email page print pageAll Topic Reviews
"Are You There Alone?""How Come Boys Get to Keep Their Noses?""My Madness Saved Me"10% Happier365 Days49 Up56 UpA Beautiful MindA Beautiful MindA Beautiful MindA Book of ReasonsA Can of MadnessA Child's Life and Other StoriesA Dangerous LiaisonA Fight to BeA First-Rate MadnessA Good Enough DaughterA Heartbreaking Work of Staggering GeniusA Lethal InheritanceA Lethal InheritanceA Life ShakenA Life Worth LivingA Little PregnantA Message from JakieA Million Little PiecesA Numerate LifeA Pocket History of Sex in the Twentieth CenturyA Slant of SunA Special EducationA Tribe ApartAbout FaceAddicted Like MeADHD & MeAEIOUAgainst Medical AdviceAgents in My BrainAileen - Life and Death of a Serial KillerAlgernon, Charlie and IAll Out!All Seasons PassAlphavilleAlzheimer'sAn Anthropologist on MarsAn EducationAn Unquiet MindAngela's AshesAngelheadAnna Freud: A BiographyAnnie's GhostsAnother Bullshit Night in Suck CityAnthology of a Crazy LadyApples and OrangesApproaching NeverlandAre You There, Vodka? It's Me, ChelseaAs I Live and BreatheAs Nature Made HimAt Home in the Heart of AppalachiaAt the End of WordsAvalancheBad BoyBad GirlBeautiful BoyBeautiful WreckBecoming AnnaBen Behind His VoicesBequest and BetrayalBereftBertrand RussellBlackoutBlanketsBloodlettingBodies in Motion and at RestBoneBorn on a Blue DayBoyBoy AloneBoyleBrain on FireBreaking ApartBreaking the SilenceBrokenBulimics on BulimiaBuzzCamus and SartreCharles DarwinChasing the HighCheeverCherryCity of OneCluesClumsyComfortComplications Compulsive ActsConfessions of a Cereal EaterConfessions of a Former ChildConfessions of a Grieving ChristianConfessions of the Other MotherConfidingConquering the Beast WithinContesting ChildhoodCrackedCrazyCry Depression, Celebrate RecoveryDamned to EternityDancing at the Shame PromDante's CureDaughter of the Queen of ShebaDavid Sedaris Live at Carnegie HallDays With My FatherDefeating the VoicesDementia Caregivers Share Their StoriesDepression and NarrativeDescartesDetourDevil in the DetailsDiagnosis: SchizophreniaDirty DetailsDirty SecretDivided MindsDivine MadnessDon't Get Too ComfortableDown Came the RainDress Your Family in Corduroy and DenimDrinkingDriving My FatherDrunkardDryEarly Embraces IIIEinsteinEinstein and OppenheimerElectroboyElegy for IrisElijah's CupElliott Smith and the Big NothingElsewhereEnough About YouEpilepticEvery Girl Tells a StoryEverything In Its PlaceExamined LivesExiting NirvanaFaces of Huntington'sFamily BoundFast GirlFearless ConfessionsFind MeFinding Iris ChangFirst Person Accounts of Mental Illness and RecoveryFirst Person PluralFixing My GazeFlanneryFolie a DeuxFor the Love of ItFortress of My YouthFranz KafkaFraudFree RefillsFreudFriedrich NietzscheFrom Joy Division to New OrderFumblingFun HomeFuriously HappyGalileo Get Me Out of HereGirl in Need of a TourniquetGirl Walking BackwardsGirl, InterruptedGirl, InterruptedGirls on the VergeGoing BlindGoing Through Hell Without Help From AboveGraysonGrowing Up JungGuttedHalf a Brain Is EnoughHardcore from the HeartHead CasesHeal & ForgiveHeal & Forgive IIHeavier than HeavenHeinz KohutHeinz KohutHello from Heaven!Hello to All ThatHer HusbandHer Last DeathHigh PriceHole in My LifeHolidays On IceHolidays on IceHope's BoyHouse of Happy EndingsHouse of Happy EndingsHow I Stayed Alive When My Brain Was Trying to Kill MeHow to Lose Friends & Alienate PeopleHow to Make Love Like a Porn Starhow to stop timeHumeHunger Makes Me a Modern GirlHurry Down SunshineI Feel Bad About My NeckI Never Promised You a Rose GardenI Remain in DarknessI'd Rather Eat ChocolateI'd Rather LaughIf I Die Before I WakeImagining RobertIn Search of FatimaIn the Realms of the UnrealIn the Wake of SuicideInside TherapyInternInvisible No MoreIt Happened to NancyIt Takes a Worried ManJack Cole and Plastic ManJean-Paul SartreJohn Stuart MillJourneys with the Black DogJust CheckingKafkaKantLa SierraLab GirlLast Flight OutLearning to FallLet Me Make It GoodLife As We Know ItLife InterruptedLife ReimaginedLimboLincoln's MelancholyListening in the Silence, Seeing in the DarkLittle PeopleLive For Your Listening PleasureLive Through ThisLiving in the Shadow of the Freud FamilyLiving With SchizophreniaLiving with SchizophreniaLockeLonelyLong ShotLook Me in the EyeLooking for