About this series

We are aware of the effects of serious mental illness on those living with these conditions; however, any of us without personal experience can only see the outward manifestations. Could we look to the arts for additional sources that might nurture our empathy and understanding of the inner lives of people with serious mental health conditions?

Unsurprisingly, for something as ubiquitous as mental illness, this topic has a large cultural footprint. Representations of different conditions and symptoms can be found spanning many mediums such as memoirs, films, visual arts, and music. In this series, we highlight pieces of writing and art that seek to portray the experience of those living with a serious mental health condition. The first installment of the series is an autobiographical account of life with schizophrenia.

Who is Elyn Saks?

Professor Elyn Saks received her schizophrenia diagnosis at the age of 28;¹ however, as early as the age of 8, Professor Saks had a terrifying experience that acted as a harbinger of the illness.² Despite night terrors, compulsive rituals, and outbursts of bizarre behavior throughout her early years, Professor Saks was determined to not allow the debilitating impacts of her psychotic symptoms to take control; she graduated as class valedictorian and graduated with a degree in philosophy from the University of Oxford.²

Currently, Professor Saks is a Professor of law, psychology, and behavioral sciences at the University of Southern California Gould School of Law and an esteemed author of several nonfiction books.³ Additionally, Professor Saks is dedicated to advocating for the legal rights and humane treatment of people with mental health conditions.⁴

About The Center Cannot Hold: My Journey Through Madness

The Center Cannot Hold provides a rare and valuable window into the life of a person living with schizophrenia. Professor Saks possesses a rare talent for expressing her thoughts and feelings, providing an honest and eye-opening account into the difficult experiences that she endured. Her writing offers a unique perspective to help understand the inner life of someone with schizophrenia.

How do the themes in the work relate to the wider clinical picture?

In her memoir, Professor Saks describes moments of crisis and the experience of knowing that a major episode could be imminent. The latest findings indicate that there is a dose–response relationship between the number of stressful life events and risk of relapse in people with first-episode psychosis.⁵ There is a need for both individuals and institutions to develop interventions that could mitigate the impact of stressful life events;⁵ greater consideration of how to empower people with schizophrenia to mitigate the impact of stress is also needed. This is particularly important given the recent findings on the harmful impact of fear of relapse on the well-being of patients and their caregivers.⁶

Professor Saks has forged an impressive career that spans the challenging fields of law, medicine, and academia. However, in the wider world, employment is less common for someone living with schizophrenia compared with those without schizophrenia.⁷ A recently published population-based registry study of all people with schizophrenia in Sweden reported that 24% of individuals were employed 3 years before their first diagnosis; this dropped to 10% five years after illness onset.⁷ This is particularly troubling when we compare these findings with those for people with bipolar disorder: 45% were employed 3 years before diagnosis, and 34% were employed 5 years after diagnosis.⁷ Patients who were younger (aged 18–44 years) were more likely to work compared with those aged ≥45 years.⁷ Those with a higher level of education were more likely to work than those classed as having a middle or low level of education, and those who were married or cohabiting were also more likely to work than those who weren’t.⁷ A high number of psychiatric hospitalizations and substance use was also associated with a lower likelihood of employment.⁷

How can this story inspire us?

Much like Professor Saks, every patient with schizophrenia has their own story to tell. In clinical settings, healthcare professionals should encourage their patients to openly share their feelings and thoughts not only to strengthen the therapeutic alliance, but also to facilitate the development of patient specific management strategies.

Cite this article as Portraits: The Center Cannot Hold: My Journey Through Madness by Elyn Saks. Connecting Psychiatry. Published in April 2024. Accessed [month day, year]. [URL]

References:

Mass General Brigham McLean. Elyn Saks: Making Peace with Mental Illness. 2015. Available at: https://www.mcleanhospital.org/news/elyn-saks-making-peace-mental-illness Last accessed: October 2023.
Simon J. Am J Psychiatry 2008;165:3
Hachette Book Group. The Center Cannot Hold. 2023. Available at: https://www.hachettebookgroup.com/titles/elyn-r-saks/the-center-cannot-hold/9781401301385/?lens=hachette-books. Last accessed: October 2023.
USC Gould School of Law. Professor Elyn Saks Receives American Psychiatric Association Patient Advocacy Award. 2022. Available at: https://gould.usc.edu/news/professor-elyn-saks-receives-american-psychiatric-association-patient-advocacy-award/. Last accessed: October 2023.
Bhattacharyya S, et al. Lancet Psychiatry 2023;10:414–425.
Zukowska Z, et al. Soc Psychiatry Psychiatr Epidemiol 2022;57:1305–1318.
Holm M, et al. Acta Psychiatr Scand 2021;143:61–71.