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      FIG. 4 Contact with Reality Unity of the Personality

      This schema also includes the psychic disorders known as the neuroses. The neuroses, A. P. Moyes writes, are a “relatively benign group of personality disturbances,” in which the “personality remains socially organized.”⁴ This is not to say that the neurotic individual has a well-integrated personality. Every neurotic problem stems from a conflict in the personality which splits its unity to some extent and reduces its contact with reality. In both the neuroses and the psychoses there is an evasion of reality; the difference, as Freud points out, is that the neurotic ignores reality while the psychotic denies it. However, every withdrawal or evasion of reality is an expression of the schizoid disturbance.

      Against the background of a seemingly adjusted personality, neurotic symptoms have a dramatic quality which dominates the clinical picture. A neurotic phobia, obsession, or compulsion is often so striking that it focuses the attention to the exclusion of the underlying schizoid split. In this situation, treatment tends to be directed to the symptom rather than to the more deep-seated personality problem. Such an approach is necessarily less effective than one which sees the symptoms as a manifestation of the basic conflict between the ego and the body and directs the therapeutic effort to the healing of this split. In Figure 4, I have placed the neuroses in parentheses to indicate that they are included in the schizoid phenomenon.

      One reason for the increasing recognition of the schizoid problem is the shift of psychiatric interest from the symptom to the personality. Psychotherapists are growing increasingly aware of the lack of feeling, the emotional detachment, and the depersonalization of their patients. It is now generally recognized that the schizoid condition with its deep-seated anxieties is directly responsible for symptom formation. Important as the symptom is to the disturbed individual, it occupies a secondary role in current psychological thinking. If symptoms are alleviated in psychotherapy without regard to the underlying schizoid disturbance, the treatment is regarded as supportive and the results are considered to be only temporary. To the degree, however, that the schizoid split can be overcome, the improvement in the patient occurs on all levels of his personality.

      While psychotherapists are conscious of the widespread incidence of schizoid tendencies in the population, the general public is ignorant of this disorder. The average person still thinks in terms of neurotic symptoms and assumes that in the absence of an alarming symptom, everything is all right. The consequences of this attitude may be disastrous, as in the case of a young person who commits suicide without warning or suffers a so-called nervous breakdown. But even if no tragedy occurs, the effects of the schizoid disturbance are so serious that we cannot overlook its presence in neurotic behavior or wait until a crisis occurs.

      Late adolescence is a critical period for the schizoid individual. The strong sexual feelings that flood his body at this time often undermine an adjustment which he had previously been able to maintain. Many young people find themselves unable to complete their high school studies. Others do so with an effort, but run into trouble in the first years of college. On the surface the problem may appear as described below.

      A teenager who had done fairly well at school runs into difficulty with his studies. His marks drop, his interest lags, he becomes restless, and he starts running around with “bad” characters. His parents ascribe his behavior to a lack of discipline, poor will power, rebelliousness, or the mood of today's youngsters. They may close their eyes to his difficulties in the hope that he will outgrow them. This rarely happens. They may berate the young person and attempt to coerce him into a more responsible attitude. This generally fails. In the end, they reluctantly accept the idea that seemingly bright children become “dropouts,” that some are just naturally “floaters,” that many young people from good backgrounds engage in destructive or delinquent activities; and they give up any attempt to comprehend the attitude of their adolescent children.

      The schizoid individual cannot describe his problem. As far back as he can remember, he has always had some difficulty. He knows that something is wrong, but it is a vague knowledge that he cannot put into meaningful words. Without the understanding of his parents or teachers, he resigns himself to an inner desperation. He may find others who share his distress and with whom he can establish a rapport based on a mode of existence that is “different.” He can even rationalize his behavior and gain some sense of superiority by proclaiming that he is not a “square.”

      I shall present four cases to illustrate some of the different forms the schizoid disturbance can take and the common elements in all four. In each case the disturbance was severe enough to require therapeutic help. In all cases, it was ignored or overlooked until a crisis occurred.

VARIETIES OF SCHIZOID PERSONALITY AND BEHAVIOR

      1. Jack was a young man, twenty-two years old when I first saw him. He had graduated high school at eighteen, after which he spent a year singing folk songs in coffee houses. He followed this with two years in the army, then drifted from one job to another.

      Jack's crisis occurred after his release from the army. In the company of his friends, he took some mescaline, a hallucinogenic drug. The result was an emotional experience that shocked him. He said:

      I had hallucinations that are impossible to describe. I saw women in every conceivable stimulating position. But when I came out of it, I hated myself. My guilt about sex confuses me. The strange thing is that I claim to be unconventional, left wing, no sex limitations, et cetera. I can reason this out, but I can't get away from the feeling of guilt. It frightens and depresses me.

      This experience, induced by the drug, broke down Jack's adjustment. The schizoid tendency in his personality, which he had managed to keep under control, broke through into the definitive symptoms of the disorder. He described them as follows:

      a. Fright—“At times the fright is so severe that I can't be left alone. I think I'm just plain afraid of losing my mind.”

      b. Hypochondriasis—“Every little pimple, scratch, pain, et cetera, scares me to death. I immediately think of cancer, syphilis…”

      c. Detachment—“Once I felt like I was slipping from reality, sort of removed; and within the past few weeks, I've felt removed almost constantly, as though I'm somewhere else watching myself.”

      When the symptoms appear with the intensity described above, the diagnosis is easy. However, it would be a mistake to assume that there had been no previous evidence of the schizoid disturbance. Jack had experienced severe fright in the form of night terrors when he was very young. And even as a child he struggled with feelings of unreality. He related that:

      As early as I can remember [six or seven years], I've always felt different, but I was constantly convinced by my parents that this was normal. In grade school I usually felt sort of strange—example: sitting in class watching the other pupils and wondering if they felt the same confusion as I did.

      The unfortunate aspect of this problem was that no one in Jack's immediate entourage seemed to understand his difficulties. “My parents and friends convinced me that this feeling [of being different and strange] was a normal feeling,”

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