9
Schizoid Personalities
The person whose character is essentially schizoid is subject to widespread misunderstanding, based on the common misconception that schizoid dynamics are always suggestive of grave primitivity. Because the incontrovertibly psychotic diagnosis of schizophrenia fits people at the disturbed end of the schizoid continuum, and because the behavior of schizoid people can be unconventional, eccentric, or even bizarre, nonschizoid others tend to pathologize those with schizoid dynamics—whether or not they are competent and autonomous, with significant areas of ego strength. In fact, schizoid people run the gamut from the hospitalized catatonic patient to the creative genius.
As with the other typological categories, a person may be schizoid at any level, from psychologically incapacitated to saner than average. Because the defense that defines the schizoid character is a primitive one (withdrawal into fantasy), it may be that healthy schizoid people are rarer than sicker ones, but I do not know of any research findings or disciplined clinical observations that support this assumption empirically. There is long-standing evidence (E. Bleuler, 1911; M. Bleuler, 1977; Nannarello, 1953; Peralta, Cuesta, & de Leon, 1991) and some recent suggestions from neuroscience and genetics (Weinberger, 2004) that the most frequent premorbid personality type in those who become schizophrenic is schizoid. But the converse idea, that all schizoid people are at risk of a psychotic break, has no empirical basis.
One reason schizoid people may be pathologized is that they are comparatively rare. People in majorities tend to assume that their own psychology is normative and to equate difference with inferiority (as happened with people of minority sexual orientation for many years). The psychoanalytic concept of the schizoid person has a lot in common with the Jungian concept of the introvert, specifically the kind of individual who would test as an introverted, intuitive, feeling, judging type (INFJ) on the Jungian-derived Myers Briggs inventory. INFJs constitute only about 1% of the overall population in the areas where personality distribution has been studied, and are understood as having strengths as “mystics” or “confidants.”
Vocations like philosophical inquiry, spiritual discipline, theoretical science, and the creative arts attract people with this kind of character. At the high-functioning end of the schizoid spectrum we might find people like Ludwig Wittgenstein, Martha Graham, and other admirably original and somewhat eccentric individuals. Albert Einstein (1931) wrote about himself:
My passionate sense of social justice and social responsibility has always contrasted oddly with my pronounced lack of need for direct contact with other human beings and human communities. I am truly a “lone traveler” and have never belonged to my country, my home, my friends, or even my immediate family, with my whole heart; in the face of all these ties, I have never lost a sense of distance and a need for solitude. . . . (p. 9)
In 1980, with the publication of DSM-III, conditions that most analysts would regard as different possibilities on the schizoid spectrum, or as minor variants on a general schizoid theme, appeared as discrete categories in the DSM. Complicated theoretical issues influenced this decision (see Lion, 1986), one reflecting differences of current opinion that echo old controversies about the nature of certain schizoid states (Akhtar, 1992; E. Bleuler, 1911; Gottesman, 1991; Jaspers, 1963; Kraepelin, 1919; Kretschmer, 1925; Schneider, 1959). Many analytic practitioners continue to regard the diagnoses of schizoid, schizotypal, and avoidant personality disorders as nonpsychotic versions of schizoid character, and the diagnoses of schizophrenia, schizophreniform disorder, and schizoaffective disorder as psychotic levels of schizoid functioning.
I am often asked whether I see schizoid people as on the autistic spectrum, and I am not sure how to answer. Our taxonomic categories remain arbitrary and overlapping, and acting as if there are discrete present-versus-absent differences between labels is not usually wise clinically, when one is trying to get a sense of a patient’s individual uniqueness. Perhaps schizoid psychology, especially in its high-functioning versions, can be reasonably viewed as at the healthy end of the autistic spectrum. Certainly on the basis of their observable behavior, some schizoid individuals seem as unrelated, odd, and detached as those with diagnosed autism or Asperger syndrome.
But people who are diagnosably autistic often report an internal inability to imagine what others are thinking and feeling and being motivated by, whereas schizoid people, despite their withdrawal, are more likely to be preternaturally attuned to the subjective experience of others. I have heard Asperger-diagnosed parents say that they had to be taught that their children need to be hugged. Even if he had trouble getting himself to hug his child, a schizoid father would have no difficulty understanding the child’s need. Schizoid people are more likely to describe themselves as overwhelmed by affect than as lacking it. So in these areas there seems to me a significant difference in the territory under consideration.
DRIVE, AFFECT, AND TEMPERAMENT
IN SCHIZOID PSYCHOLOGY
Clinical experience suggests that temperamentally, the person who becomes schizoid is hyperreactive and easily overstimulated. Schizoid people often describe themselves as innately sensitive, and their relatives frequently mention their having been the kind of baby who shrinks from too much light or noise or motion (cf. Bergman & Escalona, 1949, on babies with unusual sensitivities). It is as if the nerve endings of schizoid individuals are closer to the surface than those of the rest of us. Doidge (2001) depicts them as “hyperpermeable” to external impingements. Although most infants cuddle, cling, and mold themselves to the body of a warm caregiver, some newborns stiffen or pull back as if the adult has intruded on their comfort and safety (Brazelton, 1982; Kagan, 1994). One suspects that such babies are constitutionally prone to schizoid personality structure, especially if there is a “poor fit” (Escalona, 1968) between themselves and their main caregivers.
