The Center Cannot Hold: My Journey Through Madness

Elyn returns to New Haven and resumes treatment a few weeks before classes start. She starts seeing Dr. Joseph White who is a senior member of the Yale faculty, recommended by YPI. Dr. White endorses psychoanalysis, and while it is not the recommended or obvious treatment for Elyn’s illness, it is the only one that seems to work for her.

Elyn resumes classes at Yale and is relieved to be back. Though they occasionally resurface, she learns to keep her symptoms mostly hidden from view by compartmentalizing and dealing with them in sessions with Dr. White. However, feedback that Elyn receives on her first memo assignment leads her to believe that she is not good enough, causing her to unravel once again. A classmate contacts Dr. White for her, who suggests that Elyn head to the ER; Elyn refuses, panicked by memories of the last time. She eventually waits for her next appointment with Dr. White, by which time she is deep in psychosis again. Dr. White suggests a new drug, Navane, which Elyn finally agrees to take. Although she reacts well to it, Elyn doesn’t like how it makes her feel, and she goes off medication again less than two weeks later.

Elyn eventually makes a close friend, a first-year student named Steve Behnke. For the first time, Elyn confides the details of her entire psychiatric history in someone who is not a medical professional. Steve is an empathetic and nonjudgmental listener, and their friendship deepens. He becomes a lifelong friend.

The second semester at Yale, Elyn and Steve both choose the same electives: criminal law and the mental health law clinic. The latter class involves representing actual patients in psychiatric hospitals under the guidance of their professor. Steve and Elyn work on cases together, choosing to represent psychiatric patients and children.

Elyn does well on all her exams, earning honors grades (the highest grade) in most papers. However, she earns the second highest grade—a pass—on the take-home exams in criminal law. This sets off her anxiety and delusions once again. Dr. White puts Elyn back on Navane, at double her usual dose; eventually the medication takes effect, and Elyn begins to function normally again.

During the summer, Steve and Elyn both stay behind in New Haven and continue their work representing patients and poor children. Elyn continues to take the increased dose of Navane, as well as an antidepressant. As the second year begins, Elyn goes back to her usual dosage; simultaneously, she begins to experience brief hallucinations at night.

Despite this, the worry of side-effects of the drug, particular a condition called tardive dyskinesia (TD)—“a neurological disorder that causes involuntary movements […] in your face and around your mouth” (203)—leads Elyn to beg off medication. Under Dr. White’s reluctant guidance, they begin tapering down the dosage; by the fourth week, Elyn descends into full-fledged psychosis again. Dr. White increases the dosage, and Elyn feels better almost instantly.

Steve and Elyn continue to advocate for patients, and Elyn encounters the absurdities of the mental health care system, as well as its blind spots. In one case, they fight on behalf of a patient who has been refusing medication for religious reasons and win him the right to refusal. Eventually the patient is moved to another ward, where he talks to no one except Elyn and Steve on the phone. When they go to meet him in person, Elyn and Steve are told by one of the nurses that the patient is psychotic. His record reads that he is “bizarre” and selectively mute and has been “overheard talking on the telephone about his legal rights with his imaginary lawyers” (205). His status as a “mental patient” had led the staff to believe that the patient’s lawyers were merely a figment of his imagination.

One of Elyn’s favorite cases is one she works on for the next six years, a young man named Jefferson with an intellectual disability. Elyn and Steve search to find an appropriate group facility for individuals with autism and intellectual disabilities and have Jefferson transferred. His case inspires Elyn to continue fighting for patients who have been misdiagnosed and are not receiving the help they need.

As the end of law school draws near, Elyn is faced with the reality of having to find a job. This is a daunting prospect to her, as she has never been anything but a student. She also finds it excruciatingly painful to speak up in class, though she has been performing excellently in her academics. The latter experience consistently evokes in her a feeling that there is nothing wrong with her, and she goes off medication again; she promptly descends into psychosis, which is stemmed only once she is back on the Navane.

Elyn is aware of the limitations of her condition and knowing she will never be able to perform well in court, she decides to make a difference to the lives of mental patients in a different way. Elyn works to join the Yale Law Journal as a student-staff member, submitting a topic-statement on the subject of use of restraints in psychiatric institutions. Her work is accepted, and her Note, The Use of Mechanical Restraints in Psychiatric Hospitals” (213), is published in the Journal in 1986. It is later used by a lawyer at the Bazelon Center for Mental Health Law to challenge the use of restraints in a Midwestern hospital through a class action lawsuit.

Graduation comes as a “victory” for Elyn, who by this time has managed to “construct some survival tools” (214). She has found a school in which she has academically thrived; she has found a psychiatrist whom she trusts and helps her manage her condition with respect and dignity; and she has found a friend. However, the change that looms right after graduation poses a challenge for Elyn. She chooses to stay on in Connecticut to be close to both Dr. White and Steve. In a familiar pattern in which Elyn sets a goal, accomplishes it, and then falls apart, Elyn competes the law board exam in the 99th percentile, and promptly has a psychotic episode. Dr. White manages to have her up her medication, and this restores her cogency.

