The Center Cannot Hold: My Journey Through Madness

I have schizophrenia, and this is by far the best account of having schizophrenia I have read. Elyn Saks describes it all: the side effects of the medicines, the stigma attached to schizophrenia, and the deepest, darkest areas of psychosis and delusional thinking.

Rossa Forbes is a contributor to Goddess Shift: Women Leading for a Change

In 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 imbalance

I 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.

A must read for any aspiring counselor, or psychologist. Gives a deeply personal autobiographical reflection on schizophrenia as a disease and the differences in the way care is managed US vs. European models. Also, illustrates various forms of psychoanalysis and therapy well in schizophrenic populations.

Thank you Elyn Saks for helping me understand mental illness and humanity just a little bit more!

Unbelievable. Gripping. Really gives you a feel for what it must be like to have a severe mental illness. Her perseverance in handling schizophrenia, pursuing her dreams and finding a doctor that will work with her are encouraging to all. Amazing story and it is a true. This is not fiction.

Having fallen into the anti-medication camp when it comes to the treatment of mental "illness", this book definitely gave me pause for thought. Though not pro-medication, Elyn Saks convincingly shows that, at least in her case, schizophrenia can be a controllable condition with medication. An amazing life story worth reading by both those interested in mental health issues and those who like inspirational biographies.

I liked that this book shows the struggle and very constant and repeated denial of someone with a mental illness. I dislike that there's such a stigma around mental health and therefore the struggle is even harder for those. I honestly recommend this book for everyone; it provides great insight on the struggle that many have NO idea that the person right next to them can be going through!

Wow.... this book is incredible. I was so moved by the author's bravery, and honesty, and I was so impressed by what she has accomplished in her life despite her struggles. It is also a scary book, because it reveals the depths to which one can be severely mentally ill and still existing, and functioning, within the world. I definitely recommend this book, and commend the author for revealing her struggles by writing it!

As someone studying to enter the mental health field and someone who has schizophrenic family this book was both informative and eye opening. I really felt for the narrator through her trials and triumphs. Truly an amazing story of hardship and advocacy for those society is quick to stigmatize

My coworker suggested this book to me. We work for psychiatric facilities and she had recently read it. I was completely engulfed in it and couldn't put it down. I was fascinated by her experiences and was amazed at the stories she told. It really opened my eyes to schizophrenia and I have suggested this book to many doctors, nurses, and other coworkers at the psych hospital that I work for.

Vivid and heart wrenching. A must-read for anyone who wants to know more about schizophrenia, which is often portrayed as a violent disease, one to be viewed with suspicion and fear. Saks takes us into her psychotic, broken thought processes while also heaping on information and education.

This is an engaging picture of the difficulty faced by a brilliant woman who became a psychoanalyst despite having psychotic episodes. It took a lot of courage for her to write this book and it should be required reading for those in the fields of psychiatry, clinical psychology, and psychoanalysis.

For those interested in psychology/psychiatry this book is an absolute must. Written by an exceptionally intelligent woman, it is a first person account of dealing with an active psychosis on literally a daily basis. She takes you inside her turmoil as you live through her incessant ordeal. Not surprisingly, she makes the medical profession look less than sparkling (I am a physician). I highly recommend this book.

I am a practicing psychiatrist and this book is so well written that it has added much to my understanding of the experience of schizophrenia from the perspective of the patient. It is a wonderful resource for anyone needing to know more about this illness. I salute the author for her courage to manage her illness and to share her journey. It is a gift to everyone.

A welcome manifestation of a radical idea that things aren't condemned to be black or white as usually thought. A diagnoses of schizophrenia is expected to take the life out of you, but clearly Saks has shown that it is as distinct from you as you can possible imagine. The illness is not you and your are not the illness, is the main focus of the book. She shows how a high functioning life can be fabricated with the help of support, talk therapy and medication. I hope her voice reaches the millions across the world who would heavily benefit from her story.

The book is coherently written and makes an easy read. An autobiography at the end of the day.

