Book Review: ‘The Center Cannot Hold: My Journey Through Madness’


In The Center Cannot Hold: My Journey Through Madness, author Elyn R. Saks delves deep into her own experience of living in with schizophrenia to serve up a riveting first-person account of mental illness. Saks, a professor of law and psychiatry at the University of Southern California, is able to write authoritatively about her illness as an expert, but the drama in this non-fiction narrative comes from her point of view as a woman who has experienced psychotic breaks. 

Saks’ ability to acquire advanced degrees and secure a position in academia is part of the hope that pervades the book. Saks is a very determined and intelligent woman who has wrestled many demons to live a rich and satisfying life. At times, she’s had to spare some details about her mental health history in order to be accepted by others. But Saks holds nothing back in her book.

The Center Cannot Hold explores every corner of the experience of schizophrenia. The disease, writes Saks, “rolls in like a fog, becoming imperceptibly thicker as time goes on.” For Saks, the illness emerged when she went away to college, and the fog thickened with every life transition. Saks was hospitalized several times during her university years, suffering from delusions and paranoia and sometimes forgetting to eat or bathe. Yet she graduated from Vanderbilt as class valedictorian and went on to study at Oxford and Yale. 

Saks’ battles with schizophrenia continued, and each stressful situation she faced brought the possibility of another psychotic break. She could have given up, avoided stress and change, and withdrawn from the challenges her chosen career presented. Saks persevered, though, battling again and again with her inner demons. Sometimes she won, sometimes she lost. Losing usually meant hospitalization. 

Throughout her battle, Saks sometimes believed that others were trying to kill her, or that she was able to kill with her thoughts. Medication was both her savior and her enemy. Like many patients, Saks felt like taking meds was admitting weakness, and she was afraid of long-term side effects, including involuntary movements, weight gain, lethargy, and more. The author describes her attempts to stop taking medication, and the horrible consequences of those attempts. 

People with schizophrenia face massive stigma in our society. Many people think schizophrenics are dangerous, or that they are insane and cannot be helped. Saks explains that the psychotic breaks of schizophrenia are intermittent, and the stretches of time between each episode vary by individual as well as over time for each person. Schizophrenics, she points out, are typically more dangerous to themselves than to others, though she acknowledges that their behavior can seem frightening. 

As a USC professor, Saks is now recognized as an expert in mental health law. In this book, she has bravely revealed not only her past struggles with mental illness but her experiences of it. The result is a chilling tale of a woman who is, at times, grappling with madness. The book is an inspiring story of her interior drama and her success in overcoming the fog that threatens her from within.