Excerpts from Must Read Books & Articles on Mental Health Topics
Books, Part VI

Integrated Ego Psychology- Norman Polansky
Chapter 9- The Pursuit and Dread of Love, pp. 201-233

Ours is a generation of togetherness. In contrast to earlier eras in which social functions were held for such respectable reasons as excluding others, sexual stimulation, and cheerful gluttony, we now make elaborate plans to be with, share with, talk with people. Privacy is a valued and expensive commodity in urban living. Nevertheless, we seek each other out.
    Such restless searching for human contact bespeaks famine in the Promised Land. Never have so many owed so little to so many. Though constantly tossed together, people feel overwhelmingly alone. Much professional counseling consists of providing prostheses against this void. Group workers encourage group cohesiveness, caseworkers offer support, and "your analyst is the best friend money can buy." What is missing in relationships people already have? Why can these empty people not replenish each other? Most frequently missing is the ability to get close.
    Since before 1900, sociologists have been writing about the process of impersonalization as an accompaniment of industrialization and urbanization. Even popular magazines discuss alienation using jargon in about the same way as the American Sociological Review (Seeman, 1959). Philosophers and theologians have looked up from their preoccupations to notice the estrangement among other men. In a warm, rather naive dissertation, Martin Buber (1958) discussed the "I-Thou" relation, as if he had made a discovery of the distances among people. But, then, perhaps he had. It is not necessary to innovate for the whole culture to have invented for oneself, and each person's uncovering of his own aloneness is, in fact, unique.
    Clinicians have encountered the same phenomenon among their patients. As early as 1942, Deutsch wrote of the "as if" personality. Although these patients appear to behave normally and, to have socially expectable responses, she points out that they lack warmth; they are not able to become genuinely attached to others. The as if personality employs "a mimicry which results in ostensibly good adaptation to the world of reality despite the absence of object cathexis" (Deutsch, 1942, p. 304).
    The patient's inability to integrate a constant image of himself is a major issue. He is at the mercy of transient identifications, in which he adopts, chameleon-like, traits from the people with whom he finds himself. The relationship of Deutsch's observations to the theories of Erikson on the problem of ego identity and of Mahler on individuation is apparent. But, one wonders what she would have had to say about the famous sociologist, Charles Horton Cooley (1902). This inordinately shy man developed the conception of the "looking-glass self," saying that a person's appraisal of his own worth is but a reflection of how he thinks he is seen by those around him. Cooley did not emphasize inner continuities, did he?
    Khan began a most important paper by referring to "a new type of patient that has come into prominence in the last two decades" (1960, p. 430). Paraphrasing Fairbairn (see below), Khan remarked further that "a fixation in the early oral phase ... promotes the schizoid tendency to treat other persons as less than persons with an inherent value of their own" (1960, p. 430).
    Writing nearly a quarter century later, Eagle (1984) has said,

As a rule today's patients do not simply present classically neurotic problems of an oedipal nature. Rather, they present the kinds of problems which have come to be labeled schizoid, borderline, and narcissistic. For whatever reasons, problems of self and object relations--experienced as feelings of meaninglessness, feelings of emptiness, pervasive depression, lack of sustaining interests, goals, ideals and values, and feelings of unrelatedness--are the overwhelmingly predominant symptoms of today's modal patient. (p.73)

    Erikson has written in a similar vein: "the patient of today suffers most under the problem of what he should believe in and who he should--or, indeed, might--be or become, while the patient of early psychoanalysis suffered most under inhibitions which prevented him from being what and who he thought he was" (1963, p. 279). We do not really know how to account for historical changes in the nature of patients. Have we all been participant observers of a major historical movement? For example, the dehumanization to which Khan referred has been attributed to the growth of totalitarianism in our world, and even to a vastly greater population density. Or have therapists been forced by the workings of the marketplace to attempt the treatment of a broader range of patients previously not seen? Whatever the reasons, the changed patient load has challenged the emergence of changed theory. In ego psychology, the phenomena Eagle mentions are thought about as issues in the schizoid spectrum.

