The Schizoid: A Persecuted Minority
January 18, 2005
Brian--
Hey, buddy. What's been occupying your days and moods? Do you ever venture into the depths of introspection? Do you sometimes scrupulously pour over the events of your life, and your place in the world? Do you ever become engrossed in the somber hues and sober tints of your inner mental life? Well, you should, buddy. It brings out your "I's."
My inner mental life IS my life. A thing that has reached terrifying proportions in my life is the fact that I seem to make little if any contact with living people. I know what has happened. From most of them there is so little to be learned, so little to be seen or discovered in them that is original and revelatory, that I have gotten into the habit of ignoring them. It was always that way with me: the inside teeming and quick rhythm was more important. It is even more so now, but how dangerous it is, how easily it will let one fall into the habit of peopling the world with one's own desires and images! I feel it happening all the time, but seem to do nothing to prevent this loss. I have paid a truly great price for the years of my young loneliness: I am forever locked in myself, deeply imbedded in the flesh and bones of myself is a hungry peering person, astigmatic, tired, alone.
I am lost to the world with which I used to waste so much time; it has heard nothing from me for so long that it may very well believe that I am dead (or at least petrified)! It is of no consequence to me whether it thinks me dead; I cannot deny it, for I really am dead to the world. I am dead to the world's tumult, and I rest in a quiet realm! I live alone in my one-room apartment, in my imaginary friendships and in my letters! That is, when I'm not otherwise occupied with my daily workout regimen in the exercise room of my apartment building.
I live out my days tunneling, tunneling through my thoughts to ever greater depths -- like Kafka's mole-rat digging into the earth below, creating a labyrinthine burrow of seemingly infinite complexity that is safe from the encroachment of others. "And with that I lose myself in a maze of technical speculations, I begin once more to dream my dream of a completely perfect burrow, and that somewhat calms me; with closed eyes I behold with delight perfect or almost perfect structural devices for enabling me to slip out and in unobserved. While I lie there thinking such things I admire these devices very greatly, but only as technical achievements, or as real advantages, for this freedom to slip out and in at will, what does it amount to? It is the mark of a restless nature, of inner uncertainty, disreputable desires, evil propensities that seem still worse when one thinks of the burrow, which is there at one's hand and can flood one with peace if one only remains quite open and receptive to it. For the present, however, I am outside it seeking some possibility of returning, and for that the necessary technical devices would be very desirable. But perhaps not very desirable after all. Is it not a very grave injustice to the burrow to regard it in moments of nervous panic as a mere hole among which one can creep and be safe?" Ah, yes! The freedom to slip "out and in" at will, as Kafka calls it. That's the famous "in and out program," which I discuss in greater depth, below.
Yes, in my burrow, in my solitary thoughts, I dream my dreams. But they are the dreams of "the undeveloped heart." I dwell in my burrow with a gallery of images, the images of a plethora of people: the monstrous and the good -- some unbelievably good. They remain phantoms, however. I lack the ability to care enough about another person; I suffer from a deficiency of the capacity for love, joy, and empathy to occupy myself with real people. The passageways of my burrow are redolent of indifference: the benign but vaguely repellent odor of emotional emptiness.
I live in fear by day and night; fear as deep as the marrow of the bone; doubt that I am worthy of life; since everyone around me denies it as I deny it to myself; which makes all love, all trust, all joy impossible.
From the tunnels of my imagination come a host of memories. All sorts of ghosts haunt these long, lonely corridors; foulness and miasma are everywhere, with here and there a vent-hole through which the phantom of one of my old acquaintances from within converses with another one of my old acquaintances from without.
My burrow is the resting place of all failure and all effort. To my life's pain it is a detritus, and to unfulfilled wishes a residue. It is the conscience of my life's experiences where all things converge and clash. There is darkness here, but no secrets. Everything has its true or at least its definitive form. There is this to be said for the muck-heap of my memories and imaginings, that it does not lie. Innocence dwells in it. Every foulness of my existence, fallen into disuse, sinks into that ditch of truth wherein ends the huge hoard of meaninglessness, to be swallowed, but to spread in endless rumination. It is a vast confusion. No false appearance, no whitewashing, is possible; filth strips off its shirt in utter starkness, all illusions and mirages scattered, nothing left except what is, showing the ugly face of what ends. Reality and disappearance: here, a bottleneck proclaims drunkenness, a basket-handle tells of home-life; and there the apple-core that had literary opinions again becomes an apple-core. Here my memories enjoy more than fraternity, they share a close intimacy. That which was painted is besmeared. The last veil is stripped away. The repository of memories that constitutes my mind is a cynic. It says everything. Endlessly. My burrow comprises the entrails of a monster. Mine is the life of a miserable sod. Ah, yes, Les Miserables!
I am in a dark place. I would live in utter darkness in my burrow but for The Word that emanates from higher realms. As the psalmist said: "Since God's word is a light for my path I will be sure not to stumble as long as it is with me. If God's word is in my heart then I can be sure that it will be there whenever I am in a dark place." Psalm 119: 105-106.
Yes, buddy, I was evicted from the library because I quoted scripture. An odd crime, don't you think? You interfered with my right to quote from Holy Writ on a public access computer at the library. Isn't that a First Amendment violation? Well, I guess you're not a Scientologist! I'll add that to my collection of atrocious memories: to the virtuoso collection of wounds and angers I harbor against my fellow man. I will dig a special hole in my burrow for the following memory: "On April 21, 2004, Brian Patrick Brown summoned the Metro DC Police to have me evicted from the Cleveland Park Library because I quoted from a Psalm." I'll add that memory to the permanent archives.
Be that as it may.
My session with The Mad Monk last week (Wednesday January 12, 2005) was a disaster. I walked out after about five minutes. I couldn't take it anymore. The last consult had been three weeks earlier, on December 22, 2004.
The Mad Monk showed no interest at all in how I was, how I felt, what I had been doing, how I had spent the holidays. Of course, obviously, they were Christian holidays, which are of no interest to Dr. Bash. But I myself am one-half Christian -- technically, at least. My mother was a Polish-Catholic coal-miner's daughter, after all. I suppose you could call me "The Half-Jewish Patient."
"So why did you wait three weeks to see me?" asked Dr. Bash. "I'm saving money. I save money on transportation by seeing you every three weeks," I said. Actually, I was being polite. Financial concerns were not my only reason for waiting three weeks to consult Dr. Bash. I'm simply sick of The Mad Monk.
"Do you take a bus to get here?" she asked. "No, subway," I said (Underground Man that I am). "Well, you could save money by walking here," the ever-practical Dr. Bash said. "Or," she continued, "you could walk one way and take the subway the other way. You could walk here and take the subway home. Or you could take the subway here and walk home." Dr. Bash covered all the permutations and combinations. She's nothing if not thorough, at least in regard to meaningless minutiae.
Dr. Bash then said: "Walking is good exercise. Do you get exercise?" "Yes," I replied, "I work out in the exercise room." "What kind of exercise do you do?" she inquired. "Well," I said, "we have an exercise room in my apartment building and they have different machines. I work out on an eliptical machine."
"Do you talk to anyone in the exercise room?" Dr. Bash asked. "No," I said. It was at this point that I started to get agitated. I knew what was coming. "You could try to make friends with someone in the exercise room," she said. "I have problems making friends, Dr. Bash." The Mad Monk then said, "Did you even try?" "No," I replied. I interrupted: "Dr. Bash, I have very serious psychological problems. The psychological problems impair my ability to make friends. I have very serious personality problems." At that point Dr. Bash offered the one-word dismissive comment, "So?"
Presently I could feel a rush of rage bubbling up from my inner core. I calmly said, rising from my chair: "Well, Dr. Bash, I'll see you in three weeks." I walked toward the door. Dr. Bash said: "Where are you going?" I said: "I'm leaving. I can't take it anymore." And I left. "In and out."
Do you notice anything about the totality of the interaction, buddy? The Mad Monk set the entire inane agenda. I had not seen her in three weeks. I have no friends, no family, no social interaction of any kind. I went to the clinic to talk with my therapist. And she proceeded to examine me about why I chose to see her every three weeks instead of every two weeks; my means of transportation to and from the clinic; my exercise routine; and my failure to make friends with people in the exercise room. Then she faulted me for not making an effort to befriend fellow tenants in the exercise room.
"Dr. Bash, I have a problem making friends." "Did you even try?" That phrase ("Did you even try?") really gnawed at my gut. Almost two months ago I presented Dr. Bash a copy of a letter issued by the DC Department of Employment Services, dated November 17, 2004 (Daryl Hardy, 202 698-5146), requesting that Dr. Bash (the letter specifically referred to Dr. Bash by name) prepare a statement about my mental status that would allow the agency to begin to assist me in seeking employment. Dr. Bash refuses to prepare such a statement, thereby impairing my ability to get a job. Bottom line: "She didn't even try!" The fact is that Dr. Bash is not doing all that she can do to help me and all that she has been reasonably requested to do by the DC Government to help me. She then proceeds to chastise me for failing to do all that I can do to make friends. The Mad Monk is a disaster!
