Book Analysis: The Center Cannot Hold

Book Analysis: The Center Cannot Hold

“The Center Cannot Hold: My Journey Through Madness” is a memoir by Elyn Saks. The purpose of the book is to create awareness and explore the struggles of living with a mental illness, specifically, schizophrenia. Elyn narrates the difficulties in her life as a young person living with a mental illness that is on the verge of disabling her budding academic success (Saks, 2007). Some of the major issues surrounding mental illness include the fear of not being able to comprehend what is happening in one’s life as the signs of mental illness crop up. It is also common for people with mental illness to be misdiagnosed, misunderstood, judged, and lacking support even from their families (Saks, 2007). Elyn details a gut-wrenching struggle trying to come to terms with psychosis and accepting a diagnosis of schizophrenia that diminishes her chances of living a normal life.

Diagnosis and Treatment

Elyn managed to rise above her “grave diagnosis” through psychotherapy, psychosocial intervention, and pharmacology. Steggles (2016) argues that individuals with psychotic symptoms find it challenging to address daily life situations such as communication, self-care, maintaining relationships, and motivation for life. In this regard, psychotherapy such as talk therapy provides valuable benefits such as helping one understand the difference between delusions and reality, build self-esteem, and insight (Steggles, 2016). Elyn engaged in talk therapy that focused on psychoanalysis beginning with a three-year treatment Mrs. Jones. Later she continued with psychoanalysis through the help of Dr. White and Dr. Kaplan.

Psychosocial interventions also assisted Elyn to address her psychosis. Elyn experienced support from her peers while in school and her psychiatrists, as well as colleagues when she started her employment. Varga at al. (2018) notes that peer support for people with mental illness gives individuals the strength to tackle day-to-day challenges. The support offers a sense of empowerment to the individual to keep fighting the daily challenges. During her school days, Elyn received help from her friend Steve, who worked hand in hand with her through various projects. In employment, Elyn had not only the support of her psychiatrists but also that of her work colleagues. While it was difficult to remain stable, the support of her psychiatrists and colleagues helped her succeed in her career.

Most importantly, pharmacology played a significant role in Elyn’s ability to overcome the crisis caused by mental illness. For instance, antipsychotic medication for schizophrenia assisted in addressing chemical imbalances in the patient’s brain (Ganguly, Soliman & Moustafa, 2018). The goal of medication is to decrease the psychotic symptoms and allow an individual to achieve some level of normal functioning. While Elyn was initially opposed to taking drugs, she later realized that she would never achieve any level of adequate functioning without them. She was on different medication at various stages of her mental illness, including Trilafon, Navane, and Zyprexa.

Elyn’s case is exceptional because while she experienced one of the severe forms of schizophrenic psychosis, she managed to beat the odds. One of the most remarkable aspects in her case is that she never engaged in any violent acts as is most assumed of schizophrenic patients. The book details many patients with mental illness who committed violent acts but Elyn did not reach such levels despite her severe bouts of mental illness (Saks, 2007). Also, Elyn success can be attributed to her desire to get better. Despite the many setbacks she faced, Elyn never gives up hope that she will be triumphant. Her desire to beat her illness is one of the major contributing factors to overcome her psychosis. Elyn also had almost no family support when she was diagnosed with mental illness at a very young age. She checked herself to a mental health clinic even though she never accepted, she was mentally ill (Saks, 2007). She suffered extreme treatment modalities such as being put in restraints and seclusion but overcame all these challenges.

Critical Analysis

Elyn indicated that writing the book was “something of a risk” because she is exposing her mental illness to the world while she is in the professional world. Such a book could likely allow her credibility as a teacher and author to be questionable because of the assumptions she makes about mental illness and treatment of individuals with mental illness (Saks, 2007). Elyn may also have been concerned about being accused of bias based on how she presents her opinion on the way institutions, professionals, and society treats people with mental illness. For example, she could easily receive backlash for accusing American mental institutions of mistreating or disregarding the rights of mental health patients (Saks, 2007). Elyn does offer strong opinions about the poor treatment of people with mental health both in health institutions and in the criminal justice system.

Elyn’s book could be considered stigma-producing in the way it expresses mundane symptoms as indicators of mental illness. For example, she begins by describing her fear of the dark when she was a child or afraid that someone was lurking at the window, waiting to harm her. These are typical behaviors and feelings that many children experience when they are young. However, Elyn describes them as the first indicators of her mental illness. These indicators can increase stigma as many commonplace behaviors can be viewed as signs of mental illness.

The most moving aspects of the book include Elyn’s tormenting thoughts, but she cannot say them aloud. She has to keep hiding the truth about her “inner demons” to the rest of the world to appear normal. Another moving aspect is the physical and emotional turmoil that Elyn undergoes. For example, she loses weight immensely such that she looks “ghostly” but still does not receive enough support from her family or friends (Saks, 2007). Also, when she is hospitalized against her will, nobody wants to listen to her. Whenever she voices her inner thoughts, she is punished through restraints and often remains in isolation from the rest of the patients. The book should have included more details on what she has done to help improve the lives of other mental health patients. She does feature several people with mental health conditions, but we never know of any laws and conditions do improve for them.

Conclusion

I have learned that schizophrenia is a debilitating mental condition that can easily be mistaken for other conditions such as dissociative personality disorder and bipolar disorder. However, these are significantly different conditions and even the treatment modalities matter. In this way, an accurate diagnosis of schizophrenia is essential to address it in a timely and effective manner. I would recommend this book to others because it provides essential information regarding the challenges of identifying, diagnosing, and treatment of mental illness. For people living with mental illness or whose loved ones have suffered such a disorder, it offers important information in managing their life.

References

Ganguly, P., Soliman, A., & Moustafa, A. A. (2018). Holistic management of Schizophrenia symptoms using pharmacological and non-pharmacological treatment. Frontiers in Public Health, 6, 166.

Steggles, G. (2016). Psychological Progress in Schizophrenic Patients undergoing Psychoanalytic Psychotherapy. Int J Psychol Psychoanal, 2, 012.

Saks, E. (2007). The Center Cannot Hold: My Journey Through Madness. New York: Hachette Books.

Varga, E., Endre, S., Bugya, T., Tényi, T., & Herold, R. (2018). Community-based psychosocial treatment has an impact on social processing and functional outcome in schizophrenia. Frontiers in psychiatry, 9, 247.