Mental illness is complicated and completely unique from any other health challenge. The breadth of physical, emotional, social and legal factors are well beyond what anyone who has never experienced it can understand. However many do want to have healthy family, business and friendship relationships with a person experiencing mental illness This will be a wonderful asset to achieve that.

A welcome manifestation of a radical idea that things aren't condemned to be black or white as usually thought. A diagnoses of schizophrenia is expected to take the life out of you, but clearly Saks has shown that it is as distinct from you as you can possible imagine. The illness is not you and your are not the illness, is the main focus of the book. She shows how a high functioning life can be fabricated with the help of support, talk therapy and medication. I hope her voice reaches the millions across the world who would heavily benefit from her story.

The book is coherently written and makes an easy read. An autobiography at the end of the day.

Saks tells the story of an accomplished young woman suddenly confronted with severe mental illness. Decades later her story holds up as frighteningly relatable. An invaluable read for anybody interested in the ugly truth about psychosis.

Mental illness is complicated and completely unique from any other health challenge. The breadth of physical, emotional, social and legal factors are well beyond what anyone who has never experienced it can understand. However many do want to have healthy family, business and friendship relationships with a person experiencing mental illness This will be a wonderful asset to achieve that.

What a compelling and engaging book about a person's journey through life and career with psychotic episodes. Saks conveys both her drive and her confusion, her emotional anguish and her everyday experience with such depth and detail that you feel you really get to know her and understand her perspective well, automatically making you better appreciate the experience and stigma many with mental illness face. I highly recommend this book as a psychologist and a reader.

I was astonished by Prof. Saks' description of her symptoms of mental illness. It was very different from the descriptions I had obtained from undergraduate psychology courses. I was also truely uplifted by the strength of character she showed to overcome her disability and go on not only to become a successful law professor but also an advocate for the legal rights for the mentally ill. I had been afraid that a book about a schizophrenia's life would be depressing, but instead this was fascinating and very inspiring story. The symptoms she describes were terrible. But her ability to open a window to the world on the schizophrenic experience will be helpful to others with similar symptoms.

I found this book so helpful in understanding what my son is going through. Hearing about the disorder from a medical or doctor's perspective just wasn't sufficient. I really wanted to hear from someone going through it and Dr. Saks was so direct and thoughtful about describing her illness. She made me realize that the illness does not define the person, its just one part of who they are and with the right medication and support it can be managed. This book gave me hope, which is really what we all need when struggling with mental health issues. Thank you Dr. Saks.

I am a professional psychotherapist and this autobiography is one of the best written and explained histories of someone challenged by a crippling mental health disorder. Elyn is eloquent in her descriptions of events over a long period of time and how she resolves to work with her condition in such a way that she has brilliant, full functioning in the world of today. If someone with a similar history were to read this account they might save themselves years of pain and could possibly live a full and satisfying life. I would recommend this book to both professionals and lay readers. It was, indeed, a page turner for me and I would love to meet Elyn. She has great courage in disclosing her journey!!

Educational, honest, and thought provoking. Sadly, mental illnesses remain hidden and ignored in our society. I like how the author uses "coming out of the closet", oppression is a huge barrier to treatment. This book has exposed, how we as a society, simply try to control and restrain someone who has mental illness, rather than assisting to make life livable with mental illness. I am in awe of the authors enduring strength and conviction. It truly has opened my mind as to the physical restraints that have been used on patients, how terrible these are. Not that I didn't know restraints are used, but to live it through the eyes of the patient has changed my outlook. The author was able to get me into her character, it was as though I was her, experiencing one psychotic episode after another. I suggest this book to all for and education and "true" read.

Although the author does not represent the severely mentally ill, stricken with devastation to their once high achieving lives, I admire her strength and perspective in communicating her journey. Thank you. If only it were this easy.

I just finished reading, "The Center Cannot Hold," by Elyn R. Saks. This book was so good I couldn't put it down. I loved the way Saks took me on a journey through her life battling the symptoms of Schizophrenia. This book is a courageous and most inspiring look at how she managed to achieve her academic goals, excel in very rewarding and productive careers and create a life of happiness despite having a mental illness. Like Saks, I've experienced a lot of challenges due to mental illness. I can empathize and identify with treatment received in psychiatric hospitals, in therapy sessions with good and not so good psychoanalysts and having to take psychotropic medications against personal judgment. This book is a MUST read for mental health consumers, family members and clinicians everywhere!

