The Center Cannot Hold: My Journey Through Madness (12 page)

"I don't think you understand," I said patiently. "I'm not going to
survive the year. I have no concerns about future swims, or what I will
look like in a bathing suit."

Although the staff and Dr. Barnes knew what I was doing, no one
seemed to know or understand why, and there was no way I could tell
any of them that the impetus for my behavior, the commanding
impulse, came from inside my head but was not mine. It was someone
else commanding me. I was afraid the staff would laugh at me—and as
frightened as I was, the thought of derision frightened me even more.
In retrospect, it was a life-threatening deception, somewhat along the
lines of hiding recurrent chest pains from one's cardiologist from
embarrassment.

Nearly four months in the hospital passed like this, and I did not
get better; in fact, I only got worse. At twenty-one, I was convinced
that I would die soon, so much so that I refused to discuss anything
about the future. I spent most of my time alone in the music room or
the bathroom, burning my body, or moaning and rocking, holding
myself as protection from unseen forces that might harm me. When I
was able to stir at all, I roamed the hospital tunnels.

Although they were aware that my health was not improving, the
doctors at the Warneford began suggesting that it was time I leave the
hospital. Maybe they were fearful that if I didn't go soon, I never
would. With this in mind, they referred me to Dr. Anthony Storr, a
well-known psychiatrist and psychoanalyst who consulted to the
Warneford.

Initially, Dr. Storr and I went through the usual question-and-
answer session, but there was something a bit different about this
conversation and, indeed, about the doctor himself—he seemed more
alert than I was used to, and genuinely interested in hearing
everything that was on my mind. I had a palpable sense of actually
being
heard,
but not judged. And so, instead of keeping my darkest
thoughts to myself, as I'd done with Dr. Hamilton, I told Dr. Storr
everything, and edited nothing in the telling. His eyes didn't widen in
surprise or horror; he didn't tsk-tsk, he didn't shake his head in
dismay. He simply leaned forward, kept eye contact with me, and
listened intently, without flinching, to every word.

Dr. Storr's subsequent recommendations were not only simple,
they were in direct contradiction to those made by the doctors who
four months before had suggested I leave school and be hospitalized.
"Your mind is very sick," he said calmly, "and just as I'd advise with a
sick body, it needs a specific kind of exercise to help it heal. That
means resuming the work you love. It makes you happy, it gives you
purpose, it challenges you. And so you need to stay at Oxford, in your
program."

I was overjoyed, and relieved. In addition to hearing me, he'd
somehow
seen
me as well.

"But there's a slight catch to this," he said, and I held my breath.
"You need to be in intensive talk therapy. Intensive, Elyn. Rigorous,
often difficult, and, if we can arrange it, every single day. And not
short-term, either, but for a long time. For the foreseeable future. Do
you understand what I'm telling you?"

Yes, yes, yes, whatever you say.
I'm sure I was nodding like a
string puppet. In fact, at that point, if he'd said, "I recommend that
you walk barefoot on broken glass for an hour each day," I'd have
happily done it.

Dr. Storr quickly compiled a list of five psychoanalysts who might
be able to treat me, but a certain Elizabeth Jones was the only person
on his list who had time immediately available.

I repeated her name to myself.
Elizabeth Jones, Elizabeth Jones.
I
desperately hoped that this Elizabeth Jones might be someone who
would help me reclaim whatever was left of my life.

I had come to Oxford an ambitious and even idealistic young
woman. I'd wanted to make new friends; I'd wanted people to like me.
I'd wanted to study what I loved, do well, earn my degree, and move
full-fledged into the community of scholars I so respected. But none of
that had happened. For all my efforts, I had earned only the stigma of
a mental patient. Many years later, the words in Dr. Storr's report
seem prescient: "For
a person like this, it is analysis or nothing."

