Functioning with Schizophrenia

The Yale Daily News ran a February 29 story on Elyn Saks whose recent memoir The Center Cannot Hold: My Journey Through Madness. Time magazine voted it one of the top ten best non-fiction books of 2007. One of the interesting aspects of the story is Saks’ crediting of her psychoanalysis as being critical to her management of her schizophrenia. While schizophrenia is currently viewed as a brain disease (medical model), that does not mean that it is not amenable, in part, to psychotherapeutic intervention. Bertram Karon, for one, has written about this mode of treatment. Saks has spoken explicitly about the importance of her psychotherapy treatment. She has also spoken about her humiliating experiences on psychiatric wards.

Here’s an excerpt from the story:

Saks said the initial symptoms of her condition began appearing around age six or seven, when she started to experience phobias, obsessions and night terrors. Her teen years brought a bout with anorexia and drug use that landed her in a daytime rehabilitation program, she said. Then she began hearing thoughts in her head that were not her own.

“It was as if my mind were a sand castle and all the sand were sliding away,” she said.

After graduating first in her class from Vanderbilt University, Saks began studying philosophy at Oxford on a Marshall Scholarship. That is when she really broke down. Stricken by depression and paranoia, the five-foot-ten Saks shriveled to 95 pounds, and she fantasized about dousing herself with gasoline and lighting herself on fire.

“I was a witch who deserved to be burned at the stake,” she said.

Through intense psychoanalytical treatment and medication, Saks was able to return to school and earn her masters in 1981.

At Yale, after her public breakdown on the roof of the law library, a professor took her to the emergency room, where she was bound to a gurney, constantly monitored and forcibly medicated. Contrasting the “benign neglect” of British hospitals’ hands-off approach, Saks said the American treatment was degrading and humiliating.

Saks, believing she could escape her illness if only she could live without medication, tried repeatedly to reduce her drug regimen, but each attempt failed. Her condition finally improved, she said, only after she accepted her illness.

“The more I accepted that I had a mental illness, the less it defined me,” she said.

Saks concluded by talking about the implications of her own experiences for public policy. She suggested that researchers find alternatives to mechanical restraint by studying ways to make patients want to seek help, and by providing legal incentives to doctors to use other methods.

Kalea Chapman, Psy.D.


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Clinical Psychologist practicing in the Los Feliz neighborhood of Los Angeles, California.

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