The StrangerLoose GirlLosing Mum and PupLosing My MindLove Is a Mix TapeLove SickLove Times ThreeLove Works Like ThisLove You, Mean ItLuckyLudwig WittgensteinLyingMad HouseMad PrideMadame ProustMadnessMagical ThinkingMalignant SadnessManicMarcel ProustMarcus AureliusMary BarnesMaverick MindMe Talk Pretty One DayMeaningMelanie KleinMemoirMemoirs of an Addicted BrainMemoirs of My Nervous IllnessMen-ipulationMisconceptionsMiss American PieMockingbird YearsMomma and the Meaning of LifeMommies Who DrinkMonkey MindMore, Now, AgainMortificationMy Age of AnxietyMy Body PoliticMy Brain Tumour AdventuresMy DepressionMy Father's HeartMy First Cousin Once RemovedMy Flesh and BloodMy Horizontal LifeMy Life Among the Serial KillersMy Sister LifeMy Stroke of InsightName All the AnimalsNeural MisfireNietzscheNietzsche: The Man and His PhilosophyNinety DaysNo Hurry to Get HomeNo Impact ManNo More ShavesNolaNotebooks 1951-1959NothingOdd Girl Speaks OutOedipus WreckedOf Spirits & MadnessOn Being RapedOn the Edge of DarknessOn the MoveOne Hour in ParisOne Hundred DaysOphelia SpeaksPagan TimePassing for NormalPeople Who Eat DarknessPerfect ChaosPerfect ExamplePermanent Present TensePersepolisPlanet of the BlindPlaying with FirePlease Don't Kill the FreshmanPoisoned LovePollockPOPismPortraits of Huntington'sPoster ChildProzac DiaryPsychiatrist on the RoadPsychosis in the FamilyPuppy Chow Is Better Than ProzacQuitting the Nairobi TrioRaising BlazeReasons to Stay AliveRebuiltRecovered, Not CuredRelative StrangerRescuing JeffreyRestricted AccessRevengeRewind, Replay, RepeatRichard RortyRiding the Bus With My SisterRobert Lowell, Setting the River on FireRoom For JRosemaryRough MagicRunning After AntelopeRunning with ScissorsScattershotSchizophreniaSchopenhauerSecond OpinionsSectionedSeeing EzraSeeing the CrabSex & Single GirlsSex ObjectShakespeareShe Bets Her LifeShe Got Up Off the CouchShut the DoorSickenedSilencing the VoicesSimone de BeauvoirSinging in the FireSkin GameSlackjawSlut!SmashedSome Assembly RequiredSome Kind of GeniusSometimes Madness Is WisdomSongs from the Black ChairSongs of the Gorilla NationSoren KierkegaardSpeak to MeSpeaking Our Minds: Revised EditionSpecial SiblingsSpentStandbyStick FigureStill LivesStretchSunset StorySurviving OpheliaSwing LowTales from Both Sides of the BrainTales of PsychotherapyTalk to HerTellingTelling Tales About DementiaThe Accidental BillionairesThe AddictThe Anatomy of HopeThe Anti-Romantic ChildThe Bastard on the Couch CDThe BeastThe Bell JarThe Best Seat in the HouseThe Body SilentThe Boy on the Green BicycleThe Boy Who Loved WindowsThe Buddha & The BorderlineThe Burn JournalsThe Camera My Mother Gave MeThe Cancer Monologue ProjectThe Center Cannot HoldThe Chelsea WhistleThe Churkendoose AnthologyThe Day the Voices StoppedThe Devil WithinThe DisappearanceThe Discomfort ZoneThe Doctor Is InThe Eden ExpressThe Family SilverThe Farm Colonies: Caring for New York City's Mentally Ill In Long Island's State HospitalsThe Fasting GirlThe First Man-Made ManThe First TimeThe Geography of BlissThe Glass CastleThe Good DoctorsThe Hillside Diary and Other WritingsThe Incantations of Daniel JohnstonThe Last AsylumThe Last Good FreudianThe Last Time I Wore a DressThe Liars' ClubThe Lives and Loves of Daisy and Violet HiltonThe Lives They Left BehindThe LobotomistThe Long GoodbyeThe Looked After Kid: Memoirs from a Children's HomeThe Loony-Bin TripThe Madness of Our LivesThe Making of a PhilosopherThe Making of Friedrich NietzscheThe Man Who Couldn't EatThe Man Who Shocked the WorldThe Man Who Tasted ShapesThe Marvelous Hairy GirlsThe Maximum Security Book ClubThe Me in the MirrorThe Memory PalaceThe Mercy PapersThe Mistress's DaughterThe Naked Bird WatcherThe Naked Lady Who Stood on Her HeadThe Night of the GunThe Noonday DemonThe Notebook GirlsThe NursesThe Only Girl in the CarThe Orchid ThiefThe Other HollywoodThe OutsiderThe Philosopher's Autobiography The Philosophical Breakfast ClubThe Philosophical IThe Pits and the PendulumThe Pornographer's GriefThe Private Memoirs and Confessions of a Justified Sinner The Professor and the MadmanThe Psychopath TestThe Quiet RoomThe Red DevilThe Rescue of Belle and SundanceThe Ride TogetherThe Rules of the TunnelThe Secret of LifeThe Shaking Woman or A History of My NervesThe