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“I’M FLYING! I’VE ESCAPED!”

PROLOGUE

ELYN SAKS, VANDERBILT UNIVERSITY FRESHMAN, was hosting a high school student considering Vanderbilt in her dorm room. Elyn had become increasingly anxious during her first semester. With the arrival of a stranger, her agitation spiked. And she snapped.

With no warning, Elyn ran into the wintry Nashville night. A blanket that she had impulsively wrapped around her head traced her path into the dark. She darted around the snowy campus, extending her arms as if in flight. The high school student, frightened and confused, pleaded for Elyn to come back inside. But Elyn couldn’t stop herself. “Even though I heard her,” Elyn later wrote, “even though I registered the genuine fear in her voice, I continued to run, as though powered by some kind of engine. ‘No one can get me!’ I shouted. ‘I’m flying! I’ve escaped!’ ” (Saks, 2008).

Elyn ran farther and faster. The night hid the details around her, and sound was muffled. It felt like total and perfect silence, a silence that ended only when she recognized her visitor’s voice begging her to calm down. Slowly, she began to ask herself where she was and what she was doing. Eventually, Elyn decided that she could stop.

This wasn’t the first time that Elyn had lost touch with reality or behaved irrationally. One night she ordered her friends to dare her to do something. At first, they played along, telling her to sing a song, then dance. But Elyn took it further, “You want me to swallow this whole bottle of aspirin?” She did, frightening her friends, who rushed her to the emergency room. Other times, she would go days without eating, sleeping, or bathing. And she wasn’t always able to distinguish what was real from what was not. After a tumultuous freshman year, Elyn asked her parents to help her find a therapist. It was the first time she sought treatment for her symptoms. Eventually, she would be diagnosed with schizophrenia, a serious psychological disorder in which sufferers are often disconnected from the world around them.

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Elyn’s outbursts in college were early indicators of the series of psychotic breaks she would eventually suffer. Over the years, even as she remained in school, she experienced delusional beliefs, such as thinking that her therapist wanted to kill her. She also often exhibited strange speech patterns, like telling her therapist, “I won’t let you go. Throw. So.” And she frequently had hallucinations—for example, hearing her name being called when she was alone.

Elyn sometimes found it hard to mask these and other symptoms in public. One time, for example, while working on a group project, Elyn casually asked her fellow students whether they had ever killed anyone. When they expressed concern, she responded with disjointed words, “You know. Heaven and hell. Who’s what, what’s who.” Then, climbing out onto the roof, Elyn waved her arms and yelled, “This is the real me” (Saks, 2008).

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Over many difficult years, Elyn struggled with her condition and tried a number of different treatments. She sometimes lost touch with reality for months at a time and spent extended periods in inpatient psychiatric hospitals. Although about half of people with schizophrenia experience either a single episode or a less severe version of the disorder, Elyn’s experience predicted a grim future. She was told she would never be able to live and work on her own.

Throughout these struggles, however, Elyn actively sought treatment for her symptoms and continued to work very hard in school. And with help from skilled clinicians, her effort paid off. She graduated from Vanderbilt first in her class and went on to earn a Master’s at Oxford University in England and a law degree at Yale University. Today, Elyn’s schizophrenia is well controlled by medication and therapy, treatments you’ll learn about in Chapter 14. Elyn describes her emergence from her symptoms of schizophrenia as “daylight dawning after a long night.”

Elyn is now happily married and has a startlingly successful academic career. In 2009, Elyn won a MacArthur Foundation fellowship, popularly known as a “Genius Grant.” Elyn decided to use her MacArthur funding to found an institute for studying ethics related to mental health. But this meant publicly sharing her diagnosis. Elyn was worried, and family and friends fueled her unease. One colleague challenged her, “You want to be known as the schizophrenic with a job?” (Carey, 2011). But to Elyn’s surprise, “coming out” as a successful person with schizophrenia was widely applauded. In fact, it motivated many others to share similar stories.

In her memoir, Elyn observes that she will always need treatment to control the symptoms of her illness. But Elyn has benefited from advances in our understanding of mental illnesses such as schizophrenia, and she is hopeful that the story of her success will spur mental health professionals to reconsider the assumption that people with schizophrenia are unlikely to ever live productive, successful lives.

In this chapter, you’ll learn about the symptoms that characterize some of the most common psychological disorders, including schizophrenia, the disorder experienced by Elyn. The symptoms of many psychological disorders are not as outwardly severe as those that Elyn experienced for years. And there is a wide range of psychological disorders that differ in symptoms, severity, and prognosis. But whether the psychological symptoms are obvious or not, they can seriously impair a person’s ability to function. You’ll also learn in this chapter about some of the underlying causes of psychological disorders. As you’ll see, biological, psychological, and environmental factors have been implicated as contributing to many psychological disorders. Later in the chapter, we’ll come back to Elyn’s story.