This is an opera based on Elyn R. Saks’s best-selling book The Center Cannot Hold.  Subtitled “My Journey Through Madness,” the memoir recounts the author’s struggle with schizophrenia.  Here, Saks has collaborated with composer/psychiatrist Kenneth B. Wells on the opera’s libretto.  

The librettists utilize the device of having three different singers portray Elyn.  One manifestation, the “Lady of the Charts,” represents her when psychotic.  The others are Elyn as a law student and the present day Professor Saks as a law professor.  Another dramatic device involves the use of a chorus to embody the protagonist’s schizophrenic delusions.  At the height of her paranoia, as Elyn sings Beethoven’s 5th Symphony in an effort to keep herself together, the chorus recalls the Symphony’s opening notes by singing “Elyn must die.”  

The opera opens with Elyn as Professor Saks reflecting on her childhood. Even then there were signs of the illness that, to quote a famous poem by William Butler Yeats, ensures “the center cannot hold” in Elyn’s life. During the first act, Elyn, a Yale law student, becomes psychotic in front of her friends and is hospitalized. In a Connecticut hospital she is put in restraints and treated by various mental health professionals. She imagines she hears demons threatening to kill her.  Elyn’s diagnosis and condition overwhelm her parents, who have been called by the hospital.  

In the second act, Elyn works to reintegrate her fragmented mind.  She is determined to get back to law school.  She is released from the hospital. She finds an antipsychotic medication, with fewer side effects, that she can live with. She resolves to devote her career to mental health law.  At the conclusion of the opera, Elyn anticipates graduation.  She has been instrumental in winning a class action suit against the use of restraints in psychiatric patients.  Her parents, friends and doctors proclaim their pride in her accomplishments.


Fans of Elyn Saks’s book might find it strange to discover that it has been adapted as an opera.  However, there is a long tradition of operas that depict madness (eg. Lucia di Lammermoor).  Furthermore, one might say that opera provides an ideal vehicle for describing the horror of mental illness.  Instead of having the author simply tell us about her delusions, the audience experiences them.  The composer has found a musical style to express them that feels genuine.  And a special dimension is added to the material by virtue of his background as both psychiatrist and musician.


Elyn Saks’s book The Center Cannot Hold (Hachette Books, New York, 2015) provides an account of how the author’s once-discouraging diagnosis inspired a legal career spent helping others with schizophrenia.  

A live performance of selections from the opera with commentary by Dr. Wells will be given at the College of Physicians of Philadelphia on September 13, 2018:  

Wells’s opera was presented in 2016 by the Semel Institute at UCLA, in conjunction with the Pacific Opera Project.  A video of that production may be streamed through Mental Health America:  

An insightful article about the opera has appeared in the Journal of the American Medical Association:  



Running Time (in minutes)


Based on

The Center Cannot Hold by Elyn R. Saks