Elyn eventually lands a job at Connecticut Legal Services (CLS), where she begins representing clients on family law and housing cases. The work leaves her little time or resources to think and strategize much, and Elyn finds it grueling and overwhelming. She begins to look for work elsewhere while continuing Jefferson’s case pro bono. Steve and Elyn’s combined efforts win Jefferson five years of compensatory, state-sponsored special education.

Elyn discovers that the medical insurance from her job at CLS will cover the cost of her analysis; however, this requires an official diagnosis from Dr. White, who has refrained from giving one so far to avoid labels. Now, Dr. White officially diagnoses Elyn with “schizoaffective disorder, depressive type (221). The diagnosis of a thought disorder (as opposed to a mood disorder like depression) greatly upsets Elyn, and she relapses. This leads Dr. White to up Elyn’s dosage again.

Elyn applies for and accepts a two-year position at a local law school teaching legal research and writing. Steve announces that he is leaving New Haven for Washington where his girlfriend beginning a doctoral program. Elyn is heartbroken, but unlike the changes she has faced before, is confident that she will survive this one.

Elyn writes that accepting the teaching position is “one of the best professional decisions I ever made” (225). She does well throughout the year, making friends with colleagues and staying in therapy and on her medication. However, Dr. White suddenly announces his impending retirement in three months, and Elyn’s condition instantly deteriorates. Understanding how bad the situation has gotten, Steve returns to New Haven and spends several days taking care of Elyn. Yale convinces Dr. White to stay on an additional year, and Elyn recovers.

In the summer of 1988 Elyn completes one teaching year and prepares to apply for new jobs. She also has a trip home planned for the Fourth of July, but the night before, she develops a terrible headache. Elyn sees a doctor and is prescribed Tylenol with codeine but begins throwing up and loses her memory over the next five days.

When Elyn is taken to the ER by friends, her psychiatric history rules out any further diagnosis. However, one of Elyn’s friends calls her parents, and her mother arrives and takes her to an internist. Diagnostic tests reveal that Elyn has a subarachnoid hemorrhage, a type of brain bleed which has a mortality of 50%. Luckily, an angiogram reveals that Elyn does not require further surgery, as the aneurism seems to have bled out and destroyed itself.

The hospitalization required for these procedures requires Elyn to be off all other medications, and she descends into psychosis. Dr. White asks a colleague of his to check up on Elyn during her hospital stay. These visits, as well as the ones from her parents, help Elyn. Eventually the memory impairment and the headaches lift, and she is cleared for discharge, albeit with no clear conclusion as to what caused the bleed. The experience leaves Elyn terrified at the thought of what may have happened but also appreciative of a second chance at life.

Elyn goes back to her second year of teaching at the small law school while continuing to apply for a tenure-track position elsewhere. Over 35 law schools respond to her application with interest. She ultimately accepts an offer from University of Southern California in Los Angeles.

The move is months away, and Elyn spends the time until then fulfilling her remaining teaching responsibilities as well as continuing to work on Jefferson’s case. Since he is doing very well in his current home, Elyn works to get him relocated to another, higher-functioning group home. Despite Jefferson’s enthusiasm, something triggers him at his new home a few weeks in. When Jefferson begins to shout at and threaten the people at the home, the police are called; they take him to the local mental hospital where he is restrained, forcibly medicated, and isolated. Jefferson spends the next few years bouncing from group home to group home with bouts of hospitalization in between. The experience serves as a hard lesson for Elyn that she might have been fighting for what seemed best from her point of view, but not necessarily from Jefferson’s.

Elyn prepares to visit Los Angeles over spring break. Just before she leaves, she receives news that her Uncle Norm has died by suicide, overdosing on pills. Elyn pauses to wonder whether this will be her story one day.

During her trip to Los Angeles, Elyn finds a new analyst suggested by Dr. White named Kaplan. Kaplan is comfortable blending psychoanalysis with medication, a style that has worked well for Elyn in the past. Over the July 4 weekend in 1989, Elyn permanently leaves New Haven and relocates to Los Angeles.

Elyn begins organizing her work and listing her goals to achieve tenure. She also begins teaching a class in mental health law, which she thoroughly enjoys. The class offers opportunity to discuss a range of topics close to Elyn’s own heart, including the academic and intellectual competence of individuals with mental illness, and their rights to refuse medication when in a hospital.

Despite keeping busy, Elyn feels herself beginning to slip sometime into the first semester. She manages to contact Kaplan, who calls her into his office immediately. Kaplan calmly urges Elyn to up her dosage of Navane, and she feels better soon after. Kaplan’s composed response to Elyn’s display of psychosis, as well as the fact that he did not rush to hospitalize her, reassure her; however, his immediate recourse to medication presages a long battle between the two.