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Some Thoughts about Schizoid Dynamics
Nancy McWilliams
For many years I have been trying to develop a fuller understanding of the subjectivities
of individuals with schizoid psychologies. I am not referring to the version of Schizoid
Personality Disorder that appears in descriptive psychiatric taxonomies like the DSM, but to the
more inferential, phenomenologically oriented psychoanalytic understanding of schizoid issues.
I have always been more interested in exploring individual differences than in arguing about
what is and is not pathology, and I have found that when individuals with schizoid dynamics--
whether patients, colleagues, or personal friends--sense that their disclosures will not be
disdained (or “criminalized,” as one therapist recently put it), they are willing to share with me a
lot about their inner world. As is true in many other realms, when one becomes open to seeing
something, one sees it everywhere.
I have come to believe that people with significant schizoid tendencies are more common
than is typically thought, and that there is a range of mental and emotional health in such people
that runs from psychotically disturbed to enviably robust. Although I have become persuaded
that the central issues for schizoid individuals are not “neurotic-level” conflicts (cf. Steiner,
1993), I note that the highest-functioning schizoid people, of whom there are many, seem much
healthier in every meaningful respect (life satisfaction, sense of agency, affect regulation, self
and object constancy, personal relationships, creativity) than many people with certifiably
neurotic psychologies. Although the Jungian concept of “introversion” is perhaps a less
stigmatizing term, I prefer “schizoid” because it implicitly refers to the complex intrapsychic life
of the introverted individual rather than to a preference for introspection and solitary pursuits,
which are more or less surface phenomena.
One of the reasons that mental health professionals seem not to notice the existence of
high-level schizoid psychology is that many people with schizoid dynamics hide, or “pass,”
among non-schizoid others. Not only does their psychology involve a kind of allergy to being
the object of someone else’s intrusive gaze, they have learned to fear that they will be exposed as
weird or crazy. Given that non-schizoid observers do tend to attribute pathology to people who
are more reclusive and eccentric than they are, the schizoid person’s fears of being scrutinized
and found abnormal or less than sane are realistic. In addition, some schizoid people worry
about their own sanity, whether or not they have ever lost it, and their fears of being categorized
as psychotic may constitute the projection of a conviction that their inner experience is so
private, unrecognized, unmirrored, and intolerable to others that their isolation equates with
Many nonprofessionals regard schizoid people as peculiar and incomprehensible. But to
add insult to injury, mental health professionals have had a tendency to equate the schizoid with
the mentally primitive, and the primitive with the insane. Melanie Klein’s (1946) brilliant
construal of the “paranoid-schizoid position” as the precursor of the capacity to comprehend the
separateness of others (the “depressive position”) has contributed to this habit of mind, as has the
general tendency in the field to see developmentally earlier phenomena as inherently “immature”
or “archaic” (cf. Sass, 1992, p. 21, on the Great Chain of Being fallacy). In addition, we have
tended to suspect schizoid personality manifestations as being possible precursors of a
schizophrenic psychosis. Behaviors common in schizoid personality can certainly mimic the
early stages of schizophrenic withdrawal. The adolescent who begins to spend more and more
time in his room and in his fantasy life and eventually becomes frankly psychotic is a familiar
clinical phenomenon. And schizoid personality and schizophrenia may, in fact, be cousins:
Recent research into the schizophrenic disorders has identified genetic dispositions that can be
manifested anywhere on a broad spectrum from severe schizophrenia to normal schizoid
personality (Weinberger, 2004). (On the other hand, there are many people diagnosed with
schizophrenia whose premorbid personality could be conceptualized as predominantly paranoid,
obsessional, hysterical, depressive, or narcissistic.)
Another possible reason for associating the schizoid with the pathological is that many
schizoid individuals feel an affinity for people with psychotic disorders. One colleague of mine,
self-described as schizoid, prefers working with psychotically disturbed individuals to treating
“healthy neurotics,” because he experiences neurotically troubled people as “dishonest” (i.e.,
defensive), whereas he perceives psychotic ones as engaged in a fully authentic struggle with
their demons. Some seminal contributors to personality theory--Carl Jung and Harry Stack
Sullivan, for example--not only seem by most accounts to have been characterologically rather
schizoid, but may also have had one or more short-lived psychotic episodes that never turned
into a long-term schizophrenic condition. It seems safe to infer that the capacity of these analysts
to grasp the subjective experience of more seriously disturbed patients had a lot to do with their
access to their own potential for madness.
Even highly effective and emotionally secure schizoid people may worry about their
sanity. A close friend of mine found himself distressed when watching the movie, A Beautiful
Mind, which depicts the gradual descent into psychosis of the brilliant mathematician, John
Nash. The film effectively draws the audience into Nash’s delusional world and then discloses
that individuals whom the viewer had seen as real were hallucinatory figments of Nash’s
imagination. It becomes suddenly clear that his thought processes have moved from creative
brilliance to psychotic confabulation. My friend found himself painfully anxious as he reflected
on the fact that, like Nash, he can not always discriminate between times when he makes a
creative connection between two seemingly unconnected phenomena that are in fact related, and
times when he makes connections that are completely idiosyncratic, that others would find
ridiculous or crazy. He was talking about this anxiety with his relatively schizoid analyst, whose
rueful response to his description of this insecurity about how much he could rely on his mind
was, “Yeah. Tell me about it!” (In the section on treatment implications, it will become clear
why I think this was a responsive, disciplined, and therapeutic intervention, despite its seeming
to be a casual departure from the analytic stance.)
Notwithstanding the existence of some connections between schizoid psychology and
psychotic vulnerability, I have been impressed repeatedly with the phenomenon of the highly
creative, personally satisfied, and socially valuable schizoid individual who seems, despite an
intimate acquaintance with what Freud called the primary process, never to have been at serious
risk for a psychotic break. The arts, the theoretical sciences, and the philosophical and spiritual
disciplines seem to contain a high proportion of such people. So does the profession of
psychoanalysis. Harold Davis (personal communication) reports that Harry Guntrip once joked
to him that “psychoanalysis is a profession by schizoids for schizoids.” Empirical investigations
into the personalities of psychotherapists now ongoing at Macquarie University in Sydney,
Australia (Judith Hyde, personal communication) are finding that although the modal personality
type among female therapists is depressive, among male therapists, schizoid trends predominate.
My own guess about why this is so includes the observation that high-functioning
schizoid people are not surprised or put off by evidence of the unconscious. That is, they have
intimate--and at times uneasy--familiarity with processes that in most people are out of
awareness, an access that makes psychoanalytic ideas more accessible and commonsensical to
them than they are to those of us who spend years on the couch hacking through repressive
defenses to make the acquaintance of our more alien impulses, images, and feelings. Schizoid
people are temperamentally introspective; they like to wander among the nooks and crannies of
their mind, and they find in psychoanalysis many evocative metaphors for what they find there.
