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The Forsaken Body

SELF-POSSESSION

There is something about the physical appearance of the insane individual that strikes us as strange and bizarre. We sense that he is out of contact with things around him. This impression is conveyed by certain physical signs that distinguish the schizophrenic from the normal.

I saw a girl in my office some time ago who was in an obvious psychotic state. She carried her head to one side, as if her neck were bent at an angle. Her eyes had a wild, distraught look. Her face had an expression of fear and agony. She tore at her hair with both hands, moaned and muttered. Her speech was slurred and I could not understand her. I sensed, however, that she understood what I was saying.

She was the patient of one of my associates who was on a hospital call at the time. Although she had no appointment with him, her desperation brought her to the office. She would not quiet down. Any attempt to calm her was resisted forcibly. She continued to moan and tear at her hair. When her doctor was reached he spoke to her on the phone and she became more tractable. Finally, his arrival ended the episode, for he was able to calm her and drive her home.

The appearance of this patient indicated such an evident disturbance that a glance was sufficient to reveal the diagnosis. However, no diagnosis of schizophrenia should be based simply upon a person's state of agony and torment, for it can be shown that similar agonizing emotions may occur in response to a tragic event. For example, a mother might react in like manner to the death of her child. She would moan, tear her hair, and refuse to move. The agony and torment of the insane is no less real because we are unaware of the reason for their suffering. The two situations differ, of course, in their causative factors. In the case of the mother, the anguish is related and proportionate to a known and accepted cause; the behavior of the insane person appears disproportionate to the apparent stresses of his immediate situation. The observer cannot perceive the cause of his actions; and the insane person, whether he knows the cause or not, cannot communicate it to us.

The opposite situation can also exist in insanity. The cause may be known or visible, but the psychotic person's reaction seems to bear no relation to this cause. The simplest example is the lack of reaction to an obvious loss or injury, as in the case of a schizophrenic parent who kills a child but shows no grief. Thus, the lack of meaningful response to the events of the external situation is an accepted indication that “something is off.”

When we say that the psychotic is out of contact with reality, we do not necessarily mean that he is unaware of what is happening around him. The catatonic, for example, is fully aware of what one says or does to him. And the girl in the above illustration, I am sure, knew what I was doing and heard my questions. I asked her what was troubling her. But she couldn't answer this question. She was reacting to a situation inside herself, that is, to certain feelings and body sensations which she did not understand and which were overwhelming her. It is not a question of the intensity of the feeling. The grief of a mother who has just lost a child would be equally intense. She, too, could ignore her environment temporarily. But she would be capable of describing her feelings and of relating them to an immediate cause.

The psychotic person is out of contact with his body. He does not perceive the feelings and sensations in his body as his own or as arising from his body. They are alien and unknown forces acting upon him in some mysterious way. Therefore, he cannot communicate them to us as meaningful explanations of his behavior. He feels terrified, and his behavior expresses this feeling, but he cannot relate it to any specific event.

The schizophrenic acts as if he were “possessed” by some strange force over which he has no control. Before the advent of modern psychiatry it was customary to regard the insane as being “possessed by a demon,” or “devil”—for which he was to be punished. We have rejected this explanation of his illness, but we cannot avoid the impression that the schizophrenic is “possessed.” No matter what the outward expression of the psychotic—whether comic, tragic, delusional or withdrawn—this impression is always present. It still serves as a valuable indication of the illness for today's observer.

It is significant that we use the concept of “possession” in our language to designate sanity. We describe a person as being “in possession of himself” or “in possession of his faculties,” or oppositely, we say that he has “lost possession of himself.” Possession in this sense refers, of course, to the control of the ego over the instinctual forces of the body. When possession is lost, these forces are out of ego control. In the psychotic individual the ego has disintegrated to a point where it can be compared to a state of anarchy in which one doesn't know what is going on and is terrified because of it. On the other hand, the loss of control which occurs in a hysterical outburst can be compared to a riot. One knows that ego authority will soon be restored and the rioting emotions brought under control. Self-possession can be gauged by the person's ability to respond appropriately to his life situations. The schizophrenic lacks this ability completely. The schizoid individual is handicapped in his responsiveness by the rigidity of his body.

THE SCHIZOID MASK

The first feature which strikes the observer as odd about the appearance of the schizophrenic or schizoid individual is the look of his eyes. His eyes have been described as “off,” “blank,” “vacant,” “out of touch,” etc. This expression is so characteristic that it alone can be used to diagnose the presence of schizophrenia. It has been commented on by a number of writers. Wilhelm Reich, for instance, says that both the schizoid and schizophrenic personalities “have a typical faraway look of remoteness…. It seems as if the psychotic looks right through you with an absent-minded but deep look into far distances.”¹⁹ This special look is not always present. At other times, the eyes just look vacant. Reich observed that when emotions well up in the schizophrenic, his eyes “‘go off,’ as it were.”