Fuck it, man. I've had it! I'm mad as hell, and I'm not going to take it anymore. It's called "Schizoid Rage." I have a mental disorder. A recognized mental disorder: Schizoid Personality Disorder. Yes, I am a Schizoid American. The disorder severely impairs my ability to form and maintain relationships. I don't make friends: not simply because I don't make an effort to make friends. My whole internal psychic apparatus is not geared to establishing and maintaining social relations. I need help. The help of a knowledgeable professional. Someone who understands -- really understands -- my personality disorder and is able to work with me. I'm not just a socially isolated person who has trouble making friends. I am a mentally disordered person whose lack of social relations is a symptom of the disorder. Dr. Bash claims to be an expert in cognitive therapy. Has she even read Aaron Beck's book on the cognitive therapy of persons with personality disorders? Aaron Beck, MD, incidentally (who has his own clinic in Philadelphia), is the Godfather of cognitive therapy. His book is "Cognitive Therapy of Personality Disorders," Aaron T. Beck, Arthur Freeman, and associates (1990). Message for Dr. Bash: "Read It!"
I'm thinking of organizing fellow schizoids. We need to embark on concerted action. We need to lobby Congress. We have rights. We have been ignored for too long. We are a silent (a very silent), oppressed minority. Quite frankly, I was thinking (or fantasizing) about organizing an imaginary March on Washington to draw attention to the plight of the Schizoid minority in this country. I'm talking revolt -- a civil rights movement for the solitary! "All those who cherish in their souls a secret grudge against some action of the State, or of life or destiny," wrote Victor Hugo, "are attracted to the revolt; and when it manifests itself they shiver and feel themselves uplifted by the tempest." Vive Les Miserables!
In 1988, the United States Congress atoned for admitted wrongdoing by apologizing and paying reparations to Japanese-Americans interned during World War II. More recently, the U.S. government has pushed Switzerland's banks to compensate Holocaust victims for withholding their war-time bank accounts. What about reparations for African-Americans scarred by slavery's brutal legacy? And what, I would ask, about fair treatment for schizoids?
Throughout the 20th century, apologies and reparations have been offered to numerous individuals and groups for human-rights violations including The Tuskegee Experiment in which the U.S. government tested the effects of syphilis on black men; the internment of Japanese-Americans during World War II; and the Holocaust. African-American leaders have begun to call for reparations to the descendants of slaves for the inhumanities their ancestors endured as well as for the enormous contributions of African-Americans to American culture in general.
But when, I ask, when, if ever, will the horrendous suffering -- the inescapable loneliness, social marginalization, and pariah status -- of the schizoid be recognized and addressed? When will the psychological limitations imposed by Schizoid Personality Disorder be respected and accommodated?
In point of fact, I'm only being semi-humorous. There's actually a site on the internet that refers to schizoids as "an oppressed minority." The article (written by Peggy Breece, the relative of a schizoid) talks about the special needs of the schizoid that should be recognized.
The author writes: "I have reviewed the texts used in discussing the history and assessment of Schizoid Personality and I suggest taking a new approach in creating a better living environment for schizoids. Instead of trying to change the person, I am advocating for society to become more tolerant of those exhibiting Schizoid Personality who are extreme introverts and recluses. As mentioned earlier, schizoids are absent of psychosis, but even so, those with varying mental health conditions deserve a life free of oppression and ridicule. So, how do I suggest that society begin being less critical, judgmental, and discriminatory of schizoids? Teach children at early ages that being extroverted does not mean being superior or better than those who are introverted. Teach celebration of diversity and incorporating those exhibiting Schizoid Personality (minus the 'disorder') and other mental health conditions into cultural awareness discussions.
Using education as a tool, children may begin to better understand that just as African-Americans, elderly persons, impoverished persons, and those with disabilities deserve respect and love, schizoids deserve the same opportunities and attention. Instead of mocking and ignoring, better understand how we can better understand each other's differences and turn what is considered a 'weakness' into a strength. Assimilation does not equate happiness. Instead it promotes feelings of shame, anxiety, and pain of not being allowed to just 'be.' Along with education, another strategy social workers need to facilitate is creating a social network for schizoids. For example, it would be helpful for them to come into contact with employment opportunities that would provide a social-free working environment, so when a schizoid chooses not to participate in 'office chit-chat' he or she is not deemed weird or strange. Not only that, schizoids do not feel comfortable in such settings. There should be a list of jobs sectioned off in the classifieds under 'working alone' professions. They are out there, but it is difficult to research them. Most employment ads ask for 'outgoing, social, talkative sellers.' Of course, all of those characteristics are not associated with schizoids, making it hard to find work environments compatible to their personality type and chosen life-styles.
Another benefit in creating a social network is to provide schizoids the opportunity to be themselves and talk with others that live similar lives. One could argue or even joke that it would be difficult to find schizoids to create a social network hence their lack of social interaction, but I disagree. I mean, it would be a challenge, but it is not impossible. For example, a social worker could list a support group in the newspaper or magazine or create a website so that schizoids can converse among each other yet do so in the privacy of their homes. Nonetheless, there are strategies social workers can implement to help eliminate the oppression schizoids feel. Just because this minority group does not outwardly declare, 'I deserve rights, too!' they do warrant a life free of oppression. It is a disservice for practitioners to implement strategies which incorporate 'changing' schizoids. In doing so, social workers are accepting and advocating for further social injustice and oppression.
As the NASW Code of Ethics [for Social Workers] states: Cultural Competence and Social Diversity (a) Social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures. (b) Social workers should have a knowledge base of their clients' cultures and be able to demonstrate competence in the provision of services that are sensitive to clients' cultures and to differences among people and cultural groups. (c) Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, marital status, political belief, religion, and mental or physical disability (National Association of Social Workers, Code of Ethics, January 1, 1997, 1.05).
It is the responsibility of the social work profession to not predetermine who is eligible for services. Oppression feeds on ignorance and it breeds as the ignorance becomes a social norm. Those with Schizoid Personalities do not have a 'disorder' but a gift of high independence and intellect. Regardless, in just being a sentient being they deserve access to available resources, otherwise they feel alone . . . not by choice but as the result of oppression."
I hope I don't lose you in "a maze of technical speculations," Brian, but I came across a fascinating article about the novel (later, a movie) called "The English Patient." The article analyzes the novel as the author's creative transformation of the intrapsychic world of the schizoid individual. See Norman Doidge, MD, "Diagnosing 'The English Patient:' Contributions to Understanding the Schizoid Fantasies of Being Skinless and of Being Buried Alive."
The following material provides valuable insight into the intrapsychic "burrows" of the schizoid's wishes, conflicts, and fantasies. We schizoids are not simply socially isolated; we have a distinct intrapsychic mental life. Simply talking to people in an exercise room (or speaking Hebrew, for that matter) will not cure the schizoid.
Norman Doidge writes: "I here use the diagnosis of schizoid as it was first used by British Object Relations theorists, called schizoid because of 'schisms' in the personality. Because the disorder involves an often skilled role play at ordinary social relations, clinicians often misdiagnose these patients as obsessional or higher level narcissistic characters. Akhtar has observed that these 'schisms' are based not only upon the conscious versus unconscious oppositions, but also overt and covert descriptive features. Thus the schizoid may be 'covertly' detached, self-sufficient, absentminded, uninteresting, asexual, and idiosyncratically moral, while 'covertly' exquisitely sensitive, emotionally needy, acutely vigilant, creative, often perverse, and vulnerable to corruption.' Such patients display a 'moral unevenness; [are] occasionally strikingly amoral and vulnerable to odd crimes, at other times altruistically self-sacrificing.' Guntrip argued that the key schizoid characteristics are introversion, withdrawness, narcissism, self-sufficiency, a sense of superiority, loss of affect, loneliness, depersonalization, and regression.
Affects. Even though a schizoid person's affect is constricted, he is not without affective investments. One schizoid patient, who seemed Spock-like talking to people, had a passionate fascination with machines. His experience of emotions when dealing with people was almost digital: he was on or off, without the analogical crescendos and decrescendos of passion. The smallest surge of emotion is like a bomb going off. This state of affairs finds its objective correlative [in "The English Patient"] in the mined villa, and in Kip, the bomb defuser who must turn off all his fear.
Reasons for seeking treatment. The schizoid person tends to alternate between two painful, complex states. On the one hand 'there is a consuming need for object dependence but attachment threatens the schizoid with the loss of self.' Schizoids can function well as long as they can successfully repress intense dependence. To avoid losing himself in relations he protects himself by withdrawal and affective isolation. Without meaningful relationships, with affect shut down, he feels enervated, futile, lifeless. The chronic sense of futility, meaninglessness, and deadness are easily misdiagnosed as dysthymia, depression, or minimized as mere existential anxiety.
Buried alive. Schizoid withdrawal is not only interpersonal, i.e., away from real people; there is a kind of intrapsychic withdrawal, based upon fantasy. As treatment progresses, it is not uncommon for the schizoid to reveal fantasies of having buried his self within him, where it lies waiting until it is safe to be exposed. The fantasy that the self is buried also explains a dread of many schizoids, the fear of being buried alive. A patient dreamed, "There was a baby, it was buried alive. It was horrible and no one knew." [I spoke to my former treating psychiatrist, Dr. Palombo, about a persistent distressing feeling that I had been buried alive.]
