The Center Cannot Hold by Elyn Saks

Today would have been my brother's birthday if he hadn't died in childhood from a physical illness. It seems fitting to think of him with this book, about potentially crippling brain illness. I am on the psychiatry faculty at an academic medical center and a fellow faculty member picked this book to start off our department journal club. It is a memoir of a remarkable woman and her experience with schizophrenia, an often times disabling psychotic illness. It is on the one hand ta daunting life story of an intellectually gifted woman, wrenched out of a normal life by the turbulence of severe mental illness. Voices demeaned her. Disordered thoughts confused her. Words tumbled out of her mouth in stream-of-consciousness word salad that plagued this otherwise thoughtful, gentle, and fragile woman. On the other hand I couldn't help feel like her story is unique and while it might be empowering to some patients with the same illness, it might be overwhelmingly shaming to those who cannot achieve what she did, which is an academic career at a prestigious law school. Saks captures her wobbly, dissolving thoughts in poignant passages throughout the book, but interestingly does not credit medication with saving her sanity but rather high frequency long term psychoanalysis. I have read other first hand accounts of therapy from the patient perspective, and this is commensurate with most. The take away for me was to be reminded of the really big changes that newer anti-psychotics have afforded people in terms of normalcy, as well as hoping for broader funding for non-medication interventions in psychotic illness.