Silvano Arieti refers to an “odd look or expression in their eyes,” which he credits to many observers. He himself describes a retraction of the upper lid that produces a widening of the eyes. He relates it to the common expression in schizophrenics of “bewilderment and withdrawal.” Arieti also comments on a so-called look of “madness” that he attributes to the lack in some schizophrenic eyes of normal convergence and constriction.²⁰ I believe this look is an expression of terror that can be interpreted as madness because it is unrelated to any known cause. Most commonly, one sees either the “faraway” look Reich describes or an expression of fear and bewilderment. The common denominator in all cases, however, is the inability of the schizophrenic to focus his eyes with feeling upon another person. His eyes may be wide with fear, but he does not look at you with fear; they may be full of rage, but it is not directed at you. You are uneasy in his presence because you sense an impersonal force in him that could break out and shatter you without acknowledging your existence.

One of my patients, whose eyes became glassy as he went into a catatonic state, told me later that he saw everything that took place.

Though he appeared to be “gone,” he saw my hand as I waved it before him. The mechanical function of vision was intact; light entering his eyes impressed his retina in the same way it acts on the sensitive film of a camera. When the patient came out of his catatonic state his eyes lost their glassy quality and resumed a more normal appearance. This patient's catatonic experience developed after an exercise of striking the couch with his fists while saying, “No!” The exercise evoked feelings that the patient couldn't handle and to which he reacted by “going dead.” His apparent deadness was a defense against his feelings of rage. He suppressed this rage by withdrawing from almost all contact with the external world; the withdrawal produced the glassiness of his eyes.

The subjective impression that the schizoid is unable to make contact with your eyes is the most disturbing aspect of his appearance. You do not feel that he looks at you or that his eyes touch you, but that he stares at you with seeing but unfeeling eyes. On the other hand, when his eyes focus on you, you can sense the feeling in them; it is as if they touch you.

Ortega y Gasset makes an interesting analysis of the function of vision in his essay, “Point of View in the Arts.” He notes:

Proximate vision has a tactile quality. What mysterious resonance of touch is preserved by sight when it converges on a nearby object? We shall not now attempt to violate this mystery. It is enough that we recognize this quasi-tactile density possessed by the ocular ray, and which permits it, in effect, to embrace, to touch the earthen jar. As the object is withdrawn, sight loses its tactile power and gradually becomes pure vision.²¹

Another way of describing the disturbance in the schizophrenic's eyes is to say that he “sees but does not look.” The difference between seeing and looking is the difference between passivity and activity. Seeing is a passive function. According to Webster's New International Dictionary, seeing refers to the faculty of vision “where the element of attention is not emphasized.” To look, on the other hand, is defined in this dictionary as “to direct the eyes or vision with a certain manner, purpose or feeling.” Because the schizophrenic cannot direct his vision with feeling, he lacks the full possession of this faculty or the normal control of this bodily function. His self-possession is limited.

We look at people's eyes to learn what they feel or to sense their response to us. Are they happy or sad, angry or amused, frightened or relaxed? Because the schizoid's eyes tell no story, we know he has repressed all feeling. In treating these patients I pay very close attention to their eyes. When I reach them emotionally, that is, when they respond to me as a human being, their eyes light up and come into focus. This also happens spontaneously when a patient gains more feeling in his body as a result of therapy. The color of his eyes becomes more vivid, and they look more alive. The blankness or emptiness of the eyes is thus an expression of the relative unaliveness of the total personality. The responsiveness or lack of it in the eyes of the schizoid patient gives me a clearer indication of what is going on with him than any verbal communication. More than any other single sign, the expression in the eyes of a person indicates to what extent he is in “possession of his faculties.”

Everyone senses that the eyes reveal many aspects of the personality. The eyes of a zealot burn with the fire of fanaticism, and the eyes of a lover glow with the warmth of his feeling. The brightness of a child's eyes reflects his interest in the world; the dullness which may appear in the eyes of old people indicates that this interest has waned. The eyes are windows of the body. Though they do not necessarily reveal what a person is thinking, they always show what he is feeling. Like windows, they can be shuttered or open, glazed or clear.

If parents, educators, and physicians would look (direct their vision with feeling) at children's eyes, the tragedy of the schizoid child who is not understood could be partly avoided.

The schizoid's inability to focus stems from his anxiety about the feelings which would come through in his eyes. He is afraid to let his eyes actively express fear or anger because this would make him conscious of these feelings. To look with feeling is to be aware of the feeling. The suppression of the feeling requires that the eyes be kept vacant, or distant. The lack of expression in the eyes, like the lack of responsiveness in the body, is part of the schizoid defense against feeling. However, when the feelings break through the defense and inundate the ego, the eyes “go off,” as Reich pointed out, or the fear and rage may pour through them chaotically, without focus and direction, as in the case of the schizophrenic girl in my office. Thus, when eyes have either the “far-off’ look or a look of wild, undirected rage or terror they denote schizophrenia. Vacant and distant eyes indicate a schizoid state.

