Professor Elyn Saks is a certified academic powerhouse, having been awarded a Marshall Scholarship to study at the University of Oxford and a MacArthur “Genius Grant.”
She also happens to live with schizophrenia.
It was both aspects of her identity, the law professor and the patient, that led Penn Law Professor Eric Feldman to invite her to be the inaugural speaker for Penn Law’s Fund for the Study of Behavioral Health Law and Policy, in collaboration with Penn Law’s Center on Professionalism and the Perelman School of Medicine’s Scattergood Program for Applied Ethics of Behavioral Health Care. In an April 18 talk titled “Schizophrenia and I: Making Peace with Mental Illness,” Professor Saks drew on her New York Times best-seller The Center Cannot Hold: My Journey Through Madness, in which she describes her efforts to craft a good life in the face of her dire prognosis.
Approximately 200 people attended her lecture from across campus and from the Greater Philadelphia area.
During her presentation and in the discussion that followed, Saks, the Orrin B. Evans Distinguished Professor of Law, Professor of Psychology, and Psychiatry and the Behavioral Sciences at the University of Southern California Gould School of Law, examined the thorny, difficult issues around how the law treats the mentally ill.
In making her observations and offering her conclusions, Saks poignantly reflected on her own experiences.
Shortly after entering Yale Law School, Saks was overwhelmed, had a psychotic episode and was hospitalized. Her five months of hospitalization included long-term restraints, seclusion, forcible medication, and little privacy.
That experience contrasted with the treatment she received after an earlier psychotic episode at Oxford. “My analyst was hugely helpful in defusing a sense of shame that went along with the thoughts I was having. My thoughts were violent and deeply disturbing about myself and other people. My analyst was able to tolerate everything. It’s difficult for me adequately to convey how helpful it was to me to have someone listen, not judge me, and not threaten to put me in the hospital or call the police as might have happened in the U.S.,” Saks said.
These and other incidents led her to believe that a hands-off approach, perhaps even benign neglect, is preferable to the over-interventionist approach of the American medical system. Put another way, she is “very pro-psychiatry and very anti-force.”
It was a topic that Penn Law Professor Stephen Morse returned to with Saks during their discussion following her talk. Morse, associate director of the Center for Neuroscience & Society, asked Saks about the rights of people with severe mental illness to refuse treatment, noting that drugs are only moderately effective, and the side effects can be harmful.
Saks said competency is a key standard for “informed consent.”Currently, she said, about half the jurisdictions in America adopt a standard that absent an emergency, competent patients have a right to refuse treatment.
She emphasized that “the right to refuse is extremely important.”
“If someone were to say to their doctor…, ‘a voice tells me if I take the meds it will cause a nuclear explosion’, I don’t think that person has the capacity to refuse medication and we should empower a substitute decisionmaker to decide for the patient whether to take the meds.”
Toward the end of the program, Saks asked, “Should we be studying ways that we can use force more or should we be studying ways where we don’t need to use it as much?”