The intrapsychic tomb. It is worth relating this to the phenomenon of intrapsychic tombs described by the French psychoanalyst Torok. Torok began formulating this concept following a lead by Karl Abraham. Abraham wrote to Freud of patients who seemed to show manic denial, and an upsurge of libido, as opposed to melancholia, after the death of their loved one. Torok noticed that a number of her patients related stories of sexual acts and needs right after a death. She saw this as a desperate and final attempt to sustain the relationship by the fantasy of incorporation (concretely taking a person's body inside them). She described these patients as having a fantasy of 'an exquisite corpse' entombed somewhere inside them, which they hoped to revive. One dreamed, 'I committed a terrible crime. I ate someone and then buried them... For this reason I have to spend the rest of my life in prison.' Torok brilliantly observed that in many cases of complicated grief, the anguished pining that the living bereaved feel is not their own longing for their love object, but rather, the fantasized pining of the deceased love object for them. If we deny our beloved has died, the fantasy of the beloved as alive and seeking us persists. It is all too often overlooked because we are preoccupied with our more conscious longing for the lost object. But fantasized incorporation of the deceased 'eating the object (which parallels, in ways, the Christian imagery of consuming the host)' stifles mourning. 'When, in the form of imaginary or real nourishment, we ingest the love object we miss... we refuse to mourn.... .'
Petrification fears. The schizoid person is often aware that his sense of self is fragile, and built upon a fantasy. Several of my schizoid patients had the ongoing fear that this imaginary world could all blow up at a moment's notice. While the schizoid person's surface may be nondescript, decorous, emotionless, he is terrified of being revealed as human, full of hunger. He fears being petrified and turning into rock, if another person catches him in his glance, as was Medusa when she saw herself as others saw her, i.e., in all her fantastic, composite ugliness, filled with unruly sexual and aggressive desires and defects. [Note that a letter I wrote several weeks ago (December 27, 2004) referred to Dr. Bash acting out her own Pygmalion fantasy. I attributed to her the desire to fine-tune my personality (treating me as a passive object to be acted upon) to gratify her own narcissistic needs, as a sculptor carves a passive block of marble into a statue. My imagery may relate to my petrification fears.]
Typical Development. Akhtar's extensive review has shown that rejection, traumatic overstimulation, and neglect in the first two years of life are common in the history of schizoids. [According to Dr. Bash, if a child cannot remember what happened to him, his psychological development cannot be affected by the experience.] The schizoid condition was first described by the Scottish psychoanalyst Fairbairn in the 1940s. Fairbairn found that his patients had withdrawn from parents who were overtly rejecting. They preferred to live in a rich, imaginary world. Many fiction writers are schizoid because the ability to create a vivid inner world in one's head gives one a head start at writing fiction. The downside is that the schizoid's sense of other people is impoverished.
Core belief: Not hatred, but love is the problem. Fairbairn observed that the child with the rejecting or disappointing parent develops an internalized image of the rejecting parent, called the anti-libidinal object, to which he is desperately attached. The rejecting parent is often incapable of loving, or preoccupied with his or her own needs. The child is rewarded when he is not demanding, and devalued or ridiculed as needy when he expresses his dependent longings [Compare Dr. Bash's observation that "I want everything on a silver platter" simply because I expressed a wish that she, the psychotherapist, do more than simply issue commands, make recommendations, or offer encouragement.]. Thus the schizoid's picture of 'good' behavior is distorted. The child learns never to nag or even yearn for love, because it makes the parent more distant and censorious. The child then may cover over the incredible loneliness, emptiness and ineptness he feels with a fantasy (often unconscious) that he is self-sufficient. Love and anger get hopelessly intertwined. Fairbairn argued that the tragedy of the schizoid child is that his conscience has been warped: he believes his love, not his hatred is the destructive force within. Love consumes. Hence the schizoid child's chief mental operation is to repress his or her normal wish to be loved.
Being smitten. In my experience, should the adult schizoid fall in love with someone who reminds him of his rejecting parent he will often describe himself as 'being smitten'; 'smitten' is the past participle of to smite, and to be smitten is to be disastrously and deeply affected as one falls in love, as though one has sustained a severe blow. The British frequently describe falling in love this way; I doubt that national partiality to that word is accidental. [The author of this article, which can be found on the internet, is a Canadian psychiatrist.]
Pickiness and Prickliness. On the other hand, when more nurturing people come along, the schizoid will often dream, guiltily, that he or she is being disloyal to the parent imago, betraying a pact. This intense, internal backlash derives from a pathological superego, which unlike that in a loved child, is anti-libidinal. The schizoid child has a conscience that has made love a crime. Conscience always incites us to scrupulously pour over events and see them in a moral light; the schizoid's conscience demands he focus on the new love interest in an active, picky, prosecutorial, fault-finding way. Love becomes about as pleasant as litigation, for both parties. [Note that I am a nonpracticing heterosexual and a nonpracticing lawyer!] To avoid feeling picky, he may try to withdraw or simply enter a defensive, turned off state, finding the potential lover 'boring' or 'a turn off'. He has gone into total affect shut-down. Or he may become prickly, and chronically irritable so that others know not to approach.
Under the skin, the wish for merger or fusion. Should the love object 'get under the skin', the schizoid person feels taken over; being smitten releases his own pent-up wish to merger and cling that was appropriate in early childhood, but never satisfied at that time; his own longing gives rise to the fear that he will lose the external boundary that exists between himself and the exciting love object. He feels as if the love object is possessing him, in the sense of spirit possession.
Reversal of the values of life and death; preoccupation with the living dead, and the dead in the living. While schizoid patients may have quite conventional attitudes on the surface towards life as being something good, the fantasy life, so suffused with anti-libidinal themes, often displays a reversal of values of life and death, and an emphasis on the futility of life that one sees so frequently expressed in Beckett, for example. For instance, many of us fear that death is futile, and goes on for an unrelieved eternity; Beckett depicts not death but life as futile and going on and on without meaning. Thus there is a strong tendency towards nihilism and withdrawal that must be struggled against.
Defensive Techniques against Falling in Love: Ascetic ideals. To squelch this hunger for love the schizoid may idealize asceticism. But like the ascetic who retreats to the desert to avoid human contact and temptation, he soon begins to see the temptress in his wet dreams, sanctuary drawings, and religious stories, in a return of the repressed. He concludes, mistakenly, that desire is a bottomless pit; promiscuity and celibacy may alternate, both as attempts to deal with this perceived insatiability. [Note Fernando's observation in his paper on "The Exceptions" about a patient who seemed to live in two different worlds: one in which sexuality hardly existed, and one in which it was all too frighteningly present.]
Role playing. Another anti-libidinal technique used by schizoids to preserve the pact with the bad parent is to appear to be involved with others. Thus a subset of schizoid people of the 'role playing variety' get involved in a limited way. Fairbairn showed that the schizoid can actually unconsciously disown the social role while he is playing it. A patient appeared for a long time to be free associating and involved in sessions. Only well into treatment did he disclose that he always had the omnipotent fantasy that he was controlling everything I said.
The in and out program [otherwise known, in Franz Kafka's terminology, as "the out and in" program]. A related distancing technique has been described by Guntrip as 'the in and out program' and involves 'always breaking away from what one is at the same time holding on to.' This may involve 'rushing in and out of one marriage after another', or always emphasizing to one's partner that one could get along without him or her, or always fantasizing about taking a job away from the partner while staying with the partner. Such patients are 'unable to commit... in a stable... way.' They are always negotiating the optimal distance between themselves and others, saying things like 'I need my space.' But not infinite space, for the repressed hungry self is rarely completely obliterated, and it draws them back into the optimal orbit of others.
Sadomasochistic Object Relations. The belief that love consumes or destroys one's identity, and the tendency we have to repeat, make sadomasochistic object relations with a rejecting parent substitute highly likely. Sadomasochistic hurts help keep the object at a distance, which suits the schizoid's in and out program.
Attitudes toward children. There are no children in "The English Patient." In my experience, the classic schizoid is ambivalent about the 'idea' of having children, though may be surprised at how attached he or she may become towards them, should children come along. In sicker schizoids the parental instincts seem turned to pets, collecting things, or the environment which becomes animated."
The internet contains a site by Phillip W. Long, MD, that talks about the recommended treatment of schizoid patients. Dr. Long does not address the issues of eating out, speaking Hebrew, socializing in an exercise milieu, or attending one's local synagogue (Orthodox, Reform, or Conservative).
Psychosocial Treatment -- Basic Principles: "The physician should appreciate the need for privacy in a person with schizoid personality disorder and should maintain a low-key approach that focuses on the technical elements of treatment. Such a focus will enable the patient to feel the physician's concern and caring and know that caretakers will not press beyond comfortable limits. The patient should be encouraged to maintain daily routines so that a sense of "life as usual" can counteract the worry that illness will shatter the patient's efforts to remain detached and uninvolved. Knowledge of the patient's usual pattern of functioning will counteract any tendency on the part of the health care team to become personally overinvolved or be too zealously concerned with providing social supports for the patient."
Individual Psychotherapy: "Long-term psychotherapy has been useful in selected cases. The course of therapy involves gradual development of trust. If this can be achieved, the patient may share long-standing fantasies of imaginary friendships and may reveal fears of depending on others. Patients are encouraged to examine the unrealistic nature of their fears and fantasies and to form actual relationships. Successful psychotherapy will produce gradual change. The patient should be provided with some sense of optimism that his or her basic needs can be met without encountering some overwhelming 'collapse or suffocation.' The most useful therapeutic interaction is consistent and supportive, with clear rules, an ability for the patient to set the therapeutic distance as necessary, and some tolerance for acting-out behaviors. The treatment of schizoid personalities is similar to the treatment of paranoid personalities. However, the schizoid patient's tendencies toward introspection are consistent with the psychotherapist's expectations, and the schizoid patient may become a devoted if distant patient. Extensive periods of silence, however, may be hard to bear. As trust develops, the schizoid patient may, with great trepidation, reveal a plethora of fantasies, imaginary friends, and fears of unbearable dependency - even of merging with the therapist. Oscillation between fear of clinging to the therapist may be followed by fleeing through fantasy and withdrawal."
