~ ~ ~

A respected scholar and USC law professor reveals her journey through the horrors and demons of mental illness. She has schizophrenia.

SAN FRANCISCO — Dressed in a blue power suit, Elyn Saks addressed a gathering of psychologists here with the quiet demeanor of an intellectual sure of her academic resume: college valedictorian, Oxford scholar, Yale law student, USC legal professor.

But her words were not serene. They evoked nightmares.

Over 30 years, as she forged her career, she wrestled with uncouth visions, violent commands and suicidal impulses, Saks explained to her listeners.

In her worst moments, the TV made fun of her, ashtrays danced and walls collapsed. Sure she was a witch, she burned herself as punishment with cigarettes, lighters and electric heaters.

She believed she was single-handedly responsible for the deaths of thousands of people. The brains of close associates were taken over by aliens.

Fearful of rejection, she told no one about her inner strife, other than her doctors and closest friends, even as she was hospitalized, force-fed anti-psychotic drugs and lashed to metal gurneys.

She became an exhibit, she recalled, a specimen, "a bug impaled on a pin and helpless to escape."

In her gravelly voice, Saks detailed for the psychologists how she became convinced that her former psychotherapist was a monster, how she needed to protect herself. Before one therapy session, Saks went to a hardware store to look at axes.

Still, she feared the therapist would abandon her, Saks told the audience, revealing her thoughts that back then raced toward a plot: I will kidnap her and keep her tied in my closet. I will take good care of her. I will give her food and clothes. She will always be there when I need her to give me psychoanalysis.

She was able to keep most of her delusional episodes private. "I couldn't control what I thought," she said. "But I could usually control what I said."

Saks has schizophrenia, a severe mental disorder often characterized by social isolation, disorganized speech, delusions and hallucinations.

She has defied the prediction of a doctor who once said she would never lead an independent life. She has even flourished, thanks to a strict regimen of medication and talk therapy.

Now she wants to dash the myths surrounding an illness that affects 3 million Americans: Schizophrenics aren't all emotionally out of touch, shouting and swiping at gremlins, shut away in hospitals.

Like her, some lead productive lives with good friends, loving spouses and precious emotional triumphs.

At 51, Saks says, the time has come to reveal her secret. The San Francisco speech was one of her first major public forays.

Like the story of fellow schizophrenic John Forbes Nash, the Nobel Prize-winning economist and mathematician whose life was portrayed in the book and film "A Beautiful Mind," Saks' life illustrates not only the stresses mental illness places on personal and professional relationships but also how they can be overcome.

The disease emerged when Saks was a child in Miami in the 1960s. There were little quirks: She couldn't leave her bedroom until her shoes were lined up. She slept only after she had arranged her books just so.

She suffered night terrors, sure a murderer lurked outside her window. She read Sylvia Plath's novel, "The Bell Jar," and identified with the protagonist's descent into madness.

One day, at age 16, Saks impulsively fled school in terror. On the five-mile walk home, houses began sending her messages: Look closely. You are special. You are especially bad. Look closely and ye shall find.

Her delusions followed her to Vanderbilt University, where she frightened dorm-mates, quacking like a duck and swallowing a bottle of aspirin.

"Schizophrenia," she would later say, "rolls in like a slow fog, becoming imperceptibly thicker as time goes on."

As a coping mechanism, Saks submerged herself in her schoolwork. "Tall, geeky and socially uneasy," as she describes herself then, she lost weight, existing on coffee, cigarettes, cheese sandwiches or bowls of tomato soup.

She said little in class. But Saks' academic papers often floored professors with their insights. While she was still a student, her elegant but troubled mind already worked with the acuity of a practiced academic.

Years later, when she was a Marshall scholar studying philosophy at Oxford University, Saks' disease tightened its grip. She often walked the streets, gesticulating and muttering to herself. But she would not talk to others.

It's wrong to talk. Talking means you have something to say. I have nothing to say. I am nobody, a nothing.

Admitted to a local psychiatric hospital, she insisted she was not sick and refused to take any medications. Then one day, Saks had a revelation: She looked into the mirror. And she recoiled.

"It felt as if someone had punched me in the stomach," she later wrote. "Good God, I thought. Who is that? I was emaciated and hunched over like someone three or even four times my age. My face was gaunt; my eyes were simultaneously vacant and full of terror. . . . It was the visage of a crazy person on the long-forgotten back ward of a hospital for lunatics."

She knew the person in the mirror needed help. So she agreed to start taking anti-depressants. But she was still years from realizing the true nature of her problems.

Medicated, Saks resumed her Oxford studies. She also began seeing a specialist in Kleinian analysis, a treatment advocating that patients unleash their fantasies during sessions.

One of Saks' delusions, known as Capgras syndrome, leads victims to believe close acquaintances have been replaced by identical-appearing impostors.

"I know you say you are my analyst," she told her psychotherapist. "But I also know the truth. You are an evil monster, perhaps the devil. I won't let you kill me. You are evil, a witch. I'll fight."

She graduated from Oxford in 1981, her secret double life still intact. She was on medication, but like many who suffer from mental illness, she was inconsistent in taking her pills and would stop once her brain storms settled.

While studying law at Yale years later, Saks landed in another psychiatric ward after complaining that someone had infiltrated her research. She also alarmed study mates when she climbed out a window to dance on the law library roof.

The New Haven hospital staff was harsh: Unlike the ones in Britain, staffers force-fed her drugs and roughly strapped her to gurneys. During the speech before the psychologists, she detailed her unruly thoughts at the time.