In addition, the professional practice of analysis and the psychoanalytic therapies offers an
attractive resolution of the central conflict about closeness and distance that pervades schizoid
psychology (cf. Wheelis, 1956).
I have always found myself attracted to schizoid people. In recent years I have realized
that most of my closest friends are describable this way. My own dynamics, which tilt more
toward the hysterical and depressive, are implicated in this attraction, in ways I speculate about
further on in this essay. In addition, I have been fascinated by an unexpected response to my
book on diagnosis (McWilliams, 1994). Although it is not unusual for me to be approached by
readers who tell me that they found a particular chapter useful in their understanding of some
personality type, or that some section of the book was helpful in their work with a patient, or
even that they found in the book a recognizable description of their own dynamics, something
distinctive occurs with respect to the section on schizoid personalities. Several times, after a
lecture or workshop, a person has come up to me (often someone who was sitting quietly in the
back, closest to the door), checked to be sure he or she was not impinging, and said something
like, “I just want to thank you for your chapter on schizoid personality. You really got us.”
In addition to the fact that these readers are expressing personal gratitude rather than
professional praise, I am struck by the use of the plural: “us.” I have been wondering lately
whether schizoid people are in a similar psychological position to that of individuals in sexual
minorities. That is, they are sensitive to the risk of being considered “deviant” or “sick” or
“behavior-disordered” by those of us with more common psychologies simply because they are a
minority. Mental health professionals sometimes discuss schizoid themes in a tone similar to the
tone in which they once spoke about the gay, lesbian, bisexual, and transgendered population.
We have tended both to equate dynamics with pathology and to generalize about a whole class of
people on the basis of individuals who have sought treatment for something problematic about
their idiosyncratic version of their psychology.
The schizoid sensitivity to being stigmatized makes sense to me in light of the fact that
the rest of us may unthinkingly reinforce in one another the assumption that our more
mainstream psychology is normative and that exceptions to it must therefore constitute
psychopathology. Obviously, another possibility is that there are significant internal differences
among people, expressing psychodynamic factors as well as others (e.g., constitutional,
experiential, and contextual), that are neither better nor worse in terms of mental health. The
human propensity to rank differences along some hierarchy of value runs deep, and minority
groups are typically relegated to the lower rungs of such hierarchies.
Consider further the significance of the term “us.” Schizoid people recognize each other.
They feel like members of what one reclusive friend of mine called “a community of the
solitary.” Like homosexually oriented people with “gaydar,” many schizoid individuals can spot
each other in a crowd. I have heard them describe a sense of deep and compassionate kinship
with one another, despite the fact that these relatively isolative people rarely verbalize such
kinship or approach each other for explicit recognition. I have noted, however, that there is
starting to be a genre of popular books that normalize and even valorize such schizoid themes as
extreme sensitivity (e.g., The Highly Sensitive Person [Aron, 1996]), introversion (e.g., The
Introvert Advantage [Laney, 2002]), and preference for solitude (e.g., Party of One: The Loner’s
Manifesto [Rufus, 2003]). A schizoid man I know described walking through a hall with several
classmates on the way to a seminar with a teacher he suspected of having a similar psychology.
On the way to the instructor’s office, they passed a photo of Coney Island on a hot day, a beach
scene with people crowded together so tightly that the sand was hardly visible. The teacher
made eye contact with my friend, nodded toward the picture, and made a wincing gesture
indicating dread and avoidance. My friend opened his eyes wider and nodded. They understood
each other.
How am I defining the schizoid personality?
I am using the term “schizoid” as it was used by the British object relations theorists
rather than as it appears in the DSM (see Akhtar, 1992, p. 139; Doidge, 2001, p. 284; Gabbard,
1994, p. 431; Guntrip, 1969). The DSM, arbitrarily and without empirical basis, differentiates
between schizoid and avoidant psychology, postulating that Avoidant Personality Disorder
includes a wish to be close despite the taking of distance while Schizoid Personality Disorder
represents an indifference to closeness. Yet I have never seen a person, among mental health
patients or otherwise, whose reclusiveness was not originally conflictual (cf. Kernberg, 1984).
Recent empirical literature supports this clinical observation (Shedler & Westen, 2004). We are
animals who seek attachment. The detachment of the schizoid person represents, among other
things, the defensive strategy of withdrawal from overstimulation, traumatic impingement, and
invalidation, and most experienced psychoanalytic clinicians know not to take it at face value,
however severe and off-putting it may appear.
Before the discovery of the neuroleptics, when pioneering analysts used to work with
unmedicated psychotic patients in facilities such as Chestnut Lodge, there were many reports of
even catatonically withdrawn men and women who emerged from their isolation when they felt
safe enough to reach out for human contact. (One famous case, for which I can find no written
account, involves Frieda Fromm-Reichmann, who is said to have sat quietly next to a catatonic
schizophrenic patient for an hour a day, making occasional observations about what was
happening on the ward and what the patient’s feelings about it might be. After almost a year of
these daily meetings, the patient abruptly turned to her and stated that he disagreed with
something she had said several months previously.)
The psychoanalytic use of the term schizoid derives from the observations of “schisms”
between the internal life and the externally observable life of the schizoid individual (cf. Laing,
1965). For example, schizoid people are overtly detached, yet they describe in therapy a deep
longing for closeness and compelling fantasies of intimate involvement. They appear self-
sufficient, and yet anyone who gets to know them well can attest to the depth of their emotional
need. They can be absent-minded at the same time that they are acutely vigilant. They may
seem completely nonreactive, yet suffer an exquisite level of sensitivity. They may look
affectively blunted while internally coping with what one of my schizoid friends calls
“protoaffect,” the experience of being frighteningly overpowered by intense emotion. They may
seem utterly indifferent to sex while nourishing a sexually preoccupied, polymorphously
elaborated fantasy life. They may strike others as unusually gentle souls, but an intimate may
learn that they nourish elaborate fantasies of world destruction.
The term may also have been influenced by the fact that the characteristic anxieties of
schizoid people concern fragmentation, diffusion, going to pieces. They feel all too vulnerable
to uncontrollable schisms in the self. I have heard numerous schizoid individuals describe their
personal solutions to the problem of a self experienced as dangerously fissiparous. They include
wrapping oneself in a shawl, rocking, meditating, wearing a coat inside and out, retreating to a
closet, and other means of self-comfort that betray the conviction that other people are more
upsetting than soothing. Annihilation anxiety is more common than separation anxiety in
schizoid people, and even the healthiest schizoid person may occasionally suffer psychotic
terrors such as the sense that the world could implode or flood or fall apart at any minute,
leaving no ground beneath one’s feet. The urgency to protect the sense of a core, inviolable self
can be profound (Elkin, 1972; Eigen, 1973).
