The Center Cannot Hold: My Journey Through Madness

by Elyn R. Saks

I think of that young girl sometimes, that girl I was. Not yet a teenager, she may well have had admirable willpower; she might have been stubborn, or ferocious, or strong, or fearless—or maybe she was

just plain ornery. But one thing she did not have was complete control of what was going on inside her. And she was going to have to learn that the hard way.

Boy, can I relate! I’ve been in and out of therapy and had a couple of hospitalizations during my lifetime.

I guess Plath affects a lot of teenage girls this way, depicting as she does the sense of isolation and disengagement (and not a little fear) that typifies this time of life, especially for those who are sensitive and often lost in the world of their books. For days afterward, I couldn’t stop thinking about the girl in the novel, and what she went through—for some reason it made me restless, distracted. One morning in class, with Plath on my mind, I suddenly decided that I needed to get up, leave school, and walk home. Home was three miles away.

Anne Sexton and Sylvia Plath are my two favorite poets. I believe it is because I am mentally ill too and can relate to their struggles.

In fact, it is not necessarily true that everything can be conquered with willpower. There are forces of nature and circumstance that are beyond our control, let alone our understanding, and to insist on victory

in the face of this, to accept nothing less, is just asking for a soul-pummeling. The simple truth is, not every fight can be won.

This is so true! There is no cure for mental illness thought treatment is available. The treatments available today go a long way toward helping those who are mentally ill lead relatively normal lives.

Schizophrenia rolls in like a slow fog, becoming imperceptibly thicker as time goes on. At first, the day is bright enough, the sky is clear, the sunlight warms your shoulders. But soon, you notice a haze beginning to gather around you, and the air feels not quite so warm. After a while, the sun is a dim lightbulb behind a heavy cloth. The horizon has vanished into a gray mist, and you feel a thick dampness in your lungs as you stand, cold and wet, in the afternoon dark.

Sounds a lot like depression!

For me (and for many of us), the first evidence of that fog is a gradual deterioration of basic common-sense hygiene—what the mental health community calls “self-care skills” or “activities of daily living.” Once away from my parents’ watchful

eyes, I grew inconsistent about asking myself the taken-for-granted questions. Or maybe I was muddled sometimes about what the right answers to those questions should be. Are showers really necessary? How often do I need to change clothes? Or wash them? Have I eaten anything yet today? D...

Some days, the answers were clear as a bell: Yes, of course. For heaven’s sake, Elyn, clean yourself up! And so I did. But other days, the questions and the answers were just too hard to sort out. I don’t know, I don’t know. Or, simply, I just couldn’t remember: Did I do that already? Did I do it yesterday? Taking care of myself meant doing more than reading a book or finishing a term paper; it meant strategizing, organizing, keepi...

In addition to being a dear friend and intellectual companion, Peter taught me how to enjoy simple intimacy—time spent together not doing much, holding hands, being held, being made to feel special. Peter taught me how to enjoy sexual intimacy, something that would later become difficult for me, even frightening, during the years my illness was in full bloom. He seemed to sense a wariness in me, and he responded with great tenderness and patience.

A slender, very pretty girl, Linda had a drug history and (my parents had told me

this) had been compelled to spend some time in a mental hospital. As willing as I’d originally been to have the company, her actual presence unsettled me—from the moment she arrived, I was agitated, on edge. I don’t know what ultimately set me off—the knowledge of what had happened to her, or my own increasingly convoluted inner workings—but what happened next came completely out of nowhere. I suddenly grabbed a blanket from my bed, ran outside, covered my head with the blanket, and then ran around wildly in the ice and snow, arms stretched out, pretending to fly. “What are you doing!?” Linda cried out, having followed me outside the dorm. “Stop that, Elyn, you’re scaring me!” Even though I heard her, even though I registered the genuine fear in her voice, I continued to run, as though powered by some kind of engine. “No one can get me!” I shouted. “I’m flying! I’ve escaped!”

Eventually, Linda’s plaintive cries moved me to stop; she was genuinely frightened, and even in my odd frenzy, I knew it. Perhaps she was scared because she recognized in me the kind of behavior she had seen in the hospital. Or perhaps I was just out of control and might well have scared anyone who saw me. In fact, I’d scared myself—I had no idea what had come over me. I had no clue. Some months later, I was in the dorm with Peter and Susie and once again felt the way I had the night Linda was visiting. Abruptly, I challenged them. “I’ll do anything you ask me to!” I yelled. “Ask me anything, and I’ll do it!” Laughing at first, they decided ...