Elizabeth Jones's office was actually a room on the second floor of her
home, a typical old and somewhat fusty Oxford house, more than a
century old. Mrs. Jones herself—who greeted me at her front
door—was, tall, large-boned, and stately, wearing a long flowered
dress that touched the tops of her shoes. She was, without question,
the ugliest woman I'd ever seen.

"Hello, Dr. Jones. My name is Elyn Saks." I heard myself as one
might hear a voice echoing back from the bottom of a well. My hands
were damp and shaking; I was halfway between hoping she could help
me and fearing that she wouldn't be able to. Or even want to.

"Please come in," she said kindly. "Let's sit down and talk. By the
way, I'm a psychoanalyst, Elyn, I'm not a doctor. Please call me Mrs.
Jones."

Not a doctor?
This was a little alarming; did the woman know
what she was doing? And if she didn't, what were my other choices? I
wasn't sure I had any.

Mrs. Jones led me up into a small sitting room that was all browns
and greens. It wasn't messy, but wasn't precisely neat and tidy, either.
I learned later that she had a second office (within a second home) in
London; this one, in Oxford, was modest and obviously well lived in. I
felt as though she'd welcomed me into a private place, which made me
think I could trust her.

As Mrs. Jones and I sat down, she explained how the
psychoanalysis would work. After my discharge from the hospital (in a
few weeks), we would meet three times a week. When two additional
openings became available in her schedule, I would then see her five
times a week, paying eight pounds per session—roughly the equivalent
of twelve dollars in the late seventies. An analyst of equal stature in
the States would have charged many times as much. She made only
one rule for our working together: I was to say everything that came to
my mind, no matter how embarrassing, trivial, or inappropriate it
might seem. In the years we would spend together, I'd break this rule
only once: I never told Mrs. Jones how ugly I thought she was.

Three weeks later I was officially discharged from the Warneford.
My official prognosis: "Very poor." I returned to my college house and
my courses after four months away. Not one person inquired as to my
whereabouts.

chapter seven

I STUMBLED INTO
Elizabeth Jones's office in a desperate lunge for
salvation, and in the process began one of the most extraordinary
experiences of my life. At the time it was often unmitigated hell. The
work I was beginning with Mrs. Jones was not "counseling" or
"therapy" as many Americans think of it or experience it themselves.
No, this was talk therapy of the densest, most intellectually rigorous,
challenging, and unsettling sort: Kleinian analysis, a treatment
method that found its origins in the work of Sigmund Freud.

Freud built his theory of mind and method of treatment upon the
concept of the human "unconscious"—the idea that we all think, feel,
and do what we do for reasons that we are not entirely aware of. He
believed that the unconscious was a "seething cauldron," filled with

primitive forces at war with one another, forces that literally drove us
to act. Central to Freud's thinking about psychoanalysis was the
powerful relationship between the analyst and the patient, or
analysand. From that relationship developed the "transference"—the
name Freud gave to the intense feelings, beliefs, and attitudes the
patient unconsciously recalls from early life and then directs toward
the analyst. It was the transference itself that was the thing to be
analyzed; it provided the raw material that would then be mined by
the analyst and analysand for many years.

Freud had many reservations, however, about what could be
accomplished with a psychotic analysand. He believed that psychosis
was too narcissistic, too inward-looking, to allow the patient to
develop a transference relationship with the analyst, and without that
transference, there would be no grist for the psychoanalytic mill. Now,
no one had diagnosed me as schizophrenic; indeed, even the word
"psychosis" hadn't yet been mentioned. Still, I was depressed, I was
behaving oddly, and people had a strong suspicion that I was
delusional. I'd read enough Freud at this point to know that with this
new psychoanalytic relationship, I was about to launch into uncharted
and potentially troubling waters.

Elizabeth Jones, however, was a "Kleinian"—she practiced an
offshoot of Freudian analysis developed by Melanie Klein, an Austrian
psychoanalyst who immigrated to London in the late 1920s. Unlike
Freud (and later, his daughter Anna), Klein believed that people with
psychosis
could
benefit from analysis and that the necessary
transference would develop. It was her theory that psychotic
individuals are filled with (even driven by) great anxiety, and that the
way to provide relief is to focus directly on the deepest sources of that
anxiety.