When one moves from the eyes to the total expression of the face, other signs of the schizoid disturbance are seen. The most important is an absence of facial expression, similar to the lack of feeling in the eyes. It has been said that the schizoid face has a mask-like quality. It lacks the normal play of feeling that makes the healthy face look alive. The mask takes several forms: it may show the bewilderment of the clown, the naive innocence of the child, the knowing look of the sophisticate, the haughtiness of the aristocrat. Its characteristic feature is a “fixed” smile, in which the eyes do not participate. This typical schizoid smile can be recognized by (1) its unvarying quality, (2) its lack of appropriateness, (3) its unrelatedness to a feeling of pleasure. It can be interpreted as an attempt to relieve the tension of the mask-like visage when feelings arise which the schizoid cannot express or communicate. The smile hides and denies the existence of any negative attitude. Harvey Cleckley refers to this schizoid expression as the “mask of sanity.”²²

Behind the mask of the fixed smile and the knowing look one can discern an expression in the schizoid face which I would describe as cadaverous. It is the look of a skull or death's-head. In some cases it can be seen only if a steady pressure is exerted with the thumbs upon the cheekbones on both sides of the bridge of the nose. Under this pressure the fixed smile disappears, the facial bones stand out, the color drains from the face, and the eyes seem to be hollow sockets. It is a ghastly expression and strikes one as the look of death. The patient is not aware of this expression, since it is hidden by the mask, but its presence is another gauge to the depth of his fear. It would be correct to say that the schizoid individual is “scared to death,” literally and not just in a manner of speaking. This expression also appears in the figure drawings of some patients, as Figures 2 and 13 show.

The schizoid mask is not removable at will. The schizoid's facial expression is frozen by an underlying terror, and the mask is his armor against this terror. The mask also enables the schizoid person to appear before the world without causing the shock reaction his cadaverous expression would otherwise provoke. To remove the mask, the “rigor mortis” must be thawed out, the fear and terror must be made conscious, and their grip upon the personality released.

Kretschmer poses the question that must challenge the mind of anyone who has had contact with the schizoid personality. “What is there in the deep under all these masks?” he asks. “Perhaps there is nothing, dark, hollow-eyed nothing—affective anemia.²³ He continues: “One cannot know what they feel: sometimes they don't know themselves, or only dimly.” If one asks the schizoid individual what he feels, the most common answer is, “Nothing. I don't feel anything.” Yet when, in the course of therapy, he allows his feelings to come to the surface, he will reveal that he has the same desires and wants as any other person and that they were always present. His mask and his denial of feeling is a defense against his terror and his rage, but it also serves to suppress all desires. He believes that he cannot allow himself to feel or to want, since this would leave him vulnerable to some catastrophe, rejection, or abandonment. If one wants nothing, one cannot be hurt.

At times, when the schizoid patient is out of control and overwhelmed by his inner feelings, his facial expression becomes so distorted that it looks inhuman. When he allows a feeling of anger to arise, or when he adopts the facial expression of anger, his visage frequently looks demonic. What one sees is not anger but the dark eyes and knit brows of a frightening black rage. In the regressed and withdrawn schizophrenic the face and head often resemble a gargoyle. At other times the face seems to melt and an infantile smile plays about the mouth, without, however, involving the eyes.

This dissociation between the smile about the mouth and the lack of expression in the eyes is typical of the schizoid personality. Eugen Bleuler has commented as follows on the split in the facial expression of the schizophrenic: “The mimic lacks unity—the wrinkled forehead, for example, expresses something like surprise; the eyes with their little crow's-feet give the impression of laughter; and the corners of the mouth may be drooping as in sorrow. Often the facial expression seems exaggerated and highly melodramatic.”²⁴

Another characteristic feature of the schizoid face is its rigid jaw. This is invariably present. Together with the fixed smile, it creates a marked lack of coordination between the upper and lower parts of the face. The rigid jaw expresses an attitude of defiance that belies the vacant or frightened look in the eyes. The rigidity of the jaw helps to block off any feeling of fear or terror from becoming manifest in the eyes. In effect, the schizoid is saying, I will not be afraid.

I have found that it is almost impossible for the patient to mobilize any conscious expression in his eyes before the tension is substantially reduced. This usually happens when the patient gives in to his feelings of sadness, and cries.

If one observes the crying of an infant, one will notice that it begins with a quiver in the chin. The chin recedes, the mouth droops, and the jaw drops as the infant gives way to the convulsive release of feeling in the crying. The rigidity of the schizoid jaw inhibits this release. It functions, therefore, as a general defense against all feeling.

