Rado refers has characterized all the schizoid patients I have seen. But where Rado regards it as an inherited predisposition, I explain it in terms of the struggle for survival. Uncertain of his right to exist, and committing all his energies to the struggle for survival, the schizoid individual necessarily bypasses the area of pleasurable activity. To a man fighting for his right to exist, pleasure is an irrelevant concept.
The seeming distortion in self-perception is often the most striking feature of the schizoid personality. How can one explain Jack's remark, “I feel apart from my body as if I were outside watching myself'”? Is there a fault in Jack's self-perception or is his detachment due to the lack of something to perceive? When a body is devoid of feeling, self-perception fades out. However, it is equally true that when the ego dissociates from the body, the body becomes an alien object to the perceiving mind. We are confronted here with the same duality we described at the beginning of this chapter. The withdrawal from reality produces a split in the personality, just as every split results in a loss of contact with reality. The significance of body perception can be appreciated if one accepts Rado's remark that “the proprioceptive awareness [of the body] is the deepest internal root of language and thought.” 13
The weakness in the schizoid individual's self-perception is directly related to his inability to experience pleasure. Without pleasure the body functions mechanically. Pleasure keeps the body alive and promotes one's identification with it. When the body sensations are unpleasant the ego dissociates from the body. One patient said, “I made my body go dead to avoid the unpleasant feelings.”
The constitutional approach to the schizoid problem is best represented by the work of Ernst Kretschmer, who made a detailed analysis of the schizoid temperament and physique. He found that there is a close connection between the two, and that individuals with a schizoid temperament tended to have an asthenic body build, or more rarely, an athletic body build. Broadly speaking, the asthenic body can be described as long and thin, with an underdeveloped musculature, while the athletic body is more evenly proportioned and better developed muscularly. In addition Kretschmer and Sheldon14 have called attention to the presence of dysplastic elements in the schizoid body. Dysplasia refers to the fact that the different parts of the body are not harmoniously proportioned.
The four patients whose cases were discussed at the beginning of this chapter showed these typical schizoid features. Jack's body was elongated and thin, with the underdeveloped musculature of the asthenic type. Peter's body, which seemed well proportioned and muscularly developed, could be described as athletic. Jane showed dysplasia: the upper half of her body had an asthenic quality, while the lower half was amorphous and lacked definition. Sarah's body, too, had a dysplastic appearance: the upper half of her body was asthenic, in contrast to the lower half, which was markedly athletic. Her calf muscles were as developed as those of a professional dancer, although Sarah had never engaged in sports or dancing.
Body structure is important in psychiatry because it is an expression of personality. We react to a large, heavy man differently than we do to a small, wiry one. But to base the personality upon the body type is to accept a static rather than a dynamic view of the relationship between body and personality. It ignores the motility and expressiveness of the body which are the key elements in personality. The asthenic body is a meaningful classification only because it indicates the degree of an individual's muscular rigidity. The athletic body denotes a schizoid tendency only when its movements are markedly uncoordinated. Factors such as vivacity, vitality, grace, spontaneity of gesture, and physical warmth are significant because they affect self-perception and influence the feeling of identity.
Rado's view of the schizoid disturbance rests upon the hypothesis that it results from physiological dysfunctions. This is opposed to the psychoanalytic view, expressed by Silvano Arieti, that the problem is essentially psychological. Kretschmer, on the other hand, states that the schizoid condition is constitutionally determined. Whereas both Rado and Kretschmer believe that this illness has an hereditary origin, Arieti affirms that “schizophrenia [and therefore the schizoid condition] is a specific reaction to an extremely severe state of anxiety, originated in childhood, reactivated later in life.” 15
Rado, Kretschmer, and Arieti have each concentrated upon one aspect of the problem which the others regarded as secondary. Arieti concedes, for example, that “it is a well-known fact that most schizophrenics belong to the asthenic constitutional type,” 16 but he claims that it is a result of the disorder and not its cause. To avoid the argument about which comes first, we must assume that they are interrelated phenomena. The disturbances seen in body structure and physiology are an expression in the physical realm of a process which in the psychological realm appears as disorders of thought and behavior.
Psychologically, the schizoid problem is manifested in a lack of identity and, necessarily, therefore, in a loss of normal, emotional relationships to people. Physiologically, the schizoid condition is determined by disturbances in self-perception, deficiencies in the pleasure function, and disorders of respiration and metabolism. Constitutionally, the schizoid body is defective in coordination and integration. It is either too rigid or hardly held together at all. In both cases it lacks the aliveness upon which adequate self-perception depends. Without this self-perception, identity becomes confused or lost and the typical psychological symptoms appear.
A total view of the schizoid problem should present in a unified concept both the psychic and physical symptoms of the disturbance:
1 The psychological lack of identity.
2 The disturbance in self-perception.
3 The relative immobility and the diminished tone of the body surface.
The relationship between these levels of the personality may be stated as follows: The ego depends for its sense of identity upon the perception of the body. If the body is charged and responsive, its pleasure functions will be strong and meaningful, and the ego will identify with the body. In this case, the ego image will be grounded in the body image. Where the body is “unalive,” pleasure becomes impossible and the ego dissociates itself from the body. The ego image becomes exaggerated to compensate for the inadequate body image. Constitution in the dynamic sense refers to the degree of vitality and aliveness of the body.
Their relation to one another can be shown diagrammatically as a triangle.
FIG. 5 Levels of Personality
The connections between these levels of personality are illustrated in the following case. The patient was a woman who had an ego image of herself as a superior person, above average in intelligence and sensitivity. In the course of therapy this ego image was dispelled. She reported a dream in which two children, a boy and a girl, hid themselves in the basement of a building and went on a hunger strike. She related:
In my dream I feel that they are doing this out of spite. I go down into the basement, where I see their bodies lying side by side, as if they were dead, but I notice their eyes are open and their faces seem alive in contrast to the corpse-like quality of their bodies. I feel that they represent me. I have often acted spitefully in my life. I wonder if the open eyes symbolize the mind, since I feel that this is the most alive part of me.
This patient had a tall, thin body and a hollow, gaunt face which gave her appearance a cadaverous quality. She experienced her condition one day while walking with her mother in the street. She remarked, “I felt so ashamed of her that I detached myself so as not to be involved with her. I walked beside her feeling removed from her and from the world, like a ghost.” In relating this incident, the patient realized that there was an intimate connection between her dream of the corpse-like bodies, her experience of feeling like a ghost, her detachment from her body, and the appearance of her body. And then she asked me, “Why did I have to deaden myself?” The answer to this question requires an understanding of the dynamics, the mechanism, and the etiology of the schizoid problem.
3
The Defense Against Terror
FEAR AND TERROR
Fear