Journey Through Madness
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Journey Through Madness

April 2012

MacArthur Foundation "genius award" recipient Elyn R. Saks has written extensively about the rights of the mentally ill. But her expertise goes beyond that of a high-powered legal academic. In fact, Saks herself has suffered from terrifying delusions and, during one forced hospitalization, experienced firsthand what it's like to be strapped down and rendered immobile for hours at a time. She describes all of this in her memoir, The Center Cannot Hold: My Journey Through Madness (Hyperion), which Time magazine recognized as one of the ten best nonfiction books of 2007. In December, Saks spoke with California Lawyer editor Martin Lasden at the University of Southern California, where she is a tenured professor of law and psychology.

Q: When you were diagnosed in your mid twenties with chronic paranoid schizophrenia, the doctors thought you would never be able to live independently - let alone have a career as an eminent scholar. How were you able, in such a spectacular fashion, to prove them wrong?

Well, I don't think I was sort of a lone woman who through sheer strength of will overcame odds. I had a lot of resources invested in my care. I had five-day-a-week psychoanalytic psychotherapy for decades, and I had excellent psychopharmacology. I have wonderful family and friends, and a wonderful work environment. I just love coming to work every day.

You studied philosophy at Oxford as a Marshall Scholar, so I think it's fair to ask you at least one grand philosophical question: Do you feel that your mental illness has given you any insights into the nature of free will? Is it real? Is it a biochemical illusion? Or something in between?

It's a really, really hard question. I think there's a lot of evidence that much of what we do is psychically determined, but we also feel like we have free will. In a sense my coming to accept that there were certain things that were wrong with me that were out of my control was a hard battle to win, and in a way that's saying I'm not responsible for it, it's something that befell me or happened to me. At the same time I also feel like I've made a lot of effort to have a good life and that those choices were mine, and that they were good choices to make.

You've noted that as a group the mentally ill are no more dangerous than people in the general population. Was there ever a point in your illness when you felt that you were dangerous?

Yeah, I think I was. When I was at Oxford and not on medication I had very violent thoughts and fantasies and even carried a box cutter and a serrated kitchen knife in my purse to my sessions with my analyst.

You also write in your memoir that at one point you went into a hardware store looking for an ax. So, let's just suppose for a moment that you bought an ax and then, God forbid, you ended up doing something really bad with it. If you were in the United States under our laws, is it likely that you would have been found not guilty by reason of insanity?

I had a lot of delusions about my therapist, about my safety and her safety. So I think there's a good chance that I would have been found criminally insane.

A psychiatrist once told me that just the wording of a delusion can determine whether someone is found not guilty by reason of insanity.

Sure. Say for example someone has a delusion that his next-door neighbor is spreading rumors about him and kills him, versus a delusion that his next-door neighbor has just pulled a gun on him and is about to shoot. The second delusion would qualify for the insanity defense, but the first one would not. And you can kind of understand why, because even if the first delusion was not a delusion it still wouldn't excuse what the person did. That said, when someone's mentally ill they're often very confused in their thinking, and so it's sort of hard to pin down exactly what they're thinking and fearing.

In your book Jekyll on Trial, you allude to cases in which accused murderers and rapists with multiple personality disorder claim that only one or two of their many personalities have any knowledge of the crimes they're accused of. Do people with multiple personalities need multiple lawyers?

[Laughs.] I actually read an article in a Beverly Hills newspaper once that described how a French lawyer was suing his other personalities for using up his money.

People talk about the relationship between genius and mental illness. Would you say that your illness has in any way facilitated your creativity?

You know, I think it might have made me a little bit more flexible with this idea that multiple personalities could be people by the best criteria of personal identity. I mean that's sort of an eccentric way to think. For the most part, though, my illness fights against my creativity and my productivity, and my productivity and creativity in turn fight against my illness because when I'm working I can usually keep the bad stuff to the periphery.

You're 56 years old now. What's it like to live with your brain at this point?

Pretty much what it's like to live with most people's brains who do creative or intellectual work. In many ways I'm fairly normal now, except that I have these transient thoughts, and I have periods of two or three days, several times a year, when I kind of fall off the cliff. But for the most part I think I'm pretty healthy-and probably healthier than many of my neurotic colleagues.

Legally Speaking is a series of in-depth interviews with prominent lawyers, judges, and academics, coproduced by California Lawyer and UC Hastings College of the Law.

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