also guarantees a steady stream of impulses reaching to the world for satisfaction. In the absence of this pleasure function, impulses are tentative and infrequent. The schizoid person therefore depends upon his will to cement mind to body. But the will, though hard as steel, is brittle, whereas pleasure is flexible and pervasive. It acts like the sap in the living tree to provide strength and elasticity.
The idea that there are two different mechanisms for maintaining the unity of a personality suggests that there may be some validity to the concept that somatic illness and mental illness tend to be mutually exclusive and antithetical, and that, broadly speaking, an individual is predisposed to one or to the other, but not to both at the same time. Under conditions of insupportable stress, these two unifying forces may be expected to give way with different results. When the pleasure functions disintegrate, one may generally expect somatic illness, while the disintegration of the will produces mental illness. Thus, one can anticipate an interchangeability of symptoms, depending on the state of functioning of the total organism. Leopold Bellak comments on this same phenomenon, “The low incidence of allergic disorders in psychotics, and the return of allergic complaints after improvements and recovery, is probably one of the best documented instances of such interchangeability.”17
My clinical experience is that schizophrenics rarely manifest the symptoms of a common cold; when they do, I regard it as a sign of clinical improvement. It is also well documented that states of intense emotional excitement and upheaval may alleviate physical afflictions in normal individuals. An example is the effect of emotional shock upon the condition of rheumatoid arthritis. The remission of this illness due to emotional shock was one of the observations that led to the use of cortisone in the treatment of this condition. Cortisone is similar in action to the corticosteroids which are produced by the adrenal gland in conditions of stress or shock.
The interchangeability of symptoms is dramatically illustrated in the following case of a male schizophrenic patient whom I treated for a number of years. In the course of therapy most of his schizophrenic tendencies and manifestations were considerably reduced. At one point, after what I felt had been a significant improvement, the patient developed an epidermoid cancer at the tip of his nose. Actually, the patient had been aware of this growth for some time, but had ignored it. The patient had a history of X-ray treatments on his face for an acne condition many years earlier. However, the appearance of the cancer at this particular time in the therapy seemed significant to me. Was it possible that when his escape into psychosis as a withdrawal from reality was prevented by the analytic working-through of the schizophrenic mechanisms, he attempted to withdraw from life by developing a cancer? This interpretation was accepted by the patient and proved helpful to his therapy. An operation was successfully performed, which led the patient to comment, “I guess I cut off my nose to spite my face.” Following the operation, however, the patient made a big step forward toward building a stable personality.
I do not wish to suggest that physical illness does not occur among schizophrenics or that schizophrenia cannot develop in the presence of somatic disease. We are dealing with tendencies which, while they are mutually exclusive as theoretical postulates, are only relatively so in life. One may hypothesize that once the ego anchors in reality it cannot easily be dislodged.
THE SCHIZOID RETREAT
The schizoid individual defends himself against terror and insanity by one of two strategies. The most common defensive strategy, as has been described above, is a physical and psychological rigidity that serves to repress feeling and keep the body under the control of the ego. It is structured to withstand insults from the outside world in the form of rejection and disappointment. It is a fortress within which the schizoid lives in the relative security of illusion and fantasy.
But not all schizoid individuals show this typical rigidity. Many, including Barbara, whose case was presented in Chapter 1, show in their body structures a superficial flabbiness or lack of muscle tone instead of the rigidity described above. Impulse formation is further reduced—to the point where the body looks more dead than alive, the peripheral charge is very low, and skin color is pasty yellow or muddy brown. Logically, such a condition would follow the breakdown of the rigid defense and lead to schizophrenia. However, in Barbara's case it may be postulated that a collapse occurred in early childhood, before a rigid defense could be structured by her personality. Barbara gave in before she could fight back.
To account for a personality that remains sane yet whose body structure shows collapse, it is necessary that the concept of the schizoid defense against terror be extended beyond that of rigidity. When the terror is extreme, a more desperate maneuver is required. What could be more terrifying than to picture oneself as the victim of a human sacrifice? The feelings which this image evokes would be enough to drive one out of his mind. Yet Barbara and other patients have lived with this terror and have not gone mad. They saved their sanity by believing in the necessity and the value of the sacrifice. They gave up their bodies and accepted their symbolic death, but by this action they robbed the terror of its sting. A body that lacks all feeling can no longer be frightened or shocked.
Thus, the two maneuvers by which the schizoid can defend himself can be described as (1) the rigid barricade, or (2) the retreat from the field of action. In the retreat the schizoid individual surrenders most of his troops (muscular tone) and loses the ability to fight back, although 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
