The Center Cannot Hold: My Journey Through Madness

“…explaining what I’ve come to call ‘disorganization’ is a different challenge altogether. Consciousness gradually loses its coherence. One’s center gives way. The center cannot hold. The ‘me’ becomes a haze, and the solid center from which one experiences reality breaks up like a bad radio signal.”

Elyn recounts her first encounter with psychosis, a moment in her childhood where she experiences a disconnect with the physical reality around her. Her description of this experience is vivid and detailed, as she explains how one loses the “vantage point” from which to make sense of the world. This experience, and Elyn’s description of it, is what gives birth to the book’s title.

“Most of us figure out, as we grow up, that we will ultimately belong to (or struggle with) two families: the one we’re born into and the one we make. […] For me, the process of making the second family began at the Center. We all had something in common—committing to live in a world without using drugs, without, in fact, relying on anything artificial or chemical in order to get through our days.”

Although initially resentful of it, Elyn eventually grows comfortable at Operation Re-Entry. This particular passage highlights two important things: Elyn’s need for and delight in a social group or community, and the genesis of her negative attitude towards drugs and medication. The former stands her in good stead throughout her illness, while the latter presents substantial obstacles along the way.

“Schizophrenia rolls in like a slow fog, becoming imperceptibly thicker as time goes on. […] 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.’”

Elyn begins to experience the first symptoms of schizophrenia during her time at Vanderbilt. Despite these early signs, as well as her childhood experiences of psychosis and “disorganization,” Elyn only receives a reliable diagnosis much later in life. It is only in retrospect that Elyn is able to make sense of these early signs, pointing to how common misdiagnosis is in the mental health system.

“[…] 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.”

When Elyn is offered antidepressants during her first hospitalization at Warneford, she initially refuses; her response is born from her time at Operation Re-Entry and the attitudes she acquires there. It is a sign of how poor her condition is that she agrees to take the medication shortly after, upon catching a glimpse of her reflection in the mirror. Elyn’s condition has deteriorated so much that she is more terrified of her illness than she is determined to avoid medication.

“The admission note summed things up pretty well: ‘Thin, tall, chain-smoking, sad, inappropriate laughter at times, seems physically and mentally retarded.’

I hated myself.”

Elyn constantly and consistently measures her self worth by her intelligence and subsequent academic and professional achievements. The appearance of “mental retardation” as present in the note is especially disturbing to her. However, Elyn’s past and future achievements completely negate this possibility, going on to that mental health professionals are not immune to stereotyping and misdiagnosis.

“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.”

Elyn’s experiences of hospitalization in England and the United States are vastly different, the chief difference being in the attitude of the staff towards the patients. Elyn observes that in the former, patients are treated as individuals worthy of respect, dignity, and autonomy. Being someone who prizes her identity as a scholar and is initially of her illness, this is particularly reassuring to Elyn.

“Her tolerance and understanding seemed endless, and her steady and calm presence contained me, as if she were the glue that held me together. I was falling apart, flying apart, exploding—and she gathered my pieces and held them for me.”

Mrs. Jones is a key figure in Elyn’s treatment journey. Sessions with Mrs. Jones serve as a “safety valve” for Elyn, a safe space to share and explore the deepest, darkest thoughts and fantasies she experiences. Vital to this is Mrs. Jones character and temperament as a therapist, particularly her tolerance, patience, empathy, and lack of judgment. Sessions with her are what help Elyn get through her time at Oxford and successfully complete her degree.

“Instead, I was increasingly drawn to the study of psychology and law. I was fascinated by the insanity defense, for example, and the complicated civil issues in mental health law, such as involuntary commitment.”

Elyn’s experiences with mental illness and the hospital system draw her interest to both fields of psychology and law. Though she initially goes on to study the latter, the two fields intersect in her eventual academic pursuits and practice. Elyn’s dual interests in these fields also signal her capacity for empathy and her desire to give back to the community, as she has personal experience in these fields and wants to better the existing systems in some way.

“Crutches were bad. If you needed a crutch, that meant you were a cripple. It meant you were not strong enough to manage on your own. It meant you were weak, and worthless. For me, my worth was defined in and by work.”

Elyn continues to reject medication, even as her psychosis persists. Along with a general aversion towards medication born out of her time in rehab, Elyn also carries with her ideas about strength and independence that inhibit her from seeking any kind of external help. This extends not just to the use of medication, but also to her relationship with her parents, where she refuses to confide in them the extent of her illness in a bid to “solve” her problem without their help or interference.

“Surprisingly, he told me that he didn’t think I was schizophrenic. ‘You seem to be working very hard to connect with me,’ he observed. ‘And you’ve been operating successfully in the world, whereas one of the chief markers of schizophrenia is not connecting, and not being able to function.’”

Dr. Pritzer, a psychiatrist at Student Health Services at Yale, does not believe Elyn to have schizophrenia, owing to how she seems to make efforts to connect with him. This is highlighted as atypical of individuals with schizophrenia, who are described to be inward-looking and withdrawn. While Elyn is later diagnosed with schizophrenia, she continues to display this seemingly atypical behavior, desirous of and cherishing human connection.

“As frightened as I was, I was equally angry, and frantic to find a way to show defiance—not an easy task, when you’re in four-point restraints and pinned under a tuna net.”

Elyn is forcibly placed in restraints for the first time when she is hospitalized at Yale. The experience is a terrifying one, even more so than all her past episodes of psychosis. However, even in her terror and deep in psychosis, she still feels the need to express her defiance. This is indicative of Elyn’s strong need for autonomy and general strength of will.