Group Therapy: "Group psychotherapy may be helpful. A prolonged period of silent withdrawal may often be followed by gradual involvement in the group process. It is important for the group leader to protect the schizoid patient from criticism by other members for not participating verbally in the early affiliative phase of the group. [In group, I was criticized for talking too much; the male group member attacked me for "taking up 80% of the group sessions." Much of the criticism directed at me by group members was antitherapeutic, and was not defended against by the group leaders.]
In group therapy settings, a schizoid patient may be silent for a year or more; nonetheless, involvement does take place. The patient should be protected against aggressive attack by group members on his proclivity for silence. With time, the group may become a meaningful experience for the patient and provide social contact, as well as therapy. Group therapy is particularly useful for schizoids, who are provided with a social network in which they have the opportunity to overcome fears of closeness and feelings of isolation. They learn, in the supportive milieu of the group, to communicate their thoughts and feelings directly to others and, by so doing, move toward more normal behavioral patterns."
Aaron T. Beck, MD, a leading cognitive therapist, has written the following about the treatment of schizoid patients. "In contrast to the treatments of such Axis I disorders as depressive disorder and anxiety disorders, the therapy for personality disorders requires a long period of therapeutic work--often one or more years. Also, much more therapeutic concentration deals with transference issues, exploring childhood patterns, and even revivifying pathogenic childhood experiences. In that respect, cognitive therapy has an increasing convergence with psychodynamic therapy. The major differences are that the cognitive therapist is more active and directive, the therapeutic sessions are more structured, the content is based on exploring and testing cognitive distortions and basic beliefs, and the patient is expected to carry out homework assignments."
All the internet sites I've read concerning the treatment of schizoids emphasize the absolute requirement of the therapist to refrain from placing pressure on the patient. This treatment guideline is the polar opposite of Dr. Bash's approach, which is coercive; I suspect that the severe worsening of my condition since I started seeing Dr. Bash is directly attributable to her coercive style.
Treatment Provider Guidelines: The clinician must respect the SPDs need for a safe distance and his/her fear of engulfment. Early in treatment, the SPD may feel lost and tongue-tied. The treatment provider must neither intrude nor fall into counter-detachment. Also, the treatment provider must convey understanding of the internal experience of the SPD; their limited communication must be sufficient for a therapeutic connection. Even high functioning SPDs worry that they are aberrant and incomprehensible. Be alert for possible psychotic processes; assess for hallucinations, delusions, and a thought disorder.
Countertransference Issues: SPDs are unable to make interaction rewarding to the service provider, i.e., there is a general lack of responsivity, a frustrating incapacity to relate, and a general and pervasive lack of empathy. It may become increasingly easy to overlook or ignore these individuals. Most treatment providers are slightly depressive and their fear of abandonment is greater than their fear of engulfment; they naturally try to move close to the people they wish to help. [Early on Dr. Bash chastised me inappropriately. "I can't work with you. You don't want to change. I can't work with a patient who doesn't want to change. Look, I need satisfaction too. I need to see that the patient is responding to my working with him. I need to see change." Once again, note Dr. Bash's requirement that I gratify her own narcissistic needs. See letter dated December 27, 2004 citing the paper by Phyllis Beren.]
In any event, such are the trials of the Orthodox schizoid. The Orthodox schizoid suffers the most severe discrimination in our society. But the Reform schizoid is also frequently misunderstood. Even the Reform schizoid can find himself rejected by the gregarious members of society. Actually, Reform schizoids go by the name "The Solitary Type." I thought I'd acquaint you with the basic features of the Reform, or Solitary, type. Orthodox schizoids, by the way, reserve a special coldness for the Reform. As Orthodox schizoids say: "Assimilation does not equate happiness." It's a schizoid thing, buddy. You wouldn't understand.
The Solitary type prefers solitude; and disprefers not having or losing solitude. Dr. John M. Oldham has defined the Solitary personality style. The following six characteristic traits and behaviors are listed in his The New Personality Self-Portrait.
Solitude. Individuals with the Solitary personality style have small need of companionship and are most comfortable alone.
Independence. They are self-contained and do not require interaction with others in order to enjoy their experiences or to get on in life.
Sangfroid. Solitary men and women are even-tempered, calm, dispassionate, unsentimental, and unflappable.
Stoicism. They display an apparent indifference to pain and pleasure.
Sexual composure. They are not driven by sexual needs. They enjoy sex but will not suffer in its absence.
Feet on the ground. They are unswayed by either praise or criticism and can confidently come to terms with their own behavior.
Source: Oldham, John M., and Lois B. Morris. The New Personality Self-Portrait: Why You Think, Work, Love, and Act the Way You Do. Rev. ed. New York: Bantam, 1995.
Character Strengths and Virtues
Solitude, [silence, recollection].
Independence, self-containment, autonomous competence, creativity.
Sangfroid, even-tempered, calmness, dispassion, imperturbability, detachment; observation, concentration, clarity of vision, being-informed, science.
Stoicism, indifference, self-control, self-restraint, [self-sacrifice].
Sexual composure, not passionately sexual.
Feet on the ground, responsibility (Oldham, 275-86).
Signature Strengths
"Curiosity [interest, novelty-seeking, openness to experience]: Taking an interest in ongoing experience for its own sake; finding subjects and topics fascinating; exploring and discovering"
"Love of learning: Mastering new skills, topics, and bodies of knowledge, whether on one's own or formally; obviously related to the strength of curiosity but goes beyond it to describe the tendency to add systematically to what one knows"
"Persistence [perseverance, industriousness]: Finishing what one starts; persisting in a course of action in spite of obstacles; "getting it out the door"; taking pleasure in completing tasks"
"Fairness: Treating all people the same according to notions of fairness and justice; not letting personal feelings bias decisions about others; giving everyone a fair chance"
"Humility / Modesty Letting one's accomplishments speak for themselves; not regarding oneself as more special than one is"
"Self-regulation [self-control]: regulating what one feels and does; being disciplined; controlling one's appetites and emotions"
"Humor [playfulness]: Liking to laugh and tease; bringing smiles to other people; see the light side; making (not necessarily telling) jokes" (Peterson & Seligman, 29, 30).
Selected from Christopher Peterson and Martin E. P. Seligman, (2004). Character Strengths and Virtues: A Handbook and Classification. Oxford: Oxford UP.
Check you out next week, buddy. Hector is so lonely. Come and play with Hector. Llame Hector, por favor.
Brian--
Hey, buddy. What's been occupying your days and moods? Do you ever venture into the depths of introspection? Do you sometimes scrupulously pour over the events of your life, and your place in the world? Do you ever become engrossed in the somber hues and sober tints of your inner mental life? Well, you should, buddy. It brings out your "I's."
My inner mental life IS my life. A thing that has reached terrifying proportions in my life is the fact that I seem to make little if any contact with living people. I know what has happened. From most of them there is so little to be learned, so little to be seen or discovered in them that is original and revelatory, that I have gotten into the habit of ignoring them. It was always that way with me: the inside teeming and quick rhythm was more important. It is even more so now, but how dangerous it is, how easily it will let one fall into the habit of peopling the world with one's own desires and images! I feel it happening all the time, but seem to do nothing to prevent this loss. I have paid a truly great price for the years of my young loneliness: I am forever locked in myself, deeply imbedded in the flesh and bones of myself is a hungry peering person, astigmatic, tired, alone.
I am lost to the world with which I used to waste so much time; it has heard nothing from me for so long that it may very well believe that I am dead (or at least petrified)! It is of no consequence to me whether it thinks me dead; I cannot deny it, for I really am dead to the world. I am dead to the world's tumult, and I rest in a quiet realm! I live alone in my one-room apartment, in my imaginary friendships and in my letters! That is, when I'm not otherwise occupied with my daily workout regimen in the exercise room of my apartment building.
I live out my days tunneling, tunneling through my thoughts to ever greater depths -- like Kafka's mole-rat digging into the earth below, creating a labyrinthine burrow of seemingly infinite complexity that is safe from the encroachment of others. "And with that I lose myself in a maze of technical speculations, I begin once more to dream my dream of a completely perfect burrow, and that somewhat calms me; with closed eyes I behold with delight perfect or almost perfect structural devices for enabling me to slip out and in unobserved. While I lie there thinking such things I admire these devices very greatly, but only as technical achievements, or as real advantages, for this freedom to slip out and in at will, what does it amount to? It is the mark of a restless nature, of inner uncertainty, disreputable desires, evil propensities that seem still worse when one thinks of the burrow, which is there at one's hand and can flood one with peace if one only remains quite open and receptive to it. For the present, however, I am outside it seeking some possibility of returning, and for that the necessary technical devices would be very desirable. But perhaps not very desirable after all. Is it not a very grave injustice to the burrow to regard it in moments of nervous panic as a mere hole among which one can creep and be safe?" Ah, yes! The freedom to slip "out and in" at will, as Kafka calls it. That's the famous "in and out program," which I discuss in greater depth, below.
