periphery of the schizoid body results in an increased permeability of the surface membranes to external stimuli, which accounts for the hypersensitivity shown by most schizoid individuals. Necessarily, contact with the external environment is tenuous. Action upon the world to gain satisfaction is generally ineffective. The chronic contraction of the deep muscles is responsible for the narrowing of the body which gives it the typical asthenic appearance.
The immobilization of the body musculature in the schizoid condition has a double meaning. On one hand, it is a defense against terror and a means of maintaining some unity in the personality. On the other hand, it is a direct expression of the terror, since it represents the physical attitude of one who is frozen stiff with fear. Paul could not perceive this quality of his body because he was incapable of reacting emotionally. As long as he remained frozen, the terror would be hidden, like a skeleton in a closed closet. He had to thaw and reach out before this perception became possible. Only through the experience of the terror and its resolution into its component fears was there any hope for a significant improvement in his personality.
FIG. 6
FIG. 7
The collapse of the schizoid rigidity would plunge the individual into a schizophrenic crisis. Collapse brings about a loss of ego boundaries and the destruction of such unity and integrity as the personality has. This cannot happen to the normal individual. Once a strong contact is made with the reality of the external world, it operates to sustain the peripheral aliveness. This difference is illustrated in the reactions of these two types to excessive stress. It is an accepted concept that under sufficient stress the schizoid structure can give way, producing an acute psychotic break. In the normal individual, on the other hand, the breakdown which occurs due to insupportable stress generally takes place in the tissues and organs of the body and results in somatic illness rather than mental illness. It appears that the forces that bind mind to body are different in the two cases. One can compare these phenomena to the action of certain adhesives. Some are so strong that when a rupture is forced, it is the substance that yields and not the bonding medium. Other adhesives, such as rubber cement, permit the bonded objects to be pulled apart without the disruption of their structure.
What are the forces that unify the personality in the normal and the schizoid individual? In the normal person, body and mind are held together by the integrative function of pleasure. This refers to capacity for pleasure. Since pleasure is a principle of the body, the mind which anticipates pleasure affirms its identity with the body on the deepest level of experience. The capacity for pleasure also guarantees a steady stream of impulses reaching to the world for satisfaction. In the absence of this pleasure function, impulses are tentative and infrequent. The schizoid person therefore depends upon his will to cement mind to body. But the will, though hard as steel, is brittle, whereas pleasure is flexible and pervasive. It acts like the sap in the living tree to provide strength and elasticity.
The idea that there are two different mechanisms for maintaining the unity of a personality suggests that there may be some validity to the concept that somatic illness and mental illness tend to be mutually exclusive and antithetical, and that, broadly speaking, an individual is predisposed to one or to the other, but not to both at the same time. Under conditions of insupportable stress, these two unifying forces may be expected to give way with different results. When the pleasure functions disintegrate, one may generally expect somatic illness, while the disintegration of the will produces mental illness. Thus, one can anticipate an interchangeability of symptoms, depending on the state of functioning of the total organism. Leopold Bellak comments on this same phenomenon, “The low incidence of allergic disorders in psychotics, and the return of allergic complaints after improvements and recovery, is probably one of the best documented instances of such interchangeability.”17
My clinical experience is that schizophrenics rarely manifest the symptoms of a common cold; when they do, I regard it as a sign of clinical improvement. It is also well documented that states of intense emotional excitement and upheaval may alleviate physical afflictions in normal individuals. An example is the effect of emotional shock upon the condition of rheumatoid arthritis. The remission of this illness due to emotional shock was one of the observations that led to the use of cortisone in the treatment of this condition. Cortisone is similar in action to the corticosteroids which are produced by the adrenal gland in conditions of stress or shock.
The interchangeability of symptoms is dramatically illustrated in the following case of a male schizophrenic patient whom I treated for a number of years. In the course of therapy most of his schizophrenic tendencies and manifestations were considerably reduced. At one point, after what I felt had been a significant improvement, the patient developed an epidermoid cancer at the tip of his nose. Actually, the patient had been aware of this growth for some time, but had ignored it. The patient had a history of X-ray treatments on his face for an acne condition many years earlier. However, the appearance of the cancer at this particular time in the therapy seemed significant to me. Was it possible that when his escape into psychosis as a withdrawal from reality was prevented by the analytic working-through of the schizophrenic mechanisms, he attempted to withdraw from life by developing a cancer? This interpretation was accepted by the patient and proved helpful to his therapy. An operation was successfully performed, which led the patient to comment, “I guess I cut off my nose to spite my face.” Following the operation, however, the patient made a big step forward toward building a stable personality.
I do not wish to suggest that physical illness does not occur among schizophrenics or that schizophrenia cannot develop in the presence of somatic disease. We are dealing with tendencies which, while they are mutually exclusive as theoretical postulates, are only relatively so in life. One may hypothesize that once the ego anchors in reality it cannot easily be dislodged.
THE SCHIZOID RETREAT
The schizoid individual defends himself against terror and insanity by one of two strategies. The most common defensive strategy, as has been described above, is a physical and psychological rigidity that serves to repress feeling and keep the body under the control of the ego. It is structured to withstand insults from the outside world in the form of rejection and disappointment. It is a fortress within which the schizoid lives in the relative security of illusion and fantasy.
But not all schizoid individuals show this typical rigidity. Many, including Barbara, whose case was presented in Chapter 1, show in their body structures a superficial flabbiness or lack of muscle tone instead of the rigidity described above. Impulse formation is further reduced—to the point where the body looks more dead than alive, the peripheral charge is very low, and skin color is pasty yellow or muddy brown. Logically, such a condition would follow the breakdown of the rigid defense and lead to schizophrenia. However, in Barbara's case it may be postulated that a collapse occurred in early childhood, before a rigid defense could be structured by her personality. Barbara gave in before she could fight back.
To account for a personality that remains sane yet whose body structure shows collapse, it is necessary that the concept of the schizoid defense against terror be extended beyond that of rigidity. When the terror is extreme, a more desperate maneuver is required. What could be more terrifying than to picture oneself as the victim of a human sacrifice? The feelings which this image evokes would be enough to drive one out of his mind. Yet Barbara and other patients have lived with this terror and have not gone mad. They saved their sanity by believing in the necessity and the value of the sacrifice. They gave up their bodies and accepted their symbolic death, but by this action they robbed the terror of its sting. A body that lacks all feeling can no longer be frightened or shocked.
Thus, the two maneuvers by which the schizoid can defend himself can be described as (1) the rigid barricade, or (2) the retreat from the field of action. In the retreat the schizoid individual surrenders most of his troops (muscular tone) and loses the ability to fight