Picture this woman: An accomplished professor at one of the nation’s best law schools, she’s a highly respected expert in the field of mental health law with faculty appointments in two top medical schools and a psychology program. She’s happily married, with a wide circle of friends and colleagues who admire her.

Now picture this woman: She’s alone, lying on a hospital bed, arms and legs in restraints. She is struggling, fruitlessly, to free herself. She’s talking about creatures in the sky that want to kill her, creatures on the ground that are attacking her. She sings, she cries, she shouts. Passersby stare at her from a safe distance as she thrashes and wails.

Both pictures offer starkly different perspectives of the same woman: Elyn Saks, associate dean and the Orrin B. Evans Professor of Law, Psychology, and Psychiatry and the Behavioral Sciences at the USC Gould School of Law. She is among the university’s most accomplished faculty members, internationally respected for her scholarship.

And she has schizophrenia.

A graduate of Yale Law School and Oxford University, Saks studies and researches mental health law. She is a member of the American Law Institute, an elite group of lawyers and judges. She holds joint appointments in psychiatry at the Keck School of Medicine of USC’s Institute of Psychiatry, Law and the Behavioral Sciences and the University of California, San Diego. Since joining the law faculty at USC in 1989, she has published three books and dozens of scholarly articles in the nation’s most respected journals of law as well as medicine, psychology and psychiatry. Her work has helped change laws governing the use of restraints in hospitals and forced many to rethink preconceptions about how people with mental illnesses are treated, both within the legal system and outside it.

But her forthcoming book, The Center Cannot Hold: My Journey Through Madness (Hyperion), may create the biggest stir yet: It is a personal memoir of her remarkable life and continuing struggle with schizophrenia. Written for a general audience, the book “is the most lucid and hopeful memoir of living with schizophrenia I have ever read,” according to the renowned neurologist Oliver Sacks. It offers a startlingly honest account of a woman who has simultaneously struggled against the fiercest of mental illnesses and achieved a level of success that few imagined possible.

“I wanted to write this book to give hope to people who suffer from schizophrenia and to give understanding to those who don’t,” she says. “I hope this story will help implode the myths that surround mental illness. And, honestly, it will be nice to not have this secret anymore.”

Schizophrenia affects approximately 1 percent of the world’s population, or more than 3 million Americans. A disorder of the brain, the illness causes psychotic episodes of varying duration and severity.

Schizophrenia wasn’t a term that 8-year-old Elyn Saks would have been familiar with; even if she had, she couldn’t possibly have imagined that the “little quirks” she was developing were a prelude to the devastating prognosis she would receive in her mid-20s. Growing up in Miami, Elyn was cocooned in a pleasant, upper-middle-class home. Her father, an accomplished attorney, and her stay-at-home mother were loving with Elyn and her two brothers, and the family enjoyed a happy and relatively normal life. Still, her parents could be oblivious – in fact, as Elyn’s illness emerged she would successfully hide it from them for years; even today she hardly speaks to them of the seriousness of her condition.

So Elyn’s childhood quirks were generally discounted. It started with a need to line up her shoes in her closet before leaving her room, a compulsion to align the books on her shelves “just so” before turning off her bedroom light at night. Early signs of paranoia, manifested in a recurring feeling that someone lurked outside her bedroom window, were brushed off as the result of late dinners or scary movies.

No one noticed her first break from reality: She asked her father if they could go out for a swim. He responded impatiently, focused on work. Elyn worried she had disappointed him. And then she began to feel as if she were dissolving, as if her mind had become a sand castle with all the sand sliding away in the receding surf.

“This experience is much harder, and weirder, to describe than extreme fear or terror,” she writes. “Most people know what it is to be seriously afraid. But explaining what I’ve come to call ‘disorganization’ is a different challenge altogether: One’s center gives way. Consciousness gradually loses its coherence. The ‘me’ becomes a haze, and the solid center from which one experiences reality breaks up like a bad radio signal.”

Even at 8, she knew the experience was something to be hidden away. Her intuition about needing to keep this secret, she says, was one of several “masking skills” that she developed. They may have delayed discovery of her illness and prevented her from getting early treatment. But they also helped her pursue many avenues that might have been closed to her had others known of her illness.

Throughout her teens, Elyn expertly hid numerous symptoms: difficulty forming thoughts, hallucinations and periods of extreme paranoia. She also suffered from anorexia and flirted with drugs; when she confessed trying marijuana to her parents, they checked her into an outpatient drug treatment program where she would spend many of her afternoons and weekends throughout high school. “The Center,” as she called it, instilled in her a distrust of drugs that later resulted in reluctance to take life-saving medication for her illness.

