A much-praised memoir of living and surviving mental illness as well as "a stereotype-shattering look at a tenacious woman whose brain is her best friend and her worst enemy" (Time). 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 as 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.
A much-praised memoir of living and surviving mental illness as well as "a stereotype-shattering look at a tenacious woman whose brain is her best friend and her worst enemy" (Time). 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 as 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.
Why do we find multiple personality disorder (MPD) so fascinating? Perhaps because each of us is aware of a dividedness within ourselves: we often feel as if we are one person on the job, another with our families, another with our friends and lovers. We may fantasize that these inner discrepancies will someday break free, that within us lie other personalities - genius, lover, criminal - that will take us over and render us strangers to our very selves. What happens when such a transformation literally occurs, when an alter personality surfaces and commits some heinous deed?
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.
Psychoanalytic interpretation, according to the hermeneutic view, is concerned with meaning rather than facts or causes. In this provocative book, Elyn R. Saks focuses closely on what hermeneutic psychoanalysis is and how the approaches of hermeneutic psychoanalysts differ. She finds that although these psychoanalysts use the same words, concepts, images, and analogies, they hold to at least five different positions on the truth of psychoanalytic interpretations. Saks locates within these five models the thought of such prominent analysts as Roy Schafer, Donald Spence, and George Klein. Then, approaching each model from the patient’s point of view, the author reaches important conclusions about treatments that patients not only will-but should-reject.If patients understood the true nature of the various models of hermeneutic psychoanalysis, Saks argues, they would spurn the story model, which asks patients to believe interpretations that do not purport to be true; that is, the psychoanalyst simply tells stories that give meaning to patients’ lives, the truth of which is not considered relevant. And patients would question the metaphor and the interpretations-as-literary-criticism models, which propose views of psychoanalysis that may be unsatisfying. In addition to discussing which hermeneutic models of treatment are plausible, Saks discusses the nature of metaphorical truth. She arrives at some penetrating insights into the theory of psychoanalysis itself.
Saks managed to achieve both professional and personal success in spite of being diagnosed as schizophrenic and given a "grave" prognosis. In this memoir, she frankly and movingly discusses the disease, and the treatments that helped her to cope and thrive.
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.
Why do we find multiple personality disorder (MPD) so fascinating? Perhaps because each of us is aware of a dividedness within ourselves: we often feel as if we are one person on the job, another with our families, another with our friends and lovers. We may fantasize that these inner discrepancies will someday break free, that within us lie other personalities - genius, lover, criminal - that will take us over and render us strangers to our very selves. What happens when such a transformation literally occurs, when an alter personality surfaces and commits some heinous deed?
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