiatric drugs can put you in a never-ending nightmare. They are major tranquillizers that set most people spinning off into long periods of relapse, weight gain, apathy, and unemployment. Should Elyn Saks have chosen the drug route, my guess is that she would not be where she is today. Sylvia Nascar, the author of A Beautiful Mind, might agree that Saks got where she did because she refused to take the drugs. Nascar writes: "Nash's refusal take the antipsychotic drugs after 1970, and indeed during most of the periods when he wasn't in the hospital in the 1960s, may have been fortuitous. Taken regularly, such drugs, in a high percentage of cases, produce horrible, persistent, symptom like tardive dyskinesia. . . and a mental fog, all of which would have made his gentle reentry into the world of mathematics a near impossibility."Another affirmation I got from this book is, if someone tells you that a certain therapy worked for them, then don't wait for the latest "scientific" evidence or psychiatrists to give it their blessing as a therapy in order to try it for yourself. Everybody "knows" apparently, that psychoanalysis "doesn't work for schizophrenics." Elyn Saks gives Kleinian psychotherapy (think Freud) major credit in helping her cope. Freud has been routinely trashed by modern psychiatry as unhelpful for schizophrenia. However, as her therapist pointed out to her back in the early 1980s, therapists have built on Freud's work as the basis of their work with schizophrenia. This influence doesn't seem to be well recognized today in an age where people think Freud has no relevance. Luckily for Elyn Saks, she didn't know what everybody else knows.One can quibble by saying that since she still suffers from psychosis, then what good did psychotherapy do? I understand that she is now in training to be a psychoanalyst so she must believe in it strongly. People say the same things about cognitive behavioural therapy, which is finally getting a rethink after many years of being dismissed for schizophrenia. Most psychiatrists don't want to get that involved with their psychotic patients. It's easier and more financially rewarding to medicate them than to do the really hard work of getting to know them. I can't believe the number of people who won't try something because "there is no scientific evidence" that it works for schizophrenia. Well, individuals are not statistics, you are the persons most interested in your own recovery and you should do whatever it takes to get there. I have introduced to my son some truly unusual therapies, short of dancing on a toad's grave, but if I thought that might work, I'd be game. I noticed that most of these non-sanctioned therapies moved him forward in some way. The bottom line here is think for yourself. You are you, but you are simply a statistic to the medical profession as it stands today.To make a long story short, I think this is a great book with a lot of insight.

Between reading to this book and listening to it as I moved around my house or was in the car, I have been immersed in Elyn Saks’ story for several days. I was moved by her courage, inspired by her tenacity and brilliance and uplifted by her loving community. Also horrified by her treatment by mental health practioners at the hospital where she was restrained.

I found Ms. Saks book thoroughly engaging. I couldn't put it down & finished it in 2 days.I thought the writing was very good. Her descriptions of her psychosis so that those of us who've never experienced schizophrenic delusions can understand what they're like were superbly written. She writes in an informative but conversational tone so that it makes you feel like you're her friend & she's confiding in you. The book read quick and was gripping along the way, going from normal moments of life at an Ivy League school to stark moments of disoriented psychosis.The book was often repetitive. The author's constant and consistently present idea that staying on medication (even though it kept her sane) indicated that she was a failure makes the book a bit monotonous. Elyn has some stress in life, becomes psychotic, gets medication that helps, then refuses to take it because that would make her a failure. After awhile you just want to jump through the pages and scream "Stay on your meds!" But I guess that's the truth of how things happened so that's what she wrote. It just gets a bit frustrating. Also, I found the author to be a tad self-congratulatory for my taste, though I understand how proud she must have been to be accomplishing what she was, despite having such a debilitating mental illness. Some questions, for me at least, were left unanswered, mostly regarding her delusions and how she related to them from the inside. She speaks of them in stunning cogent detail but mostly like she is witnessing them from outside herself. Then again, maybe she was.I have noticed many people's negative reviews surround Elyn's privileged status. Mainly, she was able to get education and treatment that other schizophrenics don't have. True, but hardly a reason to review the book negatively. Should she not have written it because she wasn't poor? Plus, several times in the book she cites that she stayed in England and got treated there (for a time) rather than return to the US because of how less expensive it was to get treatment in the UK. I see this same kind of classist vitriol (of the reviewers) in another book I enjoy in this genre Prozac Nation. For some reason people get angry when people with mental illness are lucky enough to have some money which can help them succeed. Perhaps they have empathy towards those in the same predicament but who are simply (and unfortunately) less fortunate. But that's not Elyn's fault. This book is about her life with her disease. It's not a treatise on schizophrenia in general nor is it a composite sketch of everyone with the disease. It's the truth as she lived it. And a bleak and powerful one at that.

Please translate for more langages. Im Brazilian! I hope my loved one can read it some day.Mais estudantes de psicologia, profissionais da saude, pessoas com essa doença mental e familiares poderia ter acesso.We can mourn and than acept our limits while reading.I were looking for some good reference. There it is! Hehe im very thankfull.

I chose this book as an example for my tesi (not sure of what the translation might be), but i could not even imagine how important it might have become for me. It was an incredibile journey, i cried and i was filled with joy for every beautiful and well deserved happiness she encountered. I will love to write about her book, i will encourage my friends and collegues to read it, and i m sure i will think about it a lot in my life. I am gratefull for the decision to write down the details about her journey because i think is the most effective way to, at least, start to understand how hard it might be living with such condition and how much stigma there is to overcome. Thank you from the bottom of my heart.

By far the best book. I‘ve ever read. A very touching and relatable story about living with an mental illness. A must read for any schizophrenic out there.

Elyn Saks has written a beautiful , moving and astonishing account of living with a mental illness. I was blown away by her immense courage, versatility and spirit. At times, I felt so angry on her behalf about the way she was treated by mental health professionals, especially with regard to the cruel and repressive treatment that was employed during her two admissions to American psychiatric hospitals. I was absolutely appalled by her description. I wasn't very impressed by the treatment she received in the UK system either, but at least it was not brutal. And yet, despite all this, and also three life threatening physical illnesses, Elyn has not just survived, but thrived. Her achievements are phenomenal and I was impressed by the way she has used her intelligence and legal abilities to improve the American mental health system for others. Elyn also describes some of the many friends she has made, and she is clearly a wonderful person who inspires others. I was so glad the book ended with an account of happiness and fulfilment on all levels. I would recommend this book to anyone, and particularly to psychiatrists and therapists. The act of writing this inspiring book was one of enormous courage. Towards the end a psychiatrist asks: Elyn, do you want to become known as the schizophrenic with a job? I would say this is the wrong question. To me, Elyn Saks is an amazing person and law professor who also happens to have a diagnosis of schizophrenia, who has still achieved a phenomenal amount and made the world a better place through her work and through her presence.

One of the best books i have read on the subjet. Elyn is an exceptional writer and storyteller. I highly reccomemd this book to anyone wanting to better understand mental illness.