Having been originally trained in an ego psychology model, I have found it useful to
think of the schizoid personality as defined by a fundamental and habitual reliance on the
defense mechanism of withdrawal. This withdrawal can be more or less geographical, as in the
case of a man who retreats to his den or to some remote location whenever the world is too much
for him, or internal, as illustrated by a woman who goes through the motions of being present
while attending mostly to internal fantasies and preoccupations. Theorists in the object relations
movement emphasized the presence in schizoid people of a core conflict with interpersonal
closeness versus distance, a conflict in which physical (not internal) distance usually wins out
(Fairbairn, 1940; Guntrip, 1969).
In more severely disturbed schizoid people, withdrawal can look like an unremitting state
of psychological inaccessibility, whereas in those who are healthier, there is a noticeable
oscillation between connection and disconnection. Guntrip (1969, p. 36) coined the phrase “in
and out programme” to describe the schizoid pattern of seeking intense affective connection
followed by having to distance and re-collect the sense of self that is threatened by such
intensity. Although this can be particularly visible in the sexual realm, it seems to be equally
true of other instances of intimate emotional contact.
` I suspect that one of the reasons I find people with central schizoid dynamics appealing is
that withdrawal is a relatively “primitive,” global, encompassing defense (Laughlin, 1979;
Vailliant, Bond & Vailliant, 1986) that can make it unnecessary to use the more distorting,
repressing, and putatively more “mature” defensive processes. A woman who simply goes
away, either physically or psychically, when she is under stress, does not need to use denial or
displacement or reaction formation or rationalization. Consequently, affects, images, ideas, and
impulses that non-schizoid people tend to screen out of their consciousness are freely available
to her, making her emotionally honest in a way that strikes me and perhaps other not-
particularly-schizoid people as unexpectedly and even breathtakingly candid.
A related characteristic of schizoid individuals (one that may be misunderstood either
negatively as perversity, or positively as strength of character) is an indifference to, or outright
avoidance of, personal attention and admiration. Although they may want their creative work to
have an impact, most schizoid people I know would rather be ignored than celebrated. Their
need for space far outweighs their interest in narcissistic supplies of the usual sort. Colleagues
of my late husband, esteemed among his students for his originality and brilliance, have
frequently lamented his tendency to publish his writings in oddly marginal journals, with no
apparent concern to build a broad reputation in the mainstream of his field. Fame per se did not
motivate him; being understood by those who mattered to him personally was far more
important. When I told a schizoid friend that I had heard him described as “brilliant, but
frustratingly reclusive,” he looked worried and asked “Where did they get ‘brilliant’?”
“Reclusive” was fine, but “brilliant” might have sent somebody in his direction.
How do people get that way?
I have written previously about the possible etiology of schizoid dynamics (McWilliams,
1994), and in this paper I prefer to stay at the level of phenomenology, but let me make a few
summary statements about the complex etiologies of schizoid versions of personality structure. I
have become increasingly impressed with the centrality of a constitutionally sensitive
temperament, noticeable from birth, probably influenced by the genetic disposition I mentioned
earlier. I suspect that one of the expressions of this genetic heritage is a level of sensitivity, in all
its negative and positive meanings (see Eigen, 2004), far more extreme and painful than that of
most non-schizoid people. This acute sensitivity manifests itself from birth onward in behaviors
that reject experiences that are felt as too overwhelming, too impinging, too penetrating.
I have heard a number of schizoid individuals describe their mothers as both cold and
intrusive. For the mother, the coldness may be experienced as coming from the baby. Several
self-diagnosed schizoid people have told me their mothers said that they rejected the breast as
newborns or complained that when they were held and cuddled, they pulled away as if
overstimulated. A friend confided to me that his internal metaphor for nursing is
“colonization,” a term that conjures up the exploitation of the innocent by the intrusive imperial
power. Related to this image is the pervasive concern with poisoning, bad milk, and toxic
nourishment that commonly characterizes schizoid individuals. One of my more schizoid friends
once asked me as we were having lunch in a diner, “What is it about straws? Why do people like
to drink through straws?” “You get to suck,” I suggested. “Yucch!” she shuddered.
Schizoid individuals are frequently described by family members as hypersensitive or
thin-skinned. Doidge (2001) emphasizes their “hyperpermeability,” the sense of being skinless,
of lacking an adequately protective stimulus barrier, and notes the prevalence of images of
injured skin in their fantasy life. After reading an early draft of this paper, one schizoid
colleague commented, “The sense of touch is very important: We’re both frightened of it and
want it.” As early as 1949, Bergmann and Escalona observed that some children show, from
infancy on, an acute sensitivity to light, sound, touch, smell, taste, motion, and emotional tone.
More than one schizoid person has told me that his or her favorite childhood fairy tale was “The
Princess and the Pea.” Their sense of being easily overwhelmed by invasive others is frequently
expressed in a dread of engulfment, a fears of spiders, snakes and other devourers, and an Edgar
Allen Poe-like preoccupation with being buried alive.
Complicating their adaptation to a world that overstimulates and agonizes them is the
experience of invalidation and toxification by significant others. Most of my schizoid patients
recall being told by exasperated parents that they were “oversensitive” or “impossible” or “too
picky” or that they “make mountains out of molehills.” Thus, their painful experiences are
repeatedly disconfirmed by caregivers who, because their temperament differs from that of their
child, cannot identify with his or her acute sensitivities and consequently treat the child with
impatience, exasperation, and even scorn. Khan’s (1963) observation that schizoid children
show the effects of “cumulative trauma” is one way of labeling this recurring disconfirmation. It
becomes easy to see how withdrawal becomes their preferred adaptation: Not only is the outer
world too much for them sensually, it invalidates their experience, demands behaviors that are
excruciatingly difficult, and treats them as crazy for reacting in ways they cannot control.
Referring to Fairbairn’s work, Doidge (2001), in a fascinating analysis of schizoid
themes in the movie The English Patient, summarizes the childhood predicament of the schizoid
Children . . . develop an internalized image of a tantalizing but rejecting parent . . . to
which they are desperately attached. Such parents are often incapable of loving, or are
preoccupied with their own needs. The child is rewarded when not demanding and is
devalued, or ridiculed as needy for expressing dependent longings. Thus, the child’s
picture of “good” behavior is distorted. The child learns never to nag or even yearn for
love, because it makes the parent more distant and censorious. The child may then cover
over the resulting loneliness, emptiness, and sense of ineptness with a fantasy (often
unconscious) of self-sufficiency. Fairbairn argued that the tragedy of schizoid children is
that . . .they believe it is love, rather than hatred, that is the destructive force within.
