"The Little Engine that Could"If you're deciding what to read next, I strongly recommend Elyn R. Saks' The Center Cannot Hold: My Journey Through Madness. I guarantee you won't forget it soon.
Saks is an acclaimed professor of law and psychiatry. She also struggles with severe symptoms of schizophrenia. She risked her reputation in academia in order to give hope to others like herself, and to counter the negative stereotypes about mental illness held by both the general public and mental health professionals:
"I wanted to dispel the myths ... that people with a significant thought disorder cannot live independently, cannot work at challenging jobs, cannot have true friendships, cannot be in meaningful, sexually satisfying love relationships, cannot lead lives of intellectual, spiritual, or emotional richness."The topic is inherently compelling, and Saks masterfully describes what it is like to be tormented by inner demons, to be forcibly restrained on a hospital bed, to require medications that alter one's mental state and can cause horrific, irreversible side effects. She articulately describes her years of talk therapy, in which she came to understand the functional underpinnings of her psychotic thoughts, for example in warding off feelings that would have been consciously threatening.
I enjoyed her dry humor in highlighting the condescension and absurdities of the mental health system. In one case she reviewed during a legal internship, the patient was restrained because he refused to get out of bed. In another case, a young man was deemed delusional because he continually spoke with "imaginary lawyers" - who turned out to be none other than Saks and her colleague.
For years, in order to excel, Saks had to lead a double life. Swirling around her, constantly threatening, was the stigma of mental illness. While writing an academic paper on restraints, she asked a professor, "Wouldn't you agree that being restrained is incredibly degrading, not to mention painful and frightening?" With a kind and knowing look, the professor responded: "These people are different from you and me. It doesn't affect them the way it would affect us."
This book is especially important reading for mental health professionals in the United States, where medication reigns supreme (it has become practically taboo to recommend psychotherapy for severe psychosis, despite ongoing research establishing its efficacy) and coercion often trumps choice. Saks contrasts her experience of being hospitalized in the United States with her experience in England, where restraints have not been in widespread use for more than 200 years. In doing so, she gives us a deeper appreciation of the trauma induced by coercive and sometimes brutal treatment.
"The Little Engine that Could" is what her close friend Steve Behnke calls her, referring to her indomitable spirit even in the face of hospital clinicians' dire predictions about her future.
I highly recommend this courageous and brilliant memoir.
A 45-minute video of Saks' talk at this year's American Psychological Association convention is available online at her personal website. Other books by Saks include Refusing Care: Forced Treatment and the Rights of the Mentally Ill (2002) and Jekyll on Trial: Multiple Personality Disorder and the Criminal Law (1997).