“I wasn’t diagnosed early; I wasn’t treated early. I stumbled around in the dark for years, clutching my Aristotle and negotiating my life as best I could, until I was blessed by the wisdom and guidance of Mrs. Jones, and given reason to hope in the future. But with Dr. Kerrigan’s announcement, those days had officially come to an end.”

Mrs. Jones’ attitude towards Elyn, viewing her as an individual, made a substantial and positive difference to Elyn’s mental health. Dr. Kerrigan’s approach is in sharp contrast to this, viewing Elyn simply as a “mental patient” and pronouncing a prediction that Elyn will never be able to resume her studies in keeping with this label. Elyn goes on to prove Dr. Kerrigan’s prediction wrong, highlighting the error of stereotyping or underestimating individuals with mental illness.

“My determination to go back to school was not part of my delusional thinking; it was part of my self. I believed myself to be the person who would go back to law school and finish it. That’s who I believed myself to be, and that wasn’t delusional.”

Despite the constant messaging Elyn receives from medical professionals that she will not be able to pursue academic work due to her illness, she perseveres in the opposite direction. Her clarity on this being rooted in a strong sense of self, rather than delusion, is significant, and calls to the coping skills given to her by her parents.

“One of the worst aspects of schizophrenia is the profound isolation—the constant awareness that you’re different, some sort of alien, not really human. Other people have flesh and bones, and insides made of organs and healthy living tissue. You are only a machine, with insides made of metal. Medication and talk therapy allay this terrible feeling, but friendship can be as powerful as either.”

Elyn describes the loneliness and isolation experienced by people with schizophrenia, acknowledging the role of not just medication and therapy, but also real human connection, in alleviating these feelings. This observation is drawn from Elyn’s own experiences of friendships and community providing stabilizing influences in her life, from her group at Vanderbilt to her lifelong friendship with Steve Behnke.

“No one had bothered to notice that in addition to making phone calls, sometimes our client received them; no one had bothered to inquire whether he actually may have had a lawyer or lawyers. He was crazy—ergo, his lawyers were imaginary.”

Elyn describes the case of a client who, being a “mental patient”, was assumed to have psychosis when he was seen talking to his lawyers on the phone. Elyn uses this example to drive home the point that medical professionals, too, are capable of perpetuating stereotypes and stigma.

“My Note helped someone. My work had made a difference. It helped another attorney and it helped patients who were no different from me. No different at all.”

Elyn’s writing on the use of physical restraints is used by a lawyer to fight a class action lawsuit against a psychiatric institution. The fact that her work is benefiting psychiatric patients like her feels extremely rewarding to Elyn, highlighting her capacity for empathy and her need to give back to the community.

“It’s a little like having a meteor land in your backyard without hitting the house. You can either focus on the meteor, and what almost happened, or you can focus on the fortunate miss and what didn’t happen. I decided to do my best to focus on the miss.”

Elyn comes away from her experience of brain hemorrhage with gratitude for having survived it. This positive outlook is characteristic of her, as she consistently approaches difficult situations with resilience, and through the lens of a survivor.

“So, right off the bat, Kaplan and I laid the groundwork for our years-long battle—how much medication he thought I needed vs. how little medication I thought I needed.”

From the very beginning, Elyn’s relationship with Kaplan is not a completely easy one. While medication is one of the things they argue about, other issues crop up over time. Elyn’s choice to highlight this somewhat inauspicious start to their relationship works to foreshadow its eventual end.

“Thinking about MPD […] led me to ask similar questions of myself: Who was I, at my core? Was I primarily a schizophrenic? Did that illness define me? […] It’s been my observation that mentally ill people struggle with these questions perhaps even more than those with serious physical illnesses, because mental illness involves your mind and your core self as well.”

As Elyn encounters other psychiatric illnesses, it leads her to think more deeply about her own condition and its relationship to her identity. Since mental illness is located in the mind, Elyn opines that the condition naturally gives rise to these questions; furthermore, Elyn’s identity is rooted in her intellect and the performance of her mind, which further contributes to such questioning.

“And so I began. I was on a mission. At the end I would either be the Lady of the Charts, or a reasonable combo of Elyn and Professor Saks. But somebody had to go.”

Kaplan presents the idea that Elyn views herself through three different lenses. His later pronouncement of schizophrenia as an official diagnosis leaves Elyn upset and equally determined to prove him wrong. Even years into her illness, Elyn finds it difficult to reconcile her mental illness alongside the other parts of her that exist, especially her scholarly side; she hopes to erase “the Lady of the Charts” altogether.

“Mental illness comes with stigma attached to it, and that stigma can set off a negative reaction, even from the nicest people, with good intentions and kind hearts. Even for many of these people, those with mental illness are other; they’re not like ‘us’."

Elyn describes the effects of stigma about mental illness, and the othering that it leads to. Her observation is born not just of the reactions of other people to her illness, but also her own responses to her condition: Elyn spends many years in denial about her illness, viewing it as something to distance herself from and eventually erase.

“Ironically, the more I accepted I had a mental illness, the less the illness defined me—at which point the riptide set me free."

When Elyn eventually accepts the fact of her illness, she experiences an easing of inner conflict. This highlights how, even if her condition is not her entire identity, it is nevertheless an essential and undeniable part of who she is.

“It seemed that I had come at last to a time in my life when there were more good days than bad ones."

As Elyn makes peace with her different identities, she simultaneously sees success in her professional life and comfort in her personal one, making friends and finding love. Over time and with consistent effort, Elyn sees that it is possible to live a happy, fulfilled life even with mental illness; this realization ultimately drives her to write this book.