A dynamic interpretation of the tension in and about the schizoid head was suggested to me by a short unpublished monograph on the snarling reflex.²⁵ Generally, the schizoid patient cannot snarl, that is, he cannot curl his upper lip and bare his teeth. Normal individuals find it easier to make this gesture. The schizoid difficulty is due to the immobilization of the upper half of the face, extending over the scalp to the nuchal region at the junction of the head with the back of the neck. These nuchal muscles are tightly contracted in the schizoid condition. One can appreciate the tension involved if one assumes an exaggerated expression of fright: opening the eyes wide, raising the brows, and pulling the head back. One then feels the muscles at the base of the skull contract. Snarling and biting require a direction of motion exactly opposite to that which occurs in fright. In biting, the head is brought forward, so that the upper teeth inflict the bite while the lower ones hold the object. Since the schizoid is frozen in the state of terror, he cannot execute this movement or make the gesture of snarling.

The schizoid inhibition of snarling and biting relates to a deep-seated oral disturbance which is also manifest in the schizoid reluctance to reach out with his mouth and to suck. This total oral disturbance stems from an infantile conflict with a mother who could not fulfill the child's oral erotic needs. The infant's frustration leads to biting impulses, to which the mother reacts with such hostility that the child has no alternative but to suppress its oral desires and repress its oral aggression.

BODILY RIGIDITY, FRAGMENTATION, AND COLLAPSE

Another common finding in the schizoid body is the lack of alignment between the head and the rest of the body. The head is often carried at an angle to the trunk, inclining either left or right. This carriage is another indication of the dissociation between the head and the body, but I never fully understood the reason for this position of the head until a patient made the following observation. He was at an interview, under considerable emotional stress. Suddenly, his vision became fuzzy, and objects appeared to lose form. When he put his head to one side, his vision cleared. If he tried to hold it straight, the disturbance recurred. He was able to go through the interview leaning his head on his hand. The probable explanation of this phenomenon is that the inclined position of the head allowed him to use one eye, the dominant one, for vision and to avoid the difficulty of convergence and accommodation required when both eyes attempt to focus on an object.

Rigidity and tension also characterize the remainder of the schizoid body. One almost always sees a rigidity of the shoulders and neck, which seems related to an attitude of haughtiness and withdrawal. I interpret this expression as an attitude of “being above it,” the “it” meaning the body and bodily desires and feelings. This attitude becomes generalized as being above people or the bodily pleasure of life. The haughtiness is most clearly manifest in patients who have a long, thin neck which seems to detach the head from the rest of the body. In these cases the shoulders are depressed, accentuating the separation. In other cases the shoulders are elevated, as if the patient were trying to hold himself up by his shoulders. As a result of the rigidity of the shoulder girdle, the arms hang from their sockets like appendages rather than as extensions of a unified organism.

Schizoid rigidity is not the same as the rigidity of the compulsive neurotic, which stems from a tension that contains a strong emotional charge. The neurotic is frustrated and angry; the schizoid is terrified with a suppressed rage. The body structure of the rigid neurotic individual has an essential unity which is lacking in the schizoid structure. The rigidity of the schizoid is like ice compared to the steel of the rigid neurotic. In the schizoid personality the rigidity is as brittle at it is hard, as constricting as it is containing. Kretschmer quotes Strindberg, who became schizophrenic, as saying, “I am as hard as ice yet so full of feeling that I am almost sentimental.”²⁶

Schizoid feeling is sentimentality because it lacks a direct connection with physical sensation. It can be described as a “cool” feeling which reflects denial of need and rejection of bodily pleasure. Normal feeling is emotional rather than sentimental because it is grounded in physical sensation; emotional feelings, therefore, are warm or hot (passionate). On the other hand, the schizoid is not devoid of feeling or even passion when it is a question of defending the rights of the underprivileged or fighting for a cause. His dedication to principles reflects a selflessness that is at the core of his personal difficulties. This is not to say that the defense of justice is the exclusive domain of the schizoid. What is meant here is that the schizoid, lacking a sense of personal identity, frequently seeks a justification for living in social causes, isms, and panaceas. Schizoid sentimentality is the result of the abstraction of feeling from the self and the body. It denotes a loss of personal identity, which is compensated for through social identifications.

Further examination of the schizoid body reveals several other characteristic disturbances. One commonly finds that the upper half of the body is relatively underdeveloped muscularly. The thorax tends to be narrow, tight, and held in a deflated condition. This thoracic constriction, which is particularly evident in the lower ribs, necessarily limits respiration. In other cases, however, where the illness is less severe, one may find a compensatory inflation of the chest, considered “manly” by some patients and developed through weight-lifting exercises. In the collapsed body, the chest is deflated, soft, and toneless. In all cases, there is a marked constriction of the body about the waist, due to a chronic contraction of the diaphragm.