“Dance the twist!” they said. I did. “Come on, ask me to do anything,” I pleaded. “You want me to take my shirt off?” I did. Glancing at each other nervously, my friends started to realize something had gone seriously haywire. “You want me to quack like a duck? I can quack like a duck!” And I did. “You want me to swallow this whole bottle of aspirin?” And I did. Suddenly, the way they were looking at me sank in. They were scared to death. And suddenly, so was I—the dangers of what I’d done were staring us all in the face. I ran into the bathroom and quickly made myself vomit, then could...

“No, no,” I said weakly, “I was just playing around. It was stupid. I’ll be fine, really.” They wanted to call a psychiatrist, but I assured them there was no need, that I was perfectly OK. Ultimately, and reluctantly, they allowed us to leave. Shaken and somewhat fragile (and completely mystified at myself ), I left the hospital with Peter, both of us wondering what on earth had just happened. We talked about it for days afterward, and then gradually the intensity of the feelings and the experience seemed to fade. When I thought about it at all, it was with confusion and a growing sense of unease: What was that? Each of these incidents was isolated and brief, lasting only an hour or so, and I was able to bring them to a close on my own. They w...

Philosophy and psychosis have more in common than many people (philosophers especially) might care to admit.

the line between creativity and madness can be razor thin (a fact that has been unfortunately romanticized), examining and experiencing the world in a different way can lead to sharp and fruitful insights.

theirs. If anyone noticed that in effect I’d taken my leave of them even while being physically present, they said nothing. No one looking at me would have known there was a storm going on inside. But there was a storm, and it was horrible.

I’ve had storms going on inside me and wondered why those closest to me couldn’t see it since the eyes are said to be the windows to the soul. Horrible is putting it mildly!

It was as though in the absence of the familiar Vanderbilt routine, the fantasies had come to fill the void, and I couldn’t shut them off. Whole hours would go by at night when I was stuck in this alternative universe, struggling to decipher what was going on inside my head. Scenarios came and went of their own accord—it was like being unable to get out of the theater while demented movies ran endlessly through the night. I have been falsely accused of using drugs and put into a residential drug treatment program. Staff from Operation Re-Entry work there. At the program I spend time with no one. I speak hardly at all. I carry my Aristotle book everywhere. Staff call me in and tell me I must start socializing more. I can’t. I am called in again and staff order me to start talking. They say my Aristotle is a crutch and that I must stop carrying it around with me. “No,” I cry. “I will not give up my Aristotle!” Staff take my Aristotle away by force. I lose control, tearing the office up in a wild frenzy, shouting at the top of my lungs. Staff restrain me. Several hold me down and they call 911. The ambulance takes me to the emergency room.

I have issues myself with unwanted intrusive thoughts. Everyone has them but those of us who deal with mental illness have a harder time dealing with them. Those who don’t suffer from mental illness can handle them on their own while a mentally ill person may not be able to.

nothing I had to say was worth hearing, or so said my mind. It’s wrong to talk. Talking means you have something to say. I have nothing to say. I am nobody, a nothing. Talking takes up space and time. You don’t deserve to talk. Keep quiet.

Demons are what I call the negative thoughts in my head. They always say negative things to me.

And the vivid fantasies had followed me across the ocean. My doctor finds me huddled in a corner. He wants me to socialize with other people in the program. I don’t want to. They force me into a room where there are other people. I am supposed to talk to them. A man introduces himself, “Hi, my name is Jonathan.” I do not respond. “What’s your name?” Again I do not respond. “Are you a student here?” I mutter something to myself. My doctor comes over and encourages me to talk to this young man. I start screaming and run wildly about the room. Some of the attendants restrain me by force.

What was real, what was not? I couldn’t decipher the difference, and it was exhausting. I could not concentrate on my academic work. I could not understand

what I was reading, nor was I able to follow the lectures. And I certainly couldn’t write anything intelligible. So I would write something unintelligible, just to have...