Love consumes. Hence the schizoid child’s chief mental operation is to repress the
normal wish to be loved. (pp. 285-286)
Describing the central dilemma of such a child, Seinfeld (1993, p. 3) writes that the schizoid
individual has “a consuming need for object dependence, but attachment threatens the schizoid
with the loss of self.” This internal conflict, elaborated in countless ways, is the heart of the
psychoanalytic understanding of schizoid personality structure.
Some seldom-noted aspects of schizoid psychology
1. Reactions to loss and separation
Non-schizoid people, among whom are presumably the authors of the DSM and many
others in the descriptive psychiatric tradition, often conclude that because schizoid individuals
resolve their closeness/distance conflicts in the direction of distance and seem to thrive on being
alone, they are not particularly attached and therefore are not reactive to separation. Yet
internally, schizoid people may have powerful attachments. In fact, those that they have may be
more intensely invested with emotion than are the attachments of people with much more
obviously “anaclitic” psychologies. Because schizoid individuals tend to feel safe with
comparatively few others, any threat to or loss of their connection with the people with whom
they do feel comfortable can be devastating. If there are only three individuals by whom one
feels truly known, and one of these is lost, then one-third of one’s support system has vanished.
Thus, a common precipitant of a schizoid person’s seeking treatment is loss. Another, a
related concern, is loneliness. As Fromm-Reichmann (1959/1990) noted, loneliness is a painful
emotional experience that remains curiously unexplored in the professional literature. The fact
that schizoid people repeatedly detach and seek solitude is not evidence of their being immune to
loneliness, any more than an obsessional person’s avoidance of affect means that he or she is
indifferent to strong emotion, or a depressive person’s clinging denotes the absence of wishes for
autonomy. Schizoid individuals may seek treatment because, as Guntrip (1969) notes, they have
retreated so far from meaningful relationships that they feel enervated, futile, and internally
dead. Or they come to therapy with a specific goal: to go on a date, to become more social, to
initiate or improve a sexual relationship, to conquer what they have been told is “social phobia.”
2. Sensitivity to the unconscious feelings of others
Possibly because they are undefended against the nuances of their own more primal
thoughts, feelings, and impulses, schizoid individuals can be remarkably attuned to unconscious
processes in others. What is obvious to them is often invisible to less schizoid people. Many
times I have had the experience of thinking I was behaving relatively inscrutably, or no
differently from how I behaved on any other day, only to have a schizoid friend or patient
confront me about my “obvious” state of mind. In my book on psychotherapy (McWilliams
2004), I told the story of a schizoid client, a woman whose most passionate attachments were to
animals, who was the only one of my patients to pick up the fact that something was bothering
me in the week after I was diagnosed with breast cancer, when I was trying to keep that fact
private pending further medical intervention. Another schizoid patient once arrived for her
session on an evening when I was looking forward to a weekend with an old friend, took one
look at me acting in what I thought was a thoroughly ordinary, professional way as I sat down to
listen to her, and teased, “Well! Aren’t we happy tonight!”
One seldom-appreciated quandary in which interpersonally sensitive schizoid individuals
find themselves repeatedly involves the social situation in which they perceive, more than others
do, what is going on nonverbally. The schizoid person is likely to have learned from a painful
history of parental disapproval and social gaffes that some of what he or she sees is conspicuous
to everyone, and some is emphatically not. And since all the undercurrents may be equally
visible to the schizoid person, it is impossible for him or her to know what is socially
acceptable to talk about and what is either unseen or unseemly to acknowledge. Thus, some of
the withdrawal of the schizoid individual may represent not so much an automatic defense
mechanism as a conscious decision that avoidance is the better part of valor.
This is inevitably a painful situation for the schizoid person. If there is a proverbial
elephant in the room, he or she starts to question the point of having a conversation in the face of
such silent disavowal. Because schizoid individuals lack ordinary repressive defenses and
therefore find repression hard to understand in others, they are left to wonder “How do I go
forward in this conversation not acknowledging what I know to be true?” There may be a
paranoid edge to this experience of the unspoken/unspeakable: Perhaps the others are aware of
the elephant and have decided not to talk about it. What is the danger they perceive that I do
not? Or perhaps they are genuinely unaware of the elephant, in which case their naiveté or
ignorance may be equally dangerous. Kerry Gordon (unpublished manuscript) notes that the
schizoid person lives in a world of possibility, not probability. As with most patterns that re-
enact a theme repeatedly and come to have a self-fulfilling quality, schizoid withdrawal both
increases a tendency to live in primary process and creates further withdrawal because of the
aversive consequences of living increasingly intimately in the realm of primary-process
3. Oneness with the universe
Schizoid individuals have often been characterized as having defensive fantasies of
omnipotence. For example, Doidge (2001, p. 288) mentions a seemingly cooperative patient
who “disclosed, only well into treatment, that he always had the omnipotent fantasy that he was
controlling everything I said.” Yet the schizoid person’s sense of omnipotence differs in
critical ways from that of the narcissistic or psychopathic or paranoid or obsessional person.
Rather than being invested in preserving a grandiose self-image or maintaining a defensive need
for control, schizoid people tend to feel connected with their surroundings in profound and
interpenetrating ways. They may assume, for example, that their thoughts affect their
environment, just as their environment affects their thoughts. This is more of an organic,
syntonic assumption than a wish-fulfilling defense (cf. Khan’s [1966] writing on “symbiotic
omnipotence”). Gordon (unpublished manuscript) has characterized this experience more as
“omnipresence” than omnipotence and relates it to Matte-Blanco’s (1975) notion of symmetrical
There is something about feeling a lack of ontological differentiation or elaboration of
self that strikes me about such phenomena. Rather than omnipotence, it feels to me as if schizoid
individuals retain some sense of primary fusion, of Balint’s (1968) “harmonious, interpenetrating
mix-up.” The recurring narrative in schizoid psychology concerns how this relatedness has
become inharmonious and toxic. In this connection, Doidge (2001) mentions the frequent
assertion of Samuel Beckett, whose work resounds with schizoid themes, that he had never been
born. A therapist in an audience to whom I talked about schizoid psychology voiced the
perception that schizoid people are “insufficiently incarnated,” existing in a world in which their
bodies are no more real to them than their surround.
This sense of relatedness to all aspects of the environment may involve animating the
inanimate. Einstein seems to have approached his understanding of the physical universe by
identifying with particles and thinking about the world from their perspective. Such a tendency
to feel a kinship with things is usually understood as a consequence of turning away from
people, but it may also represent unrepressed access to the animistic attitude that most of us
encounter only in dreams or vague memories of how we thought as a child. Once when we were
eating muffins together, a friend of mine commented, “I must be doing well. These raisins aren’t
bothering me.” I asked what it was about raisins that was problematic: “You don’t like the
taste?” She smiled. “You don’t understand. They could be flies!” This anecdote sparked an
association in a colleague to whom I told it. She volunteered that her husband, whom she
considers schizoid, dislikes raisins for a different reason. “He says they hide.”
