to be very enlightened and do the right thing for her children. She is also the little girl who is bright, eager, excitable, and compulsive. As children, these people are characterized by insecurity; as adolescents by anxiety; and as adults by an inner feeling of frustration and failure. These reactions are more severe than the words imply. Their childhood insecurity is related to a feeling of being different and of not belonging. Their adolescent anxiety verges on panic and may end in terror. Their adult feeling of frustration and failure has an underlying core of despair.
APPROACHES TO THE SCHIZOID PROBLEM
The schizoid disturbance has been investigated along a number of lines, three of which are important to this study. These are the psychological, the physiological, and the constitutional. Psychology attempts to explain behavior in terms of conscious or unconscious mental attitudes. Physiology seeks the answers to disturbed attitudes in derangements of bodily functions. The constitutional approach relates personality to body structure.
Psychologically, the term “schizoid” is used to describe behavior which qualitatively resembles schizophrenia but is more or less within normal limits.6 The specific behavior patterns which suggest this diagnosis are summarized as follows:
1. The avoidance of any close relations with people; shyness, seclusiveness, timidity, feelings of inferiority.
2. Inability to express hostility and aggressive feelings directly— sensitivity to criticism, suspiciousness, the need for approval, tendencies to deny or distort.
3. Autistic attitudes—introversion, excessive daydreaming.
4. Inability to concentrate, feelings of being dazed or doped, sensations of unreality.
5. Hysterical outbreaks with or without apparent provocation, such as screaming, yelling, temper tantrums.
6. The inability to feel emotions, especially pleasure, and the lack of emotional responsiveness to other people, or exaggerated reactions of hyperexcitement and mania.7, 8, 9
Schizoid behavior, however, often appears to be normal. As Otto Fenichel points out, the schizoid individual has succeeded in “substituting pseudo-contacts of manifold kinds for a real feeling contact with other people.”10 Pseudo-contacts take the form of words which are substituted for touch. Another form of pseudo-contact is role playing, which is a substitute for an emotional commitment to a situation. The main complaints of schizoid individuals, as Herbert Weiner states, “revolve about their not being able to feel any emotions: they are estranged from others, withdrawn and detached.”11
It can be shown that the psychology which characterizes the schizoid individual is related to his lack of identity. Confused as to who he is, and not knowing what he wants, the schizoid individual either detaches himself from people and withdraws into an inner world of fantasy or he adopts a pose and plays a role that seemingly will fit him into normal life. If he withdraws, symptoms of shyness, seclusiveness, suspiciousness, and unreality will predominate. If he plays a role, the outstanding symptoms will be tendencies to deny or distort, sensitivity to criticism, feelings of inferiority, and complaints of emptiness or lack of satisfaction. There may be alternations between withdrawal and activity, depression and excitement, with rapid or exaggerated mood changes. The schizoid picture presents many contrasts. Some schizoids are highly intelligent and creative, although their pursuits may be limited and unusual, while others appear dull and lead empty, docile, and inconspicuous lives.
Another view of the schizoid personality, a physiological one, is offered by Sandor Rado.12 According to Rado the schizoid personality is characterized by two physiological defects. The first, an “integrative pleasure deficiency,” denotes an inability to experience pleasure. The second, “a sort of proprioceptive diathesis,” refers to a distorted awareness of the bodily self. The pleasure deficiency handicaps the individual in his attempt to develop an effective “action self,” or identity. Since pleasure is “the tie that really binds” (Rado), the action self that emerges in the absence of this binding power of pleasure is brittle, weak, prone to break under stress, hypersensitive. This pleasure deficiency to which 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