In the area of drive as classically understood, the schizoid person seems to struggle with oral-level issues. Specifically, he or she is preoccupied with avoiding the dangers of being engulfed, absorbed, distorted, taken over, eaten up. A talented schizoid therapist in a supervision group I belonged to once described to the group members his vivid fantasy that the physical circle of participants constituted a huge mouth or a giant letter C. He imagined that if he exposed his vulnerability by talking candidly about his feelings toward one of his patients, the group would close around him, making the C into an O, and that he would suffocate and expire inside it.
While fantasies like those of my colleague invite the interpretation that they constitute projections and transformations of the fantasizer’s own hunger (Fairbairn, 1941; Guntrip, 1961; Seinfeld, 1991), the schizoid person often does not experience appetitive drives as coming from within the self. Rather, the outer world feels full of consuming, distorting threats against security and individuality. Fairbairn’s understanding of schizoid states as “love made hungry” addresses not the day-to-day subjective experience of the schizoid person but the dynamics underlying the opposite and manifest tendencies: to withdraw, to seek satisfactions in fantasy, to reject the corporeal world. As Kretschmer noted in 1925, schizoid people are even apt to be physically thin, so removed are they from emotional contact with their own greed.
Similarly, schizoid people do not impress one as being highly aggressive, despite the violent content of some of their fantasies. Their families and friends often regard them as unusually gentle, placid people. A friend of mine, whose general brilliance and schizoid indifference to convention I have long admired, was described lovingly at his wedding by an older sister as having always been a “soft person.” This softness exists in fascinating contradiction to his affinity for horror movies, true-crime books, and visions of apocalyptic world destruction. The projection of drive can be easily assumed, but this man’s conscious experience—and the impression he makes on others—is of a sweet, low-keyed, lovable eccentric. Most analytic thinkers who have worked with people like my friend have inferred that schizoid clients bury both their hunger and their aggression under a heavy blanket of defense.
Affectively, one of the most striking aspects of many high-functioning individuals with schizoid dynamics is their lack of common defenses. They tend to be in touch with many emotional reactions at a level of genuineness that awes and even intimidates their acquaintances. It is common for the schizoid person to wonder how everybody else can be lying to themselves so effortlessly when the harsh facts of life are so patent. Part of the alienation from which schizoid people suffer derives from their experiences of not having their own emotional, intuitive, and sensory capacities validated—because others simply do not see what they do. The ability of a schizoid person to perceive what others disown or ignore is so natural and effortless that he or she may lack empathy for the less lucid, less ambivalent, less emotionally harrowing world of nonschizoid peers.
Schizoid people do not seem to struggle quite the way narcissistic people do with shame or introjectively depressive people do with guilt. They tend to take themselves and the world pretty much as is without the internal impetus to make things different or to shrink from judgment. Yet they may suffer considerable anxiety about basic safety. When they feel overwhelmed, they hide—either literally with a hermit’s reclusiveness or by retreat into their imagination (Kasanin & Rosen, 1933; Nannarello, 1953). The schizoid person is above all else an outsider, an onlooker, an observer of the human condition. One of my schizoid friends told me his tombstone should read, “Here lies ___________. He read and thought about life to the hilt.”
The “split” implied in the etymology of the word “schizoid” exists in two areas: between the self and the outside world, and between the experienced self and desire (see Laing, 1965). When analytic commentators refer to split experience in schizoid people, they refer to a sense of estrangement from part of the self or from life that is essentially “dissociative” (another word used frequently by analysts personally and professionally acquainted with schizoid psychology, such as D. W. Winnicott). The defense mechanism of splitting, in which a person alternately expresses one ego state and then another opposite one, or divides the world defensively into all-good and all-bad aspects, is a different use of the word.
DEFENSIVE AND ADAPTIVE PROCESSES
IN SCHIZOID PSYCHOLOGY
As I noted previously, the pathognomonic defense in schizoid personality organization is withdrawal into an internal world of imagination. In addition, schizoid people may use projection and introjection, idealization, devaluation, and to a lesser extent, the other defenses that have their origins in a time before self and other were fully differentiated psychologically. Among the more “mature” defenses, intellectualization seems to be the preference of most schizoid people. They rarely rely on mechanisms that blot out affective and sensory information, such as denial and repression; similarly, the defensive operations that organize experience along good-and-bad lines, such as compartmentalization, moralization, undoing, reaction formation, and turning against the self, are not prominent in their repertoires. Under stress, schizoid individuals may withdraw from their own affect as well as from external stimulation, appearing blunted, flat, or inappropriate, often despite showing evidence of heightened attunement to affective messages coming from others.
