At the same age as Elyn Saks I was diagnosed with schizophrenia thirty-three years ago. The article “Infiltrating the Enemy of the Mind” touched me profoundly because I’ve this enemy in my mind. I went on to become a child psychiatrist and while many of us need to spend a lot of our time prescribing medications, the rule in our clinic is that no child is seen for medications without also being in talk therapy. If only Robert’s family knew how important their presence was for his well-being. We now know that this is probably a misdirection of the causal arrows, but that family therapy that teaches the creation of a positive and nurturing home environment works at preventing hospitalization.
Her successes probably suggest that the relationship in some nonspecific way focused as Elyn Saks’s analyst did on the “deepest sources of…anxiety.” Other psychotherapists (systems theory family therapists) then developed the notion of the “double-bind” in family communication as causative in schizophrenia. On another point, the wonderful therapist Frieda Fromm-Reichman, whose humanity and caring come through in her willingness to go where her patients were (an example in the popular literature can be found in Joanne Greenberg’s novel I Never Promised You a Rose Garden), also gave us the mistaken etiologic idea of the “schizophrenogenic” mother. Alas when we checked in on our patients after discharge from our care and we had moved on to another part of the program, all of them had quickly relapsed. He also required each of us to take one patient from the so-called “backwards,” people with chronic schizophrenia who sat for years doing very little, and treat them with “talk therapy.” We were amazed that not one of us failed to return these patients to the community, much like Robert, the reviewer’s brother. Ed Hornick used to invite a patient in from the joint staff/patient daily group meeting to offer a critique of our performance. When I was a resident in psychiatry at Albert Einstein College of Medicine, during our rotation through the Bronx State Hospital our mentor Dr. I read with great interest Jay Neugeboren’s review of Elyn Saks’s The Center Cannot Hold: My Journey Through Madness.
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