Because most human anxiety stems from very primitive (read:
infantile) fantasies about bodily parts and bodily functions, the direct
nature of Kleinian interpretation calls for using the same kind of
language that the patient's fantasies are couched in. To do this,
Kleinian analysts employ the same words and images that the
analysand uses—and as a consequence, Kleinian analysts can
sometimes sound just as crazy as their patients do. These simple yet
often startling exchanges between doctor and patient operate
something like arrows shot directly at whatever it is that's upsetting
the person being analyzed. If the arrow hits, it punctures the target;
what results is something like a valve opening and long-pent-up steam

being released.

A central tenet of both classical and Kleinian analysis is that the
treater must remain fairly anonymous to her patient—she does not
answer questions about herself, have pictures of her family on the
wall, tell you where she went to school or where she is going on
vacation. Indeed, you don't even see your analyst during your
sessions—how she looks as she reacts to you and what you are saying.
You're on the couch. There is a simple reason for this: If the analyst is
a so-called blank slate, the traits the patient attributes to her come
primarily from the patient rather than the analyst. That's where
transference develops, and the patient becomes better able to see how
her mind works. And it was that process—and, ideally, reaping the
fruit of it—that Elizabeth Jones and I embarked upon.

Though I never knew much about Mrs. Jones's life, I came to know
her well from the way she reacted to me in the consulting room: with
tolerance, patience, and understanding. Her voice was calm and
soothing; she clearly didn't frighten easily. At the same time she was
both extremely empathic and rigorously honest. She was also the first
accomplished professional woman I had come to know.

During my sessions with Mrs. Jones, I whispered—because I was
convinced that people in the house next door or across the street were
able to hear what I was saying. Soon, some of the beliefs that had
begun at the Warneford (for example, that beings in the sky controlled
my thoughts and were poised to hurt me) took center stage in my
thinking again. I would mutter complete nonsense, disconnected
words and rhymes, which even as I whispered them out loud gave me
great shame. I didn't want Mrs. Jones to hear them, in spite of her
absolute "tell everything" rule.

Me: "They're messing with fetuses. They think it's us whereas the
truth is God. Voices went, tabernacle, out to the edge of time. Time.
Time is too low. Lower the boom. The TV is making fun of me. The
characters are laughing at me. They think I am a failure and deserve to
suffer. Everyone watching knows. The TV is telling the story of my
life."

The doctors in the hospital had been stiff and formal when they
dealt with me, seemingly more interested in giving me advice—"Eat
more, Elyn!"—than in figuring out what was going on inside my head.
Mrs. Jones was different. Her training had prepared her well for me,
and she went directly to the heart of the matter, in the process sparing
neither my feelings nor my assumptions about how a proper British

matron should speak.

Mrs. Jones: "Tell me about your difficulties at university."

Me: "I'm not smart enough. I can't do the work."

Mrs. Jones: "You were first in your class at Vanderbilt. Now you're
upset about Oxford because you want to be the best and are afraid you
can't be. You feel like you are a piece of shit from your mother's
bottom."

Me: "I'm closing the curtains from now on because people across
the street are looking at me. They can hear what I'm saying. They are
angry. They want to hurt me."

Mrs. Jones: "You are evacuating your angry and hostile feelings
onto those people. It is you who are angry and critical. And you want
to control what goes on in here."

Me: "I
am
in control. I control the world. The world is at my whim.
I control the world and everything in it."

Mrs. Jones: "You want to feel in control because in fact you feel so
helpless."

Me: "I had a dream. I was making golf balls out of fetuses."

Mrs. Jones: "You want to kill babies, you see, and then make a
game out of it. You are jealous of the other babies. Jealous of your
brothers, jealous of my other patients. You want to kill them. And then
you want to turn them into a little ball so you can smack them again.
You want your mother and me to love only you."