The Center Cannot Hold: My Journey Through Madness

Elyn views Kaplan’s diagnosis as a call for her to surrender to the illness and accept defeat, which she refuses to do. Instead, she meets with a cognitive-behavioral psychologist, Dr. Benson, to learn strategies that will help her keep her psychotic thinking in check while she reduces her medication dosage. She runs Steve by her plan but is deliberately vague with Kaplan.

At Dr. Benson’s suggestion, Elyn joins the Manic-Depressive and Depressive Association of Los Angeles (MDDA), a support group for individuals suffering from the same. Elyn finds it easy to be there and empathizes with the struggles faced by others in the group who, like Elyn, resent being on medication and don’t believe there is anything actually wrong with them.

A few months into lowering her dosage, Elyn is exhausted at having to control the psychosis and symptoms that keep threatening to break through. She meets with Kaplan, who sees her florid psychosis and immediately urges her to up her medication if she wants to avoid hospitalization. Elyn refuses but runs into her colleague Edward McCafferey at the university. Edward drives Elyn home, and he and Kaplan (over the phone) convince Elyn to take her medication. She finally does so but feels like a failure.

Exhausted and defeated following her most recent experience with battling psychosis, Elyn spends the next few days not doing much else besides talking to Steve for hours and having multiple sessions with Kaplan; eventually, she resumes work again. Over time her publications and achievements catch the eye of USC’s medical school, and she is offered an academic appointment there which she happily accepts.

Elyn’s equation with Kaplan continues to deteriorate. A thyroid nodule leaves her to receive a possible diagnosis of Marfan syndrome, “a genetic connective-tissue disease with a life expectancy in women of about forty-five” (280). While it is eventually confirmed that Elyn does not have the disease, she experiences anxiety in the meantime, and Kaplan’s dismissiveness about the potential diagnosis is upsetting. They argue about whether Elyn ought to be on antianxiety medication rather than antipsychotics, and Kaplan loses his temper and forbids any discussion about medication henceforth. Elyn finally realizes that she has been displaying “maladaptive stubbornness.” She acknowledges that she will always need to be on medication, and this acceptance immediately makes her feel better.

Elyn continues to explore “MPD” and decides to write a book about it. As part of research for it, she spends several months visiting patients with “MPD” at a local hospital. She also watches videos of patients being administered the Structured Clinical Interview for Dissociative Disorders (SCID-D), a diagnostic test for “MPD” or Dissociative Identity Disorder (DID). The process gives Elyn insight into the commonalities shared between different kinds of mental illnesses.

At the beginning of Elyn’s fifth year at USC, she submits her application for tenure which includes numerous published articles and a book proposal and is accepted. As per her pattern, she experiences a short bout of psychosis following this achievement, but quickly settles down with Kaplan’s help and increased medication. Elyn also meets and begins dating Will, a man who works in the law library. Although Will eventually leaves his position at the library, Elyn and he continue seeing each other. When they kiss for the first time, it feels “even better than getting an article published” (292).

Elyn’s relationship with Will continues to grow and deepen, and Elyn looks to obtain psychoanalytical training. Wanting to gain a deeper understanding of why the process has worked for her, Elyn also wants to give back and help someone the way she has been helped.

Kaplan reacts negatively the first time Elyn mentions the idea of joining the Los Angeles Psychoanalytic Society and Institute (LAPSI). Over time, however, he softens, and Elyn eventually meets with the LAPSI’s director of admissions. The meeting goes well, and Elyn applies and is admitted to the institute.

Within the small group of people who are part of the program, Elyn makes instant friends with a couple of women, Alicia and Janet. After gaining some training, Elyn begins treating patients as well (notably, with the publication of The Center Cannot Hold, she intends to stop clinical practice, as she will lose her anonymity to her patients). As time passes, Elyn sees the importance of disclosing her own history with mental illness and does so to the head of the institute; she is received with support, warmth, and positivity.

Elyn publishes her book, Jekyll on Trial: Multiple Personality Disorder and Criminal Law, in 1997, with Steve’s help and collaboration; it is very well received. Steve moves to Harvard, where his interest turns to ethics; he eventually become the Director of Ethics at the American Psychological Association in Washington, D.C. Steve and Elyn’s friendship remains strong over the years.

The availability of more information on the side effects of medication like Navane, which includes increased chances of breast cancer, leads Elyn to advocate for a change of medication. Kaplan switches her to Zyprexa, a new drug, which works far better for Elyn despite its side effect of weight gain. Zyprexa helps keep the psychotic thinking under control better than anything else ever has in the past, and Elyn she finally experiences long periods where she has no psychotic thoughts at all. She realizes that this is normal for most other people and that she does truly need medication.