“What my experience at the Center primarily did,” she writes, “was drill into me an unflinching attitude toward illness or weakness: Fight it. You can fight it, and you can win. To be weak is to fail; to let your guard down is to surrender; and to give up is to dismiss the power of your own will.”

Saks’ determination to fight proved to be a two-edged sword. Her stubbornness helped her survive many terrifying experiences and prevent a slide toward incapacitation. But it also kept her from acknowledging that her illness was not something she could will away. She was in her 40s by the time she was able to admit to herself that her illness was not going away, and that medication and therapy would be necessary for the rest of her life.

Despite brief periods when her illness broke through her carefully crafted shell, Saks was a successful student. At Vanderbilt University, she received straight A’s. She fell in love with philosophy, immersed herself in books, made a few close friends who appreciated her quirkiness and shared her academic ambitions. She learned ancient Greek so she could read Aristotle’s original writings. She graduated first in her class and received the university’s prestigious Founder’s Medal. She capped her undergraduate experience by accepting a Marshall Scholarship to study philosophy at Oxford University.

For Saks, the move to England was nothing short of traumatic. “Within weeks after my arrival in Oxford,” she writes, “almost everything I said came out in monosyllables.” She began to mutter and gesticulate to herself while walking down the street.

“When I heard the sounds I was making, I felt neither disturbed nor surprised. For some reason, it helped me feel calmer. It seemed to provide an arm’s length distance between me and the people who were walking past me. Oddly, it was soothing, like clutching a well-worn blanket might have been to a frightened child.”

Thoughts of suicide prompted her to seek help, and she voluntarily checked herself into the hospital; she would spend time there, on and off, for the next two years. She describes one psychotic episode in her book:

“In my fog of isolation and silence, I began to feel I was receiving commands to do things – such as walk all by myself through the old abandoned tunnels that lay underneath the hospital. The origin of the commands was unclear. In my mind, they were issued by some sort of beings. Not real people with names or faces, but shapeless, powerful beings that controlled me with thoughts (not voices) that had been placed in my head. Walk through the tunnels and repent. Now lie down and don’t move. You must be still. You are evil. The effect of those commands on me during those nights and days was powerful. It never occurred to me that disobedience was an option, although it was never clear what might happen if I disobeyed. I do not make the rules. I just follow them.”

Saks submitted to medication, intense therapy and inpatient treatment during her time at Oxford. And with the help of a dedicated psychoanalyst, she was able to complete a Master’s of Letters in philosophy with exceedingly positive reviews from her thesis examiners.

Work seemed to be a form of therapy that helped focus her energies. “At the same time that my mind was starting to betray me, it was also becoming the source of enormous satisfaction,” she writes. “Suddenly, I had attainable goals, a sense of productivity and purpose, and tangible results against which I could measure my progress.”

Her psychoanalyst was another anchor. Mrs. Jones (all Saks’ analysts are given pseudonyms in the book) had been Saks’ safe-house in Oxford – the one place she could unleash her demons and know she would not be judged.

Psychoanalysis is a rigorous, intense form of talk therapy. Mental health experts debate whether psychoanalysis is beneficial for schizophrenics; for Saks, it has been crucial. She met with Mrs. Jones five days a week. In their free-form sessions, Saks unloaded fantasies, nightmares, violent thoughts. Mrs. Jones helped interpret them so that Saks could turn the violence inside out and recognize its origins. Mrs. Jones’ insights at once comforted and frightened Saks.

As she wrote in her book:

“At the very same time I was terrified of Mrs. Jones, I was equally terrified I was going to lose her, so much so that I could barely tolerate weekends when I would not see her for two days. I’d start to unravel on Thursday and be nearly inconsolable until Tuesday. In the intervening time, it took everything I had to protect myself – and my friends – from what was going on in my head:

‘Yes, of course, let’s get a hamburger, OK, let’s discuss that book we both read,’ all the while plotting ways to keep Mrs. Jones from abandoning me: I will kidnap her and keep her tied up in my closet. I will take good care of her. I will give her food and clothes. She will always be there when I need her to give me psychoanalysis.

“And then, once back in her office again, I’d tell her every single evil thing.

“Me: ‘I will not let you go on vacation this year. I have a weapon. I will take you to my room and put you in my closet. You will stay with me. You will not have a choice. I won’t let you go. Throw. So.’

“Her: ‘You feel absolutely dependent on me, like a baby, and that makes you angry. You imagine ways to keep me near you, and some of these ways have violence in them, so that you will show me you are stronger than I am.’

