The Center Cannot Hold: My Journey Through Madness

Four years after starting at Oxford, Elyn finally completes her degree in 1981. Although aiming for a Master of Letters (MLitt) degree, her thesis is commended to be of DPhil quality.

As therapy with Mrs. Jones is going well, Elyn chooses to stay on in England for one more year. She also decides that she wants to volunteer to help people with mental illness. She interviews to do so at Warneford but loses her chance when she reveals she used to be a patient there. She is accepted for a volunteer position at Littlemore Hospital, another psychiatric institution in Oxford. Here, Elyn works on the Activities Unit, leading exercise and art groups and interacting with patients.

During her time in Littlemore, Elyn experiences how she too can perpetuate stigma around mental illness unconsciously. She also observes how British hospitals, unlike American ones, rarely use any kind of mechanical restraint, or “punish” the patients for infractions; a gentle reprimand is expressed instead. Elyn’s time at Littlemore gives her great satisfaction, leaving her feeling like she is doing “something worthwhile” ( ).

In her third year of analysis with Mrs. Jones, Elyn notices that she is developing hypochondriac tendencies. She takes this new fear of falling ill to mean that she does not want to die anymore. By the end of the third year, Mrs. Jones tells Elyn that it is time for her to return to the United States. However, the impending end of their time together leaves Elyn anxious, and she begins having fantasies of different ways to keep Mrs. Jones with her. Mrs. Jones helps her work through these, explaining them as a result of the pain of separation, but Elyn’s pain only seems to worsen.

Elyn decided to apply to law school in the United States. She scores well on the LSATs and is accepted by all the schools she applies to: Harvard, Stanford, and Yale. Elyn chooses Yale.

Her final session with Mrs. Jones leaves Elyn in tears, and she refuses to leave the waiting room. Despite both Mrs. Jones's and her husband’s gentle coaxing, Elyn does not budge, clinging to the pipes in the waiting room as they try to physically move her. Elyn spends several hours like this, until Dr. Brandt tells her they will call the police if she doesn’t leave. Elyn finally agrees and bids Mrs. Jones a tearful goodbye.

Elyn’s parents receive her at the airport in Miami. Although Elyn eventually tells them about the second hospitalization, they don’t talk about it much. A “wall of appropriateness” (118) between Elyn and her parents prevents them from indulging in anything more than surface conversation. Elyn spends her time at home grieving her separation from Mrs. Jones and writing her long letters, some of which Mrs. Jones occasionally replies to. She also pays a short visit to her old friends, Kenny and Margie Collins, who live in Carbondale, Illinois.

Elyn finally begins classes at Yale, and the schedule is challenging and exhausting. She has no time to write to Mrs. Jones, and without the “safety valve” ( ) of these letters, the pressure begins to build up inside her and she begins to have psychotic thoughts and hallucinations once again.

Unable to bear it any longer, Elyn visits Student Health Services two weeks into the semester. Her first appointment is with a young and inexperienced intern who is unable to help her; her second appointment is with the on-call psychiatrist who is better equipped but wants to give her medication, a neuroleptic called Trilafon. When Elyn refuses, the psychiatrist and two other doctors threaten hospitalization; Elyn convinces them to let her spend the weekend in the Student Health infirmary instead.

Later that night, Elyn steps outside the building to smoke a cigarette; as she walks back in, one of the nurses spots her, and startled, Elyn runs and hides. When the staff eventually finds her, she is stressed out and speaking unintelligibly. When she eventually calms down, she is told that she cannot stay the night as she is “too difficult to manage” (128). They send her back to her room with some Trilafon, which Elyn does not take.

Elyn returns to Student Health the next morning, and she is visibly worse; she crawls under a desk and starts to rock and moan. She has delusions of faceless creatures hovering close by waiting to kill her. When the staff try to organize a hospital bed somewhere for her, however, Elyn makes a break for it and runs back across campus.

Elyn heads to the library, where she manages to calm down by the end of the day. When she gets back to her room, she finds a message left for her by the psychologist from Student Health Services. Elyn has been reassigned to Hans Pritzer, a senior psychologist and psychoanalyst.

Elyn meets with Dr. Pritzer and confesses her thoughts of being controlled by people. Despite this, Dr. Pritzer does not think Elyn has schizophrenia because she seems to be trying hard to connect with him, which is contrary to how schizophrenia generally presents. Elyn continues to meet regularly with Dr. Pritzer, but her thoughts grow more agitated and violent.

Elyn is assigned her first legal memo assignment in class. She hands in a 50-page document when the limit is 15 pages. Though her work is very good, it does not meet the assignment specifications. The feedback disheartens Elyn, and her second memo assignment sends her into an anxious tailspin.