Yes, in my burrow, in my solitary thoughts, I dream my dreams. But they are the dreams of "the undeveloped heart." I dwell in my burrow with a gallery of images, the images of a plethora of people: the monstrous and the good -- some unbelievably good. They remain phantoms, however. I lack the ability to care enough about another person; I suffer from a deficiency of the capacity for love, joy, and empathy to occupy myself with real people. The passageways of my burrow are redolent of indifference: the benign but vaguely repellent odor of emotional emptiness.
I live in fear by day and night; fear as deep as the marrow of the bone; doubt that I am worthy of life; since everyone around me denies it as I deny it to myself; which makes all love, all trust, all joy impossible.
From the tunnels of my imagination come a host of memories. All sorts of ghosts haunt these long, lonely corridors; foulness and miasma are everywhere, with here and there a vent-hole through which the phantom of one of my old acquaintances from within converses with another one of my old acquaintances from without.
My burrow is the resting place of all failure and all effort. To my life's pain it is a detritus, and to unfulfilled wishes a residue. It is the conscience of my life's experiences where all things converge and clash. There is darkness here, but no secrets. Everything has its true or at least its definitive form. There is this to be said for the muck-heap of my memories and imaginings, that it does not lie. Innocence dwells in it. Every foulness of my existence, fallen into disuse, sinks into that ditch of truth wherein ends the huge hoard of meaninglessness, to be swallowed, but to spread in endless rumination. It is a vast confusion. No false appearance, no whitewashing, is possible; filth strips off its shirt in utter starkness, all illusions and mirages scattered, nothing left except what is, showing the ugly face of what ends. Reality and disappearance: here, a bottleneck proclaims drunkenness, a basket-handle tells of home-life; and there the apple-core that had literary opinions again becomes an apple-core. Here my memories enjoy more than fraternity, they share a close intimacy. That which was painted is besmeared. The last veil is stripped away. The repository of memories that constitutes my mind is a cynic. It says everything. Endlessly. My burrow comprises the entrails of a monster. Mine is the life of a miserable sod. Ah, yes, Les Miserables!
I am in a dark place. I would live in utter darkness in my burrow but for The Word that emanates from higher realms. As the psalmist said: "Since God's word is a light for my path I will be sure not to stumble as long as it is with me. If God's word is in my heart then I can be sure that it will be there whenever I am in a dark place." Psalm 119: 105-106.
Yes, buddy, I was evicted from the library because I quoted scripture. An odd crime, don't you think? You interfered with my right to quote from Holy Writ on a public access computer at the library. Isn't that a First Amendment violation? Well, I guess you're not a Scientologist! I'll add that to my collection of atrocious memories: to the virtuoso collection of wounds and angers I harbor against my fellow man. I will dig a special hole in my burrow for the following memory: "On April 21, 2004, Brian Patrick Brown summoned the Metro DC Police to have me evicted from the Cleveland Park Library because I quoted from a Psalm." I'll add that memory to the permanent archives.
Be that as it may.
My session with The Mad Monk last week (Wednesday January 12, 2005) was a disaster. I walked out after about five minutes. I couldn't take it anymore. The last consult had been three weeks earlier, on December 22, 2004.
The Mad Monk showed no interest at all in how I was, how I felt, what I had been doing, how I had spent the holidays. Of course, obviously, they were Christian holidays, which are of no interest to Dr. Bash. But I myself am one-half Christian -- technically, at least. My mother was a Polish-Catholic coal-miner's daughter, after all. I suppose you could call me "The Half-Jewish Patient."
"So why did you wait three weeks to see me?" asked Dr. Bash. "I'm saving money. I save money on transportation by seeing you every three weeks," I said. Actually, I was being polite. Financial concerns were not my only reason for waiting three weeks to consult Dr. Bash. I'm simply sick of The Mad Monk.
"Do you take a bus to get here?" she asked. "No, subway," I said (Underground Man that I am). "Well, you could save money by walking here," the ever-practical Dr. Bash said. "Or," she continued, "you could walk one way and take the subway the other way. You could walk here and take the subway home. Or you could take the subway here and walk home." Dr. Bash covered all the permutations and combinations. She's nothing if not thorough, at least in regard to meaningless minutiae.
Dr. Bash then said: "Walking is good exercise. Do you get exercise?" "Yes," I replied, "I work out in the exercise room." "What kind of exercise do you do?" she inquired. "Well," I said, "we have an exercise room in my apartment building and they have different machines. I work out on an eliptical machine."
"Do you talk to anyone in the exercise room?" Dr. Bash asked. "No," I said. It was at this point that I started to get agitated. I knew what was coming. "You could try to make friends with someone in the exercise room," she said. "I have problems making friends, Dr. Bash." The Mad Monk then said, "Did you even try?" "No," I replied. I interrupted: "Dr. Bash, I have very serious psychological problems. The psychological problems impair my ability to make friends. I have very serious personality problems." At that point Dr. Bash offered the one-word dismissive comment, "So?"
Presently I could feel a rush of rage bubbling up from my inner core. I calmly said, rising from my chair: "Well, Dr. Bash, I'll see you in three weeks." I walked toward the door. Dr. Bash said: "Where are you going?" I said: "I'm leaving. I can't take it anymore." And I left. "In and out."
Do you notice anything about the totality of the interaction, buddy? The Mad Monk set the entire inane agenda. I had not seen her in three weeks. I have no friends, no family, no social interaction of any kind. I went to the clinic to talk with my therapist. And she proceeded to examine me about why I chose to see her every three weeks instead of every two weeks; my means of transportation to and from the clinic; my exercise routine; and my failure to make friends with people in the exercise room. Then she faulted me for not making an effort to befriend fellow tenants in the exercise room.
"Dr. Bash, I have a problem making friends." "Did you even try?" That phrase ("Did you even try?") really gnawed at my gut. Almost two months ago I presented Dr. Bash a copy of a letter issued by the DC Department of Employment Services, dated November 17, 2004 (Daryl Hardy, 202 698-5146), requesting that Dr. Bash (the letter specifically referred to Dr. Bash by name) prepare a statement about my mental status that would allow the agency to begin to assist me in seeking employment. Dr. Bash refuses to prepare such a statement, thereby impairing my ability to get a job. Bottom line: "She didn't even try!" The fact is that Dr. Bash is not doing all that she can do to help me and all that she has been reasonably requested to do by the DC Government to help me. She then proceeds to chastise me for failing to do all that I can do to make friends. The Mad Monk is a disaster!
Fuck it, man. I've had it! I'm mad as hell, and I'm not going to take it anymore. It's called "Schizoid Rage." I have a mental disorder. A recognized mental disorder: Schizoid Personality Disorder. Yes, I am a Schizoid American. The disorder severely impairs my ability to form and maintain relationships. I don't make friends: not simply because I don't make an effort to make friends. My whole internal psychic apparatus is not geared to establishing and maintaining social relations. I need help. The help of a knowledgeable professional. Someone who understands -- really understands -- my personality disorder and is able to work with me. I'm not just a socially isolated person who has trouble making friends. I am a mentally disordered person whose lack of social relations is a symptom of the disorder. Dr. Bash claims to be an expert in cognitive therapy. Has she even read Aaron Beck's book on the cognitive therapy of persons with personality disorders? Aaron Beck, MD, incidentally (who has his own clinic in Philadelphia), is the Godfather of cognitive therapy. His book is "Cognitive Therapy of Personality Disorders," Aaron T. Beck, Arthur Freeman, and associates (1990). Message for Dr. Bash: "Read It!"
I'm thinking of organizing fellow schizoids. We need to embark on concerted action. We need to lobby Congress. We have rights. We have been ignored for too long. We are a silent (a very silent), oppressed minority. Quite frankly, I was thinking (or fantasizing) about organizing an imaginary March on Washington to draw attention to the plight of the Schizoid minority in this country. I'm talking revolt -- a civil rights movement for the solitary! "All those who cherish in their souls a secret grudge against some action of the State, or of life or destiny," wrote Victor Hugo, "are attracted to the revolt; and when it manifests itself they shiver and feel themselves uplifted by the tempest." Vive Les Miserables!
In 1988, the United States Congress atoned for admitted wrongdoing by apologizing and paying reparations to Japanese-Americans interned during World War II. More recently, the U.S. government has pushed Switzerland's banks to compensate Holocaust victims for withholding their war-time bank accounts. What about reparations for African-Americans scarred by slavery's brutal legacy? And what, I would ask, about fair treatment for schizoids?
Throughout the 20th century, apologies and reparations have been offered to numerous individuals and groups for human-rights violations including The Tuskegee Experiment in which the U.S. government tested the effects of syphilis on black men; the internment of Japanese-Americans during World War II; and the Holocaust. African-American leaders have begun to call for reparations to the descendants of slaves for the inhumanities their ancestors endured as well as for the enormous contributions of African-Americans to American culture in general.
But when, I ask, when, if ever, will the horrendous suffering -- the inescapable loneliness, social marginalization, and pariah status -- of the schizoid be recognized and addressed? When will the psychological limitations imposed by Schizoid Personality Disorder be respected and accommodated?
In point of fact, I'm only being semi-humorous. There's actually a site on the internet that refers to schizoids as "an oppressed minority." The article (written by Peggy Breece, the relative of a schizoid) talks about the special needs of the schizoid that should be recognized.