4. The schizoid-hysterical romance
I mentioned earlier my attraction to people with schizoid psychologies. As I think about
this phenomenon and reflect on the frequency with which other heterosexual women with
hysterical dynamics seem to be drawn to men with schizoid trends, I find that in addition to my
experience of schizoid people as inspiringly honest, there are dynamic reasons for the resonance.
Clinical lore abounds with observations about hysterical/schizoid couples, about their
misunderstandings and pursuer-distancer problems, about each party’s inability to imagine that
the other sees one as powerful and demanding rather than as one sees oneself--that is, fearful and
needy. But despite our recent appreciation of two-person processes, there is surprisingly little
professional writing about the intersubjective consequences of specific and contrasting
individual psychologies. Wheelis’s short story, (1966/2000) “The Illusionless Man and the
Visionary Maid” and Balint’s (1945) classic depiction of the ocnophil and the philobat seem to
me more germane to the schizoid-hysterical chemistry than any more recent clinical writing.
The admiration between a more hysterical person and a more schizoid one is frequently
mutual. Just as the hysterically organized woman idealizes the capacity of the schizoid man to
stand alone, to “speak truth to power,” to contain affect, to tap into levels of creative imagination
that she can only dream of, the schizoid man admires her warmth, her comfort with others, her
empathy, her grace in expressing emotion without awkwardness or shame, her capacity to
experience her own creativity in relationship. To whatever extent opposites do attract, hysterical
and schizoid individuals tend to idealize each other--and then drive each other crazy when their
respective needs for closeness and space come into conflict. Doidge (2001, p. 286) memorably
compared love relations with a schizoid person to litigation.
I think the affinity between these personality types goes further, however. Both schizoid
and hysterical psychologies can be characterized as hypersensitive, as preoccupied with the
danger of being overstimulated. Whereas the schizoid person fears being overwhelmed by
external sources of stimulation, the hysterical individual feels endangered by drives, impulses,
affects, and other internal states. Both types of personality have also been associated with
trauma of the cumulative or strain variety. Both are almost certainly more right- than left-
brained. Both schizoid men and hysterical women (at least those who regard themselves as
heterosexual—my clinical experience is not vast enough for me to generalize about others) tend
to see the opposite-sex parent as the locus of power in the family, and both feel too easily
invaded psychologically by that parent. Both suffer a consuming sense of hunger, which the
schizoid person may try to tame and the hysterical person may sexualize. If I am right about
these similarities, then some of the magic between schizoid and hysterical individuals is based
on convergence rather than opposition. Arthur Robbins (personal communication) goes so far as
to say that inside every schizoid individual is a hysterical one, and vice versa. An exploration of
this idea would constitute another paper, one I hope some day to write.
Therapeutic implications
People with significant schizoid dynamics, at least the healthier, more vital and more
interpersonally competent individuals in that group, tend to be attracted to psychoanalysis and
the psychoanalytic therapies. Typically, they cannot imagine how anyone would want to comply
with manualized interventions that relegate individuality and the exploration of the inner life to a
minor role in the therapeutic project. If they have the resources to afford it, higher-functioning
schizoid individuals are excellent candidates for psychoanalysis proper. They like the fact that
the analyst intrudes relatively little on their associative process, they enjoy the inviolable space
that the couch can provide, and they appreciate being freed from potential overstimulation by the
therapist’s corporeality and facial affect. Even in once-a-week and face-to-face arrangements,
schizoid patients tend to be grateful for the therapist’s careful avoidance of intrusion and
premature closure. And because they “get” primary process and know that a training program
has acquainted the therapist intimately with it, they can hope that their inner life will not evoke
shock or criticism or disdain.
Despite the fact that most high-functioning schizoid patients accept and value traditional
analytic practices, what goes on in the successful treatment of such patients is not well captured
in Freud’s formulation of making the unconscious conscious. Although some unconscious
aspects of schizoid experience, most notably the dependent longings that stimulate defensive
withdrawal, do become more conscious in a successful therapy, most of what is therapeutically
transformative to schizoid individuals involves the experience of elaborating the self in the
presence of an accepting, nonintrusive, but still powerfully responsive other (Gordon,
unpublished paper). The celebrated hunger of schizoid individuals is, in my experience, mostly
a hunger for the kind of recognition about which Benjamin (e.g., 2000) has so evocatively
written, a recognition of their subjectivity. It is their capacity to engage in the struggle to attain
such recognition, and their capacity to reinitiate that process when it has broken down, that has
been most deeply injured in those who come to us for help.
Winnicott, whose biographers (e.g. Kahr, 1996; Phillips, 1989; Rodman, 2003) depict
him in ways that suggest a deeply schizoid man, has described development in language directly
applicable to the treatment of the schizoid patient. His concept of the caregiver who allows the
child to “go on being” and to “be alone in the presence of the mother” could not be more
relevant. His appreciation of the importance of a facilitating environment characterized by
nonimpinging others, who value the true and vital self over compliant efforts to accommodate to
others’ defenses, might be a recipe for psychoanalytic work with schizoid patients. Because the
analytic frame supplies the essential ingredients of a nonimpinging atmosphere, relatively
conventional technique is well suited to high-functioning schizoid patients. Unless the analyst’s
narcissism expresses itself in a need to bombard the analysand with interpretations, classical
analytic practice gives the schizoid person room to feel and talk at a tolerable pace.
Still, there has been some attention in the clinical literature to the special requirements of
those schizoid patients who need something that goes beyond standard technique. First, because
speaking from the heart can be unbearably painful for the schizoid person, and being spoken to
with emotional immediacy may be comparably overwhelming, a therapeutic relationship may be
furthered by transitional ways to convey feeling. One woman I worked with, who struggled
every session to talk at all, finally called me on the telephone, weeping. “I want you to know
that I do want to talk to you,” she said, “but it hurts too much.” We were eventually able to
make therapeutic progress in a highly unconventional way, by my reading to her from the more
accessible and less pejorative psychoanalytic literature on schizoid psychology and asking her if
the descriptions fit her experience. My hope was to spare her the agony of formulating and
giving voice to feelings she regarded as incomprehensible to others and symptomatic of a
profound, lone madness. She reported that it was the first time she had known that there were
other human beings like her.
