8/22/2019 0 Comments
By Natalya Ortolano
I could almost hear the words ringing through my head as I quickly ducked into the back row of the auditorium for my first “Fundamentals of Neuroscience” class. “I’ll do a project on anything except neuroscience,” I had said to my thesis mentor before rotating in her lab. However, the ubiquitin ligase I had set out to characterize was indifferent to my opposition to studying the brain. Rather than being involved in cell cycle regulation as I had hypothesized (and secretly hoped), the protein seemed relevant to neurogenesis. Over time, I warmed up to the idea, but as my background was a mix of cell biology and microbiology, I had hoped to get a formal introduction to neuroscience by auditing the course where I now sat in the back row.
Ultimately, this course not only helped me develop a stronger foundation in neuroscience, but also introduced me to a topic I had become increasingly exposed to through my own personal experiences during graduate school: mental health disorders.
My most enlightening moment during this class came in the final week, when we focused heavily on a disorder I knew very little about: schizophrenia. In class, we met with a psychiatrist and a schizophrenic patient, who answered some of the psychiatrist’s questions about living with the disorder. While I can’t discuss the details of this conversation, I was struck by the significant impact schizophrenia has on its patients, especially in regards to the delusions they experience and the challenges they face in finding appropriate treatment when knowledge of the underlying disease pathology is limited.
Listening to this patient relate their experiences first-hand made me want to understand more about what it’s like to live with schizophrenia. The psychiatrist recommended we read The Center Cannot Hold: My Journey Through Madness, a memoir by Dr. Elyn Saks detailing her path to becoming the founder of The Saks Institute for Mental Health Law, Policy, and Ethics while grappling with schizophrenia. The memoir is a must read that depicts an insightful and captivating exploration into one woman’s fall into psychosis and her ultimate triumph. The book draws attention to some of the often-overlooked struggles faced by those seeking help for mental health issues, while demystifying its symptoms.
Although I do not have schizophrenia, I found Elyn’s journey relatable, as I have also struggled with mental health during my time in graduate school. In particular, I could connect with Elyn’s struggle to find appropriate treatment and medication during her time in higher education. I’ve had my bouts with depression throughout graduate school and, while auditing the neuroscience class, discovered that I suffered from ADHD and generalized anxiety disorder. What was most surprising during my attempts to improve my mental health in graduate school was how challenging it was to arrive at a diagnosis and determine the most appropriate medication and therapy.
My struggle with ADHD and anxiety isn’t uncommon. In fact, according to the NIH, about 10% of children and 5% of adults in the US have ADHD, and comorbidity with generalized anxiety disorders is common. However, less than 1% of the US population has schizophrenia. Those without firsthand experience of schizophrenia often have many misconceptions about how to define the disease. An insight into exactly what it is like is provided by Elyn Saks’ own experiences in the Center Cannot Hold.
One of the most striking parts of her novel was her encounters with schizophrenia during her childhood. While acute symptoms of schizophrenia generally do not occur until the late teens and early twenties, Elyn could remember symptoms as early as when she was eight years old. One of her first experiences with psychosis occurred after reading The Bell Jar by Sylvia Plath, after which she finds herself unable to stop thinking about the main character and how much she relates to her. She decides, in the middle of the school day, to walk the three mile trek home. As she walks, she notices the colors of the houses she is passing are becoming more and more intense. She begins to hear messages from the houses, not aloud, but as thoughts in her head that belonged to the houses. They were telling her things like, “You are special. You are especially bad.”
This sort of experience became a common occurrence for Elyn throughout her life, persisting during her time as an undergraduate at Vanderbilt University, a graduate student at Oxford University, and a law student at Yale University. What struck me as she retold her time spent in mental institutions and therapy was the intimate and important relationships she developed with her therapists and friends. It was these relationships that kept her sane and able to identify herself when she was falling into psychosis.
I was surprised, given how common my mental health struggles, that I was able to relate so much with Elyn’s struggles with taking medication and finding a stable, realistic mental health regimen. A poignant element within the book was Elyn’s relationship with Mrs. Jones, her therapist while she was at Oxford University. Unlike the talk therapy I have experienced, Mrs. Jones subscribed to something known as Klenian analysis, a method developed by Melanie Klein and inspired by Sigmund Freud’s theories regarding the human unconscious. While Freud did not believe those who experienced psychosis could benefit from psychoanalysis, Melanie Klein did and developed a method of psychoanalysis to be used as a treatment for these patients. Elyn and Mrs. Jones met regularly, having intense sessions of psychoanalysis that can only be done justice by reading Elyn’s own description in the book.
The work Elyn and Mrs. Jones accomplished together while at Oxford was crucial for Elyn’s earning her Masters of Letters degree and continuing on to Yale Law School. In the Center Cannot Hold, when it was time for Elyn and Mrs. Jones to part ways, Elyn struggles to leave Mrs. Jones' office. After her final meeting, she sits in the office for an entire day, unable to move or stop crying. While Mrs. Jones continued to see her patients, her husband escorts Elyn out of the building. Elyn’s schizophrenia and psychosis were more difficult to manage until she settled in at Yale and developed a new rapport with another therapist. I too struggled when my therapist moved to a new institution - I stopped attending therapy, afraid to develop a new relationship with a therapist, and my anxiety became less manageable. It wasn’t until I realized how much my mental health had suffered since losing my therapist that I sought help again, but the transition was very challenging.
Overall, I highly recommend reading The Center Cannot Hold. Reading about Elyn Saks’ experiences with receiving her schizophrenia diagnosis, finding medication and therapy appropriate for her, and handling her schizophrenia during big life transitions was inspiring. This book taught me not only what it’s like to live with schizophrenia, but with mental health in general. As a graduate student with a new appreciation for navigating mental health treatment, Elyn Saks’ experiences was also surprisingly relatable. However, whether you have a lot or a little understanding of mental health disorders, The Center Cannot Hold is an enlightening read about a woman’s journey to succeed in life despite an underrepresented and often misunderstood disorder.
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