The author writes: "I have reviewed the texts used in discussing the history and assessment of Schizoid Personality and I suggest taking a new approach in creating a better living environment for schizoids. Instead of trying to change the person, I am advocating for society to become more tolerant of those exhibiting Schizoid Personality who are extreme introverts and recluses. As mentioned earlier, schizoids are absent of psychosis, but even so, those with varying mental health conditions deserve a life free of oppression and ridicule. So, how do I suggest that society begin being less critical, judgmental, and discriminatory of schizoids? Teach children at early ages that being extroverted does not mean being superior or better than those who are introverted. Teach celebration of diversity and incorporating those exhibiting Schizoid Personality (minus the 'disorder') and other mental health conditions into cultural awareness discussions.
Using education as a tool, children may begin to better understand that just as African-Americans, elderly persons, impoverished persons, and those with disabilities deserve respect and love, schizoids deserve the same opportunities and attention. Instead of mocking and ignoring, better understand how we can better understand each other's differences and turn what is considered a 'weakness' into a strength. Assimilation does not equate happiness. Instead it promotes feelings of shame, anxiety, and pain of not being allowed to just 'be.' Along with education, another strategy social workers need to facilitate is creating a social network for schizoids. For example, it would be helpful for them to come into contact with employment opportunities that would provide a social-free working environment, so when a schizoid chooses not to participate in 'office chit-chat' he or she is not deemed weird or strange. Not only that, schizoids do not feel comfortable in such settings. There should be a list of jobs sectioned off in the classifieds under 'working alone' professions. They are out there, but it is difficult to research them. Most employment ads ask for 'outgoing, social, talkative sellers.' Of course, all of those characteristics are not associated with schizoids, making it hard to find work environments compatible to their personality type and chosen life-styles.
Another benefit in creating a social network is to provide schizoids the opportunity to be themselves and talk with others that live similar lives. One could argue or even joke that it would be difficult to find schizoids to create a social network hence their lack of social interaction, but I disagree. I mean, it would be a challenge, but it is not impossible. For example, a social worker could list a support group in the newspaper or magazine or create a website so that schizoids can converse among each other yet do so in the privacy of their homes. Nonetheless, there are strategies social workers can implement to help eliminate the oppression schizoids feel. Just because this minority group does not outwardly declare, 'I deserve rights, too!' they do warrant a life free of oppression. It is a disservice for practitioners to implement strategies which incorporate 'changing' schizoids. In doing so, social workers are accepting and advocating for further social injustice and oppression.
As the NASW Code of Ethics [for Social Workers] states: Cultural Competence and Social Diversity (a) Social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures. (b) Social workers should have a knowledge base of their clients' cultures and be able to demonstrate competence in the provision of services that are sensitive to clients' cultures and to differences among people and cultural groups. (c) Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, marital status, political belief, religion, and mental or physical disability (National Association of Social Workers, Code of Ethics, January 1, 1997, 1.05).
It is the responsibility of the social work profession to not predetermine who is eligible for services. Oppression feeds on ignorance and it breeds as the ignorance becomes a social norm. Those with Schizoid Personalities do not have a 'disorder' but a gift of high independence and intellect. Regardless, in just being a sentient being they deserve access to available resources, otherwise they feel alone . . . not by choice but as the result of oppression."
I hope I don't lose you in "a maze of technical speculations," Brian, but I came across a fascinating article about the novel (later, a movie) called "The English Patient." The article analyzes the novel as the author's creative transformation of the intrapsychic world of the schizoid individual. See Norman Doidge, MD, "Diagnosing 'The English Patient:' Contributions to Understanding the Schizoid Fantasies of Being Skinless and of Being Buried Alive."
The following material provides valuable insight into the intrapsychic "burrows" of the schizoid's wishes, conflicts, and fantasies. We schizoids are not simply socially isolated; we have a distinct intrapsychic mental life. Simply talking to people in an exercise room (or speaking Hebrew, for that matter) will not cure the schizoid.
Norman Doidge writes: "I here use the diagnosis of schizoid as it was first used by British Object Relations theorists, called schizoid because of 'schisms' in the personality. Because the disorder involves an often skilled role play at ordinary social relations, clinicians often misdiagnose these patients as obsessional or higher level narcissistic characters. Akhtar has observed that these 'schisms' are based not only upon the conscious versus unconscious oppositions, but also overt and covert descriptive features. Thus the schizoid may be 'covertly' detached, self-sufficient, absentminded, uninteresting, asexual, and idiosyncratically moral, while 'covertly' exquisitely sensitive, emotionally needy, acutely vigilant, creative, often perverse, and vulnerable to corruption.' Such patients display a 'moral unevenness; [are] occasionally strikingly amoral and vulnerable to odd crimes, at other times altruistically self-sacrificing.' Guntrip argued that the key schizoid characteristics are introversion, withdrawness, narcissism, self-sufficiency, a sense of superiority, loss of affect, loneliness, depersonalization, and regression.
Affects. Even though a schizoid person's affect is constricted, he is not without affective investments. One schizoid patient, who seemed Spock-like talking to people, had a passionate fascination with machines. His experience of emotions when dealing with people was almost digital: he was on or off, without the analogical crescendos and decrescendos of passion. The smallest surge of emotion is like a bomb going off. This state of affairs finds its objective correlative [in "The English Patient"] in the mined villa, and in Kip, the bomb defuser who must turn off all his fear.
Reasons for seeking treatment. The schizoid person tends to alternate between two painful, complex states. On the one hand 'there is a consuming need for object dependence but attachment threatens the schizoid with the loss of self.' Schizoids can function well as long as they can successfully repress intense dependence. To avoid losing himself in relations he protects himself by withdrawal and affective isolation. Without meaningful relationships, with affect shut down, he feels enervated, futile, lifeless. The chronic sense of futility, meaninglessness, and deadness are easily misdiagnosed as dysthymia, depression, or minimized as mere existential anxiety.
Buried alive. Schizoid withdrawal is not only interpersonal, i.e., away from real people; there is a kind of intrapsychic withdrawal, based upon fantasy. As treatment progresses, it is not uncommon for the schizoid to reveal fantasies of having buried his self within him, where it lies waiting until it is safe to be exposed. The fantasy that the self is buried also explains a dread of many schizoids, the fear of being buried alive. A patient dreamed, "There was a baby, it was buried alive. It was horrible and no one knew." [I spoke to my former treating psychiatrist, Dr. Palombo, about a persistent distressing feeling that I had been buried alive.]
The intrapsychic tomb. It is worth relating this to the phenomenon of intrapsychic tombs described by the French psychoanalyst Torok. Torok began formulating this concept following a lead by Karl Abraham. Abraham wrote to Freud of patients who seemed to show manic denial, and an upsurge of libido, as opposed to melancholia, after the death of their loved one. Torok noticed that a number of her patients related stories of sexual acts and needs right after a death. She saw this as a desperate and final attempt to sustain the relationship by the fantasy of incorporation (concretely taking a person's body inside them). She described these patients as having a fantasy of 'an exquisite corpse' entombed somewhere inside them, which they hoped to revive. One dreamed, 'I committed a terrible crime. I ate someone and then buried them... For this reason I have to spend the rest of my life in prison.' Torok brilliantly observed that in many cases of complicated grief, the anguished pining that the living bereaved feel is not their own longing for their love object, but rather, the fantasized pining of the deceased love object for them. If we deny our beloved has died, the fantasy of the beloved as alive and seeking us persists. It is all too often overlooked because we are preoccupied with our more conscious longing for the lost object. But fantasized incorporation of the deceased 'eating the object (which parallels, in ways, the Christian imagery of consuming the host)' stifles mourning. 'When, in the form of imaginary or real nourishment, we ingest the love object we miss... we refuse to mourn.... .'
Petrification fears. The schizoid person is often aware that his sense of self is fragile, and built upon a fantasy. Several of my schizoid patients had the ongoing fear that this imaginary world could all blow up at a moment's notice. While the schizoid person's surface may be nondescript, decorous, emotionless, he is terrified of being revealed as human, full of hunger. He fears being petrified and turning into rock, if another person catches him in his glance, as was Medusa when she saw herself as others saw her, i.e., in all her fantastic, composite ugliness, filled with unruly sexual and aggressive desires and defects. [Note that a letter I wrote several weeks ago (December 27, 2004) referred to Dr. Bash acting out her own Pygmalion fantasy. I attributed to her the desire to fine-tune my personality (treating me as a passive object to be acted upon) to gratify her own narcissistic needs, as a sculptor carves a passive block of marble into a statue. My imagery may relate to my petrification fears.]
Typical Development. Akhtar's extensive review has shown that rejection, traumatic overstimulation, and neglect in the first two years of life are common in the history of schizoids. [According to Dr. Bash, if a child cannot remember what happened to him, his psychological development cannot be affected by the experience.] The schizoid condition was first described by the Scottish psychoanalyst Fairbairn in the 1940s. Fairbairn found that his patients had withdrawn from parents who were overtly rejecting. They preferred to live in a rich, imaginary world. Many fiction writers are schizoid because the ability to create a vivid inner world in one's head gives one a head start at writing fiction. The downside is that the schizoid's sense of other people is impoverished.