A schizoid person who cannot directly describe the anguish of isolation can probably talk
about such a state of mind as it appears in a film or poem or short story. Empathic therapists
working with schizoid clients often find themselves either initiating or responding to
conversations about music, the visual arts, the dramatic arts, literary metaphors, anthropological
discoveries, historical events, or the ideas of religious and spiritual thinkers. In contrast to
obsessional patients, who avoid emotion by intellectualizing, schizoid patients may find it
possible to express affect once they have the intellectual vehicle in which to do so. Because of
this transitional function, the art therapies have long been seen as particularly suited to this
Second, sensitive clinical writers have also noted that schizoid individuals have radar for
evasion, role-playing, and the false note. For this reason and others, one may need to be more
“real” with them in therapy. Unlike analysands who eagerly exploit information about the
therapist in the service of intrusive demands, or the fueling of idealization or devaluation,
schizoid patients tend to accept the analyst’s disclosures with gratitude and continue to respect
his or her private, personal space. Writing under a pseudonym, an Israeli patient notes that
“People with schizoid personality . . . tend to feel more comfortable with people who are
in touch with themselves, who do not fear to reveal their weaknesses and appear mortal.
I refer to an atmosphere that is relaxed and informal, where it is accepted that people err,
may even lose control, behave childishly or even unacceptably. In such surroundings a
person who is very sensitive by nature may be more open and expend less energy on
hiding his/her differences. (“Mitmodedet,” 2002, p. 190)
Robbins (1991), in a case report exemplifying both a sensitivity to transitional topics and
the awareness of the patient’s need for him to be real, describes a schizoid woman who came to
him devastated by the sudden death of her analyst and yet unable to talk about her pain. The
image she evoked in him of a stranger on a lonely island, simultaneously contented and crying
out for rescue, seemed potentially too frightening to share with her. The therapy began to
deepen, however, when the two participants talked about an ostensibly trivial topic:
One day she came in and mentioned that she had just had a quick bite at a local pizza
shop. . . . We started to talk about the wide variety of pizza places on the West Side, both
agreeing that Sal’s was by far the best. We continued to share our mutual interest, now
extending throughout Manhattan, in pizza shops. We traded information and seemed to
take mutual pleasure in the exchange. Certainly quite a deviation from standard analytic
procedure. On a far subtler level, both of us started to learn something very important
about the other though I suspect her knowledge was largely unconscious. Both of us
knew what it meant to eat on the run, to hungrily grab something that filled an
inexplicable dark hole but which at best was a temporary palliative to an insatiable
appetite. This hunger, of course, was kept to oneself, for who could bear to reveal the
intensity of such rapaciousness. . . .The pizza discussions became our bridge to a union,
the re-experiencing of a shared relatedness that ultimately became the starting point for
the patient to give form and shape to her past and present. Our pizza connection served
as a haven, a place where she felt understood.
One reason that a therapist’s willingness to reveal personal experiences catalyzes the
therapy with schizoid clients is that even more than other individuals, these patients need to have
their subjective experience acknowledged and accepted. Reassurance feels patronizing to them,
and interpretation alone, however accurate, may fall short of conveying that what has been
interpreted is unsurprising and even positive. I have known many people who spent years in
analysis and emerged with a detailed understanding of their major psychodynamics, yet
experienced what they uncovered as shameful admissions rather than as expressions of their
essential humanity in all its ordinary depravity and virtue. The willingness of the analyst to be
“real”--to be flawed, wrong, mad, insecure, struggling, alive, excited, authentic--may be the most
believable route to fostering the schizoid person’s self-acceptance. This is why I view the quip
of my friend’s analyst, the “Yeah, tell me about it!” response to his anxieties about losing his
mind, as both quintessentially psychoanalytic and deeply attuned.
Finally, there is the danger with schizoid patients that as they become more comfortable
and self-revealing in therapy, they will make the professional relationship a substitute for the
satisfactions they could be pursuing outside the consulting room. Many a therapist has worked
with a schizoid client for months or years, feeling increasingly gratified in their engagement,
before remembering with a jolt that the person originally came for help because of wanting to
develop an intimate relationship that has so far shown no signs of being initiated. Because the
line between being an encouraging presence and being an insensitive nag can be thin, it is a
delicate art to embolden the patient without being experienced as impatient and critical in ways
reminiscent of the early love objects. And when the therapist inevitably fails to be perceived
differently, it takes discipline and patience to contain the patient’s hurt and outrage about once
more being pushed into toxic relatedness.
Concluding comments
In this paper I have found myself feeling a bit like an ambassador for a community that
prefers not to involve itself in public relations. It is interesting what aspects of psychoanalytic
thinking enter the public professional domain, as it were, and what aspects remain relatively
arcane. On its own merits, the work of Guntrip should have done for schizoid psychology what
Freud did for the oedipal complex or Kohut did for narcissism; that is, expose its presence in
many domains and detoxify and destigmatize our relationship to it. And yet even some
experienced psychoanalytic therapists are relatively unfamiliar with or indifferent to analytic
thinking about schizoid subjectivities. I suppose that, for obvious reasons, no writer who
understands schizoid psychology from the inside has the urge that a Freud or Kohut had to start a
movement touting the universality of the themes that pervade one’s own subjectivity.
I also find myself wondering if some large-scale parallel process is at work in the lack of
general attention to psychoanalytic knowledge about schizoid issues. George Atwood once
commented to me that the controversy over whether or not multiple personality (dissociative
identity disorder) “exists” is strikingly parallel to the ongoing, elemental internal struggle of the
traumatized person who develops a dissociative psychology: “Do I remember this right or am I
making it up? Did it happen or am I imagining it?” It is as if the mental health community at
large, in its dichotomous positions about whether there really are dissociative personalities or
not, is enacting a vast, unacknowledged countertransference that mirrors the struggle of the
patients in question. Comparably, we might wonder whether our marginalizing of schizoid
experience parallels the internal processes that keep schizoid individuals on the fringes of
engagement with the rest of us.
I think that we in the psychoanalytic community have both understood and
misunderstood the schizoid person. We have been privy to some brilliant writing about the
nature of schizoid dynamics, but in parallel to what can happen in a psychotherapy that produces
insight without self-acceptance, the discoveries of the most intrepid explorers in this area have
too often been translated into the language of pathology. Many of the patients who come to us
for help do have quite pathological versions of schizoid dynamics. Many others, including
countless schizoid individuals who have never felt the need for treatment, exemplify highly
adaptive versions of similar dynamics. I have tried in this paper to explore some ways in which
schizoid psychology differs from other self-configurations, emphasizing that this differentness is
neither inherently worse nor inherently better, neither less nor more mature, neither a
developmental arrest nor a developmental achievement. It just is what it is and needs to be
appreciated for what it is.
The author wishes to thank George Atwood, Michael Eigen, Kerry Gordon, Ellen Kent, Sarah
Liebman, Arthur Robbins, Deborah Thomas, and the late Wilson Carey McWilliams for their
contributions to this essay.
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9 Mine Street
Flemington, NJ 08822
Biographical statement:
Nancy McWilliams is author of Psychoanalytic Diagnosis: Understanding Personality
Structure in the Clinical Process (1994), Psychoanalytic Case Formulation (1999), and
Psychoanalytic Psychotherapy: A Practitioner
s Guide (2004), all with Guilford Press. A
graduate of NPAP, she teaches psychoanalytic theory and therapy at the Graduate School of
Applied and Professional Psychology at Rutgers University and is President-Elect of the
Division of Psychoanalysis (39) of the American Psychological Association. She has a private
practice in Flemington, NJ.