Elyn continues to do well academically and professionally. She publishes another book in 2002: Refusing Care: Forced Treatment and the Rights of the Mentally Ill. While she still finds teaching stressful, she excels and connects with students who have mental health issues of their own. Being able to help gives her great satisfaction.

Elyn and Will move in together. They become sexually intimate, and it feels comfortable and fulfilling for Elyn. She also finally opens up to him about her diagnosis of schizophrenia; however, Will is not surprised, having suspected something like this all along, based on his astute observations of her. They eventually become engaged.

Shortly after their engagement, Elyn finds out that Alicia has been diagnosed with breast cancer. Elyn realizes that she is due for a mammogram herself; the results reveal that she, too, has breast cancer. The stress of the diagnosis triggers a psychotic episode; Will sees Elyn like this for the first time, and though it scares him, he supports her. Elyn undergoes surgery followed by weeks of radiation. News of her diagnosis spreads, and her parents, friends, and colleagues show support.

Alicia and Elyn both eventually make it through their battles with cancer, and planning resumes for Elyn’s wedding. Elyn and Will are married surrounded by family and friends. They take a honeymoon trip to France and England and meet with some of Elyn’s old friends. Within a few years, Elyn’s many accomplishments and publications deem her worthy of receiving an“endowed chair, “one of the highest honors that a university bestows on a faculty member” (316). Elyn’s friend and colleague Edward McCaffery receives one alongside her, which makes her very happy. Elyn feels like she has arrived at a place “when there were more good days than bad ones” (316).

The final set of chapters sees a progression in Elyn’s perception of and engagement with her illness. As she works on academic writing surrounding “MPD,” Elyn grapples with questions about her own illness and its relationship to her identity. She simultaneously struggles with accepting that she needs medication. Going off medication is her way of distancing herself from something she does not accept as a part of her. Her issues with medication are further intensified by the development of mild TD, a side effect of the medications. Nevertheless, early on in this journey, Elyn recounts an important analogy that is presented to her: her illness is likened to diabetes, a medical condition that requires medication to maintain the body’s balance. Although it takes Elyn years before she reaches acceptance, the analogy sticks with her.

Kaplan’s assertion that he will not treat her without medication and her experience of Capgras syndrome as a result of Zyprexa withdrawal result in Elyn finally realizing that her illness will require lifelong medication. However, her relationship with Kaplan nevertheless deteriorates. Feeling safe and comfortable with a therapist is vital to the efficacy of treatment, and irrespective of what may cause these feelings to erode, it becomes important to either repair such a relationship or move on. Elyn’s account describes how reparation is no longer an option, and she starts working with other therapists. However, she acknowledges the significant contributions Kaplan made towards managing her illness. After Kaplan, she chooses to work with two practitioners simultaneously, one focused on psychoanalysis and the other specialized in psychopharmacology. Each of them has differing perspectives on Elyn’s illness. These perspectives sometimes conflict, but she has achieved enough insight and awareness about her condition to understand the importance of marrying both approaches in her case.

While Elyn’s mental illness becomes more manageable, she encounters struggles with physical illness. She battles cancer twice but comes out of each experience with gratitude and a greater appreciation for life. This attitude is characteristic of Elyn’s scrappy spirit. Elyn’s experiences with cancer also allow her to see her relationship with her parents more clearly. While there is support pouring in from all quarters—which underscores how strong Elyn’s social circle has become—her parents maintain distance from her. This allows Elyn to retrospectively understand that, despite the love she has had from them, they have also chosen to remain unavailable to her; it is their way of coping. This may have exacerbated some of Elyn’s own struggles growing up.

Despite her health, Elyn’s professional and personal lives continue to thrive. She achieves tenure and other high honors; following the completion of her academic goals, Elyn looks for other ways to give back to the community, training in and practicing psychoanalysis herself. The satisfaction she feels in her professional life also frees Elyn up to focus on her personal one; with the management of the Lady of the Charts and the fulfillment of Professor Saks, there is time to focus on Elyn. She makes faculty friends and finds love. She is doing so well both internally and externally that she feels comfortable enough to open up to her social circle about her illness.

As Elyn moves from shock and denial to acceptance in her own journey with schizophrenia, she breaks stereotypes and removes the stigma surrounding mental illness for herself. What she once viewed as a discrete and separate part of her life, something to be defeated or conquered, she now reconciles as part of her identity. Her experiences of professional and personal success perhaps contribute to, or are mirrored by, her acceptance of her illness as a part of who she is. She does not romanticize her illness; she accepts the difficulties and challenges that it poses. What she reiterates, however, is that the medical community’s focus ought to shift beyond merely combating illness, to facilitating a full and happy life for patients. Her recounting of her journey is her attempt to display that there is a realistic possibility for individuals with severe mental illness to live a “rich and satisfying life” (333).