A true story of one who encountered madness in the form of schizophrenia, and persevered through and with it, to remain a contributing member of society, as a professor in law school. Wonderful if you have any connection to someone with schizophrenia.

Excellent insight into the anger, fears, denials, realizations, emotions, hospitalizations, medications, and successes of the life of a woman with mental illness told from her point of view. Elyn Saks lets you into her world by telling her story, and what she went through to achieve the accomplishments she has made to help others with mental illnesses.

The Center Cannot Hold is probably one of the most amazing books every written. Why? Because it was written by Elyn Saks who is schizophrenic. To say that this highly educated, highly spirited woman has jumped hurdles to get where she is today, is to say nothing at all. For, her battles have been frequent, frightening and huge. I've worked with schizophrenics. They are, for the most part, the heart breakers of the world of mental illness. Often highly intelligent, young, their roads to success are set out in front of them - until the first symptoms begin. Then,thrust upon them for no reason other than a bad mix of brain chemicals, comes the frightening world of delusions and hallucinations. Medications work, then they don't, then when they do, the side effects are disabling. They spend so much time in hospitals simply because no one has come up with the proper medication. I never believed 'talk' therapy worked much, but obviously I was wrong. It certainly helped Elyn. I cannot believe how hard Elyn Saks worked to get where she is today. She is, quite simply, a marvel. I thoroughly enjoyed this book. I think it gives hope to those who are burdened by schizophrenia along with those sad families who are forced to witness their loved ones so ill. Hurray Elyn! Keep up the good work and thanks for fighting the good fight.

This is a very moving account of a very successful professional who struggles with mental illness. Anyone who treats mental illness, or lives with someone with such struggles, will find the book useful and sensitive.

Ms. Saks's personal account of schizophrenia is touching, heart-wrenching, and inspirational. I chose to read it after wondering if my husband who recently committed suicide might have also suffered from schizophrenia. I hope that anyone suffering with a mental illness will read this account and learn from it. Mental illness does not have to be a death sentence. When a person can trust a doctor and in family and friends to help, there can be hope of a productive life.

I'm a pharmacy student, and reading this book really helped me understand what it's been like historically for people with mental disorders. Amazing, amazing firsthand account of life with schizophrenia.

This is a book I recommend for anyone wanting insight into schizophrenia and the many ways mental illness can affect a person. Elyn has shared her story with unusual courage and openness. I have a better understanding of people I love who struggle with similar issues.

powerful and realistic descriptions and insights into a very prolific law professor and scholar who has lived with schizophrenia and discusses both the effects of the stigma of mental illness externally, as well as the impact internally. Especially the fear that others have and the belief that author had that medication was somehow bad and demonstrated her weakness, rather than a feasible treatment.

Fantastic read! couldn't put it down and I learned so much! I have so much admiration and respect for the author. She is a brilliant and compassionate person. I'm sure writing about her experiences can help many people!

This book should be read by everyone because it challenges the way society sees people who struggle with mental illness. This book is well written; it spells out the vocabulary used by those in the psych profession so that anyone can understand. Additionally, I believe Saks does a great job getting the reader to understand what it would feel like to experience an episode.

I just finished "The Center Cannot Hold" after it showed up in my the store recommended reading. What an amazing book. It's been my experience that sometimes people who aren't writers by trade can tell an engrossing story but not necessarilly tell it WELL...not the case with Elyn Saks. It's an amazing story that's beautifully written. At her darkest times in the book, I felt so much pain and empathy, and only knowing that she came out the other side successful got me through. And boy, did she come out successful. A gripping and inspiring read for anyone interested in mental health.

Riveting account of mental illness, the debate over medication, the fight not to be defined and confined by the stigma. Inspiring for anyone to read, comforting and revelatory to share the company if you have a mental illness, whether it is a thought disorder or a mood disorder.