... Such a libidinal imbalance accounts for the schism between her private intensity and outward detachment. Those who develop schizoid tendencies are thought to be constitutionally sensitive, and to have experienced cold and intrusive parenting (McWilliams, 2006). For schizoid personalities, attachment is danger. ...
... Retreat is a robust and ingrained protective mechanism for schizoid personalities. Other protective coping mechanisms, such as reaction formation or repression, are underdeveloped, leaving them acutely emotionally vulnerable, or ''hyperpermeable'' (Doidge, 2001), when not in retreat (McWilliams, 2006). Although schizoid personalities long for understanding and connection, they are exquisitely sensitive to exposure and intrusion. ...
... The contemporary relational analyst's expressiveness and eagerness to unpack enactments may provoke the schizoid person's default defense of withdrawal. Intimacy, the healing hallmark of relational work, can undo their sense of security by activating the threat of annihilation (McWilliams, 2006). Retreating inward downregulates the overstimulation of relational contact, restoring safety. ...
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In hopes of contributing to the developing self-critique of relational analysis, I offer a case that illustrates a modified approach, one informed by current dialogue. The patient described had considerable unmet selfobject needs and a schizoid sensitivity to intrusion, engendering the question explored: How do two minds meet if one is largely relationally dissociated and acutely vulnerable when integrated? A premature emphasis on intersubjectivity would have obscured the patient’s narcissistic needs and reinforced her tendency to retreat. Suspending the goal of intersubjectivity allowed for a regressive process to occur, and for contact to become safe before analyst and patient paved the way for future mutual relatedness.
... At very early ages these individuals would likely have the heritable biological predispositions toward a specific general profile of FFM personality traits; namely some combination of high openness, low extraversion, high neuroticism, and low agreeableness. Probable attributes include high sensitivity to their external environment [55,113] and relatively socially reserved disposition [55,114]. Attachment theory research has shown how fundamental habits of behavior within mother-infant dyads create characteristic patterns that reinforce over time (Bowlby, as cited in [115]. ...
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Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing conceptualizations. Patients endure great stigma, poor treatment outcomes, and condemnatory prognosis. Current conceptualizations suffer from unstable categorical borders, heterogeneity in presentation, outcome and etiology, and holes in etiological models. Taken in aggregate, research and clinical experience indicate that the class of psychopathologies oriented toward schizophrenia are best understood as spectra of phenomenological, cognitive, and behavioral modalities. These apparently taxonomic expressions are rooted in normal human personality traits as described in both psychodynamic and Five Factor personality models, and more accurately represent explicable distress reactions to biopsychosocial stress and trauma. Current categorical approaches are internally hampered by axiomatic bias and systemic inertia rooted in the foundational history of psychological inquiry; however, when such axioms are schematically decentralized, convergent cross-disciplinary evidence outlines a more robust explanatory construct. By reconceptualizing these disorders under a dimensional and cybernetic model, the aforementioned issues of instability and inaccuracy may be resolved, while simultaneously opening avenues for both early detection and intervention, as well as for more targeted and effective treatment approaches.
... For instance, the International Statistical Classification of Diseases (ICD-9;World Health Organization, 1978) has for several decades (until the release of ICD-10) listed "introverted personality" (Code 301.21) and "introverted personality disorder of childhood" (Code 313.22) as personality disorders. Indeed, introversion has been equated with Autism Spectrum Disorder (Grimes, 2010) and with schizophrenia (McWilliams, 2006;Wells, 1964). Just a decade ago (Pierre, 2010;Steadman, 2008), proposals were advanced that introversion be listed as a personality disorder for the DSM-V (American Psychiatric Association, 2013). ...
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Cultures explicitly and implicitly create and reinforce social norms and expectations, which impact upon how individuals make sense of and experience their place within that culture. Numerous studies find substantial differences across a range of behavioral and cognitive indices between what have been called “Western, Educated, Industrialized, Rich, and Democratic (WEIRD)” societies and non-WEIRD cultures. Indeed, lay conceptions and social norms around wellbeing tend to emphasize social outgoingness and high-arousal positive emotions, with introversion and negative emotion looked down upon or even pathologized. However, this extravert-centric conception of wellbeing does not fit many individuals who live within WEIRD societies, and studies find that this mismatch can have detrimental effects on their wellbeing. There is a need to better understand how wellbeing is created and experienced by the large number of people for whom wellbeing manifests in alternative ways. This study investigated one such manifestation—the personality trait of sensory processing sensitivity (SPS)—qualitatively investigating how sensitive individuals experience and cultivate wellbeing within a WEIRD society. Twelve adults participated in semi-structured interviews. Findings suggest that highly sensitive individuals perceive that wellbeing arises from harmony across multiple dimensions. Interviewees emphasized the value of low-intensity positive emotion, self-awareness, self-acceptance, positive social relationships balanced by times of solitude, connecting with nature, contemplative practices, emotional self-regulation, practicing self-compassion, having a sense of meaning, and hope/optimism. Barriers of wellbeing included physical health issues and challenges with saying no to others. This study provides a rich idiographic representation of SPS wellbeing, highlighting diverse pathways, which can lead to wellbeing for individuals for whom wellbeing manifests in ways that contradict the broader social narratives in which they reside.
... For instance, the International Statistical Classification of Diseases (ICD-9;World Health Organization, 1978) has for several decades (until the release of ICD-10) listed "introverted personality" (Code 301.21) and "introverted personality disorder of childhood" (Code 313.22) as personality disorders. Indeed, introversion has been equated with Autism Spectrum Disorder (Grimes, 2010) and with schizophrenia (McWilliams, 2006;Wells, 1964). ...
Full-text available
Cultures explicitly and implicitly create and reinforce social norms and expectations, which impact upon how individuals make sense of and experience their place within that culture. Substantial differences in research findings across a range of behavioral and cognitive indices can be seen between what have been called ‘Western, Educated, Industrialized, Rich, and Democratic (WEIRD)’ societies, and non-WEIRD cultures. Indeed, lay conceptions and social norms around wellbeing tend to emphasize social outgoingness and high-arousal positive emotions, with introversion and negative emotion looked down upon or even pathologized. However, this extravert-centric conception of wellbeing does not fit many individuals who live within WEIRD societies, and studies find that this mismatch can have detrimental effects on their wellbeing. There is a need to better understand how happiness is created and experienced by the large number of people for whom wellbeing manifests in alternative ways. This study investigated one such manifestation – the personality trait of Sensory Processing Sensitivity (SPS) – qualitatively investigating how sensitive individuals experience and cultivate wellbeing within a WEIRD society. Twelve adults participated in semi-structured interviews. Findings suggest that highly sensitive individuals perceive that wellbeing arises from harmony across multiple dimensions. Interviewees emphasized the value of low-intensity positive emotion, self-awareness, self-acceptance, positive social relationships balanced by times of solitude, connecting with nature, contemplative practices, emotional self-regulation, practicing self-compassion, having a sense of meaning, and hope/optimism. Barriers of wellbeing included physical health issues and challenges with saying no to others. This study provides a richer idiographic representation of SPS wellbeing, highlighting diverse pathways which can lead to wellbeing for individuals for whom wellbeing manifests in ways that contradict the broader social narratives in which they reside.