The most adaptive and exciting capacity of the schizoid person is creativity. Most truly original artists have a strong schizoid streak—almost by definition, given that one has to stand apart from convention to influence it in a new way. Healthier schizoid people turn their assets into works of art, scientific discoveries, theoretical innovations, or spiritual pathfinding, while more disturbed individuals in this category live in a private hell where their potential contributions are preempted by their terror and estrangement. The sublimation of autistic withdrawal into creative activity is a primary goal of therapy with schizoid patients.
RELATIONAL PATTERNS IN SCHIZOID PSYCHOLOGY
The primary relational conflict of schizoid people concerns closeness and distance, love and fear. A deep ambivalence about attachment pervades their subjective life. They crave closeness yet feel the constant threat of engulfment by others; they seek distance to reassure themselves of their safety and separateness yet may complain of alienation and loneliness (Eigen, 1973; Karon & VandenBos, 1981; Masterson & Klein, 1995; Modell, 1996; Seinfeld, 1991). Guntrip (1952), who depicted the “classic dilemma” of the schizoid individual as “that he can neither be in a relationship with another person nor out of it, without in various ways risking the loss of both his object and himself,” refers to this dilemma as the “in and out programme” (p. 36).
Schopenhauer’s famous parable about porcupines on a cold night (see Luepnitz, 2002) captures the dilemma of schizoid people: When they move close for warmth, they prick one another; when they move away from the pain, they get cold. This conflict can be enacted in the form of intense but brief connection followed by long periods of retreat. A. Robbins (1988) summarizes the dynamic as the message, “Come close for I am alone, but stay away for I fear intrusion” (p. 398). Sexually, some schizoid people are remarkably apathetic, often despite being functional and orgasmic. The closer the other, the greater the worry that sex means enmeshment. Many a heterosexual woman has fallen in love with a passionate musician, only to learn that her lover reserves his sensual intensity for his instrument. Similarly, some schizoid people crave unattainable sexual objects, while feeling vague indifference toward available ones. The partners of schizoid people sometimes complain of a mechanical or detached quality in their lovemaking.
Object relations theories of the genesis of schizoid dynamics have been, in my own view, burdened by efforts to locate the origins of schizoid states in a particular phase of development. The adequacy of the fixation–regression hypothesis in accounting for type of character structure is, as I suggested previously, problematic, yet its appeal is understandable: It normalizes puzzling phenomena by considering them simple residues of ordinary infantile life. Melanie Klein (1946) thus traced schizoid mechanisms to a universal paranoid–schizoid position of early infancy, before the child has fully taken in the separateness of others. Other early object relations analysts followed suit in developing explanatory paradigms in which schizoid dynamics were equated with regression to neonatal experience (Fairbairn, 1941; Guntrip, 1971). For a long time, theorists tended to accept the developmental bias of the fixation–regression model, yet they differed about which early phase is the fixation point. For example, in the Kleinian tradition, Giovacchini (1979) regarded schizoid disorders as essentially “prementational,” whereas Horner (1979) assigned their origins to a later age when the child emerges from symbiosis.
The concept of schizoid personality overlaps considerably with the paradigm of avoidant attachment, one of the insecure attachment styles (Wallin, 2007). Babies labeled “avoidant” or “dismissive” by attachment researchers react to Ainsworth’s Strange Situation with what looks like indifference to whether or not their mother is present. Although they may seem perfectly comfortable, their heart rates during separation have been found to be elevated, and their cortisol (stress hormone) levels rise (Spangler & Grossmann, 1993; Sroufe & Waters, 1977). Ainsworth and colleagues (1978) reported that the mothers of these children were rejecting of their normal dependency. Grossmann and Grossmann (1991) later noted that they were particularly unresponsive to sadness in their babies. Main and Weston (1982) described mothers of avoidant infants as brusque, emotionally unexpressive, and averse to physical contact with their children.
These findings are interesting to consider in the context of clinical speculations about the interpersonal etiologies of schizoid personality. A parent who is dismissive or contemptuous of a child’s neediness could certainly foster a defensive self-sufficiency in that child (Doidge, 2001; Fairbairn, 1940). Some people with a history of early isolation and neglect may be understood as having learned to make a virtue out of a necessity by avoiding closeness and relying on their inner world for stimulation. Harry Stack Sullivan and Arthur Robbins, two analysts whose own schizoid trends prompted them to interpret the schizoid experience to the larger mental health community, both suffered significant early deprivation of companionship (Mullahy, 1970; A. Robbins, 1988).