Events from the prologue play out in detail, as Elyn meets two classmates, the members of her small group, to finish a memo assignment at the Yale Law School library on a Friday night. Elyn starts speaking incoherently and runs onto the roof, scaring her classmates. Although she eventually comes back inside, her classmates leave in a hurry; Elyn stays past midnight, hiding among the stacks of books.

The next morning she approaches Professor M. to ask for an extension; she is still speaking gibberish. Concerned, the professor invites her home for dinner; Elyn accepts, then climbs onto a roof outside.

Dinner at Professor M’s house does not go well, and Professor M telephones the psychiatrist on call at the Student Health Center, whom Elyn nicknames “The Doctor.” Despite Elyn’s reluctance, Professor M takes Elyn to the emergency room at Yale-New Haven Hospital. The Doctor and his team forcibly strap Elyn onto a gurney and make her swallow medicine. He also issues a “Physician’s Emergency Certificate” (146), which allows the hospital to hold Elyn for fifteen days. Due to a lack of space, Elyn is transferred to Yale Psychiatric Institute (YPI) across town; she is kept in restraints and feels hurt and humiliated.

At YPI, Elyn is taken to a “seclusion room”; her restraints are loosened a little after she screams and gasps that she is unable to breathe. Elyn feels more frightened than she has ever been in her life; she is also angry and sings loudly for hours on end to signal her defiance.

Against her wishes, Elyn’s parents are contacted. She is kept in restraints for almost ten hours, and after they are removed, she is moved to an Intensive Care Program which warrants constant monitoring. Unaware that the hospital has already informed her parents, Elyn calls them but downplays her situation. While her father is relatively calm, her mother seems more concerned (her mother’s younger brother, Uncle Norm, has been struggling with depression, and Elyn reminds her mother of him). Elyn’s parents insist that they are coming to see her.

Later in the day, Elyn asks to retrieve a pack of cigarettes from her bag. She also manages to take a small metal ring and a lighter. These are discovered by the nurse when Elyn gets ready for bed at night. Elyn refuses to hand them over and threatens to harm the nurse in a panic; this causes the staff to restrain her again and dose her with Trilafon.

Despite the medication, Elyn continues to be beset by delusions. She begs to be freed from the restraints the next morning but is refused. Finally in the evening, Elyn apologizes to the nurse she threatened and is freed from the restraints. However, she is kept confined to the room and transferred back to Memorial Unit 10 (MU10) at the Yale-New Haven Hospital fifteen hours later, when a bed opens up there.

At MU10, Elyn meets with Dr. Kerrigan who wants to do a full evaluation and diagnosis before admitting her to an appropriate facility. Elyn is distraught and wants to return to graduate school, but Dr. Kerrigan extinguishes any hope of this. He also suggests that Elyn use restraints, believing them to be a form of therapy. The staff is instructed use them “liberally” with her, and they do so for the next three weeks.

Elyn is considered disruptive to other patients and mostly kept apart from them. She is often restrained even for minor infractions. She struggles balancing her experience of psychoanalysis (which involves saying everything that is on her mind) with behaving in a manner that does not bring punishment. She is put on Valium in addition to the Trilafon, which makes her feel dull and doped.

Elyn’s parents come to visit her after the hospital contacts them, and they spend Thanksgiving together. They are stunned to see Elyn’s condition but keep the conversation light and easy. The staff believe that Ellen’s parents are not taking her condition seriously, but their levity and irreverence is Elyn’s family’s way of coping with the difficult situation.

Elyn eventually befriends two other patients—Susan, a woman the same age as her who has bulimia, and Mark, who is barely eighteen and has no short-term memory. Susan’s treatment mostly consists of doctors telling her to exert her willpower and not binge and purge, which Elyn understands to be unhelpful. Elyn is also upset by how Mark, who is childlike, does not seem to be getting the right help either.

The Physician’s Emergency Certificate signed at Elyn’s admission finally expires, and although Elyn does not want to stay on, she opts for voluntary admission—the other option would be a formal proceeding called a “civil commitment hearing” (165) in which a judge decides the outcome. Wanting to avoid any record of court-mandated admission to a psychiatric institution, Elyn chooses to stay on voluntarily. However, she discovers that MU10 has contacted Yale and withdrawn her admission without her knowledge or permission, and she is distraught.

Elyn finally receives a diagnosis: “Chronic paranoid schizophrenia with acute exacerbation” (167). Her prognosis listed as grave. At the time, there is little information about the treatment of schizophrenia except for a few antipsychotic medications that do not always work. People with schizophrenia were generally considered “hopelessly evil or helplessly doomed” (169). Elyn is heartbroken; nevertheless, she chooses to stay on at YPI to be close to Yale. She hopes to return to law school as soon as she can.