The Center Cannot Hold is an awe-inspiring book about Elyn Saks and her life with Schizophrenia. Elyn starts with describing her childhood growing up with her seemingly normal family. Elyn started displaying symptoms of her schizophrenia while she was an adolescent, shortly after she graduated high school and started college.
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Elyn’s symptoms included talking and mumbling to herself about the demons in her head, isolating herself from her friends and family, and refusing to admit that she had a mental disorder. Her psychotic breaks happened usually whenever she was experiencing a change, whether it was good or bad. She was unable to distinguish between her hallucinations and delusions, and reality. Elyn states that her hallucinations were very vivid and realistic, hard to escape, and they’d come out of the blue without warning. The voices in her head would say things like I am a nobody, a nothing, You don’t deserve to talk, I am unworthy, If I tried to kill myself, I know I would succeed, I’m a piece of shit and I deserve to die, I am God. I give life but I can also take it away, and many times she mentions I have killed many people throughout the book. Elyn also mentions many times the demons inside her head control her actions and thoughts. There was often an underlying problem that caused Elyn to feel this way. Elyn struggled and often neglected her diet and was therefore often emaciated. She wouldn’t be able to remember the last time she showered or brushed her teeth because her psychotic episodes were so intense.
Elyn also brought to light her experiences in mental hospitals and her very vivid and descriptive memories of being restrained and tied down. Elyn noticed that with psychotherapy, her symptoms and psychotic episodes seemed to lessen, and her cognitive capacities started to return back to her normal functioning. This disease affected her personal and professional life. It took a major emotional and physical toll on not only her life, but as well as her family’s lives. Once Elyn admitted to having a disease and was willing to put aside her stigma against medicine, she started to manage her symptoms much better she even fell in love. Her disease brought many other medical obstacles that she had to overcome including a subarachnoid hemorrhage, breast cancer, and Tardive Dyskinesia. But she overcame those obstacles and has become a successful writer, professor, and psychoanalytic.
Schizophrenia is classified by the DSM-5 as a psychotic disorder. Psychotic disorders are characterized by unusual thinking, distorted perceptions, and odd behaviors (Beidel, Stanley, Bulik, & M.A., 2016, pp. 413). Those diagnosed with psychotic disorders experience being out of touch with reality and unable to think in a logical or coherent manner. They often are found mumbling or talking to themselves or behaving differently. Some psychotic disorders are classified as chronic and others as merely a temporary state of confusion.
Schizophrenia is defined in the DSM-5 as a severe psychological disorder characterized by disorganization in thought, perception, and behavior (Beidel, Stanley, Bulik, & M.A., 2016, pp. 414). Those diagnosed with schizophrenia do not have logical thoughts or can accurately perceive the world as what it is. They often believe that aliens or demons/the devil is out to get them or spying on them. Elyn Saks mentions many times throughout her novel that the demons inside her head were out to get her. Elyn never mentioned in her book about having visual hallucinations, but rather hearing voices in her head. All around me were thoughts of evil beings, posied with daggers. They’d slice me up in thin slices or make me swallow hot coals (Saks p.273). As a result of these thoughts, those who have schizophrenia often behave oddly with behaviors such as: appearing to talk to themselves, speaking random thoughts that are going through their head, or even locking themselves away in their homes to prevent the enemy that is in their heads from getting to them. As I grew steadily more isolated, I began to mutter and gesticulate to myself while walking down the street, something I had never done on my worst days at Vanderbilt or in Miami the summer before (Saks p. 55).
Schizophrenia is a serious psychological disorder because the condition creates severe impairment and is often chronic even with the best available treatments (Beidel, Stanley, Bulik, & M.A., 2016, pp. 415). Each diagnosis, as well with other mental illness, is unique to the individual. Symptoms, treatment options, and outcomes are different with each diagnosis.