Shared HeartThe Shiniest JewelThe Siren's DanceThe Statistical Life of MeThe Story of My FatherThe Strange Case of Hellish NellThe Summer of a DormouseThe SurrenderThe Talking CureThe Thought that CountsThe Three of UsThe Vagina MonologuesThe Velveteen FatherThe Winter of Our DisconnectThe Woman Who Walked into the SeaThe Years of Silence are PastThe Yellow HouseThe Yipping TigerThick As ThievesThinTiger, TigerTits, Ass, and Real EstateTo Redeem One Person Is to Redeem the WorldTo Walk on EggshellsTransforming MadnessTrue CompassTruth & BeautyTruth Comes in BlowsTuesdays with MorrieTweakTwitch and ShoutUltimate JudgementUndercurrentsUnholy GhostUnlikelyVoices of AlcoholismVoices Of Alzheimer'sVoices of CaregivingVoices of RecoveryVoluntary MadnessWaiting for DaisyWar FareWashing My Life AwayWastedWaveWe're Not MonstersWeather Reports from the Autism FrontWeekends at BellevueWhat Did I Do Last Night?What Goes UpWhat I Learned in Medical SchoolWhat's Normal?When a Crocodile Eats the SunWhen Breath Becomes AirWhen Do I Get My Shoelaces Back?.....When It Gets DarkWhen the Piano StopsWhen You Are Engulfed in FlamesWhere Did It All Go Right?Where is the Mango Princess?Where the Roots Reach for WaterWhile the City SleptWhile They SleptWho Was Jacques Derrida?Why I'm Like ThisWildWill's ChoiceWinnicottWinnieWish I Could Be ThereWith Their EyesWomen Living with Self-InjuryWomen, Body, IllnessWrestling with the AngelYou Must Be DreamingYour Voice in My HeadZeldaZor
Every memoir of mental illness is a testament to human resilience in the face of that dread experience: the loss of the very faculties that make us what we are. Reason, emotion, volition, memory, thinking, the sense of oneself as a person, the sense of belonging in the world; any or all of these can be eroded in mental illness, along with the sense of hope that they will repair, and that we will return to ourselves. There are as many paths to recovery as there are individuals affected by mental illness, and the literature in this area is notable for its diversity. Autobiographies feature individuals who would be unknown if they had not published an account of their experience, as well as individuals who are already well known, but whose mental illness has previously been generally unknown. Elyn R Saks is one of the latter category. Saks is an academic author with several books to her credit (Jekyll on Trial: Multiple Personality Disorder and Criminal Law (1997); Interpreting Interpretation: The Limits of Hermeneutic Psychoanalysis (1999); Refusing Care: Forced Treatment and the Rights of the Mentally Ill (2002)). To this is impressive collection is added something less academic, and altogether more remarkable, a personal memoir of mental illness. The Center Cannot Hold. My Journey Through Madness covers Saks' life so far, from her childhood in Florida to her current life as Professor of Law in Southern California.
Saks' life makes an interesting study even without her lifelong encounter with mental illness. Academic achiever of the first order, Marshall scholar, holder of separate academic appointments in law and psychiatry, and psychoanalyst, Saks is well placed to offer a unique perspective on mental health issues. Five years ago I read her Refusing Care, and found it a nicely balanced account of issues relating to mental health law. While I admired the range of that book, and the depth of analysis, I put that down to careful and dispassionate analysis, and a willingness to examine issues from all sides. I had no idea that the book was informed as much by personal experience of coercive measures such as forced medication, mechanical restraint, legal coercion, the debilitating effects of stigma, and having to face the consequences of actions made under the influence of illness. While The Center Cannot Hold places the arguments of Refusing Care in a new context, it is my guess that Saks would want those arguments to be evaluated in their own right, not as views having a special warrant as those of a 'mental health consumer'. And when Saks speaks as a mental health consumer she does not lean on her academic status to support her position; her views are those of a young and mid-life woman eager to succeed in her chosen career, but dogged by frightening and disorienting experiences.
