he retains control of the rest of his personality. He may be compared to a general without an army, but he is very much better off than an army in chaos without a general. The schizophrenic condition is one of chaos in which each faculty of the personality abandons the others. The schizoid retreat is a maneuver to avoid a rout.
In both schizoid rigidity and schizoid retreat the defense against insanity is the power of the rational mind to sustain the individual's function in society under all conditions. In schizoid rigidity the mind acts through the will. In the schizoid retreat the will is inoperative, but the mind joins forces with the enemy to avoid a final defeat. Barbara did this by identifying with her demon. Having no will to cope with danger, Barbara avoided disaster by being submissive in every situation. This submission was tolerable, since it could be rationalized as a sacrifice in the interest of survival.
Generally, these two defense maneuvers are mutually exclusive. The individual who has committed all his energies to the rigid barricade cannot retreat if his defense is overrun. His ego lacks the flexibility to rationalize a defeat and the collapse of his resistance could lead to a psychotic break. The schizoid individual whose defense is based on retreat and sacrifice has lost the possibility of making a stand. A further retreat becomes impossible, and if required, decompensation into schizophrenia would occur. Nevertheless, these two defense maneuvers are related to each other logically and historically. Logically, schizoid rigidity is a defense against collapse, while the retreat stems from a breakdown of a previous resistance. Historically, it can be shown that the schizoid maneuver of retreat and sacrifice developed at an early age in the child following an unsuccessful effort to erect a rigid defense against the impact of parental hostility.
BREAKDOWN AND SCHIZOPHRENIA
Since the schizoid defense serves to keep repressed impulses in check, it depends upon a degree of control that taxes the endurance of the individual. Consequently many forces can upset the schizoid equilibrium and bring on a psychotic episode. It is not his defense which protects the schizoid person against a nervous breakdown, but the amount of health which persists in his personality. Here follow a few of the common situations that can produce a collapse in the schizoid structure.
1. Often an acute psychotic attack is brought on by the use of a drug which temporarily prevents the mind from exercising its control over the body. Mescaline and LSD function in this way. Under the influence of these hallucinogenic drugs, direct contact with the body is broken. The sensations and fantasies which flood the schizoid mind often produce a feeling of terror so overwhelming that it shatters the ego. It may be recalled that Jack was shocked by his experience with mescaline. The danger of LSD in the treatment of borderline schizophrenics is now recognized.
2. Lack of sleep, as Paul Federn has pointed out,18 is another factor which may produce a psychotic break in predisposed individuals. It has been shown that sleep deprivation produces hallucinatory phenomena even in normal individuals. Lack of sleep weakens the mind's control of the body. A breakdown may occur in a schizoid individual who spends his nights studying for exams.
3. Emotional situations which the schizoid individual cannot handle may produce a break-down. Schizoid patients have been known to crack up in the face of an impending marriage, a financial crisis, or following the birth of a child. One of my patients attempted suicide after rejection by a young man.
4. Critical periods of life: adolescence and menopause. Adolescence with its surging sexual impulses is a particularly difficult period for the schizoid personality. Indeed, schizophrenia was formerly called dementia praecox because it occurred most frequently in early adulthood. Menopause is another period when inadequate ego adjustments collapse under the impact of strong emotions, often plunging the individual into an emotional crisis.
A nervous breakdown is a loss of control over feelings and behavior. Its manifestations differ, however, from one patient to another. In some patients it appears as an overwhelming anxiety and confusion. Others become wildly destructive and have to be restrained. Still others develop paranoid delusions. And some become progressively withdrawn and unresponsive. Each reacts according to the dynamics of his personality structure, that is, according to the relative strength of the repressed impulses and the defenses against them. In all cases the experience contains common elements which show that a similar process is at work. These elements are:
1. Confusion and feelings of anxiety verging on terror.
2. Estrangement—a state of partial unreality in which one cannot tell if one is dreaming or awake. In this situation one pinches oneself to tell the difference. Estrangement occurs when a person is overwhelmed by sensations.
3. Depersonalization—the loss of the feeling of self.
4. Finally, schizophrenia—a withdrawal and regression to infantile or archaic levels of functioning as a means of survival.
The person going through a breakdown is not aware that repressed feelings have broken through his defenses. Such an awareness would require self-knowledge and ego strength that the schizoid doesn't have. When he acquires these through therapy he is in a position to release the repression without danger to himself or others. The incident which sets off the breakdown may be almost insignificant. If conditions are right, it acts like the fuse which explodes the dynamite. The catastrophic result can only be explained in terms of the terror which is buried within the personality. On no other basis can one understand the extreme steps that the person will take if the terror continues.
The schizophrenic state is a denial of reality. If the denial is complete, the terror vanishes. Since one aspect of his terror is the fear of being destroyed, the schizophrenic's condition is a refuge. He can hardly be destroyed if he is not “here,” that is, not existing in present time and space. He cannot be punished if he is not himself, that is, if he is really Napoleon or Jesus Christ or some god in disguise. On the other hand, if his terror stems from his fear that he will destroy someone else, then a paranoid mechanism removes his fear. He has no reason to reproach himself, since, by means of the paranoid delusion, he is convinced that others are scheming to destroy him. It is amazing how little anxiety the paranoid individual shows when he recounts his story of imagined persecutions. Finally, not to feel and not to think dispels all fear.
4
The Forsaken Body
SELF-POSSESSION
There is something about the physical appearance of the insane individual that strikes us as strange and bizarre. We sense that he is out of contact with things around him. This impression is conveyed by certain physical signs that distinguish the schizophrenic from the normal.
I saw a girl in my office some time ago who was in an obvious psychotic state. She carried her head to one side, as if her neck were bent at an angle. Her eyes had a wild, distraught look. Her face had an expression of fear and agony. She tore at her hair with both hands, moaned and muttered. Her speech was slurred and I could not understand her. I sensed, however, that she understood what I was saying.
She was the patient of one of my associates who was on a hospital call at the time. Although she had no appointment with him, her desperation brought her to the office. She would not quiet down. Any attempt to calm her was resisted forcibly. She continued to moan and tear at her hair. When her doctor was reached he spoke to her on the phone and she became more tractable. Finally, his arrival ended the episode, for he was able to calm her and drive her home.
The appearance of this patient indicated such an evident disturbance that a glance was sufficient to reveal the diagnosis. However, no diagnosis of schizophrenia should be based simply upon a person's state of agony and torment, for it can be shown that similar agonizing emotions may occur in response to a tragic event. For example, a mother might react in like manner to the death of her child. She would moan, tear her hair, and refuse to move. The agony and torment of the insane is no less real because we are unaware of the reason for their suffering. The two situations differ, of course, in their causative factors. In the case of the mother, the anguish is related and proportionate to a known and accepted cause; the behavior of the insane person appears disproportionate to the apparent stresses of his immediate situation. The observer cannot perceive the cause of his actions; and the