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 has a paralyzing effect upon the body. Normally, an individual reacts to fear with fight or flight. He attempts to remove the danger or to escape it. If these reactions are blocked, his self-control is shattered. His personality collapses and his sanity is threatened. In this situation insanity can be avoided by certain maneuvers which deny and repress the fear. Some measure of self-control is reestablished, but the fear is not eliminated. In its repressed state it becomes a vague terror. It is transformed into the fear of losing control or going out of one's mind.
Underlying the fear of insanity is a terror which is all the more frightening since it is nameless and faceless. Its horror is expressed in such images as the snake pit. This terror lurks in the depths of each schizoid individual and can be compared to an unexploded bomb. The explosion of the terror into consciousness is a “world shattering” experience for the individual. It is represented in the schizoid mind as a world-destruction, or Weltuntergang fantasy or as a feeling of total annihilation. The schizoid individual reacts to this threat with a feeling of “falling apart” or “going to pieces.” Against this terror and its catastrophic effects he erects desperate defenses. If these defenses fail, the only means left of avoiding this terror is the complete escape into the unreality of schizophrenia.
Superficially, the terror appears to be related to the fear of insanity. Jack, whose case was presented in Chapter 2, said, “I think I'm just plain afraid of losing my mind.” Most patients experience the terror similarly. However, it can be shown that terror itself is the force that threatens to overwhelm the ego and destroy the sanity of the individual, and the schizophrenia is a final attempt to escape this terror. What is this nameless fright?
Fears become nameless and faceless when they are repressed. In the unconscious, they live on, with the terrifying effect they had upon the child. After a patient has been successfully released from the grip of this terror, some of its elements become clear. These are the fear of being abandoned, the fear of being destroyed, and the fear of destroying someone. But these are specific fears because they are conscious, while the unconscious terror of the schizoid is an amorphous dread whose tentacles chill the bones and paralyze the will. This terror is like the proverbial skeleton in the closet, which becomes less frightening when the door has been opened and its reality confronted. Before the closed door which hides the unknown, the person trembles with an overwhelming fear that saps his courage and defeats his resolution. Therapy must help the patient gain the courage and strength to face his fears. In the process, he will inevitably experience his terror. With the support and understanding of the therapist, this experience can have a positive effect.
Paul reported such an experience after having been in therapy about a year:
I've had a strange week. I have been alternating between periods of absolute helplessness and feeling much more alive. Friday I was quite active, but Saturday I just couldn't get on my feet. I felt the whole day slip through my fingers. I got very depressed and I cried a little. Sunday was better. I went out. Monday I felt so completely dead I just wanted to lie in bed the rest of my life.
That night I was coming out of a dream and in a half awake state; I turned over on my back and reached out with my mouth to suck. My lips were trembling, and I became very anxious and almost paralyzed. My arms felt heavy and lifeless, like dead weights which I couldn't move. I had to use all my will power