A common misconception about the disorder is that a common symptom of schizophrenia is having multiple personalities and often confused with Dissociative Identity Disorder. Dissociative Identity Disorder is a DSM-5 classified disorder that falls under the disorders’ category. So not to get confused with DID, schizophrenia does not involve having multiple personalities, but rather an inability to perceive the world in an appropriate or adequate way. Symptoms of the disorder include: hallucinations, delusions, disorganized speech, disorganized or catatonic behavior, and negative symptoms [(behaviors, emotions, or thought processes that exist in people without a psychiatric disorder but are absent in people with schizophrenia)] (Beidel, Stanley, Bulik, & M.A., 2016, pp. 416). Cognitive symptoms of the disorder involve visual and verbal deficits, ability to pay attention, information processing, and abstract reasoning.
People diagnosed with schizophrenia often have additional psychological disorders along with it; depression and anxiety disorders being the most common. 45% of people diagnosed with schizophrenia have depression and 47% have anxiety disorders (Beidel, Stanley, Bulik, & M.A., 2016, pp. 421).
Pharmacologic treatment is the treatment of choice for schizophrenics, with the most common medication being antipsychotics. Antipsychotics block dopamine receptors and depending on the drug, blocking may be temporary, permanent, partial or complete, and the type of blocking affects how well the drug works (Beidel, Stanley, Bulik, & M.A., 2016, pp. 442). Antipsychotics do not improve negative symptoms or cognitive impairments, but rather decrease positive symptoms (the behaviors most people often associate with schizophrenia). Once Elyn had stopped or lowered her dosage of her antipsychotic, she began to relapse and began experiencing her symptoms all over again. Elyn starts with random mumblings and then is unable to sleep at night. Then, she starts saying things like I’m responsible for many deaths. Have I killed you yet (Saks p.275)?
Psychosocial treatment involves psychoeducation, cognitive-behavioral treatment, social skills training, supported employment, and comprehensive integrated care. Psychoeducation educates patients and their families about the disorder. This disease is difficult and takes an emotional toll on not only the patient, but also their families. The relationships with the patient can be considerably difficult. The goal of this treatment is to reduce stress on the family members and help both the clinician and the family work with the patient. It helps patients and their families to understand schizophrenia and how to interact with the patient.
Cognitive-behavioral treatment (CBT) is used to try and reduce or eliminate symptoms. Patients continue their medication while being in CBT and between 20 and 50% of people with schizophrenia continue to have hallucinations despite taking antipsychotic medication. CBT consists of psychoeducation about psychosis and hallucinations, exploration of individual beliefs about hallucinations and delusions, education in using coping strategies to deal with the symptoms, and improving self-esteem (Beidel, Stanley, Bulik, & M.A., 2016, pp.445). When delivered by experts in the profession, CBT has shown to drastically reduce hallucinations.
Elyn’s story fits with what we would expect given the diagnosis. She had the hallucinations, delusions, disorganized behavior and speech, and the social seclusion while having psychotic episodes. Elyn took control of her disease by continuing her therapy and taking her recommended dosage of antipsychotics. She still has her episodes every once in a while, but she is living with her disease. I feel that other patients and clinicians may find this book helpful in many ways. This book gives insight and offers hope for those who are diagnosed with schizophrenia. It tells the story of everything Elyn went through to get to where she is today. There is no cure for schizophrenia, but her story gives hope to those who are diagnosed with it that people can live with disease.
This book would also be helpful for clinicians, as well. This book offers insight into how patients are really feeling and that sometimes clinicians do not always understand what is going on in their mind. This book also tells about the different approaches Elyn’s clinicians used to try and help her. This book should not be a recommended read for patients recently diagnosed with the disorder because it could scare the patients and therefore increase their symptoms. For patients who have had the disorder for a decent amount of time, and by the discretion of their therapist, this book may be a helpful tool. It offers hope and encouragement for those who have schizophrenia, and that people can live a seemingly normal life (with the occasional setbacks).
Schizophrenia is a complex disease and is the most common psychotic disorder. It has been the most thoroughly studied and Elyn Sak’s The center cannot hold offers insight to her experiences with living with schizophrenia.
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