And me wasn’t worth much. I’m not sick. I’m just a bad, defective, stupid, and evil person. Maybe if I’d talk less I wouldn’t spread my evil around.

Intrusive thoughts by what I refer to as demons.

There is nothing about me to like.

Intrusive thought

That night was terrible. I lay awake in a pool of sweat, unable to sleep, a mantra running through my head: I am a piece of shit and I deserve to die. I am a piece of shit and I deserve to die. I am a piece of shit and I deserve to die.

Intrusive thoughts- demons

One by one, each member of the staff tried to talk me into using antidepressant medication. Their recommendation surprised me. I thought they would encourage me to take something that would calm my body or organize my speech. Either way, antianxiety or antidepressant, I was adamant in my refusal. All mind-altering drugs are bad. I am weak, I simply need to get stronger, try a little harder, and all will be well. Was that the sentient part of my mind speaking, or the fractured part? I could not tell.

I was more than willing to try medications because I was tired of being “crazy.”

late. I had

all the makings of an excellent mental patient.

For me, suicidal ideations which stemmed from severe depression and finally a suicide attempt with overdose of pills

I was a psychiatric patient, in a hospital for the mentally ill. The in-sane. Unlike inpatient units in the States, however, this one had no locked doors. I can leave anytime I want, I told myself, trying for reassurance. After all, if I stayed, it was because I decided to.

I’ve had one ER visit and three mental breakdown hospitalizations

Only the craziest of the crazies come to a mental hospital. I am lazy. I have not fought hard enough. If I had really tried, I wouldn’t need to be here.

Intrusive thoughts

“I’m not sick,” I protested. “I’m bad.” Then

It took me quite a long time to realize how sick I really was.

easy on the eyes as well. His mother was foreign, so he didn’t look or act in a way I’d come to think of as classically British; he seemed more open and approachable than anyone I’d met in Oxford. He effortlessly made jokes; he spoke to me as though we were friends; he seemed to care about me. I looked forward to our appointments, no matter how difficult the conversations were. It was human contact, and I craved that. While he listened to my negative thoughts and feelings, Dr. Hamilton showed little interest in knowing what they were about; instead, he focused solely on how I might make them go away. Rather than delving into my past or my unconscious, he focused entirely on my present—what we could do to make things better “right now” and how I might begin digging out of my depression. He offered some simple, concrete suggestions, like making written lists and a schedule, to keep me on track and not overwhelmed by what I had to do (and things I kept forgetting to do, like washing my clothes).

I had no trouble accomplishing the simple “homework” assignments he gave me, such as preparing a daily schedule each morning and sticking to it; in the evenings I was reading Aristotle’s Metaphysics in the original Greek. I was both the mental patient and the student, and was competently balancing both, pacing myself, managing things.

sobs. I don’t have anything to say. I am a failure. It is only a matter of time before people see I am stupid. And crazy.

Intrusive thoughts-demons

herring,” he said calmly. “It’s not what’s really going on with you.” I was disconsolate. “But what’s wrong with me, that I can’t eat? Is this anorexia? Am I going to die?” He said anorexia was a grab bag term. “We’re not going to focus on symptoms and labels, Elyn. Let’s focus instead on you getting your work done. And for now, just eat more, OK?” His simple-sounding approach to my weight loss didn’t help much, but it didn’t dampen my feelings for him, either. He was so smart, so sensitive, so kind. He knows me like no other, I thought, and he knows what’s best. I would leave his office temporarily reassured—well, if this is what he thinks, it must be true—but once outside, I’d slam into the wall of the truth: It was all going badly wrong. I started muttering again—I am a bad person, I deserve to suffer. People are talking about me. Look at them; they’re staring at me. They’re talking about me.

Intrusive thoughts- demons

What transpired among us didn’t much comfort or reassure me, but at least my worst fantasies had not come true. They didn’t disown me, or tell me I was a failure, or accuse of me being weak by having to take medication. In fact, they were kind, concerned, supportive. But I was such a horrible disappointment to myself. How could I not be a disappointment to them as well?

am bad. Only good people get food. I deserve to starve. I deserve to be tortured. Starvation is a fitting torture for me.

Psychosis

Now she’s walking down the street. She’s ugly. People are looking at her. People are not to be trusted. Be careful. Be vigilant. They will hurt you That man’s face just turned into a monster face. Be inconspicuous. Don’t let them see you.