A seemingly opposite type of relatedness that may encourage a child’s withdrawal is an impinging, overinvested, overinvolved kind of parenting (Winnicott, 1965). The schizoid man with the smothering mother is a staple of popular literature and can also be found in scholarly work. A type of family background commonly reported to clinicians by schizoid male patients is a seductive or boundary-transgressing mother and an impatient, critical father. Although DSM-IV gives no information on gender distribution for schizoid, schizotypal, and avoidant diagnoses, it is my impression that therapists see more males than females with schizoid personalities. This would accord with the psychoanalytic observation that because most primary caregivers are female, and because girls identify with female caregivers whereas boys tend to disidentify from them eventually (Chodorow, 1978, 1989; Dinnerstein, 1976), women are more prone to disorders characterized by too much attachment (e.g., depression, masochism, dependent personality disorders) and men to those characterized by too little (e.g., psychopathy, sadism, schizoid conditions).
The content, not just the degree, of parental involvement may also contribute to the development of a pattern of schizoid aloofness and withdrawal. Numerous observers of the families of people who developed a schizophrenic psychosis have stressed the role of contradictory and confusing communications in psychotic breakdowns (Bateson et al., 1956; Laing, 1965; Lidz & Fleck, 1965; Searles, 1959; Singer & Wynne, 1965a, 1965b). It is possible that such patterns foster schizoid dynamics in general. A child raised with double-binding, pseudomutual, emotionally dishonest messages could easily come to depend on withdrawal to protect the self from intolerable levels of confusion and anger. He or she would also feel deeply hopeless, an attitude often noted in schizoid patients (e.g., Giovacchini, 1979).
It is typical of the literature on schizoid phenomena—an extensive literature because of the huge social cost of schizophrenia—that contrasting and mutually exclusive formulations can be found everywhere one looks (Sass, 1992). These inconsistencies uncannily mirror the dissociated self-states of the schizoid person. It is not impossible that both impingement and deprivation codetermine the schizoid pattern: If one is lonely and deprived, yet the only kind of parenting available is unempathic and intrusive, a conflict between yearning and avoiding, between closeness and distance, would be highly likely.
Elizabeth Howell (2005) notes that Fairbairn’s conceptualization of schizoid experience can form a basis for also understanding dissociative disorders, borderline phenomena, and narcissism (p. 3), all of which have elements of falseness, split experience, difficulty with affect tolerance, and internalization of toxic others. Schizoid psychology in particular may emerge from a pattern of microdissociations in response to traumatic overstimulation by caregivers who are insensitive to the child’s temperamental sensitivity and intensity. Masud Khan’s (1963, 1974) studies of schizoid conditions inferred “cumulative trauma” from failures of realistic maternal protection inherent in the mother’s intense overidentification with the baby. Some contemporary students of trauma and dissociation (e.g., R. Chefetz, personal communication, September 12, 2010) consider schizoid psychology to be understandable through the lens of dissociative processes (disordered affect regulation and somatic experience, chronic depersonalization and/or derealization, etc.) as the product of repetitive relational trauma. In a vivid communication of this process, a talented musician once told me, with characteristic schizoid access to imagery, that before his father died (when he was 9), the world was in color; afterward, it was in black and white.
THE SCHIZOID SELF
One of the most striking aspects of people with schizoid personalities is their disregard for conventional social expectations. In dramatic contrast to the narcissistic personality style, the schizoid person may be markedly indifferent to the effect he or she has on others and to evaluative responses coming from those in the outside world. Compliance and conformity go against the grain for schizoid people, whether or not they are in touch with a painful subjective loneliness. Even when they see some expediency in fitting in, they tend to feel awkward and even fraudulent making social chitchat or participating in communal forms, regarding them as essentially contrived and artificial. The schizoid self tries to stand at a safe distance from the rest of humanity.
Many observers have commented on the detached, ironic, and faintly contemptuous attitude of many schizoid people (E. Bleuler, 1911; M. Bleuler, 1977; Sullivan, 1973). This tendency toward an isolated superiority may have its origins in fending off the incursions of an overcontrolling or overintrusive Other about which I have just hypothesized. Even in the most seemingly disorganized schizophrenic patients, a kind of deliberate oppositionality has long been noted, as if the patient’s only way of preserving a sense of self-integrity is in making a farce of every conventional expectation. Under the topic of “counter-etiquette,” Sass (1992) comments on this phenomenon:
Cross-cultural research has shown ... that schizophrenics generally seem to gravitate toward “the path of most resistance,” tending to transgress whatever customs and rules happen to be held most sacred in a given society. Thus, in deeply religious Nigeria, they are especially likely to violate religious sanctions; in Japan, to assault family members. (p. 110)
One way of understanding these apparently deliberate preferences for eccentricity and defiance of custom is to assume that the schizoid person is assiduously warding off the condition of being defined—psychologically taken over and obliterated—by others.