“Her tolerance and understanding seemed endless, and her steady calm presence contained me, as if she were the glue that held me together. I was falling apart, flying apart, exploding – and she gathered my pieces and held them for me.”

Whatever Oxford and Mrs. Jones were able to hold together for Saks, however, was swiftly shattered as she left Oxford. She had become interested, through her philosophy studies and her own experiences, in psychology and law – issues such as involuntary commitment for medical treatment and the insanity defense. After being accepted by every program to which she applied, she decided on Yale Law School.

The first year of law school is intense for any student. For Saks, the stress of the program, together with the trauma of the cross-Atlantic move and the loss of a perfectly calibrated routine, was too much. Off medication and without a therapist, she found herself unable to concentrate, hallucinating and suffering from delusions and paranoia.

After just two weeks in New Haven, Saks sought help at the campus student health service. When she arrived, her words were a jumble – a “word salad,” as doctors call it. “My name is Elyn,” she told health services staff. “They used to call me ‘Elyn, Elyn, watermelon.’ At school. Where I used to go. Where I am now having trouble. There’s trouble. Right here in River City. Home of the New Haveners. Where there is no haven, new or old. I’m just looking for a haven. Can you give me haven? Aren’t you too young? Why are you crying? I cry because the voices are at the end of time. Time is too old. I’ve killed lots of people.”

In Oxford, Saks had never been involuntarily restrained, forced to take medication or in any way detained against her will. She discovered, quickly and brutally, that she would not receive such gentle treatment in the United States.

One of her law professors convinced her to seek help at Yale-New Haven Hospital. When she refused to hand over a carpenter’s nail that she had unthinkingly slipped into her pocket earlier in the day, she was slammed onto a bed and bound by thick leather straps at her arms and legs.

Saks responded to forced treatment with defiance, anger and fear. Her symptoms worsened. The hospital contacted her parents, against her wishes.

Until that point, she had told her mother and father only that she had been treated for depression at Oxford. By the time they arrived, Saks had been subjected to multiple drugs and evaluations. And she received, for the first time, a formal diagnosis: chronic paranoid schizophrenia with acute exacerbation. Her prognosis: grave.

Saks’ doctors expected that she would soon lose the ability to care for herself. She was deemed unable to form attachments or keep friendships. She certainly was not expected to live independently or have a productive career. In fact, the hospital had already withdrawn her from Yale Law School, unbeknownst to her.

Saks wouldn’t give in. After weeks of medication, her psychosis began to lift. But side effects took hold: she lost the ability to move her facial muscles, and her walk slowed to a pained shuffle. Saks and her parents sought treatment in a Philadelphia hospital, where she resumed psychoanalysis and slowly weaned herself off medication.

In 1983, one year after she’d first set foot on Yale’s campus, Saks returned to law school, off medication and under the care of a new psychoanalyst. This pattern would continue for years: she would experience a period of psychosis, triggered by a stressful school assignment, a life change, or disappointment. She’d take medication at her doctor’s recommendation, and then wean herself off meds as her psychosis subsided – often against her doctor’s wishes. And then the illness would reemerge, full force.

Saks uses the analogy of a riptide: “You get sucked in, and your first instinct is to fight it. The harder you fight, the more energy you expend. But the simple truth is, a riptide is stronger than you; you cannot outmuscle it, and if you continue to try, you drown. The lesson is to stop fighting and go with it. Save your strength, stop fighting, and the riptide itself will quickly propel you out of harm’s way, into calmer waters. But first, you have to give in.”

 Still, she got through law school – quite successfully. She was an editor for the Yale Law Journal, developed close friendships with classmates and professors, and worked in Yale’s mental health and children’s law clinics.

Helping psychiatric patients was deeply rewarding. She knew how they felt, and she was learning about the laws that governed their rights.

Saks wrote a short paper, published in the Yale Law Journal, focusing on the use of restraints in psychiatric hospitals. Restraints had not been used in England for more than two centuries, she found, but they were used liberally in the United States. Saks proposed a model statute that would require a greater degree of negligence before a doctor could be held liable for not restraining someone – in essence, giving doctors less motivation for using restraints. Her research later bolstered a class-action lawsuit filed by the Bazelon Center for Mental Health Law in Washington, D.C., challenging the use of restraints in a Montana hospital. The case led to significant changes in the use of such restraints. (To her delight, Saks was invited this year to serve on the Bazelon Center’s board of trustees.)

After graduating from Yale, Saks worked briefly at a public interest law firm and then taught at a local law school, now Quinnipiac University.

