Elyn R. Saks: Mind matters

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.

We need more resources so people can do well. Mine is not the story of a lone woman who overcame odds. Enormous treatment resources were invested, five-day-a-week psychotherapy for decades, great psychopharmacology, wonderful friends and family, a supportive work environment. I'm not saying that everybody [with schizophrenia] can be a professor, but most people I think can live up to their "potential."

That sounds intensive and expensive. I don't think this country would spend that kind of money on mental healthcare.

But we might be able to study things that are less expensive and [are still] efficacious. We need to be thoughtful and resourceful.

We tend to operate on the Ford Pinto model -- we'll take a calculated risk and let something potentially dangerous stay out there, until something bad happens, and then we just deal with the immediate problem, not the underlying one.

The only way to prevent these extremely low-probability events is just tie everybody up. You can't really predict it, [and] the cost of never having [it] happen is that we all lose a lot of liberty.

What happens if research ultimately finds all these mental disorders are genetic or bad brain wiring?

People could feel more sympathetic to the patient -- that it's physical, totally out of their control and not their fault. On the other hand, people could feel more helpless -- that this is something hardwired, that there's nothing you can do about it.

There are so many movies that deal with mental illness -- "The Snake Pit," "Marnie," "One Flew Over the Cuckoo's Nest," even a "Terminator," with the heroine locked up as delusional. What do you make of these?

Some are good, some are not so good. Sometimes I see movies that make [mental hospitals] seem like summer camp. And then there's "falling in love with the therapist and life gets better," which does a disservice. [In reality] there was no roommate [in mathematician John Nash's story, "A Beautiful Mind"] -- that was just a cinematographic device that personified his thoughts.

On the other hand, entertainment [is] a way to get across something that is real. "A Beautiful Mind" did a good job, apart from that roommate thing. I thought it was very clever, the way they brought you into his delusional world, and only well into it do you see what it is.

How has the pharmacology changed?

The meds have gotten much better. I resisted for years the idea that I had mental illness or schizophrenia. I had all these convoluted explanations, and the way to prove that I wasn't [mentally ill] was to get off medication, so I would try with great gusto and miserably fail. My analyst said: "You're spending all of your time fighting the medication and the diagnosis. You need space for your professional life, your personal life." I got on continuous medication and then switched to the new meds, and it was like daylight dawning after a dark night. Suddenly I could see the world clearly. I had a fantasy that everybody's mind contained the chaos mine did -- they were just more polite about saying it out loud. And then I took this medication and thought, huh, maybe everybody else doesn't have the chaotic, violent thoughts that I used to have. It made me realize that I had the illness, but it also made the illness define me less.

I get lots of e-mails -- probably the prime thing people ask is, how do I get my mother/brother/spouse to take medication? I encourage them to go to the National Alliance on Mental Illness website. There are some good books for families. A lot of people with mental illness are in denial, so you've got to get the person to accept that they have a mental illness.

Like the start of a 12-step program?

Right, but I disagree with that. You can say, "I understand you don't think you have a mental illness, but you're complaining about sleeplessness or agitation, and this pill will help with that. Why don't you give it a try?" You don't force humiliation on them, but you get them to want to take treatment. It doesn't work all the time.

If you're diagnosed with cancer, you probably tell the doctor to throw everything at it. But with mental illness, that's not always the reaction.

I [used to] say, "I don't want to use a crutch," but then I thought, if my foot were broken, I'd use a crutch. Aren't my neuro-transmitters entitled to gentle, kind and caring treatment too? So I totally got over the "narcissistic" injury of being mentally ill and needing medication, and now it's like, whatever works. [The poet Rainer Maria] Rilke said, "Don't take away my devils, because my angels will leave too." I say my angels have already fled; I'll take the pill in a heartbeat.

The insanity defense may come up in the Arizona case. How should that defense figure in criminal cases in general?

It's not going to be a popular thing to say, but we should take more account of mental health issues, at least when we sentence people. There should be some mitigation for someone who was really struggling.

Are there words being used that you can't stand to hear?

People who would never dream of using an ethnic or racial slur talk about nutcases, wackos, loony tunes, and people all the time say, "Oh, he's crazy," and it's hurtful, it really is hurtful. I don't know what we should be called. The PC lingo is [mental health] "consumer," which makes mental health services sound like getting a car serviced, but I really don't have a better word. We're not supposed to use "patient" anymore. People don't like it.

Did your book revealing your schizophrenia change your relationships?

Probably. Mostly for the better. It's not really nice to have a big secret; it's nice to be able to say what you're feeling and thinking and not worry. One of the funniest e-mails I got [was from] this guy who said, "Professor Saks, you and the doctors are all wrong, you actually are a space alien and the medication has poisoned [you]."

patt.morrison@latimes.com

This interview was edited and excerpted from a longer taped transcript. Interview archive: latimes.com/pattasks.

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