Abandonment is thus a lesser evil than engulfment to schizoid people. Anticipating Blatt’s (2008) comprehensive work on the polarities of self-definition and relationship, Michael Balint (1945), in a famous essay with the evocative title “Friendly Expanses—Horrid Empty Spaces,” contrasted two antithetical characters: the philobat (lover of distance), who seeks the comforts of solitude when upset, and the “ocnophil” (lover of closeness), who gravitates toward others, seeking a shoulder to cry on. Schizoid people are the ultimate philobats. Perhaps predictably, since human beings are often drawn to those with opposite and envied strengths, schizoid people tend to attract (and to be attracted to) warm, expressive, sociable people such as those with hysterical personalities. These proclivities set the stage for certain familiar and even comic problems in which the nonschizoid partner tries to resolve interpersonal tension by continually moving closer, whereas the schizoid person, fearing engulfment, keeps moving farther away.
I do not want to give the impression that schizoid individuals are cold or uncaring. They may care very much about other people yet still need to maintain a protected personal space. Some gravitate to careers in psychotherapy, where they put their exquisite sensitivity to use safely in the service of others. Allen Wheelis (1956), who may have experienced himself as schizoid, wrote an eloquent essay on the attractions and hazards of a psychoanalytic career, stressing how people with a core conflict over closeness and distance may be drawn to the profession of psychoanalysis. As an analyst, one gets to know others more intimately than anyone else has ever known them, but one’s own exposure is within predictable professional bounds.
For someone with schizoid dynamics, self-esteem is often maintained by individual creative activity. Issues of personal integrity and self-expression tend to dominate self-evaluative concerns. Where the psychopath pursues evidence of personal power, or the narcissist seeks admiring feedback to nourish self-regard, the schizoid person wants confirmation of his or her genuine originality, sensitivity, and uniqueness. This confirmation must be internally rather than externally bestowed, and because of their high standards for creative endeavors, schizoid people are often rigorously self-critical. They may take the pursuit of authenticity to such extreme lengths that their isolation and demoralization are virtually guaranteed.
Sass (1992) has compellingly described how schizoid conditions are emblematic of modernity. The alienation of contemporary people from a communal sensibility, reflected in the deconstructive perspectives of 20th-century art, literature, anthropology, philosophy, and criticism, has eerie similarities to schizoid and schizophrenic experience. Sass notes in particular the attitudes of alienation, hyperreflexivity (elaborate self-consciousness), detachment, and rationality gone virtually mad that characterize modern and postmodern modes of thought and art, contrasting them with “the world of the natural attitude, the world of practical activity, shared communal meanings, and real physical presences” (p. 354). His exposition also calls effectively into question numerous facile and oversimplified accounts of schizophrenia and the schizoid experience.
TRANSFERENCE AND COUNTERTRANSFERENCE
WITH SCHIZOID PATIENTS
Although one would assume intuitively from their predilection for withdrawal that schizoid people would shun encounters as intimate as psychotherapy and psychoanalysis, when treated with consideration and respect, they are often appreciative of and cooperative in the therapy process. The clinician’s discipline in addressing the client’s own agenda, and the safe distance created by the customary boundaries of treatment (time limitations, fee arrangements, ethical prohibitions against social or sexual relationships with clients), seem to decrease the schizoid person’s fears about enmeshing involvements.
Schizoid clients approach therapy with the same combination of sensitivity, honesty, and fear of engulfment that typifies their other relationships. They may be seeking help because their isolation from the rest of the human community has become too painful, or because they have suffered a loss of one of the very few people they felt close to, or because they have circumscribed goals related to their isolation, such as a wish to get over an inhibition against dating or pursuing other specific social behaviors. Sometimes the psychological disadvantages of their personality type are not evident to them; they may want relief from a depression or an anxiety state or another symptom syndrome. At other times, they may arrive for treatment afraid—sometimes rightly—that they are on the brink of going mad.
It is not uncommon for a schizoid person to be tongue-tied and to feel empty, lost, and pained in the early phases of therapy. An anguished schizoid woman I treated (McWilliams, 2006a), who became mute for long periods in every session, finally telephoned to tell me, poignantly, “I want you to know that I want to talk to you, but it hurts too much.” A therapist may have to endure long silences while the patient internalizes the safety of the setting. Eventually, however, unless a client is excruciatingly nonverbal or confusingly psychotic, most people with schizoid psychologies are a pleasure to work with. As one would expect, they are often highly perceptive of their internal reactions, and they are grateful to have a place where honest self-expression will not arouse alarm, disdain, or derision. I have been touched many times by the gratitude of schizoid individuals when they feel understood and treated with respect, not only when patients have expressed such appreciation, but when I get warm e-mails from self-diagnosed schizoid readers who spontaneously thank me for writing this chapter and another article (McWilliams, 2006b) that explores their psychology without pathologizing them.
The initial transference–countertransference challenge for the therapist working with a schizoid patient is to find a way into the person’s subjective world without arousing too much anxiety about intrusion. Because schizoid people may withdraw into detached and obscure styles of communication, it is easy to fall into a counterdetachment, in which one regards them as interesting specimens rather than as fellow creatures. Their original transference “tests,” as per control–mastery theory, involve efforts to see whether the therapist is concerned enough for them to tolerate their confusing, off-putting messages while maintaining the determination to understand and help. Naturally, they fear that the therapist will, like other people in their lives, withdraw from them emotionally and consign them to the category of hopeless recluse or amusing crackpot.
