The Center Cannot Hold: My Journey Through Madness

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Elyn R. Saks is an esteemed professor, lawyer, and psychiatrist and is the Orrin B. Evans Professor of Law, Psychology, Psychiatry and the Behavioral Sciences at the University of Southern California Law School, yet she has suffered from schizophrenia for most of her life, and still has ongoing major episodes of the illness. THE CENTER CANNOT HOLD is the eloquent, moving story of Elyn's life, from the first time that she heard voices speaking to her as a young teenager, to attempted suicides in college, through learning to live on her own as an adult in an often terrifying world. Saks discusses frankly the paranoia, the inability to tell imaginary fears from real ones, the voices in her head telling her to kill herself (and to harm others); as well the incredibly difficult obstacles she overcame to become a highly respected professional. This beautifully written memoir is destined to become a classic in its genre.

The title is a line from "The Second Coming," a poem by William Butler Yeats, which is alluded to in the book.
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About the author

Elyn R. Saks is a professor at the University of Southern California Law School and the University of California, and Research Clinical Associate at the Los Angeles Psychoanalytic Society and Institute. She graduated from Oxford as a Marshall Scholar and received her J.D. from Yale Law School. She has published three books and more than two dozen articles, and serves on the board of several mental health foundations. She lives in Los Angeles with her husband, Will Vinet.
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Additional Information

Publisher
Hachette Books
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Published on
Aug 14, 2007
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Pages
352
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ISBN
9781401389543
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Features
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Language
English
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Genres
Biography & Autobiography / Personal Memoirs
Biography & Autobiography / Social Scientists & Psychologists
Psychology / Psychopathology / General
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Content Protection
This content is DRM protected.
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Available on Android devices
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Eligible for Family Library

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It has been said that how a society treats its least well-off members speaks volumes about its humanity. If so, our treatment of the mentally ill suggests that American society is inhumane: swinging between overintervention and utter neglect, we sometimes force extreme treatments on those who do not want them, and at other times discharge mentally ill patients who do want treatment without providing adequate resources for their care in the community.

Focusing on overinterventionist approaches, Refusing Care explores when, if ever, the mentally ill should be treated against their will. Basing her analysis on case and empirical studies, Elyn R. Saks explores dilemmas raised by forced treatment in three contexts—civil commitment (forced hospitalization for noncriminals), medication, and seclusion and restraints. Saks argues that the best way to solve each of these dilemmas is, paradoxically, to be both more protective of individual autonomy and more paternalistic than current law calls for. For instance, while Saks advocates relaxing the standards for first commitment after a psychotic episode, she also would prohibit extreme mechanical restraints (such as tying someone spread-eagled to a bed). Finally, because of the often extreme prejudice against the mentally ill in American society, Saks proposes standards that, as much as possible, should apply equally to non-mentally ill and mentally ill people alike.

Mental health professionals, lawyers, disability rights activists, and anyone who wants to learn more about the way the mentally ill are treated—and ought to be treated—in the United States should read Refusing Care.
The goal of this book is to shed psychoanalytic light on a concept--informed consent-- that has transformed the delivery of health care in the United States. Examining the concept of informed consent in the context of psychoanalysis, the book first summarizes the law and literature on this topic. Is informed consent required as a matter of positive law? Apart from statutes and cases, what do the professional organizations say about this? Second, the book looks at informed consent as a theoretical matter. It addresses such questions as: What would be the elements of a robust informed consent in psychoanalysis? Is informed consent even possible here? Can patients really understand, say, transference or regression before they experience them, and is it too late once they have? Is informed consent therapeutic or countertherapeutic? Can a "process view" of informed consent make sense here? Third, the book reviews data on the topic. A lengthy questionnaire answered by sixty-two analysts reveals their practices in this regard. Do they obtain a statement of informed consent from their patients? What do they disclose? Why do they disclose it? Do they think it is possible to obtain informed consent in psychoanalysis at all? Do they think the practice is therapeutic or countertherapeutic, and in what ways? Do they think there should or should not be an informed consent requirement for psychoanalysis? The book should appeal above all to therapists interested in the ethical dimensions of their practice.
The goal of this book is to shed psychoanalytic light on a concept--informed consent-- that has transformed the delivery of health care in the United States. Examining the concept of informed consent in the context of psychoanalysis, the book first summarizes the law and literature on this topic. Is informed consent required as a matter of positive law? Apart from statutes and cases, what do the professional organizations say about this? Second, the book looks at informed consent as a theoretical matter. It addresses such questions as: What would be the elements of a robust informed consent in psychoanalysis? Is informed consent even possible here? Can patients really understand, say, transference or regression before they experience them, and is it too late once they have? Is informed consent therapeutic or countertherapeutic? Can a "process view" of informed consent make sense here? Third, the book reviews data on the topic. A lengthy questionnaire answered by sixty-two analysts reveals their practices in this regard. Do they obtain a statement of informed consent from their patients? What do they disclose? Why do they disclose it? Do they think it is possible to obtain informed consent in psychoanalysis at all? Do they think the practice is therapeutic or countertherapeutic, and in what ways? Do they think there should or should not be an informed consent requirement for psychoanalysis? The book should appeal above all to therapists interested in the ethical dimensions of their practice.
It has been said that how a society treats its least well-off members speaks volumes about its humanity. If so, our treatment of the mentally ill suggests that American society is inhumane: swinging between overintervention and utter neglect, we sometimes force extreme treatments on those who do not want them, and at other times discharge mentally ill patients who do want treatment without providing adequate resources for their care in the community.

Focusing on overinterventionist approaches, Refusing Care explores when, if ever, the mentally ill should be treated against their will. Basing her analysis on case and empirical studies, Elyn R. Saks explores dilemmas raised by forced treatment in three contexts—civil commitment (forced hospitalization for noncriminals), medication, and seclusion and restraints. Saks argues that the best way to solve each of these dilemmas is, paradoxically, to be both more protective of individual autonomy and more paternalistic than current law calls for. For instance, while Saks advocates relaxing the standards for first commitment after a psychotic episode, she also would prohibit extreme mechanical restraints (such as tying someone spread-eagled to a bed). Finally, because of the often extreme prejudice against the mentally ill in American society, Saks proposes standards that, as much as possible, should apply equally to non-mentally ill and mentally ill people alike.

Mental health professionals, lawyers, disability rights activists, and anyone who wants to learn more about the way the mentally ill are treated—and ought to be treated—in the United States should read Refusing Care.
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