The Mere Anarchy of the Day-to-Day: The Center Cannot Hold by Elyn R. Saks

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“In the long hours of the trip, with the stale air and the bad food and the transient sounds of fussy babies and coughing passengers, I was cold, and alone, and awash in fantasy and grief. Over and over, I replayed the previous five years, trying frantically every single moment to keep the demons in my head from invading the plane and savaging the other passengers. From time to time, I considered asking the flight attendant whether she would mind if I jumped out the emergency door. Other than that, it was an uneventful flight.”

I know a clinical psychologist who has been in active practice for over a decade who takes issue with the phrase “mental illness.” I asked her why once; she shrugged and said that the word illness suggests a cure, which in turn suggests the sort of finality that isn’t always realistic. She worried the model, taken from medicine, could be particularly harmful for those people who experience recurrent episodes: those for whom narrowing in on treatment is a long-term process of going to therapy, adjusting medications and paying attention to physical and emotional responses. Recovery, she felt, was sometimes more cyclical than linear. Some patients end up blaming themselves when they can’t just get better.

This conversation was very much in my mind as I read The Center Cannot Hold by Elyn R. Saks. This book is a brave and often harrowing chronological account of living with paranoid schizophrenia — and the eventual recovery that allows Saks to function as a law professor who advocates for the rights of people whose conditions have placed them at the mercy of institutions that strip them of autonomy and protection. Saks relates the stigma, silence, and marginalization of day-to-day existence with schizophrenia, bringing into account her behavior during the most challenging years of her life: the impulse to hide the worst of the symptoms, the shame associated with recurrent psychotic breaks, and the repeated attempts to go off the medications that help her function.

Was her childhood anxiety a preview of the episodes she would experience as an adult? Where was the evidence of the latent condition in the quirks of the teenager? In short, how or why did she end up in institutionalized, “floridly psychotic” and with a grave prognosis? Even in the parts of the book where the narrative slows and Saks resumes a more ordinary life, the possibility of another free-fall into the world of delusions, implanted thoughts, debilitating anxiety, and disordered thinking feel too close for comfort.

My favorite parts of the book were when Saks confronts the more thorny issue of how to construct a sense of self that is not defined entirely by one thing: schizophrenia. And yet, as Saks has said elsewhere, the schizophrenic mind is a shattered one. How can she bring together the three disparate parts of her identity? Will she always only be the immobilized and restrained Lady of the Charts? Or can she integrate the lucid and responsible Professor Saks? And, finally, will she ever get to simply be Elyn, a woman who has goals far higher than the options laid before her when she received her diagnosis?

I would recommend this book to anyone interested in listening to the voice of someone who might very well have ended up completely silenced. I would caution potential readers, though: some of what Saks describes is deeply disturbing, and the treatment she receives while hospitalized is downright horrifying. That those same experiences are the ones that push her to study the overlap of law and mental health, and to work against the use of inhumane practices like four-point restraints and forced treatment, makes this an important book but not always an easy one to read. “Even humor,” Saks writes of her time in the hospital, “wasn’t a good idea. My tendency to bluff or make a wisecrack in difficult circumstances was misinterpreted time and time again.” To seek help and find abuse and subjugation, though, is sadly not an experience unique to Saks, but be aware that she describes these situations in some detail.

For me, it was worth hearing Saks out, and I was glad I stuck with it. Her prose is straightforward and matter-of-fact, and many have criticized the book for being emotionally flat. In response, I’d say that Saks is a lawyer and a high-level scholar, which sometimes comes through in a style of storytelling that is detailed and precise. She pulls no punches with the mental health establishment that she was a victim of as a young woman, and she is factual and largely unsentimental in tone. I do not see this as a drawback. Given the ground she covers in her book (and in her life) I wonder about the call for her to say it with more feeling.

That said, readers in search of deeply lyrical writing about mental illness might also be interested in Lauren Slater’s Welcome to My Country or An Unquiet Mind by Kay Redfield Jamison — both are pretty remarkable books. If you are looking for an unflinching firsthand account of what it is like to live in the throes of acute paranoid schizophrenia that ultimately calls for readers to see, as Saks says herself, “not schizophrenics, but people with schizophrenia,” pick up The Center Cannot Hold.

Melissa is writer who lives with her husband and two warring felines in Portland, Oregon. When she isn’t reading, writing, or cooking, there’s a good chance she’s trying to clicker-train her cats.