"The Center Cannot Hold" – a riveting memoir of madness

First, thank you for letting me know that length matters less than content to you – and that you like variety – in my "Coming Out Crazy" posts. My poll was minuscule, but I am very grateful for your feedback.  

I'm happy to hear it. It's much harder to write short than long – trust me on this. I worked for a tabloid – which refers to size more than content, or used to – so from now on, I will not waste endless amounts of time trying to "trim" my posts to fit an arbitrary word count. I'll say what I want to say.

To be honest, I've never cared much for numbers. Ever.

"Enough" is my favourite number.

Particularly ...  number of pounds one weighs. Number of years one lives. Number of dollars one has or does not have – or one "makes" per number of hours, days, weeks, months or years one is lucky enough to be able to work.

You see? Lucky enough. Good enough. I love "enough." Enough has no measure and cannot be quantified. It's just "enough." 

My mantra these days is – "To know you have enough is to be rich."

Those are the measures I love. Measures than are immeasurable! I don't like the word "priceless" – I prefer "incalculable." 

If you must know, and I'm confessing this here for the first time – I'm truly afflicted with numerophobia and arithmaphobia. I need a calculator to add 2 + 2 to get the right answer. And for me, the right answer is rarely 4, but a greater number, like 5 or 10 or 27 or 13,753. That's synergistic – another story!

You wouldn't want to see my bank book! 

Now then, on to bigger and better things – like moving one car out of my parking lot, for good.

Elyn R. Saks, author of "The Center Cannot Hold," was born in Miami, Florida to a comfortable family. In her memoir, she writes about living with schizophrenia, although she always refers to "battling" or "fighting" it. Language aside – and hers is not particularly positive – there are some problems in what I found an utterly fascinating narrative.

First – and this really bothered me – Saks and her editors neglected to credit Irish-born poet and playwright William Butler Yeats – winner of the 1923 Nobel Prize for Literature – for the title of her book. Maybe it's so obvious, they didn't think Yeats needed the credit. Maybe I missed it. Either way, it's relevant.

In his 1919 post-WWI poem, The Second Coming, Yeats describes the chaos of trench warfare. It perfectly mirrors the chaos Saks describes in her mind as her psychosis progressively shatters her sense of reality.

 

Here, in the first of Yeat's two-stanza poem, he powerfully evokes the madness of The Great War:

Turning and turning in the widening gyre

The falcon cannot hear the falconer;

Things fall apart; the centre cannot hold;

Mere anarchy is loosed upon the world,

The blood-dimmed tide is loosed, and everywhere

The ceremony of innocence is drowned;

The best lack all conviction, while the worst 

Are full of passionate intensity.

(Bold face is mine, not the author's.)

No mention of Yeats or his poem is made in the Saks' book. It's a small thing, but it bothered me.

More interestingly, my episodes of manic psychosis never felt remotely like her psychosis, which was more constant and with variances in intensity. 

(Perhaps her diagnosis should be schizoaffective disorder, if she must have a diagnosis. Frankly, I just prefer to think of Elyn as now in recovery from her "madness" – as I am from mine.)

When I'm psychotic, my reality shifts dramatically. I've had delusions of grandeur and believed I was God. I felt once like my car was a magic carpet flying down Bayview. Quite joyful, actually.

Yet, for Saks, her delusions are the opposite. Evil. Frightening. Monstrous. Horrifying. She believes she's the devil, that she's killing thousands of people with her thoughts.

Her wild hallucinations are often self-destructive and suicidal, too. Her vivid descriptions cut to the bone. Compared to hers, my psychotic trips were like a visit to Oz. Colourful, bright, exciting, adventurous and exhilarating.

I've read many articles and several memoirs by people with other mental disorders – mainly anxiety, manic depression or one of the bipolar spectrum of disorders. This is the first by someone who endured and remembered years of wildly "florid" psychoses in remarkable detail – all the while fighting the idea of her schizophrenia diagnosis or any need for medication.

Saks is clearly and exquisitely brilliant. She managed to complete her MA and PhD in philosophy at Oxford University primarily because of the therapy she received with a psychoanalyst. Drug free. She completed her law degree at Yale, with another psychoanalyst. Today, she continues her recovery with psychoanalysis. 

Medications play an important and necessary, but secondary role in her recovery. For Saks, it is the regular and rhythmic daily hour spent voicing freely and frankly whatever crosses her mind – and analysing the meanings behind those thoughts and words. This is the process that gives her insight. It's painstaking hard work. A lifelong process.