Great condition. This book has changed my perspective on individuals that have psychological disorders. I have a better understanding of what possibly it could be like with schizophrenia. The author has beautifully written this book.

This book helped me know what someone I love dearly is going thru. I could not understand this mental illness, reading Elyn's book was a godsend. Everything I was doing to try and help was making matters worse. I don't know what the future holds, but I will be better able to cope now that I have an understanding of this disorder. I highly recommend anyone needing an insight into schizophrenia to read this.

A must read. Gives an inside view of mental illnes articulately. This is a great book for everyone- mental health professionals, family members of people with mental illness, and the general population. The author does a great service by sharing her experience. Reading this may change the way you think of people struggling with mental illness. I have lent this book to many friends in an effort to fight societal stigma.

One of the best books about personal experiences with mental illness I've ever read. Places a lot of consideration about isolated incidences in author's life that were red flags, but sadly no one knew to look for those red flags.

This book is an eye opener even for those working with mental illness everyday. It helps the reader have more of an understanding of the experience of severe mental illness from the point of view of the person living he experience. Hopefully this courageous autobiography will also help develop empathy and reduce the stigma not only of mental illness in general, but of schizophrenia in particular.

I thought this was an excellent book on mental health in general and schizophrenia in particular. A well written,technical, but personal account of what it is like to live with mental illness. I was at times frustrated by her unwillingness to stay on her meds when they were obviously helpful, but I understand why this is true of many patients on anti psychotic drugs. An enlightening book for anyone interested in mental health.

There are few books that impart such wisdom, that offer such insight into the world of psychosis. More than anything, Dr. Saks reminds her reader that behind the illness, there is a living, breathing and most of all feeling human being. I am so grateful for this book, for the opportunity it has given me to glimpse life through the eyes of a psychotic individual. I've gained an appreciation, and hopefully I've become more empathic, more capable of being helpful. Everyone should read this book.

Lovingly written account of mental illness and life; Saks bravely bares her vulnerabilities and reveals pureness of heart; The theme of recurrent struggle speaks of but does not dwell on loss and sadness; Fascinating mind, not a wonder she ends up in research; A resilient spirit to admire through the ages. Thank you for sharing and count me a fan!

Great first person account of schizophrenia. Helpful for developing empathy and understanding in those without the process, and providing hope for those who struggle with schizophrenia. Wish I hadn't lent it as it has never come back, but maybe it will go on to do good for many others.

The writer who should not be so insightful is able to share and write about insight after medicated. This book is a must read for the mental health professional or for anyone who is looking to read a wonderful memoir of a person doing their best to overcome symptoms.

Though redundant, this autobiography deals with some of the key issues faced by those of us who suffer from mental illness focusing on our inability to deny medication. Thank you Ms. Saks for advocating for the mentally ill population who largely cannot advocate for themselves. What a Mitzva.

Thank you for this amazing memoir. It has been tremendously helpful in more clearly understanding the experience of psychosis. Also very helpful in causing the importance of talk therapy for clients with schizophrenia, which is generally discouraged as provoking regression and worsening the disease of schizophrenia. Thank you again for your insights and guidance.

This is an amazing account of an intelligent woman who will not let one of the most devastating mental illnesses, schizophrenia, beat her. Her courage and honesty are amazing. What she has achieved is beyond what "normal" people can imagine. She has done so much for those with mental illness and their families by her brave account, not just in showing how it can be managed but the failures of understanding in the medical community.

Great book for learning more about schizophrenia. She does a great job at sharing what it was (and still is) like for her to go through the process of learning about and accepting her diagnosis. I would (and have) recommended this book to others.

This book really helped me see extreme mental illness in a new light, and shed light on a lot of prejudices I didn't realize I had. Extremely well written and easy to read, as well as engaging and interesting - I would recommend it in a heartbeat to anyone interested in psychology or mental illness, anyone who enjoys academic and thought provoking topics, and just about anyone else. I think just about anyone will benefit from seeing such an unusual perspective told with such humanity.