"My mind has been both my best friend and my worst enemy," says Elyn Saks, the author of The Center Cannot Hold (Hyperion). It's hard to argue with that. While Saks has soared to the top of academia a graduate degree from Oxford, a law degree from Yale, and a tenured professorship at the University of Southern California she has also been shackled and involuntarily committed to a mental hospital. Saks, 52, has schizophrenia, a chronic brain disorder that affects one in a hundred Americans. People with schizophrenia (which affect men and women equally) sometimes suffer from hallucinations, delusions, and imagined voices. Saks' remarkable new book is a voice from a country rarely heard from, the land of psychosis. Like Girl, Interrupted by Susanna Kaysen and An Unquiet Mind by Kay Jamison, The Center Cannot Hold is the beautifully written saga of a young woman grappling with mental illness and ultimately triumphing. A movie may soon be appearing at a theater near you, given Hollywood's intense interest in the book. TIME's publishing reporter, Andrea Sachs, met with Saks (no relation) during the author's recent book-tour stop in Manhattan.
TIME: Was your illness evident when you were a child?
SAKS: In a way, I had a very good and normal childhood. I had loving and caring parents. But I had a lot of quirks or problems when I was growing up. I had phobias and obsessions. I believed that there was a man standing outside of my window every night, waiting to break in and kill us all. A lot of kids have that fear, but mine lasted for years and years.
When was your first episode?
At seven or eight. I asked my dad, 'can't we go to the cabana?' He kind of snapped at me, 'I already said no, and the weather's not great. I need to go back to work.' And at that moment, I disappointed my dad. It felt like falling apart, my self losing coherence. Imagine a sand castle with all the sand sliding away in the receding surf. So in the end, there's no center to take things in and process them and view the world. That was the first kind of scary, weird thing. Even more alarming, when I was 16 or 17, I suddenly, having just read Sylvia Plath and identifying with her, got up in the middle of the day [at school] and started walking home several miles away, something I'd never done before. I was a good girl I never skipped school. And as I was walking, the houses got very ominous and foreboding, and I started to think that they were sending me messages. 'Look! See! You must see! You are bad! You are evil!' I didn't hear it as voices; they were thoughts, but I thought they were thoughts put in my head by the houses. It was very scary.
You were a Marshall scholar at Oxford University in England. You write that your life began to unravel there. What happened?
I became very depressed. I totally lost my appetite and lost a huge amount of weight. I thought that I wasn't supposed to speak, because speaking would spread my evil around. Obviously, it's hard to make friends if you can't talk with people, so I was very socially isolated, which was extremely painful. And I had mild paranoid ideas that people were talking about me and laughing at me behind my back, which may have been true, because I looked kind of bizarre walking down the street gesticulating and talking to myself.
You were put in a mental hospital against your will. What was that like?
It was horrifying. It's demeaning and debilitating to have choice taken away in general, to not be respected as an autonomous agent. To be put in a hospital is an extreme version of that. You're totally isolated from friends and family, and from your work. Freedom of locomotion is gone; freedom of choice is gone...It causes resentment and anger. I don't say that it's the case that nobody should be ever be hospitalized against their will, but I think that we should really study ways to help people seek the treatment that would be best for them. One of the things that forcibly hospitalizing people does is deter them from seeking help in the future.
What's it like to have a psychotic episode?
It's like a waking nightmare. You're terrified, you're confused, you have beliefs that are bizarre and frightening and confusing. I hallucinate a little bit, but not much. Mostly I form delusional beliefs, like that I have killed lots of people with my thoughts, or people are setting off nuclear explosions in my brain, or my brain's going to leak out of my ears and drown people. Weird things like that, which are obviously terrifying.
What protection does medicine offer you?
It's very good. The new meds I'm on [Clozapine, an anti-psychotic medication] make the episodes come further apart; they last less long when they happen, and they're less intense when they happen. So it's a kind of floor below which I don't go. When I was on Navane [another anti-psychotic medication] back in New Haven, and the first five or 10 years in L.A., I was teetering on the edge all of the time. A slight breeze would push me over into the land of psychosis. Now, I'm mostly well. I'm mostly thinking clearly. I do have episodes, but it's not like I'm struggling all of the time to stay on the right side of the line.
Do you still experience schizophrenic symptoms?
Even today, with all the treatment and all of the medication, I still have transient psychotic thoughts, probably daily. Where a thought like, I've killed people, comes to my mind and I just say, oh that's your illness acting up.
How has being schizophrenic affected your social life?
The first two years I was ill at Oxford, I had no friends at all. It was very painful. I was unable to work. Somehow my analysis with Mrs. Jones [her psychoanalyst] in England interrupted those kind of negative symptoms, and I became able again to work and make friends. To me, friends have been one of the main things that have kept me doing well. But in terms of romantic relationships, when I became ill, I went seven years without a single date. I was so tortured by my internal demons that there was no space for another person. And then I started flirting with this guy down in the library named Will, which he didn't pick up on. He left the law school, and [later] we met in the hall, and I said, 'Let's do lunch sometime.' So he called me up and invited me to lunch. The next day, he brought a feather from his parrot, and placed it on my computer. I asked my friend that night, 'Kenny, do you think a guy who plucks a feather from his bird and places it on your computer likes you?' He said, 'I don't know, Elyn, but he likes you better than he loves his bird!' I ended up falling in love with Will [who is now her husband]. I actually told him that he was the first person I'd ever been in love with that way, and he said that made him very sad. But he's been a really great part of my life.
What is the biggest misconception that people have about schizophrenia?
There are lots of misconceptions about schizophrenia, [like that] patients are truly wild. In fact, of all the major mental illnesses, they're the least violent. People can't hold jobs, certainly not high-powered jobs...Can't have close friends and family. Can't live independently. A lot of those have some truth; they're true of a certain portion of people with schizophrenia. But it seems to me that a lot more than is now the case could be leading far more gratifying [lives]. When you tell someone, 'you're not going to be able to work,' or 'scale down your expectations,' then they do. And yet work gives most people so much of a sense of well-being, productivity. You're taking away from someone a thing that could be an important tool in their recovery by having these kind of negative expectations.
What advice would you give to other people suffering from mental illness?
Seek good care and a clinician you can really trust. Choose your friends wisely, and also choose friends that you can trust. Try to learn your illness what it looks like when it starts happening, so you can take steps before it really takes you over.
What has happened since you 'came out' as a schizophrenic?
Most people have been enormously supportive, and kind and encouraging, and some thankful. I'm getting a lot of emails from fellow consumers. People call us mental health consumers now that's the P.C. way to say it. ￼ ￼ ￼ ￼