I recently watched Professor Elyn Saks’s fascinating, heartbreaking and truly inspirational 2012 TED talk, ‘A tale of mental illness, from the inside’ in which she discusses her ongoing struggle with chronic schizophrenia. Following the talk, I went on to read her autobiography, The Centre Cannot Hold, which I can’t recommend enough. In the book Elyn takes us through her very first experiences with the illness in her youth and her constant struggle as it developed and worsened throughout early adulthood. Parts of the book are nothing shy of horrifying – giving a vivid glimpse of a life lived through the swirling mist of psychosis, and yet others provide a unique insight into the treatment of schizophrenia from the inside: we see the mental institutions (in both the UK and the US), the scores of doctors, psychologists and psychiatrists behind the scenes, and it becomes clear that even today, in this age of seemingly historically unparalleled psychological advancements, that they are still very much fumbling in the dark.
Perhaps the most shocking aspect of her retelling was the differences between British and American therapy in the late 70s and early 80s. Her treatment in the US was far stricter – lots of restraints, much sterner staff, and very little empathy, whilst in the UK (however she was in an Oxford hospital) the institution and its workers were much warmer, more honest and accepting, and open to patients coming and going as they pleased. The UK hospitals were also much more concerned with privacy, more active with psychoanalysis (a hugely important difference), and all in all a far better place for schizophrenics and other mentally disabled people to be situated. The cruciality of psychoanalysis in Elyn’s treatment is standout: whilst the US institutions seemed to rely heavily on drugs for their forms of treatment, the UK institutions were more focused on extended and regular psychoanalysis sessions in which Elyn could vent all of her thoughts, her innermost troubles, worries, anxieties in whatever disturbing forms they might take.
In psychoanalysis patients are encouaged to speak with no filter using Freudian free association (Elyn’s treatment followed an analytic method formulated by Melanie Klein, though with Keplan she moved away from this). Elyn’s earliest psychoanalyst, the elusive Mrs Jones (who remains anonymous so as to not to influence any of Elyn’s thoughts) is not considered a doctor, and yet it is apparent that her knowledge is far, far greater and profoundly more influential on Elyn’s mental state than that of any doctor: to the point where she is almost able to completely subdue Elyn’s schizophrenia through a simple steady course of therapy. Whilst still part way through university, Elyn is taken off her psychoanalytic treatment, this just before her subsequent move to the US and, perhaps unsurprisingly given her knowledge of their practises, she spirals into her most severe psychotic episode, and is soon incarcerated in a US institution upon her return home. Not only that, but the US institution forcibly cut her off from her studies at Yale. Such traumatic setbacks did not stop Elyn however, and she still completed her doctorate, and later even became a professor and an eminent academic in her field.
But I wanted to discuss Elyn’s psychoanalysis sessions a little more. Mrs Jones’s role was what we might consider a kind of impartial cognitive translator. She allows Elyn to speak freely, before (almost immediately) extracting the latent logic from her seemingly illogical ravings (see p. 92 of TCCH for a striking example of this). The accuracy of Mrs Jones’s translations is truly astonishing! Elyn notes that her second psychoanalyst moves away from Klein, and was more ‘classically Freudian’, honing in on her defenses: ‘those psychological tools we all use to protect ourselves from painful thoughts and feelings’ (p.174). They were concerned more with the form of her delusions and attempting to work backwards.
In an earlier post I spoke about Eleanor Longden’s TED talk on inner voices, and I expressed my belief that they seemed to evoke the very early stages of schizophrenia which is supported by many of the descriptions found in Elyn’s book (see esp. p.27), especially the parts where she describes the voices in the very early stages of her illness; this the point at which she looked for further help. Moreover, Elyn’s voices are incredibly similar to those of Eleanor, in that they begin by steady narration of Elyn’s actions (see p. 70 for exact narration) – mundane activities and all – and are not immediately threatening (NB – both are of a very similar age at onset too – late teens/early 20s). Though steadily, as Elyn becomes more and more paranoid as to their source, they begin to take on more menace, instructing her to perform tasks (again, Eleanor mentions this when she says that her voice instructs her to pour water over her teacher, hurt herself etc.).
Staying on this thread of language and schizophrenia, Elyn demonstrates in her talk (and much more vividly in her book) the common use of ‘clang associations’ (or ‘loose association) by schizophrenics. Picking out some specific examples, in her talk she remember saying, whilst in the midst of a psychotic episode, “crumbling world, word, voice, tell the clocks to stop, time is, time has come… I’m being pushed into a grave, this situation is grave, gravity is pulling me down, I’m scared tell them to get away”. Later in the talk she reveals the source of this verbal obsession with ‘graves’ and with it the ‘grav’ity pulling her down (upon being diagnosed with chronic schizophrenia she was given a diagnosis by psychiatrists of quote ‘grave’). The word thus resides prominently in her subconscious, and if viewed symbolically, as if reading the manifest content of a dream or voice (as with Eleanor’s voices) then this word symbolically represents the point at which she lost her sense of being fixed firmly on the ground (i.e. the loss of ‘grav’ity) the point at which her unconscious and her psychosis takes over and dominates her psyche. This is further supported by her obsession with finding a ‘flat surface’ in her next described psychotic episode: “lets go out on the roof it’s a flat surface it’s safe”. The loss of gravity thus subconsciously equates the loss of control, consciousness, and with it a movement towards an obsession with death (i.e. the grave).
Elyn is an incredible and inspiring lady who has been to places most of us can’t even imagine, and yet still manages to live a happy and fulfilling life. Much love to you Elyn.