Did you know I was God? But I'm not anymore. What I am now, I can't tell you. Have you killed anyone? I've killed hundreds of thousands with my thoughts. It's not my doing. Someone acts through my brain. I give life and I take it away.

Her medication increased, she began to level off and prepared to return to law school, reading her legal textbooks in the psychiatric ward's day room.

I'm a law student, not a mental patient. I want my life back, damn it! And if I have to bite my tongue until it bleeds, I am going to get it back.

One day, Saks did something she'd never done before: Over slices of pizza with fellow first-year law student Steve Behnke, she finally opened up about the debilitating delusions and how it felt to be tied down against your will.

"Elyn had this enormous burden," Behnke said. "Her mind has been very good to her and very bad to her."

Emboldened by Behnke's support and her continued therapy, Saks pursued the issue of mental illness as a detective would, investigating the demons in herself and others.

She researched the complex civil issues in mental health law, such as involuntary commitment and the insanity defense. As part of her law school training, she represented psychiatric patients charged with crimes in local courts.

While researching a paper on the use of mechanical restraints in psychiatric wards, Saks mentioned to a professor how such devices could be both frightening and demeaning to patients.

He dismissed the notion. "You don't really understand," he said. "These people are different than you and me. It doesn't affect them the way it would affect us."

Even today, Saks shudders at those words. "He saw people like me as being less valuable, defective," she said. "The idea that psychiatric patients would be insensitive to pain and harm. I wish I'd had the strength in my illness to say something."

At times, her outer and inner worlds collided. At one seminar on representing psychiatric patients, a professor played a tape of an interview of a man who had killed his parents.

Saks recognized him: He'd been a fellow patient at the New Haven hospital. She left the room, feeling she would violate his privacy to listen.

"When you have cancer, people send flowers. When you lose your mind, they don't."

It's a little wisdom Behnke told Saks. By then, in 1999, she'd been teaching law at USC for a decade. Suddenly, she was diagnosed with breast cancer. Friends sent bouquets as she began radiation therapy.

The stress of the cancer sent her into another spiral. She talked about little green people.

The radiation was successful, but the episode eventually led to another epiphany: She could no longer write off her episodes as fits of depression. She realized that she was schizophrenic, which meant she needed not only her continued talk therapy but also her antipsychotic medications for the rest of her life.

The admission unlocked a door.

During those years, she also began to better understand the societal implications of those suffering from schizophrenia.

She became an adjunct professor of psychiatry at the UC San Diego School of Medicine, visiting several times a year to conduct research. She wrote books dealing with society's rejection of the mentally ill.

Saks became associate dean for research at USC's Gould School of Law. In 2001, she married a witty former law librarian named Will Vinet, who brought humor to her life, made her watch cartoons to keep her laughing and helped her remain ever-watchful for the stress-induced triggers of psychotic episodes: a gloomy quietness or desire to sit alone inside a darkened room.

For Saks, the time had come for a more forthright approach: to write about mental illness as a patient, not as a professor. After all, who else knew more about the loneliness and confusion of the psych ward?

Deciding to write a book, she began to reexamine her life. She sent for her medical records in Britain and New Haven and took classes in memoir writing.

But Saks knew she might pay a price for her candor. Would her hard-earned career come crashing down if people knew the real workings of her mind?

A colleague suggested that Saks write under a pseudonym. But that would send the wrong message, Saks explained.

"Elyn," her colleague reasoned, "do you want to be known as a schizophrenic with a job?"

Saks did have her doubts. Even while properly medicated, she still harbors several irrational thoughts each day, but she manages to dismiss the obsessions. Would the parents of former students call, wanting to know how USC could keep a schizophrenic professor on its staff? Would she get hate mail?

Before the book was published, she called the law school dean. "When this book comes out, is the university going to stand behind me?" she asked. The university has given her project full support.

On Aug. 14, Saks' memoir, "The Center Cannot Hold: My Journey Through Madness," was published. The secret was out.

As she prepared to address the American Psychological Assn. convention, Saks fidgeted.

"I'm nervous," she said.

Her book had received positive reviews. But there were hints of negativity: One USC worker told Saks she would have never gone to dinner with her had she known of her schizophrenia, afraid that one of Saks' delusional episodes could occur at any time.

Saks was speaking to her first large audience since her memoir had been published. She was never comfortable with public speaking, and her hands shook visibly as she took the podium, introduced by her old friend Steve Behnke.

When she finished, a lone woman rose to her feet, followed by more audience members. Quickly, the entire crowd was standing. The applause was prolonged and emotional as listeners lined up to speak with her.

Saks knows the battle isn't over. There are relapses. On her wedding day, stress caused her to ask: "Will aliens be attending the reception?"

But there is hope for the future. A new generation of drugs, along with five-times-a-week therapy, keeps her grounded. She avoids stress. Basking in emotional support, Saks gives it as well: When she hears about a friend suffering emotional turmoil, she sends them flowers.

~~~~~

Book Review by Oliver Sacks, M.D., author of Awakenings and Musicophilia

of The Center Cannot Hold: My Journey through Madness

Schizophrenia is an ominous word — and we too often equate it with a life of misery, isolation, and psychotic torment. I know of no better corrective to this than The Center Cannot Hold, a detailed memoir of how, with medication, sensitive support (and, in Professor Saks's case, psychoanalysis), a deeply schizophrenic person can achieve a life full of creative work and love and friendships. It is the most lucid and hopeful memoir of living with schizophrenia I have ever read.

Photo and book review from http://elynsaks.usc.edu

~ ~ ~

  

mental health...[front page]

mental health : teen/young adult...

mental health perspectives...

Depression

Dysfunction / disorder

Dysfunction resources : articles books sites.

~ ~ ~