The history of efforts to understand schizoid conditions is replete with examples of “experts” objectifying the lonely patient, being fascinated at schizoid phenomena but keeping a safe distance from the emotional pain they represent and regarding the schizoid person’s verbalizations as meaningless, trivial, or too enigmatic to bother to decode. The current psychiatric enthusiasm for physiological explanations of schizoid states is a familiar version of this disposition not to take the schizoid person’s subjectivity seriously. As Sass (1992) has argued, efforts to find biochemical and neurological contributions to schizoid and schizophrenic states do not obviate the continuing need to address the meaning of the schizoid experience to the patient. In The Divided Self, R. D. Laing (1965) reassesses a schizophrenic woman interviewed by Emil Kraepelin. The patient’s words, which had been incomprehensible to Kraepelin, gain meaning when regarded from Laing’s empathic perspective. Karon and VandenBos (1981) present case after case of helpable patients who might easily be dismissed as “management” projects by clinicians who are untrained or unwilling to try to understand them.
People who are characterologically schizoid and in no danger of a psychotic break—the majority of schizoid people—provoke much less incomprehension and defensive detachment in their therapists than do hospitalized schizophrenics, the subject of most of the serious analytic writing on pathological withdrawal. But the same therapeutic requirements apply, in less extreme degree. The patient needs to be treated as if his or her internal experience, even if outlandish to others, has potentially discernable meaning and can constitute the basis for a nonthreatening intimacy with another person. The therapist must keep in mind that the aloofness of the schizoid client is an addressable defense, not an insurmountable barrier to connection. If the clinician can avoid acting on countertransference temptations either to prod the patient into premature disclosure, or to objectify and distance him or her, a solid working alliance should evolve.
Once a therapeutic relationship is in place, certain other emotional complexities may ensue. In my experience, the subjective fragility of the schizoid person is mirrored in the therapist’s frequent sense of weakness or helplessness. Images and fantasies of a destructive, devouring external world may absorb both parties to the therapy process. Counterimages of omnipotence and shared superiority may also be present (“We two form a universe”). Fond perceptions of the patient as a unique, exquisite, misunderstood genius or underappreciated sage may dominate the therapist’s inner responses, perhaps in parallel to the attitude of an overinvolved parent who imagined greatness for this special child.
THERAPEUTIC IMPLICATIONS OF THE DIAGNOSIS
OF SCHIZOID PERSONALITY
The therapist who works with a schizoid patient must be open to a degree of authenticity and a level of awareness of emotion and imagery that would be possible only after years of work with patients of other character types. While I have known many practitioners who do well with many kinds of clients without having undergone a thoroughgoing personal analysis, I doubt that unless they are schizoid themselves, they can respond effectively to schizoid patients without having had extensive therapeutic exposure to their own inner depths.
Because many therapists have somewhat depressive psychologies, and their fears of abandonment are thus stronger than their fears of engulfment, they naturally try to move close to people they wish to help. Empathy with the schizoid patient’s need for emotional space may consequently be hard to come by. A supervisor of mine once commented about my earnest and overly impinging efforts to reach a schizoid patient, “This man needs bicarbonate of soda, and you keep trying to feed him pumpkin pie.” Emmanuel Hammer (1968) commented on the effectiveness of simply moving one’s chair farther from the patient, thus giving nonverbal reassurance that the therapist will not intrude, hurry, take over, or smother.
In the early phases of therapy, most interpretation should be avoided on the basis of the patient’s fears of being treated intrusively. Also, schizoid patients probably know more about their inner life than the therapist can at this point. Comments and casual reactions may be gratefully accepted, but efforts to push the client beyond what he or she is expressing will disconcert or antagonize the schizoid person, increasing tendencies toward withdrawal. Susan Deri (1968) emphasized the importance of phrasing one’s remarks in the words or images just used by the patient in order to reinforce the person’s sense of reality and internal solidity. Hammer (1990) further cautioned against probing, quizzing, or treating the schizoid patient in a way that makes him or her feel like a “case.”
Normalizing is an important part of effective therapy with schizoid people. In Chapter 4 I discussed the general technique of “interpreting up” with reference to people at the psychotic end of the psychotic–borderline–neurotic axis; it may also be useful for schizoid patients at any level of psychological health because of their difficulty believing that their hyperacute reactions will be understood and appreciated. Even if they are demonstrably high functioning, most schizoid people worry that they are fundamentally aberrant, incomprehensible to others. They want to be fully known by the people they care about, but they fear that if they are completely open about their inner life, they will be exposed as freaks.