Psychosis

There were fantasies as well. Dr. Hamilton finds me in my bed, emaciated and confused. I have not been able to get out of bed for weeks. He is gentle and reassures me that he can help. I want to believe he can help me. He helps me get out of bed, but even with his help I can barely walk. I am too weak. I am weak. Thoughts of suicide came rushing back in, along with intense fantasies of exactly how I’d do it. Throw myself into the river. Set myself on fire. I was particularly drawn to the latter. I was, after all, a witch; being burned at the stake seemed especially fitting. It was only what I deserved.

Intrusive thoughts-demons

Please like me; please want to help me. Please don’t be disgusted with me.

Don’t look at me, don’t look at me. “You have to come back into the hospital, Elyn. Right now.”

No one will ever come, I thought. I am worthless, I cannot even control my own mind. Why would anyone want to save me?

Intrusive thoughts

“You’re very thin, Elyn. Can you tell us why you’ve lost so much weight?” “I think it’s wrong to eat,” I told them. “So I do not eat.” “But why?” they asked. “Food is evil,” I said. “And anyway, I don’t deserve to have any. I am evil, too, and food would only nourish me. Does it make any sense to you to nourish evil? No. It does not.” After a few more rounds of questions, the doctors carefully explained their recommendations to me. In England, treatment recommendations were always just that—recommendations. To leave a hospital, to stay in it, to take medications, to participate in group activities or not—they never forced any of it on me, and each time the decision was mine. Even at my craziest, I interpreted this as a demonstration of respect. When you’re really crazy, respect is like a lifeline someone’s throwing you.

Catch this and maybe you won’t drown.

You are a piece of shit. You don’t deserve to be around people. You are nothing. Other people will see this. They will hate you. They will hate you and they will want to hurt you. They can hurt you. They are powerful. You are weak. You are nothing.

Intrusive thoughts-demons

she, too, spent most of her day rocking in place.

I rock but usually from pain. It helps me deal with it.

had hanged herself the night before. I was stunned, as much by my friend’s tone as by the news she’d so calmly passed along to me. This patient had killed herself, I thought, over Dr. Hamilton. Why hadn’t staff noticed what was driving her and done something about it? Why hadn’t I done something? Didn’t anyone realize that she could have been me? In my fog of isolation and silence, I began to feel I was receiving commands to do things—such as walk all by myself through the old abandoned tunnels that lay underneath the hospital. The origin of the commands was unclear. In my mind, they were issued by some sort of beings. Not real people with names or faces, but shapeless, powerful beings that controlled me with thoughts (not voices) that had been placed in my head. Walk through the tunnels and repent. Now lie down and don’t move. You must be still. You are evil. The effect of those commands on me during those nights and days was powerful. It never occurred to me that disobedience was an option, although it was never clear what might happen if I disobeyed. I do not make the rules. I just follow them.

Another command (or thought, or message) I continually received was to hurt myself. To inflict pain on myself, because that was all I was worthy of. So I burned myself—with cigarettes, lighters (easily come by—everyone smoked then, as I did), electric heaters, boiling water. I burned my flesh in places on my body that

I often was taunted and encouraged to hurt myself by the demonic intrusive thoughts.

thought people would never see. I’d do it in the bathroom when no one was there, or down in the tunnels, or out on the grounds. Once in the music room, when I was trying my best to set my sock on fire, an attendant went by, saw what I was doing, and tsk-tsked in a mild tone, “Elyn, really, you mustn’t do that, it’s simply not on, you know.” In fact, many staff members knew what was happening; after all, they dressed my wounds, putting salve on the burns, noting the when and where in their charts. “Aren’t you concerned,” one said to me during a repair session, “that in summer, when you wear a bathing suit, these scars will show?” “I don’t think you understand,” I said patiently. “I’m not going to survive the year. I have no concerns about future swims, or what I will look like in a bathing suit.” Although the staff and Dr. Barnes knew what I was doing, no one seemed to know or understand why, and there was no way I could tell any of them that the impetus for my behavior, the commanding impulse, came from inside my head but was not mine.

“…the commanding impulse came from inside my head but was not mine.” Again, demons.