Why did she become psychotic? Who knows? That's debatable. At the age of eight, she remembers experiencing night terrors, fierce compulsions and feeling that her mind was crumbling like a sand castle.

After discovering an adolescent flirtation with recreational drugs, her parents, overreacting I think, enrolled her in a brutal rehab program that instilled in her an irrational fear and repulsion at the idea of taking drugs of any kind, including prescription drugs. This phobia plagued her for years.

After that, her family seemed relatively absent, according to her. Saks writes of constantly protecting them by masking her mental problems. 

The story of her struggle to survive and graduate from three universities on two continents – always far from her home and family – is riveting. She attended the best schools – Vanderbilt, Oxford and Yale – all on scholarship, desperately clinging to some semblance of sanity to prove that nothing was wrong with her mind. Her life then was an astonishing roller coaster ride starkly contrasting British and American approaches to psychiatric treatment. (The Brits were much more humane and liberal.)

Most of all, her passion and unquenchable thirst for knowledge buoyed her on and kept her focused despite long periods of psychosis and several hospitalizations. 

In the academic world, Saks found emotional and intellectual solace and sustenance. She could breathe and flourish. Outside that world, in "the real world," she was and is lost and feels threatened. Her routine breaks.

My psychiatrist recommended this memoir to me, I'm sure, because his approach to psychotherapy is psychoanalytic, which as Saks explains, is not always Freudian. There were many approaches.

Her first experience with psychoanalysis was in Oxford with a "Kleinian" therapist, who was not a medical doctor. 

Melanie Klein was "an Austrian psychoanalyst who immigrated to London in the late 1920s," Saks writes. "Unlike Freud (and later his daughter Anna), Klein believed that people with psychosis could benefit from analysis and that the necessary transference could develop. It was her theory that psychotic individuals are filled with (even driven by) great anxiety, and that the way to provide relief is to focus directly on the deepest sources of that anxiety."

I remember being told years ago, when my diagnosis was schizophrenia, that I would never be a candidate for psychoanalysis. Dr. Bob says that's ridiculous. "You never had schizophrenia," he said when we discussed this. He's been my therapeutic lifeline since 1991.

Besides her personal journey, the psychoanalytic process is central in this memoir. It strongly suggests that the bio-medical model driven by the excessive use of antipsychotic medications for psychosis – rarely psychotherapy of any kind – is not be the only route to recovery.

Once Elyn, as a young Oxford student, begins her psychoanalysis, she also begins to develop the insight that allows her eventually to begin to unravel the complexities at the base of her psychosis. This is where her healing begins.

I strongly recommend this memoir – warts and all. I don't know why it wasn't widely reviewed, but I suspect that's because it defies the mandate of Big Pharma. She was mentioned in a landmark Sunday, May 11, 2008 New York Times story in the "Style" section about Mad Pride. 

Next week is Mental Health Awareness Week, BTW!

Today, Saks is a University of Southern California professor of law. Mental health law is her area of expertise. She's well-published and openly advocates by telling her story, though reluctantly. She's never liked lecturing. She's also an adjunct professor of psychiatry at the University of California in San Diego and a research clinical associate at the New Center for Psychoanalysis in Los Angeles, where she lives.

She's still in analysis, and she's finally accepted her diagnosis and that her medication helps and not hurts her. Perhaps, one day, she will take her recovery beyond her diagnosis and stop labelling herself as "schizophrenic" – because she is so much more. Like so many others who live with and manage their psychoses, she has "a beautiful mind" but it appears that she's veering in the direction of the neurosciences. She is an academic, first. And is or plans to participate as subject and investigator in psychiatric and neuropsychological study of the brain – "and given brain scans," she reports at the end of her book. "The hope is that maybe then we can learn things that will help others."

She's now happily married to a good, kind, wise rock of man. 

I am, too. Her marriage, like mine, appears to be the wellspring of balance in her life and mind. It inspires in her a sense of security and hope.

We're both very lucky women – with more than enough.

Comments

[Marilyn Barnicke Belleghem]

I too have suffered with numerophobia and arithmaphobia but never had a name for them. Thanks you for the labels even though I usually dislike labels. Is there a phobia to using a calculator too? Smile!

Thank you too for your rich description and thoughts on "The Center Cannot Hold."

Marilyn