Core belief: Not hatred, but love is the problem. Fairbairn observed that the child with the rejecting or disappointing parent develops an internalized image of the rejecting parent, called the anti-libidinal object, to which he is desperately attached. The rejecting parent is often incapable of loving, or preoccupied with his or her own needs. The child is rewarded when he is not demanding, and devalued or ridiculed as needy when he expresses his dependent longings [Compare Dr. Bash's observation that "I want everything on a silver platter" simply because I expressed a wish that she, the psychotherapist, do more than simply issue commands, make recommendations, or offer encouragement.]. Thus the schizoid's picture of 'good' behavior is distorted. The child learns never to nag or even yearn for love, because it makes the parent more distant and censorious. The child then may cover over the incredible loneliness, emptiness and ineptness he feels with a fantasy (often unconscious) that he is self-sufficient. Love and anger get hopelessly intertwined. Fairbairn argued that the tragedy of the schizoid child is that his conscience has been warped: he believes his love, not his hatred is the destructive force within. Love consumes. Hence the schizoid child's chief mental operation is to repress his or her normal wish to be loved.
Being smitten. In my experience, should the adult schizoid fall in love with someone who reminds him of his rejecting parent he will often describe himself as 'being smitten'; 'smitten' is the past participle of to smite, and to be smitten is to be disastrously and deeply affected as one falls in love, as though one has sustained a severe blow. The British frequently describe falling in love this way; I doubt that national partiality to that word is accidental. [The author of this article, which can be found on the internet, is a Canadian psychiatrist.]
Pickiness and Prickliness. On the other hand, when more nurturing people come along, the schizoid will often dream, guiltily, that he or she is being disloyal to the parent imago, betraying a pact. This intense, internal backlash derives from a pathological superego, which unlike that in a loved child, is anti-libidinal. The schizoid child has a conscience that has made love a crime. Conscience always incites us to scrupulously pour over events and see them in a moral light; the schizoid's conscience demands he focus on the new love interest in an active, picky, prosecutorial, fault-finding way. Love becomes about as pleasant as litigation, for both parties. [Note that I am a nonpracticing heterosexual and a nonpracticing lawyer!] To avoid feeling picky, he may try to withdraw or simply enter a defensive, turned off state, finding the potential lover 'boring' or 'a turn off'. He has gone into total affect shut-down. Or he may become prickly, and chronically irritable so that others know not to approach.
Under the skin, the wish for merger or fusion. Should the love object 'get under the skin', the schizoid person feels taken over; being smitten releases his own pent-up wish to merger and cling that was appropriate in early childhood, but never satisfied at that time; his own longing gives rise to the fear that he will lose the external boundary that exists between himself and the exciting love object. He feels as if the love object is possessing him, in the sense of spirit possession.
Reversal of the values of life and death; preoccupation with the living dead, and the dead in the living. While schizoid patients may have quite conventional attitudes on the surface towards life as being something good, the fantasy life, so suffused with anti-libidinal themes, often displays a reversal of values of life and death, and an emphasis on the futility of life that one sees so frequently expressed in Beckett, for example. For instance, many of us fear that death is futile, and goes on for an unrelieved eternity; Beckett depicts not death but life as futile and going on and on without meaning. Thus there is a strong tendency towards nihilism and withdrawal that must be struggled against.
Defensive Techniques against Falling in Love: Ascetic ideals. To squelch this hunger for love the schizoid may idealize asceticism. But like the ascetic who retreats to the desert to avoid human contact and temptation, he soon begins to see the temptress in his wet dreams, sanctuary drawings, and religious stories, in a return of the repressed. He concludes, mistakenly, that desire is a bottomless pit; promiscuity and celibacy may alternate, both as attempts to deal with this perceived insatiability. [Note Fernando's observation in his paper on "The Exceptions" about a patient who seemed to live in two different worlds: one in which sexuality hardly existed, and one in which it was all too frighteningly present.]
Role playing. Another anti-libidinal technique used by schizoids to preserve the pact with the bad parent is to appear to be involved with others. Thus a subset of schizoid people of the 'role playing variety' get involved in a limited way. Fairbairn showed that the schizoid can actually unconsciously disown the social role while he is playing it. A patient appeared for a long time to be free associating and involved in sessions. Only well into treatment did he disclose that he always had the omnipotent fantasy that he was controlling everything I said.
The in and out program [otherwise known, in Franz Kafka's terminology, as "the out and in" program]. A related distancing technique has been described by Guntrip as 'the in and out program' and involves 'always breaking away from what one is at the same time holding on to.' This may involve 'rushing in and out of one marriage after another', or always emphasizing to one's partner that one could get along without him or her, or always fantasizing about taking a job away from the partner while staying with the partner. Such patients are 'unable to commit... in a stable... way.' They are always negotiating the optimal distance between themselves and others, saying things like 'I need my space.' But not infinite space, for the repressed hungry self is rarely completely obliterated, and it draws them back into the optimal orbit of others.
Sadomasochistic Object Relations. The belief that love consumes or destroys one's identity, and the tendency we have to repeat, make sadomasochistic object relations with a rejecting parent substitute highly likely. Sadomasochistic hurts help keep the object at a distance, which suits the schizoid's in and out program.
Attitudes toward children. There are no children in "The English Patient." In my experience, the classic schizoid is ambivalent about the 'idea' of having children, though may be surprised at how attached he or she may become towards them, should children come along. In sicker schizoids the parental instincts seem turned to pets, collecting things, or the environment which becomes animated."
The internet contains a site by Phillip W. Long, MD, that talks about the recommended treatment of schizoid patients. Dr. Long does not address the issues of eating out, speaking Hebrew, socializing in an exercise milieu, or attending one's local synagogue (Orthodox, Reform, or Conservative).
Psychosocial Treatment -- Basic Principles: "The physician should appreciate the need for privacy in a person with schizoid personality disorder and should maintain a low-key approach that focuses on the technical elements of treatment. Such a focus will enable the patient to feel the physician's concern and caring and know that caretakers will not press beyond comfortable limits. The patient should be encouraged to maintain daily routines so that a sense of "life as usual" can counteract the worry that illness will shatter the patient's efforts to remain detached and uninvolved. Knowledge of the patient's usual pattern of functioning will counteract any tendency on the part of the health care team to become personally overinvolved or be too zealously concerned with providing social supports for the patient."
Individual Psychotherapy: "Long-term psychotherapy has been useful in selected cases. The course of therapy involves gradual development of trust. If this can be achieved, the patient may share long-standing fantasies of imaginary friendships and may reveal fears of depending on others. Patients are encouraged to examine the unrealistic nature of their fears and fantasies and to form actual relationships. Successful psychotherapy will produce gradual change. The patient should be provided with some sense of optimism that his or her basic needs can be met without encountering some overwhelming 'collapse or suffocation.' The most useful therapeutic interaction is consistent and supportive, with clear rules, an ability for the patient to set the therapeutic distance as necessary, and some tolerance for acting-out behaviors. The treatment of schizoid personalities is similar to the treatment of paranoid personalities. However, the schizoid patient's tendencies toward introspection are consistent with the psychotherapist's expectations, and the schizoid patient may become a devoted if distant patient. Extensive periods of silence, however, may be hard to bear. As trust develops, the schizoid patient may, with great trepidation, reveal a plethora of fantasies, imaginary friends, and fears of unbearable dependency - even of merging with the therapist. Oscillation between fear of clinging to the therapist may be followed by fleeing through fantasy and withdrawal."
Group Therapy: "Group psychotherapy may be helpful. A prolonged period of silent withdrawal may often be followed by gradual involvement in the group process. It is important for the group leader to protect the schizoid patient from criticism by other members for not participating verbally in the early affiliative phase of the group. [In group, I was criticized for talking too much; the male group member attacked me for "taking up 80% of the group sessions." Much of the criticism directed at me by group members was antitherapeutic, and was not defended against by the group leaders.]
In group therapy settings, a schizoid patient may be silent for a year or more; nonetheless, involvement does take place. The patient should be protected against aggressive attack by group members on his proclivity for silence. With time, the group may become a meaningful experience for the patient and provide social contact, as well as therapy. Group therapy is particularly useful for schizoids, who are provided with a social network in which they have the opportunity to overcome fears of closeness and feelings of isolation. They learn, in the supportive milieu of the group, to communicate their thoughts and feelings directly to others and, by so doing, move toward more normal behavioral patterns."
Aaron T. Beck, MD, a leading cognitive therapist, has written the following about the treatment of schizoid patients. "In contrast to the treatments of such Axis I disorders as depressive disorder and anxiety disorders, the therapy for personality disorders requires a long period of therapeutic work--often one or more years. Also, much more therapeutic concentration deals with transference issues, exploring childhood patterns, and even revivifying pathogenic childhood experiences. In that respect, cognitive therapy has an increasing convergence with psychodynamic therapy. The major differences are that the cognitive therapist is more active and directive, the therapeutic sessions are more structured, the content is based on exploring and testing cognitive distortions and basic beliefs, and the patient is expected to carry out homework assignments."
All the internet sites I've read concerning the treatment of schizoids emphasize the absolute requirement of the therapist to refrain from placing pressure on the patient. This treatment guideline is the polar opposite of Dr. Bash's approach, which is coercive; I suspect that the severe worsening of my condition since I started seeing Dr. Bash is directly attributable to her coercive style.
