Summary
Elyn Saks’s novel The Center Cannot Hold chronicles the author’s struggle with schizophrenia and describes the difficulties that people with mental disorders face. Learning from the experiences of people living with mental illness helps healthcare professionals improve their understanding of mental disorders’ characteristics and treatment. Hence, this paper will analyze the novel The Center Cannot Hold, study the symptoms and manifestation of mental illness, and ways to manage it.
The Character’s Diagnosis
The author describes her symptoms as he gets older and the disease progresses. Saks (2007) began to show active signs of disorder in adulthood, the main one of which was the belief in “faceless creature from the sky,” which were evil and put on her mind thoughts that she was evil. In the acute stages of psychosis, Saks also experienced nightmares, fantasies, and hallucinations had confused speech and were unable to take care of herself because she lost her sense of reality.
The woman was also prone to impulsive behavior and actions. For instance, once, she ran out into the snowy and icy street with a blanket pretending to fly (Saks, 2007). In most cases of psychosis, Saks (2007) describes feelings of fear, disorganization, agitation, and suicidal thoughts. For example, she believes that she kills people with her thoughts and that death can solve her problem because evil like her does not deserve to live (Saks, 2007). Delusions and hallucinations interfere with the personal and work relationships of a woman as, during periods of exacerbations, she cannot concentrate on work and study, she is afraid to enter into romantic relationships due to her diagnosis, and is also forced to hide her thoughts and feelings from most friends. For example, one day, Saks (2007) thinks that her friend is an impostor and refuses to communicate with him. However, when the acute phase ended, the woman could study or work and have a social life, even when the obsessive thoughts from the creatures from the sky did not disappear. All these signs, according to DSM-5, indicate a diagnosis of schizophrenia (Table 1).
Table 1. Diagnosis Table for Saks’s Schizophrenia
Etiology of the Disorder
The author understands the first signs of schizophrenia, which manifested themselves in childhood. The first sign was fear of the man who stood outside the window and threatened the Saks family, who was only her imagination (Saks, 2007). Saks (2007) also experienced brief episodes of fantasy and depression as a teenager, but she notes that the Center was likely preventing her from developing these symptoms. Nevertheless, in college, Saks faced stress due to the need to study, communicate, and care about herself and was left without the support of the Center, which led to the first episode of acute psychosis.
The author also learns some of the causes that could lead to schizophrenia and hinder its treatment. First, her uncle had depression, but since Saks was diagnosed with this disorder for a long time, he likely also had schizophrenia. Second, over time, Saks (2007) realized that lack of work and time management, as well as life changes, are her triggers leading to deterioration. However, Saks’s most significant problem was her perception of medication as a poison and a manifestation of weakness that caused periods of refusal and return to medicines for years. This idea in Saks’s consciousness was formed by the Center, and it took decades to overcome it.
Eventually, the author identified the factors contributing to her treatment and allowing her to have a regular life. First, Saks recognized the need for medication, and the development of pharmaceuticals finally helped her not only manage her fantasies but get rid of them. For the first time, this realization comes after a woman sees her terrible state in the mirror (Saks, 2007). Secondly, the psychoanalyst was a key factor in the treatment as specialists helped her cope with emotions and fantasies. Third, the support of friends helped Saks not feel isolated. Finally, work helped the author organize her time and control her life. The combination of these factors has allowed Saks to build a successful career and relationship while living with schizophrenia.
The Models of Abnormality Applied to the Case
The biological, behavioral, cognitive, and socio-cultural models could contribute to the analysis of the disorder. Mainly, the biological abnormalities in brain functioning define the problems that Saks experiences. The woman suffers from headaches, and she is diagnosed with subarachnoid hemorrhage that may be a sign of structural brain abnormalities. Moreover, Saks may have inherited the diagnosis from her uncle, and the fact that psychotropic medications helped control her state indicates a chemical disorder in the brain. The behavioral model explains the response to various triggers. For example, writing a memo in Yale for the second time triggered a worsening of Saks’s condition, since, during the first writing of the memo, she suffered psychosis that led to a lengthy hospitalization. In fact, it was not the assignment that provoked psychosis but the fear of writing it due to the association with experience.
The cognitive model can also be applied to the analysis since Saks had incorrect patterns of perception of situations and herself. Firstly, the woman thought that all people have “demons” and thoughts of murder, but only she does not know how to control and hide them because she does not try enough (Saks, 2007). This idea interfered with treatment because Saks refused hospitalization and medication. Secondly, the author also had a false belief that she should only get the highest marks; thus, the only time she received “a pass” grade led her to psychosis (Saks, 2007). The socio-cultural model explains the emergence of this idea since the author’s parents set high standards for their children and demanded good grades and achievements from them.
Furthermore, social factors such as strong disapproval of marijuana in the 1970s forced Saks to visit the Center because her parents were worried, which led to the idea about the dangers of medication. Additionally, the fact that people with mental illness were perceived as dangerous in society made Saks hide her diagnosis and often feel isolated. Simultaneously, the fear that other people would find out about her schizophrenia and their attitude increased her stress. Consequently, all these models of abnormality provide the chance to identify and analyze Saks’ case and determine her condition.
Reflection on the Assignment
I enjoyed reading the book about Saks’s experience and completing the assignment. The book was reflected in me as a reader and clinician, since recognizing the symptoms and approaches to treating schizophrenia helped me improve my knowledge. At the same time, the author’s personal experience assisted me with understanding the feelings of people with mental illnesses, which is necessary for developing empathy and helping patients.
I had little difficulty applying the clinical criteria to Saks’s story because she showed almost all of the main symptoms according to DSM-V. A more difficult task was using abnormality models since many factors are interrelated and difficult to interpret. However, I have gained valuable experience and would like to read other books describing the personal experiences of living with mental illness to develop my diagnostic skills and understanding of patients’ needs and feelings.
Worcester-Area Treatment Resources
The Worcester area offers many services for adolescents and young adults diagnosed with schizophrenia. First, anyone can use the Emergency Services Program / Mobile Crisis Intervention (ESP / MCI). This service is free of charge, available on any day and time, and aims to overcome a crisis mental state such as psychosis, preliminary assessment, and development of a plan if necessary (“Emergency/crisis services,” n.d.). The Psychotic Disorders Research Program also provides a range of outpatient and patient services through various providers, including counseling, diagnosis, support, group sessions, and medication for people with psychotic disorders (“UMass,” n.d.). Some of the services are free, and others are partially or fully covered by different types of insurance.
Furthermore, young people and adolescents can contact the Genesis Club and Kiva Center. Genesis Club helps youth members with employment, education, housing, social connections, and transportation for free (“Member Services,” n.d.). Kiva Center organizes peer meetings, sports, and art events to support and communicate with people with mental problems (“Peer support,” n.d). In this way, these organizations can help adolescents and young adults obtain both urgent help and resources for symptom management and living with schizophrenia.
References
Emergency/crisis services. (n.d.). 2021, Web.
Member services & supports. (n.d.). 2021, Web.
Peer support meetings in Worcester, MA. (n.d.). 2021, Web.
Saks, E. (2007). The center cannot hold My journey through madness. Hyperion.
UMass Psychotic Disorders Clinical & Research Program. (n.d.). 2021, Web.