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Life, unrestrained

January 10, 2013
by Lori Ashcraft, PhD
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Elyn Saks, JD, PhD

One doesn’t have to listen to Elyn Saks, JD, PhD long before realizing that she has one of the most interesting brains on the planet—shaped not only by an innate brilliance, but also by the schizophrenia that she has learned to live with most of her adult life.

Elyn, who today is a professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California’s Gould Law School, opened with a brief recollection of her early experience with schizophrenia. Her prognosis was described as “very poor” and “grave.” She, the professionals predicted, would never be able to live on her own, let alone hold a job.

“Yet here I am,” she said. “I have not only a great job but also wonderful friends and a most beloved husband, Will Vinet.”

But her journey to recovery, marriage, and career wasn’t easy. In fact, the two biggest obstacles she would face in her personal quest for recovery and a meaningful life were posed by the treatment process itself.

“Gravely disabled”

The first—the stigma associated with mental illness—struck Elyn the first time she was put into the second—the physical restraints that signified involuntary treatment.

“The stigma of mental illness is the belief that there is a fundamental difference between mental and physical illness, between a mental disability and a physical disability. This belief is that mental illness makes one less than a whole person,” she explained.

At the time mental illness struck, she was in law school, experiencing a range of disabling symptoms that slowed the progress of her work. She decided to take responsibility for the situation by asking one of her professors for an extension on some classwork, an experience she recalls in her memoir, The Center Cannot Hold: My Journey Through Madness:

“I went to my professor’s office to ask for an extension, and began gibbering unintelligibly as I had the night before. He eventually brought me to the ER.

“Someone I will call just ‘The Doctor,’ and his whole team of goons, swooped down, grabbed me, lifted me out of the chair, and slammed me down on a nearby bed with such force that I saw stars. They bound both my legs and arms to the metal bed with thick leather straps.

“A sound came out of my mouth that I’d never heard before: half-groan, half-scream, barely human and pure terror. Then the sound came again, forced from somewhere deep inside my belly, scraping my throat raw.”

Elyn was involuntarily hospitalized. The reason given for holding her against her will was that she was “gravely disabled.” The principal supporting evidence for the claim, as she sees it, ”was that I couldn’t finish my Yale Law School homework,” a remark that drew laughs and caused her to wonder aloud,

”What would this mean for the rest of the world?”

‘Nothing benign’ about restraints

Of the next 12 months, Elyn would spend five in psychiatric hospitals on the East Coast. She recalls spending up to 20 hours per day in restraints—hands tied, hands and feet tied, or hands and feet tied with a net across her chest. Not once, though, did she ever threaten, strike, or attempt to hurt anyone. The experience was seared into her memory.

“If you have never been restrained yourself, you may have a benign image of what happens when a patient is placed in mechanical restraints. There is nothing benign about it,” she recalled, noting that “every week in the United States, several people die in restraints: they aspirate vomit, they strangle, they die of heart attacks.” To her, it is unclear whether restraints “save lives or cost lives.”

Like many who struggle to overcome a mental illness, Elyn resisted long-term use of medication, making many efforts to get off of it. She now views this resistance as evidence of the idea that “the experience of involuntary treatment sets us up to internalize the stigma that separates us from others.”

“As I think back, it seems clear to me that I had internalized the stigma against mental illness that is so pervasive in our society.” At a time when “my analyst was urging me to stay on meds and just get on with my life,” Elyn decided “I would give getting off meds one last try.”

After two weeks of cutting back, feeling that she must “complete the mission” of breaking free from meds, Elyn stubbornly resisted her worsening symptoms, as well as the opinion of her trusted psychiatrist, who suggested that he should “get you into UCLA [Medical Center] right now,” even promising to “keep the whole thing very discreet.”

“Note the double message there, the stigma,” Elyn said. “The message was, ‘you need medical care but it needs to be hidden.’” Elyn realized that her own, internalized sense of stigma was causing her to pay a heavy price.

“Eventually, I broke down in front of friends and acceded to everyone’s demand that I take more meds. I am now on meds consistently and my life is much better,” she said, adding that she came to realize, “My illness no longer defines me. It is no longer my essence.”

Three essentials for recovery

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