Even those schizoid people who are confident of the superiority of their perceptions are not indifferent to the effect they may have in alienating others. By behaving in a way that conveys that the schizoid person’s inner world is comprehensible, the therapist helps the client to take in the experience of being accepted without being asked to submit to the agenda of another person. Eventually, schizoid patients accrue enough self-esteem that even when other people fail to understand, they can appreciate that the difficulty may lie in the limitations of others rather than in the grotesqueness of their own sensibilities. The therapist’s reframing of imaginal richness as talent rather than pathology may be deeply relieving to schizoid people, who may have had their emotional reactions disconfirmed or minimized all their lives by less sensitive commentators.
One way to give a schizoid patient confirmation without being experienced as either engulfing or minimizing is to use artistic and literary sources of imagery to communicate understanding of the patient’s issues. A. Robbins (1988) describes the early part of his own psychoanalysis as follows:
When there were many lengthy silences in which I had little sense of what to say or how to communicate my feelings regarding my life history, fortunately my analyst did not desert me. Sometimes he would offer me “bedtime stories” [Robbins had never been read to as a child] in the form of citing plays, literature, and movies that had some relevance to the diffuse threads and images I presented to him in treatment. My curiosity was aroused by the references, and I made a point of reading the material. The likes of Ibsen, Dostoyevsky, and Kafka became important sources of rich symbolic material that seemed to mirror and clarify my inner experiences. Literature, and later art, seemed to give symbolic form to what I was trying to express. Most importantly, this material provided a significant means of sharing emotionally with my analyst. (p. 394)
A. Robbins and his colleagues (1980; A. Robbins, 1989) have made rich contributions to the creative arts therapies and have elaborated on the aesthetic dimension of psychoanalytic work with clients, aspects of therapy that hold particular promise for those who are schizoid.
Perhaps the most common obstacle to therapeutic progress with schizoid patients—once the therapy relationship is soundly in place and the work of understanding is proceeding—is the tendency for both therapist and patient to form a kind of emotional cocoon, in which they feel they understand each other comfortably and look forward to therapy sessions as a respite from a demanding world. Schizoid people have a tendency, with which an empathic therapist may unwittingly collude, to try to make the therapy relationship a substitute for, rather than an enhancer of, their lives outside the consulting room. Considerable time may go by before the therapist notices that although the patient develops rich insights in nearly every session, he or she has not gone to a social function, asked anybody out, improved a sexual relationship, or embarked on a creative project.
The generalization to the outside world of the schizoid client’s attainment of a safe intimacy with the therapist can be a challenge. The therapist confronts the dilemma of having been hired to foster better social and intimate functioning yet realizing that any reminders to the patient that he or she is not pursuing that goal may be received as intrusive, controlling, and unempathic with the need for space. This tension is addressable, and the naming of it may deepen the schizoid person’s appreciation of how powerful is the conflict between desire for closeness and fear of it. As with most aspects of therapy, timing is everything.
A. Robbins (1988) has emphasized the importance of the therapist’s willingness to be seen as a “real person,” not just a transference object. This recommendation has particular relevance for the schizoid person, who has an abundance of “as if” relationships and needs the sense of the therapist’s active participation as a human being: supporting risks in the direction of relationships, being playful or humorous in ways that were absent in the schizoid person’s history, and responding with attitudes that counteract the patient’s tendencies to hide or “pass” or go through the motions of connecting emotionally with others. Authenticity is important with every client, but for those with schizoid personalities, it is critical at a cellular level. With these sensitive people who have radar for falseness, one finds that the client’s transference reactions are not only not obscured by a more responsive therapeutic style, they may even become more accessible.
DIFFERENTIAL DIAGNOSIS
Schizoid psychology is usually easy to recognize, given the relative indifference of schizoid people to making a conventional impression on the interviewer. The central diagnostic challenge is assessing the strength of the client’s ego: schizoid people may be misunderstood as both more and less troubled than they are, depending on what they share with the interviewer. Less portentously, some obsessive and compulsive people, especially in the borderline-to-psychotic range, are easily misconstrued as more schizoid than they are.
Degree of Pathology
It is critical, first of all, to evaluate how disturbed a person in the schizoid range is. It is probably experience with the importance of this dimension that led the contributors to DSM-IV to give several alternative schizoid diagnoses, something they did not do for several other personality disorders that also exist with a wide range of severity. Obviously, it is critical to consider possible psychotic processes in an intake interview; questions about hallucinations and delusions, attention to the presence or absence of disordered thinking, evaluation of the patient’s capacity to distinguish ideas from actions, and, in puzzling instances, psychological testing are warranted with people who present with a schizoid style. Medication and/or hospitalization may be indicated when the results of such inquiries suggest psychosis.