Full-text available
Contribution to the field statement This study explores how ChatGPT, a large language model, can generate mentalizing-like responses tailored to specific personality structures and psychopathologies. It focuses on Borderline Personality Disorder (BPD) and Schizoid Personality Disorder (SPD), both of which involve distinct emotional intensity and regulation patterns. The study used ChatGPT's free version 23.3 to evaluate mentalizing-alike responses using the Levels of Emotional Awareness Scale (LEAS) . The findings indicate that ChatGPT was able to describe the emotional experiences of individuals with BPD as more intense, complex, and rich than those with SPD. This suggests that ChatGPT can generate mentalizing responses consistent with various psychopathologies, aligning with existing clinical knowledge . However, the study also raises concerns about potential biases and stigmas associated with mental diagnoses, which may impact the effectiveness and validity of chatbot-based interventions in clinical practice. It emphasizes the need for responsible development in mental health interventions, which considers diverse theoretical perspectives. Overall, this study contributes to the field by demonstrating the potential of ChatGPT in generating mentalizing-like responses tailored to different psychopathologies. It highlights the importance of considering diverse perspectives in the responsible use of chatbot-based interventions in mental health.
The Circle of Security (COS) intervention provides a clinical application of attachment theory demonstrated to promote adaptive interactions between parents and their children. Key to the program is the structured relationship assessment and conceptualisation of caregiver state of mind through core sensitivities. The core sensitivities are a reformulation of James Masterson’s (1976, 1985) and Masterson and Klein’s (1989, 1995) concepts of the disorders of self. They represent prototypes of three core concerns people hold in relationships and the characteristic affects and defenses utilised to manage these. Although developed specifically with COS in mind, the use of core sensitivities to understand caregiving relationships is a focal application of a broader concept. This article introduces the core sensitivities, their theoretical origins and the potential for broader application to psychotherapy.
The authors discuss the loss of the traditional setting for psychotherapy caused by the COVID-19 pandemic, a natural experiment lasting 2 years, and the finding of new channels of communication for therapy using video and telephone platforms as well as outdoor therapy spaces. The manuscript explores the experience of both patients and therapists with these new channels and investigates how the external features of the therapy frame can be subjectively experienced by different people and within different therapeutic relationships. Through patient surveys, case vignettes, and discussions with colleagues, the authors conclude that for a large group of psychotherapy patients the new channels worked as well as and sometimes even better than the old in-person appointments and that an occasional in-person “booster” session can strengthen the therapeutic alliance of ongoing teletherapy.
Schizoid Personality Disorder (SZPD) is classified as one of the cluster A (“schizophrenia‐spectrum”) personality disorders (PDs) in the DSM‐V (APA, 2013). Its core diagnostic features are emotional detachment and social isolation. However, historically, SZPD was described as considerably more complex and multifaceted in both descriptive psychiatry and psychodynamic theory. Recent research has questioned the diagnostic validity of SZPD, and it was proposed for removal in the DSM‐V – but ultimately retained. The DSM‐V conceptualization of SZPD as well as its historical forerunners in object‐relational psychodynamic theory are reviewed. Trait‐based conceptualizations of DSM‐V SZPD from the perspectives of the five‐factor model (FFM), Interpersonal Circumplex (IPC), and attachment theory are described with an emphasis on classifying it according to the dimensional traits of extraversion, openness, submissiveness, coldness, and dismissive attachment, respectively. Finally, Beck's clinically‐based, cognitive‐behavioral model of SZPD is presented that focuses on elucidating the core maladaptive beliefs, affective experiences, and interpersonal behaviors that characterize this controversial PD diagnosis. Future research on this construct is needed in order for SZPD to remain diagnostically relevant in future editions of the DSM.
Schizoid Personality Disorder (SZPD) is classified as one of the cluster A (“schizophrenia‐spectrum”) personality disorders (PDs) in the DSM‐V (APA, 2013). Its core diagnostic features are emotional detachment and social isolation. However, historically, SZPD was described as considerably more complex and multifaceted in both descriptive psychiatry and psychodynamic theory. Recent research has questioned the diagnostic validity of SZPD, and it was proposed for removal in the DSM‐V – but ultimately retained. The DSM‐V conceptualization of SZPD as well as its historical forerunners in object‐relational psychodynamic theory are reviewed. Trait‐based conceptualizations of DSM‐V SZPD from the perspectives of the five‐factor model (FFM), Interpersonal Circumplex (IPC), and attachment theory are described with an emphasis on classifying it according to the dimensional traits of extraversion, openness, submissiveness, coldness, and dismissive attachment, respectively. Finally, Beck's clinically‐based, cognitive‐behavioral model of SZPD is presented that focuses on elucidating the core maladaptive beliefs, affective experiences, and interpersonal behaviors that characterize this controversial PD diagnosis. Future research on this construct is needed in order for SZPD to remain diagnostically relevant in future editions of the DSM.
This landmark volume synthesizes the vast descriptive and dynamic literature on the phenomenology and treatment of severe personality disorders. Akhtar provides a rich harvest of evaluative procedures and therapeutic techniques. In the initial evaluation he combines traditional history taking with a penetrating examination of the patient's sense of identity, ego defenses, object relations, and psychological-mindedness. This enables the clinician to choose the most effective therapeutic strategies. Psychoanalytic psychotherapy is discussed in detail, including the synthesis of diverse approaches as well as the addition of environmental and supportive measures. This is an important exploration of the mutual interdependence of psychiatry and psychoanalysis and makes a major contribution to the understanding and psychotherapy of the personality disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
My main goal is simply to reinterpret schizophrenia and certain closely related forms of pathology (the so-called schizophrenia spectrum of illnesses, which also includes schizoid and schizotypal, and some forms of schizophreniform and schizoaffective, disorders); to show, using the affinities with modernism, that much of what has been passed off as primitive or deteriorated is far more complex and interesting—and self-aware—than is usually acknowledged. In this book I will be concerned almost exclusively with phenomenological issues, the forms of consciousness and the texture of the lived world characteristics of many schizophrenics. (PsycINFO Database Record (c) 2012 APA, all rights reserved)