Treatment Provider Guidelines: The clinician must respect the SPDs need for a safe distance and his/her fear of engulfment. Early in treatment, the SPD may feel lost and tongue-tied. The treatment provider must neither intrude nor fall into counter-detachment. Also, the treatment provider must convey understanding of the internal experience of the SPD; their limited communication must be sufficient for a therapeutic connection. Even high functioning SPDs worry that they are aberrant and incomprehensible. Be alert for possible psychotic processes; assess for hallucinations, delusions, and a thought disorder.
Countertransference Issues: SPDs are unable to make interaction rewarding to the service provider, i.e., there is a general lack of responsivity, a frustrating incapacity to relate, and a general and pervasive lack of empathy. It may become increasingly easy to overlook or ignore these individuals. Most treatment providers are slightly depressive and their fear of abandonment is greater than their fear of engulfment; they naturally try to move close to the people they wish to help. [Early on Dr. Bash chastised me inappropriately. "I can't work with you. You don't want to change. I can't work with a patient who doesn't want to change. Look, I need satisfaction too. I need to see that the patient is responding to my working with him. I need to see change." Once again, note Dr. Bash's requirement that I gratify her own narcissistic needs. See letter dated December 27, 2004 citing the paper by Phyllis Beren.]
In any event, such are the trials of the Orthodox schizoid. The Orthodox schizoid suffers the most severe discrimination in our society. But the Reform schizoid is also frequently misunderstood. Even the Reform schizoid can find himself rejected by the gregarious members of society. Actually, Reform schizoids go by the name "The Solitary Type." I thought I'd acquaint you with the basic features of the Reform, or Solitary, type. Orthodox schizoids, by the way, reserve a special coldness for the Reform. As Orthodox schizoids say: "Assimilation does not equate happiness." It's a schizoid thing, buddy. You wouldn't understand.
The Solitary type prefers solitude; and disprefers not having or losing solitude. Dr. John M. Oldham has defined the Solitary personality style. The following six characteristic traits and behaviors are listed in his The New Personality Self-Portrait.
Solitude. Individuals with the Solitary personality style have small need of companionship and are most comfortable alone.
Independence. They are self-contained and do not require interaction with others in order to enjoy their experiences or to get on in life.
Sangfroid. Solitary men and women are even-tempered, calm, dispassionate, unsentimental, and unflappable.
Stoicism. They display an apparent indifference to pain and pleasure.
Sexual composure. They are not driven by sexual needs. They enjoy sex but will not suffer in its absence.
Feet on the ground. They are unswayed by either praise or criticism and can confidently come to terms with their own behavior.
Source: Oldham, John M., and Lois B. Morris. The New Personality Self-Portrait: Why You Think, Work, Love, and Act the Way You Do. Rev. ed. New York: Bantam, 1995.
Character Strengths and Virtues
Solitude, [silence, recollection].
Independence, self-containment, autonomous competence, creativity.
Sangfroid, even-tempered, calmness, dispassion, imperturbability, detachment; observation, concentration, clarity of vision, being-informed, science.
Stoicism, indifference, self-control, self-restraint, [self-sacrifice].
Sexual composure, not passionately sexual.
Feet on the ground, responsibility (Oldham, 275-86).
Signature Strengths
"Curiosity [interest, novelty-seeking, openness to experience]: Taking an interest in ongoing experience for its own sake; finding subjects and topics fascinating; exploring and discovering"
"Love of learning: Mastering new skills, topics, and bodies of knowledge, whether on one's own or formally; obviously related to the strength of curiosity but goes beyond it to describe the tendency to add systematically to what one knows"
"Persistence [perseverance, industriousness]: Finishing what one starts; persisting in a course of action in spite of obstacles; "getting it out the door"; taking pleasure in completing tasks"
"Fairness: Treating all people the same according to notions of fairness and justice; not letting personal feelings bias decisions about others; giving everyone a fair chance"
"Humility / Modesty Letting one's accomplishments speak for themselves; not regarding oneself as more special than one is"
"Self-regulation [self-control]: regulating what one feels and does; being disciplined; controlling one's appetites and emotions"
"Humor [playfulness]: Liking to laugh and tease; bringing smiles to other people; see the light side; making (not necessarily telling) jokes" (Peterson & Seligman, 29, 30).
Selected from Christopher Peterson and Martin E. P. Seligman, (2004). Character Strengths and Virtues: A Handbook and Classification. Oxford: Oxford UP.
Check you out next week, buddy. Hector is so lonely. Come and play with Hector. Llame Hector, por favor.
posted by My Daily Struggles | 1:25 PM
9 Comments:
I have just had a limited 11 month relationship with someone that fits the descriptions on this site so well. I had already figured out the SPD thing, but the more I read about it the more I understand it, especially the moral dichotomies.
I feel sorry for him but that I cannot help him and must move on, or do you have other suggestions?
He first was attracted to me because he said he 'trusted' me.
It is sad, he is sad, but I've tried and given up.
You probably cannot help your schizoid friend. For your own sake, you might want to move on. On the other hand, your scizoid friend craves a relationship at some level, even if he does not admit it to him/herself. The humane thing would be to be there for him if he feels he wants contact.
thank you. your site was informative and personal. you make me almsot accept my SPD wiht pride, jsut becasue i can see that spd does not mean lack of worthy intelligence. but i think the "guidelines" the shrinks have about me types is so negitive. they tell them to purcerveire and wait thru the silence when all they really have to do to do is be interesting lol. and of course get us talkign about our favortie topic....what we think. personally i do tend to seek vailidation of the worth of my thinks, and to be understood, and i fear being seen in the wrong light , and naturally to have the light see me in the wrong.
as for seeking treatment, i am all for it. i am incredibly ready, but to find that person with whom i wont be afraid to feel the pain with, whom i respect, and more whom i can feel on a equal human footing with.ahhhh theres the rub.
many blessigns and i enjoyed reading.
I am a person who is diagnosed with SPD and to tell you the truth i found your long winded blogg offensive.
You make us seem like we are mentally disabled and have no control over our actions. When in reality schizoids have more control over their actions than the average person.
Stop being the victim and start finding a soltuon. Ok your shrink may be stuffed THEN CHANGE HER.
From what you have said there I honestly think you suffer from some form of depression, look to a cure to that before you start blaming it on being a schizoid.
I think I may suffer SPD. They way you described yourself and your feelings was 'bang on' with my own, which depresses me. I am married, but i fear that my coldness may eventualy drive her away. Have you suffered similar problems with your relationships?
Lastly, I have only recently have the moments of self realization you describe, and it terrifies me. I can't sleep at night, as I fear there is no hope of change. Have you been able to remedy your situation in any way?
Regards
I can't begin to explain how much reading this has helped me. I've been so depressed for the past half year... I'm in love with a Schizoid and have been taking everything so personally, even though he's finally gotten it across to me that it's not me... it's everyone... I know him well enough to know that he is one and it hurts me so badly knowing that it'd be best if I just left him alone (or so I feel it would be). I have gone about our "relationship" all wrong. I guess you can call us acquaintances because he has bluntly told me "he's not looking for friends, " and I believe it. Thank you so much for this post. If you can offer any advice, I would appreciate it.
Wow, a good portion of your little blog here has come straight (word-for-word) from the essay at:
http://www.pipeline.com/~dada3zen/schizoid_a_personality_not_a_disorder.htm
And here I thought I was just having an extreme case of deja vou.
Anyways, it certainly sounds like you could have a few other diagnoses other than SPD.
This writeup is absolutely brilliant, articulate, and correct. I have been scouring the libraries and online journals for adequate information on SPD, and you seem to have it right here, good sir.
"Thus the schizoid's picture of 'good' behavior is distorted. The child learns never to nag or even yearn for love, because it makes the parent more distant and censorious. The child then may cover over the incredible loneliness, emptiness and ineptness he feels with a fantasy (often unconscious) that he is self-sufficient. Love and anger get hopelessly intertwined. Fairbairn argued that the tragedy of the schizoid child is that his conscience has been warped: he believes his love, not his hatred is the destructive force within. Love consumes. Hence the schizoid child's chief mental operation is to repress his or her normal wish to be loved."
So very true. I am a teenaged schizoid, and I found in my research on this condition that a lot of professionals have us tagged as "empty", "hollow", and "bitter". I would argue that we are not hollow; in fact, I think that if we were hollow we perhaps wouldn't suffer as much as we do. It is because we are not hollow that we suffer. We hate this need, this driving, fervent desire to love and be loved; we try to repress it and ignore it, and it is this love that causes pain. It is ironic therefore, that we even try to repress our pain until there is nothing left.
You are the first SPD source that has managed to pinpoint this crucial distinction: SPD emptiness does not derive from a lack of stimulation, but rather, too much of it causing subsequent withdrawal due to negative condition and traumatic experiences.
I got a lot of crap from my parents, teachers, professors, and other students about my seeming detachment and inability to commit.
Actually, I have recently met a friend who is, in all sense of the word, the most empathetic and compassionate individual I have ever met. We meet at both an intellectual level and a spiritual one, yet while I find myself wanting to spend time with this friend, it pains me to do so. It pains me to see this friend, and yet it pains me when I am not in her presence.
You have a fantastic writeup here, sir, and I commend you on your excellent research.
Exquisite article!
Some points that you made (ie. Your problem is in not wanting to socialize and she tells you to socialize to solve it.) reminded me of when I went to the psychiatrist because I preferred to play video games than go to work, and they told me to comeback after I preferred going to work over playing video games...
Strange logic.
What would I need them for?
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