The Center Cannot Hold: My Journey Through Madness

by Elyn R. Saks

Although I was back in good standing, I grew somewhat quiet and withdrawn—“in myself,” as I came to call it when it had become much more extreme. Unless spoken to, I didn’t have much to say; I wasn’t sure I even deserved to be heard. I’d started to believe (or, perhaps more correctly, feel ), that speaking was actually “bad.” At one point, after I’d been asked to make a brief presentation and did so, a staff member remarked that I had spoken more in those few minutes than I had in months. Perhaps this was the beginning of my estrangement from the world, the very first inkling of my illness, something I’d never really experienced before, and a habit of mind that would intermittently mark me for the rest of my life.

As for the Center’s antidrug mission, yes, that was a success, too—but of course, I had never used drugs that much to begin with. What my experience at the Center primarily did was drill into me an unflinching attitude toward illness or weakness: Fight it. You can fight it, and you can win. To be weak is to fail; to let down your guard is to surrender; and to give up is to dismiss the power of your own will. The fundamental flaw in all of this, though, is that it neglects something intrinsic to the complex real world and to complex real human beings. 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.

Philosophy and psychosis have more in common than many people (philosophers especially) might care to admit. The similarity is not what you might think—that philosophy and psychosis don’t have rules, and you’re tossed around the universe willy-nilly. On the contrary, each is governed by very strict rules. The trick is to discover what those rules are, and in both cases, that inquiry takes place almost solely inside one’s head. And, while 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. Not only did philosophy give me a surprising joy, it also imposed a structure on both my mind and routine that I’d been unable to provide for myself. The rigor of the material, and the lively give-and-take of the students and faculty in the department, imposed a kind of order upon my days. Suddenly, I had attainable goals, a sense of productivity and purpose, and tangible results against which I could measure my progress. By the second semester of my freshman year, the department allowed me to take courses in the graduate school. I completed that year (and every year thereafter at Vanderbilt) with straight As.

Also, I was uncomfortably aware that this was costing my parents money, and that going further with it would cost them even more. What was the point? Besides, I felt exposed in a way I didn’t enjoy—it seemed that the only thing that people wanted to talk about over coffee in the morning and at the dinner table at night was the inner workings of my mind. So I went off to my third appointment with Karen and told her it would be our last meeting. “And why is that, exactly?” she asked. “My parents are upset that we haven’t figured this out,” I said, “and that you haven’t come up with some kind of plan. Besides, it costs them too much money for me to see you.” I braced myself for her objection, but none came. “All right, then,” she said calmly. “We won’t continue. But here’s what I think: You do need help. And I just want you to know that when you decide you’re ready to get it, you can and should come back to see me.” Nonplussed, I thanked her and quickly left the office. It never occurred to me back then (and if it occurred to Karen, she didn’t say so), that I was taking better care of my parents than I was of myself.

Every single night, when the house was quiet and everyone else was long asleep, there came a moment when my heart would begin to race. I’d break into a cold sweat, and my breathing would become shallow and very rapid. I didn’t know these events were panic attacks; I only knew my heart was about to burst out of my chest, and it terrified me. That’s it, I thought: Something is wrong with my heart. When I told my parents, they took me to a cardiologist immediately; he performed a number of tests, none of which indicated any heart problems. The doctor said he thought I was simply anxious, and he advised against tranquilizers, concerned that they’d make it even more difficult for me to concentrate. I wouldn’t have taken them anyway—if there was one thing I took away from Operation Re-Entry, it was an absolute determination never to take any drug that altered my mental state. So instead, the doctor prescribed Inderal, a beta blocker which I believed was supposed to quiet my heart (it’s also prescribed for panic attacks, anxiety, and nervous tension). I didn’t know that the side effects of Inderal could include depression; indeed, I felt both sad and sleepy fairly soon after taking it. But I stopped feeling like I was about to jump out of my skin. The nights grew mostly quiet, and I was able to complete my work.

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 a paper to hand to my tutor each time we met. Understandably, my tutor was flummoxed. “This is not acceptable, Miss Saks,” he said. He was neither angry nor cold, but he was somewhat disbelieving. “Surely you can agree?” he asked. “Because, you see, the work here is hard to make any sense of.” Dumbly, I nodded, sensing the hard wooden chair beneath and around me. I barely squeezed out a couple of syllables. “Yes,” I said. “Yes, I know.” I just didn’t know what to do about it.

“Jean and I are very concerned about you,” he said quietly. “We think you may be quite sick. Would you mind if I asked you some questions?” “I’m not sick,” I responded. “I’m just not smart enough. But questions, yes. Ask me questions.” “Are you feeling down?” “Yes.” “Loss of pleasure in daily activities?” “Yes.” “Difficulty sleeping?” “Yes.” “Loss of appetite?” “Yes.” “How much weight have you lost in the last month?” “About fifteen pounds.” “Do you feel like a bad person?” “Yes.” “Tell me about it.” “Nothing to tell. I’m just a piece of shit.” “Are you thinking of hurting yourself?” I waited a moment before answering. “Yes.” Richard asked still more questions; I answered yes to each one. As dim as I was, it wasn’t difficult to see the alarm on his face. “You need to consult a psychiatrist right away,” he said in a measured tone. “You need to be on antidepressant medicine. You’re in danger, Elyn.” This was serious business, he explained. I couldn’t afford to wait. I thanked Richard and Jean for their concern, and told them I would think about everything they’d said. But I was not persuaded.

When I hit the street, I couldn’t figure out at first which direction to walk in, and didn’t see any phone booths to call a taxi. So I just kept walking. My breath was coming hard and fast, my heart was pounding so hard I was certain passersby could see it. I walked another nearly two miles to get back to my dorm. Once there, I called Jean and Richard and told them what had happened. Immediately, they insisted that I needed to follow the doctor’s recommendation. “No!” I said, and hung up, defiant and scared and completely at a loss for what to do next. 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. Time stopped. By the middle of the night, I was convinced day would never come again. The thoughts of death were all around me; I realized then that they had begun the summer before, like a small trickle in a creek where I had gone wading. Since then, the water had been steadily rising. Now it was deep and fast and slowly threatening to cover my head. The next morning, haggard and beaten, I managed to call the hospital and reach Dr. Smythe. “I’m glad you called,” she said. “Please, come in as soon as you can.” That lonely night had served its purpose. No one had locked me up against my will. I entered the hospital voluntarily. If I were going to be a mental patient, at least it would be by my...

Daily, my thoughts grew more disorganized. I’d start a sentence, then be unable to remember where I was going with it. I began to stammer severely, to the point where I could barely finish a thought. No one could stand to listen to me talk; some of the patients made fun of me. Disengaged from my surroundings, I sat in the dayroom for hours at a time, jiggling my legs (I couldn’t sit still, no matter how I tried), not noticing who came in or out, not speaking at all. I was convinced I was evil. Or maybe I was crazy—after all, I was sitting in a mental hospital, wasn’t I? Evil, crazy; evil, crazy. Which was it? Or was it both?

Lynn and I often took long walks around the Warneford grounds, sometimes talking for hours. One of her favorite topics of conversation was the many meds she was taking. “They’re giving me placebos for medication,” she said, laughing, “not the real thing!” She then shared with me her amazement and delight that they actually worked! Months later, long after we’d both gone back into the world, I saw her walking around Oxford in a daze, grown obese from the drugs.