Chapter Five

The easiest way to get students to think about the mind-body problem is to bring up mental illness. Many find debates over consciousness, free will and the self too abstract, but they all care about depression, anxiety and substance abuse. These disorders force us to ask, in an especially urgent way, who we really are.

Modern psychiatry, I inform my classes, has embraced the physiological paradigm of mental illness. It stems from flawed genes or neurochemistry and is best treated with physiological remedies, such as antidepressants. This emphasis is good in some ways, because it reduces the stigma of insanity. It’s not demonic possession, or your parents’ fault, or a failure of character or willpower. It’s a disease, like diabetes. But this view can lead to despair if you think that biology is destiny. Also, medications are far from a panacea. That’s why psychological therapies persist, from cognitive-behavioral therapy to mindfulness meditation. So what is the evidence for various theories and therapies? And why do attitudes toward mental illness vary so widely across eras and cultures?

I encourage students to write about these questions—and, if they choose, to describe how mental illness has affected them or people they know. This personal approach, I say, can be a good way to hook readers emotionally and pull them into your story. When my students take advantage of this first-person option, their papers often surprise and dismay me. Here is a sampling from a recent class, with names changed. Tyler wrote about his brother’s depression, Karen about the suicide of a teenage friend, Trevor the heroin addiction of his girlfriend’s mother. Melanie admitted that she never felt much sympathy for people who were depressed until, out of the blue, “IT” struck her:

One minute I am a happy girl, I have had a perfectly good life so far, and I have never really pondered anything upsetting or had any major setbacks. The next minute IT happens… stress, anxiety, dietary changes, sleeping changes, moodiness, risky behavior, apathy, hopelessness. IT hit me like a bulldozer out of left field.

One drawback of this assignment is that papers are impossible to grade. If Jennifer reveals her fear that she has inherited her mother’s crippling depression, I’m not going to complain that her kicker lacks oomph. Students seem to find disclosing personal struggles cathartic. As Melanie wrote:

When I finally started talking about the problems I was having, it turned out that so many people around me were having or had had similar issues. Several of my close friends came out to me about their struggles with depression, and many of them are currently on treatment for depression.

Mental illness exacerbates the solipsism problem, our inability to know each other. We feel weird and ashamed, so we keep our illness secret, which can make it worse. But sharing our suffering can relieve our pain and help others, too. To dramatize this point, I tell my students the story of Elyn Saks.

Saks has impressive scholarly credentials. After graduating from Vanderbilt at the top of her class, she earned a master’s in philosophy from Oxford. At Yale Law School, from which she graduated in 1986, she edited the law journal. The University of Southern California Law School hired her in 1989, and she became Orrin B. Evans Distinguished Professor of Law, Psychology, and Psychiatry and Behavioral Sciences. In 2010 she got a doctorate in psychoanalysis, the theory/therapy invented by Freud.

Saks has written books on psychoanalysis, multiple-personality disorder and the rights of mentally impaired patients. Not until The Center Cannot Hold: My Journey Through Madness was published in 2007 did Saks reveal why she has so much expertise and interest in insanity. She is a schizophrenic. Let me restate that, and this is an important distinction. She is a person who has struggled with schizophrenia. Only a few family members, friends, colleagues and therapists knew about her illness before the release of her memoir.

Center is packed with objective information. Saks notes that the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which represents the consensus of the American Psychiatric Association, distinguishes between disorders of thought and disorders of mood. She writes:

Schizophrenia is an example of a disorder that affects thinking, and so it is referred to as a thought disorder. Bipolar disorder (what used to be called manic depression) is an example of a mood or “affective” disorder—a disorder that rests primarily in how one feels. The DSM places schizophrenia among the thought disorders characterized by psychosis. Psychosis is broadly defined as being out of touch with reality—what one of my Yale professors once referred to as “nuts.”

What makes Saks’s memoir extraordinary are her subjective descriptions. Take her recollection of a breakdown at Yale Law School. It began with her babbling incoherently to classmates in the library and twirling around in a professor’s office, arms “thrust out like bird wings.” She spewed out “word salad,” streams of words loosely associated with each other, as though an internal punning function had gone haywire. “My name is Elyn. They used to call me ‘Elyn, Elyn, watermelon.’ At school, where I used to go. Where I am now and having trouble… There’s trouble. Right here in River City. Home of the New Haveners. Where there is no haven, new or old. I’m just looking for a haven.” She ended up in an emergency ward of Yale-New Haven Hospital, where attendants forcibly sedated her. Here is what that felt like:

Strapped down, unable to move, and doped up, I can feel myself slipping away…. On the other side of the door, looking at me through the window—who is that? Is that person real? I am like a bug, impaled on a pin, wriggling helplessly while someone contemplates tearing my head off. Someone watching me. Something watching me. It’s been waiting for this moment for so many years, taunting me, sending me previews of what will happen. Always before I’ve been able to fight back, to push until it recedes—not totally, but mostly, until it resembles nothing more than a malicious little speck off to the corner of my eye, camped near the edge of my peripheral vision… Nothing I can do. There will be raging fires, and hundreds, maybe thousands of people lying dead in the streets. And it will all—all of it—be my fault. Emphasis in the original.

Before the ascendance of the biological paradigm of mental illness, many psychiatrists assumed that schizophrenia resulted from childhood trauma, usually inflicted by parents. But Saks, who grew up in Miami, had an idyllic childhood. “I woke up almost every morning,” she recalls in her memoir, “to a sunny day, a wide clear sky, and the blue green waves of the Atlantic Ocean nearby.” Her parents weren’t perfect, no parents are, but they doted on Saks and her two brothers.

Elyn Saks (far left) and other members of her family in Miami circa 1965.

Schizophrenia “rolls in like a slow fog,” Saks writes, “becoming imperceptibly thicker as time goes on.” At seven or eight, she displayed “little quirks,” like repeatedly washing her hands, or imagining a bad person lurking outside her bedroom window. She had bouts of what she calls “disorganization,” in which “consciousness gradually loses its coherence,” and her self dissolves into a jumble. In college she had friends and a boyfriend, but sometimes she forgot to bathe, and she once compulsively swallowed