The book begins with Saks' early family life in Miami. She recounts her 'family myth': the account we all have of how our families formed, developed and changed. In Saks' case there are her parents and two younger brothers. The family lead an ordinary enough life "a Norman Rockwell magazine cover or a gentle fifties sitcom". Family times were interspersed with times the parents reserved for each other, there was sibling rivalry, and formative experiences at the movies. There is a sense of strong fundamental values, material comfort, and encouragement to succeed. The childhood years contain what may have been a hint of things to come when Saks became preoccupied with the minutiae of preparations for outings, and became convinced that the family home was staked out by a malevolent figure. Then again, these could also be the passing anxieties of a young girl. Saks reflects of her parents: "they taught me what I needed to make the most of my talents and strengths…they gave me what I needed to survive." Neither they, nor Saks, had any idea just how those strengths would be tested.
From this beginning the book proceeds in developmental sequence. A key early event is Saks' adolescent confession of cannabis experimentation. This led to several years of compelled enrolment in an after school drug education program which sounds severe by any standard. Absolute rules, humiliating discipline, restricted friendships, and a code of conduct many fundamentalists would be proud of; all a far cry from the experimental spirit of the times. Saks credits this time, too, with helping her develop strength of character, although perhaps at the expense of a degree of social sophistication.
At university, Saks was a gifted student. Achieving As for almost everything, as well as many comments noting the high quality of her academic work, it is no surprise to the reader, although it was for Saks, to learn that she had been granted a Marshall scholarship to study Classics at Oxford, England. A measure of her application is that having already mastered Greek, she taught herself French in order to study commentaries in the original. This study was followed by acceptance to law school at Yale, where Saks again succeeded with distinction. Through all these years Saks had intermittent experiences with expansive mood, paranoia, delusions, voices and disturbing perceptions. There were admissions to hospitals in both the United States and England, admissions that involved experiences of traumatic treatment by clinicians, kind and compassionate care, relief from social stressors, and her own grave doubts about her future. In addition to her direct experiences with mental illness, readers are given an insight into the stigma of mental illness when Saks' symptoms of a developing brain aneurysm are dismissed by Emergency Room staff as an indication of mental illness.
Saks describes in some detail her experience in psychoanalysis with the remarkable, if austere, Mrs. Jones: "She was, without question, the ugliest woman I'd ever seen". Mrs. Jones was a classical analyst, deeply committed to the analyst's personal opacity, so it comes as some surprise when, long after termination, Saks contacts Mrs. Jones from the other side of the Atlantic, and arranges to visit. One of the tragedies of the book is Mrs. Jones' eventual loss of memory. Not only does she not remember Saks, who she had told she loved, her amnesia is more poignant given the role of memory in analysis. Psychoanalysis has continued to play a part in Saks' mental health. Never one to accept a field of knowledge as simply 'there' Saks studied and trained as an analyst, gaining admission to the Los Angeles Psychoanalytic Society and Institute.
A feature of this book is Saks' personal struggle with the idea of herself as a person with mental illness. From her time in drug rehabilitation as an adolescent she developed a deep aversion to any role for drugs in her life. She experimented many times with reduction in prescribed antipsychotic agents, especially when on one agent she developed early symptoms of tardive dyskinesia. These days she accepts that without medication she is vulnerable to relapse, and that unwanted side effects are the lesser evil.
There is much to learn from this brave personal account of mental illness. Saks has spared little in describing deeply personal aspects of her life. She is aware that as an educated middle class woman she has advantages in managing her recurrent episodes of distress that others don't have. She is typically modest in her hopes for the book: "I hope that by writing this book I help others to take some of what they need to lead a life worth living." The candor and accessibility of the book will go a long way to realizing that hope. Anyone with a clinical, academic, or personal interest in mental illness will find this book both compelling and rewarding. There is even a romantic ending as Saks falls in love and marries. The Center Cannot Hold is written in an engaging manner, and is replete with keen observations and first hand accounts of Saks' experiences which lift the book into the category of notable memoirs of mental illness.
© 2008 Tony O'Brien
Tony O'Brien RN, MPhil, Senior Lecturer, Mental Health Nursing, University of Auckland, firstname.lastname@example.org
Comment on this review