When she decided to pursue a tenure-track teaching position, USC was immediately attractive. The law school had a strong reputation; the people she met while visiting were warm and easy-going; and she loved the idea of returning to the sort of climate she had enjoyed in Miami as a child. She accepted USC’s offer and began planning for another transition. Her first goal: find a psychoanalyst.

She felt at ease in Dr. Kaplan’s Los Angeles office. “It was haphazardly decorated, with a collection of objects that didn’t seem to go together,” she writes. “Since my own office, then and now, has always been a chaotic mess, I took heart in finding Kaplan’s to be almost the same.... There was an implicit suggestion here that exterior things didn’t much matter, but that the journey to the interior mattered a great deal.”

Indeed, living a life of the mind continued to be Saks’ salvation. At USC, she threw herself into writing and teaching. She spent nearly every waking hour in her crowded law school office – and still does. Since her arrival at USC, she has been among the school’s most productive and respected scholarly writers.

From all but a few close colleagues, Saks kept her illness hidden. She was tempted again to ease off her medication as she began showing early signs of tardive dyskinesia, a progressive movement disorder caused by anti-psychotic medication. Another worrisome side effect was her dramatically increased hormone level, linked in some studies to breast cancer.

Saks switched to a new medication that seemed to be a miracle drug. Its side effects were minimal. Her grogginess dissipated, and her psychosis abated with more consistency than ever before. But the most profound effect of the drug was to convince Saks that she really was ill.

“For 20 years,” she writes, “I struggled with that acceptance, coming right up to it on some days, backing away from it on others. In spite of my intelligence and education, in spite of all the doctors and the psychotic breaks and the hospitalizations and the lessons so searingly learned, I’d nevertheless managed to hold onto the belief that basically, there was nothing unusual about my thoughts. Ironically, the more I accepted I had a mental illness, the less the illness defined me – at which point the riptide set me free.”

Saks had another revelation at about that time: she could not only form wonderful relationships with friends and colleagues, but she was capable of deep love. She fell in love, for the first time in her life, with Will Vinet, a librarian for two Los Angeles law firms.

Vinet enjoyed her “eccentricities and idiosyncrasies,” and was floored by her intelligence. “She was the smartest and most accomplished woman I’d ever known,” he says. “All of that vastly outweighed anything she could tell me of her mental problems.”

To this day, six years after their wedding, he recalls seeing her psychosis emerge in full just twice – when she was diagnosed with breast cancer, and when she was traveling alone to a conference. The experiences were “difficult,” he says, but he immediately recognized her ability to take care of herself.

“She knows when it’s happening, and she seeks out people who care about her,” he says. “She knows how to get help.”

Indeed, somehow, even in the deepest throes of psychosis, Saks has always known to call her doctor or find trusted friends. Edward McCaffery, who holds the Robert C. Packard Trustee Chair in Law at USC, was one of the USC colleagues Saks first confided in. They had both arrived at the law school in 1989 and became fast friends. Saks instinctively felt she could trust McCaffery, and she sought him out during one psychotic episode.

“It didn’t frighten me,” McCaffery says, “but seeing her in that state gave me a tremendous understanding of the burden of the disorder. Elyn had already told me of her condition – in fact, she had given me the number for her psychoanalyst, so I knew exactly what to do when I saw what was happening.”

McCaffery says Saks’ contributions to the law school are extraordinary. “There’s nothing to do other than stand and applaud Elyn – and to learn from her.”

Saks returns the sentiments. USC Law and its faculty, she says, have been extremely supportive – before and after the disclosure of her illness. “USC Law is one of the stars in the show of my life, so to speak,” she says. “I could not have had whatever successes I have had without the love and support of the law school and all the people in it.”

“The most important message here is that people with mental illnesses can be productive and achieve great things with the right support system,” says Dilip Jeste, a frequent collaborator and a professor of psychiatry and neurosciences at UC San Diego and the VA San Diego Healthcare System. “She’s so brilliant and so accomplished. What Elyn is doing will reduce the stigma surrounding mental illness and show that you can be creative and happy despite this terrible illness.”

For Saks, the struggle with schizophrenia will continue to be a daily one. And it is not the only struggle she faces: she’s coped with breast cancer, a brain hemorrhage and an ovarian cancer scare. Where her brain and body have failed her, Saks’ intellectual acuity and relentless drive to succeed – along with friends, family, doctors and medications – have compensated, resulting in a happy marriage, a stellar career and a bright future.

“For an unlucky person,” Saks says, “I am very lucky.”

If you have questions or comments on this article, please send to magazines@usc.edu.

Melinda Vaughn is the former executive director of publications and public relations at the USC Gould School of Law.