Misunderstanding a schizophrenic person as a nonpsychotic schizoid personality can be a costly blunder. It is an equally unfortunate mistake, however, to assume that a patient is at risk of decompensation simply because he or she has a schizoid character. Schizoid people are often seen as sicker than they are, and for a therapist to make this error compounds the insults these clients have absorbed throughout a life in which their individuality may have always been equated with lunacy. (Actually, even with a psychotic patient, the therapist’s stance that the client is not “just” a schizophrenic but a person with significant strengths, who can reasonably expect to be helped, is the most effective reducer of psychotic-level anxiety.)
Admiration for the schizoid person’s originality and integrity is a therapeutic attitude that is easy to adopt once one has accepted the fact that schizoid processes are not necessarily ominous. Some healthy schizoid individuals who have come to therapy about a problem not inextricably tied up with their personality will not want their eccentricities to be addressed. This is their right. Therapeutic knowledge of how to make a schizoid person comfortable and self-revealing can still facilitate work on the issues that the patient does wish to confront.
Schizoid versus Obsessive and Compulsive Personalities
Schizoid people often isolate themselves and spend a great deal of time thinking, even ruminating, about the major issues in their fantasy life. They can also, because of their conflict about closeness, appear wooden and affectless, and may respond to questions with intellectualization. Some have quirks of behavior that are or appear to be compulsive, or they use compulsive defenses to arrange their lives by an idiosyncratic set of rituals that protects them from disturbing intrusions. Consequently, they can be misunderstood as having an obsessive or obsessive–compulsive personality structure. Many people combine schizoid and obsessive or compulsive qualities, but insofar as the two kinds of personality organization can be discussed as “pure” types, there are some important differences.
Obsessive individuals, in marked contrast to schizoid people, are usually sociable and, in equally marked contrast to the schizoid person’s march to a unique drummer, may be highly concerned with respectability, appropriateness, the approval of their peers, and their reputation in the community. Obsessive people are also apt to be moralistic, observing carefully the mores of their reference group, whereas schizoid people have a kind of organic integrity and are not particularly invested in mulling over conventional questions of right and wrong. People with obsessive–compulsive personalities deny or isolate feelings, whereas schizoid individuals identify them internally and pull back from relationships that invite their expression.
SUMMARY
I have emphasized how people with schizoid personalities preserve a sense of safety by avoiding intimacy with others from whom they fear engulfment and by escaping to internal fantasy preoccupations. When conflicted about closeness versus distance, schizoid people will opt for the latter, despite its loneliness, because closeness is associated with unbearable overstimulation and with having the self taken over in noxious ways. Possible constitutional sources of schizoid tendencies include hypersensitivity and hyperpermeability of the self. In addition to the use of autistic-like withdrawal into fantasy, the schizoid person employs other “primitive” defenses but also shows enviable capacities for authenticity and creativity.
I discussed the impact of these tendencies on relations with others, with attention to the patterns of family interaction that may have fostered the schizoid person’s approach–avoidance conflict, namely the coexistence of deprivation and intrusion. I framed relevant transference and countertransference issues as including difficulties in the therapist’s initial admission into the client’s world, a tendency for the therapist to share the client’s feelings of either helpless vulnerability or grandiose superiority, and temptations to be complicit with the patient’s reluctance to move toward others. I recommended maximal self-awareness in the therapist, as well as patience, authenticity, normalization, and a willingness to show one’s “real” personality. Finally, I emphasized the importance of assessing accurately a person’s location on the schizoid continuum, and I differentiated the schizoid character from obsessive and compulsive personalities.
SUGGESTIONS FOR FURTHER READING
Much commentary on schizoid conditions is buried in writing on schizophrenia. An eloquent and absorbing exception is Guntrip’s Schizoid Phenomena, Object Relations and the Self (1969). Seinfeld’s The Empty Core (1991) is also an excellent representative of object-relational thinking about schizoid psychology. More recently, Ralph Klein’s chapters about the “self-in-exile” in a book he coedited on disorders of the self (Masterson & Klein, 1995) are very helpful to the clinician. Arnold Modell’s The Private Self (1996) is an important contribution. For more of my own thinking on this topic, readers can consult my essay on the mute schizoid woman I mentioned earlier (McWilliams, 2006a) or a recent article in the journal Psychoanalytic Review (McWilliams, 2006b).
The American Psychological Association intends to put out two videos in August 2011, to be marketed as Three Approaches to Psychotherapy: The Next Generation (Beck, Greenberg, & McWilliams, in press-a, in press-b) modeled after the famous “Gloria” tapes (Shostrum, 1965), in which a woman with that pseudonym was filmed in single-session interaction with Carl Rogers, Fritz Perls, and Albert Ellis, respectively. This time, the therapists will be Judith Beck, Leslie Greenberg, and me, and there will be one DVD of our work with a male patient and one with a female patient. Readers who would like to see me doing short-term, analytically oriented work with a patient I saw as having a basically schizoid personality structure (at the healthy end of the spectrum) can watch the DVD of my interview (and those of Beck and Greenberg) with a man named Kevin (Beck, Greenberg, & McWilliams, in press-b).