Cartoons about mental health cover Elyn R. Saks' office door at USC. Not funny, you say? Oh yeah? Panel one: drowning man yelling to his collie, "Lassie, get help!" Panel two: Lassie, on the couch in a shrink's office.
Saks deserves her laughs. The lawyer and law professor, author, MacArthur "genius" grant winner and head of USC's Saks Institute for Mental Health Law, Policy and Ethics has been on that couch -- and has probably hidden under it. Her book about life as a schizophrenic, "The Center Cannot Hold: My Journey Through Madness," is as ferocious and droll as Saks herself. Her expertise has been earned quite literally from the inside out.
It makes perfect sense that roller skating, complete with nimble turnarounds and hypnotic intensity, is Saks' sport of choice. And that she has insights to share about the still-unfolding events in Tucson.
What was your reaction to the Arizona shootings and the speculation about the mental health of the alleged killer, Jared Lee Loughner?
It was a very rough ride -- extremely traumatic, extremely tragic.
[If you don't] admit that you're ill or you need help, and then you do something totally horrific, [that] drastically increases stigma, which in turn increases people's unwillingness to get help. And for those of us who suffer with mental illness, every time someone with mental illness does something dangerous, it kind of tars us in a way that it shouldn't.
I think the media is doing a better job with this than it has with other [such events], contextualizing the violence, reporting [mental illness] success stories, but the nature of the beast [is] people are afraid of someone different. I think we should have a public discussion about mental illness and criminality and civil commitment and resources. As tragic as the [Tucson] story is, maybe it will call attention to mental health.
A few decades ago, people with alcoholism or senility were locked up in mental hospitals. Surely things have improved?
I think things have gotten better. Back in the '60s, certain policies led to opening large warehousing mental hospitals. A lot of people say lawyers really screwed things up by [then] releasing [patients] into the streets. I see it a little differently. I see our country not having the political will to do the right thing.
Some people say I'm unique, that there aren't other people with schizophrenia like me. Well, there are people like me out there, but the stigma is so great that they don't come forward. It's easy for me. I have tenure, I have a secure position, I work at a wonderful place, but there is a lot of stigma.
People told me I should do [the book] under a pseudonym. I thought that sent the wrong message. So I did it under my own name, and I've gotten a really wonderful reception.
What are some of the myths about schizophrenia?
That's a common myth that schizophrenia means split personality. The schizophrenic mind is not so much split as shattered. I like to say schizophrenia is like a waking nightmare. [When you're having a nightmare] you've got all the bizarre images and impossible things happening, and you're terrified, but then you just sit bolt upright in bed and the experience dissipates. No such luck with a schizophrenic episode -- you can't just open your eyes and make it go away.
There's a debate over how hard it should be to even briefly commit someone against his will. It's hard to do in California, easier in Arizona.
I think by the [Arizona] standards, [Loughner] was committable. People just didn't take the steps, for unknown reasons. The father [said], "I don't know how this happened." [Perhaps] the school thinks the police will do it. The parents think the school will do it. And then people feel like it's too awful to commit somebody, they may be afraid of revenge -- there's all sorts of reasons. And there's the very realistic [concern] that [they] may lose all influence over this person. Working to get people on board with a treatment is much better than force. I was restrained 20 hours at a time. I was forcibly medicated. It was a nightmare. I'm pro-psychiatry, but I'm very anti-force. We should listen to the patients. If we get people to want treatment, that's the best guarantee that they're going to take treatment.
A bunch of my work has been on the capacity to consent to or refuse treatment, and that to me is the line: whether the person lacks or has capacity. And it's a fine line. I certainly don't believe it's never appropriate to use force or coercion. I just think we should have tools to help people buy into it, so we don't have to subject them to trauma and humiliation.