Review Dialogue: A Conversation between Robert A. Burt and Elyn R. Saks

Robert A. Burt: Anne Dailey asked me to review your new book, Elyn, The Center Cannot Hold, for American Imago, even though I had already praised the book in print—specifically, on the dust jacket, where I said it was "an extraordinary, gripping account of Saks' struggle with mental illness. . . . [S]he refutes fearful prejudices and demonstrates the respect deserved by all people with serious mental illness." Before writing this, of course, I had read the book in manuscript. As I was reading (devouring it might be a more accurate description), I told my wife how captivated I was by the manuscript; she asked to see it, and for an entire day, the two of us sat across from one another in our living room, with me passing pages to Linda as quickly as I could finish them, and her waiting eagerly for more.

Now I have reread the book, and once again was struck by the strength of your narrative and the beauty of your writing style. Few books, in my experience, stand up so well on second reading. When Anne Dailey, and then Peter Rudnytsky, asked me to write a review, I happily agreed—but then found myself stumped. What more could I say than I'd already said? That's when I called you, told you my assignment and the impossibility as I saw it of writing a standard review, except to praise the book once again. I suggested that we might instead have a conversation about the book in which I would ask some questions, you would respond, and our interchange would then appear in print; and you agreed.

To begin, I have three related questions that arise from reading your previous books on mental illness and the law, Jekyll on Trial: Multiple Personality Disorder and Criminal Law(Saks and Behnke 1997) and Refusing Care: Forced Treatment and the Rights of the Mentally Ill (2002). In both books, you make initial reference to the basis for your interest in the subject matter. In Jekyll, you say, "my interest in writing on MPD stems from my research and teaching about psychiatric illness and criminal responsibility" (Saks and Behnke 1997, 2); in Refusing Care, you make a more elaborate statement:

Writing this book has been an important experience. . . . [T]his book has deep personal meaning. I have worked in mental health law for years, as a legal advocate for the mentally ill, as a volunteer at a psychiatric hospital, as a therapist, and as a teacher. I care about the issues immensely. And I find them very difficult. What follows is my attempt to come to terms with these issues.

(2002, ix)

In these prefatory remarks, of course, you make no direct reference to your own personal experience with severe mental illness—but this experience is the explicit subject matter of your most recent book, written just a few years later.

So my first question to you is: Why were you reticent in 1997 and 2002? The social stigma of mental illness is obviously powerful, as you spell out at the beginning of Refusing Care; and if you had spoken at all, even without all of the powerful personal details in The Center, you would have not only opened yourself to being targeted by this stigma, but your substantive ideas for reforming criminal and civil law treatment of mental illness might have been dismissed as "special pleading" or insufficiently "objective." All of this is a plausible explanation for silence; and you may have had more, or different, concerns that led to your silence.

My second question: Whatever the reasons for your previous silence, what led you to go public just a few years later—and in this extraordinarily detailed, gripping way?

And my third: What are the personal and professional gains and costs that have come to you as a result of your public "coming out"?

Elyn R. Saks: You are right, Bo, that when I wrote...