The Center Cannot Hold: My Journey Through Madness by Elyn R. Saks

Hachette Books, 2007

Editor’s note: This is a truncated version of the first installment of Book Reviews for Psychiatrists, a series spearheaded by Edmund S. Higgins, MD, and Emily S. Whisler, DO. Read the full review on our website here.

Evidence-based medicine is the gold standard in medical treatment, but the data neglect the human side of illness. Good stories, on the other hand, illustrate the clinical significance behind the statistics. The Center Cannot Hold is a story that cannot be told merely with bar graphs and tables. Elyn Saks’ memoir of her life with schizophrenia is an engaging story that challenges our understanding of this disorder.

Saks tells of numerous instances in which she was floridly psychotic and disorganized, with primarily delusional thoughts (eg, aliens in the sky were poisoning her; one of her professors was God; she had killed many children). She was hospitalized for many months on several occasions and diagnosed with schizophrenia or schizoaffective disorder by several well-studied psychiatrists. Her symptoms required high doses of antipsychotic medication—36 mg thiothixene, later 40 mg olanzapine, and after that 600 mg clozapine. She frequently asked her doctors to lower her dose, and on those occasions when they reluctantly agreed, she rapidly deteriorated.

Yet, when properly medicated, her cognitive functions were extraordinary for someone with her disorder, evidenced by a law degree from Yale, a tenured professorship at the University of Southern California, and a MacArthur Foundation fellowship (I’d be thrilled with any one of those!). Furthermore, she developed and maintained strong, mutually engaging social connections. In considering her trajectory, it is important to note she doesn’t seem to suffer significant negative symptoms of schizophrenia (for those who doubt, she shows her expressiveness in her TED Talk titled “A Tale of Mental Illness—From the Inside”). Some readers may even think she was misdiagnosed. In the final chapter, she presents a smart defense of her diagnosis.

The paradox of her condition might best be summed up with this vignette: Before her wedding to a man she loved, she asked a dear friend from law school, “Will aliens be attending the reception?” She was not joking. For those interested in purchasing the book, visit www.hachettebooks.com.