Some Relevant Experiences
Anybody who has been involved with persons suffering schizophrenia cannot fail to be impressed with their isolation. At times, they go to the extreme of physical withdrawal by running away, or shutting out stimuli. There is always a feeling of interpersonal coldness and detachment. Psychiatrists used to refer to the characteristic handshake of schizophrenic patients: a fervent salutation, like clasping the tail of a dead fish. Even the schizophrenic with more ability to relate typically prefers a noncommittal stance. We came on this in a social psychological study of attitudes among patients in a private psychiatric hospital years ago (Polansky, White, and Miller 1957). If, for example, you use a Likert-type format--asking whether the subject Strongly Agrees, Agrees, Doesn't Care, Disagrees, or Strongly Disagrees with a series of statements--you get an odd statistically significant pattern. Schizophrenics choose the noncommittal alternatives expressing weak agreement or disagreement or no opinion.
    At one time, it was thought that one either was or was not schizophrenic. Now, we find it more useful to think of patients as ranged along a continuous dimension we call the schizoid spectrum. A person suffering active schizophrenic illness is far out on the spectrum. But a person closer to "normal," who is not psychotic, may be termed a schizoid personality. Clinical fashions change, of course, and nowadays it is common to speak of many related problems in terms of borderline phenomena and borderline states. However, the earlier formulations about schizoid elements in the personality accented important issues of detachment and fear of closeness so I have chosen to focus on them at the risk of seeming somewhat out of date: clients do not change nearly so quickly as fashions of talking about them.
    We come into contact with many schizoid people in daily living. It may require a period of acquaintance to realize how detached the schizoid person is, for he often has made strenuous efforts in his early years to compensate for his pattern and mask it from others and himself. The college professor, so engrossed in books and papers that he scarcely notices his surroundings, much less wife and children, may be somewhat schizoid. So is the backslapping politician, salesman, or banker who seems warm and friendly until you discover how indiscriminately he distributes his warmth, and how cold his eyes remain. Even the physician who exudes bedside manner may suddenly stand revealed as essentially shy and shrinking from any human contact not ritualized into his professional role.
    So, the schizoid individual is frequently odd, self-centered, unfeeling toward you. But then he does not feel much about anything. He suffers what we call severe affect inhibition. This does not mean he has no feelings but that he blocks out most feelings so that he is literally unable to be consciously aware of them. Imagine you are a caseworker in an institution for delinquent youngsters. For the past two months you have been having regular interviews with a boy named Pete, struggling to breach his wall of toughness and bravado to involve him in discussing what is wrong with him. During your last interview, you finally had a glimmering of hope. After all the interest and concern he mutters, "Well, you're not a bad guy." You speak hopefully at staff conference this morning about his progress only to be informed sarcastically by the director of cottage life that Pete absconded from the institution last night. The implication is strong that another gullible young caseworker has been outfoxed by a fourteen year old psychopath. Flashing through your mind is the voice of a psychiatrist who warned you once that any psychopath is like "an asp in your bosom." For the moment you hate this kid and all his kind. Even after you calm down a bit, there remain the questions: Why did he do this to me? And why, now, just when we seemed to be getting somewhere?
    Such people pass through our lives as social workers, obviously all somehow related to each other. But how? I believe each represents the presence of schizoid elements in his or her personality. What do we mean by these?

The Schizoid Personality
The most noteworthy affect of the schizoid personality has been described as a feeling of futility. Nothing is worth while, no effort will do any good. It is typified in the remark "Why eat supper? You'll just be hungry before breakfast anyhow." Another patient, author of the classic comment, "Once a slob, always a slob," put it differently: "If at first you don't succeed, the hell with it." Whether the sense of futility be grasped with desperation, or waved about with bravado, the message is always the same: if the milk of life itself is poisoned, why bother?
    The feeling of futility would seem to emerge from the defense of detachment in the three phases of an infant's handling separation (see Bowlby below). It differs from depression, with which it may be confused. The feeling of futility is a defense against depression, a refusing to care at all. Yet, as so often happens, the cure may be worse than the disease. With the detachment comes a kind of massive blocking of feelings which we have called affect inhibition. The patient does his best to literally feel nothing. The price for succeeding may well be terror. For one way we know we are alive, exist, are persons, is that we are filled with feelings. Not to feel and not to care gives rise to enormous emptiness and a numbness with awesome connotations of death. It is a bleak and hopeless state of mind from which, fortunately, not even suicide promises much. The danger, on the other hand, is that it does not threaten much, either.
    One would expect futility to be accompanied by a withdrawal from personal relations, and from life, and indeed it typically is. Yet there are persons whose behavior reflects this affective syndrome, with whom we do not immediately make the association. Take the delinquent, for example. The stereotype of a delinquent youngster is of a young man, eyes flashing, face hardened, in motion, aggressively beating someone or driving away recklessly from his latest escapade. These are rare occasions for the truly delinquent personality. More typically, we find him slouched against a wall, eyes half closed, cigarette dangling, flaccid, bored, and boring. His normal stance is an overt demonstration of indifference to the life about him. He has trouble getting pleasure from the milder forms of stimulation most of us enjoy. Among other things, professional criminals are said to be poor lovers, the price paid for psychological anesthesias.
    Danger is usually involved in criminal acts, and a delinquent's face may light up as he tells you how much he enjoyed being chased by the police. Why the love of risks? I was once taught to think about danger as an urge toward self-destruction, but I no longer believe this the most parsimonious explanation. There is indifference to self-destruction, to be sure, founded on an illusory omnipotence. But the driving force is a craving for excitement. Only at moments of crisis, pain, or intense pleasure does the schizoid delinquent feel fully alive.
    The craving for excitement, with its ugly and frightening consequences, must be seen as itself a defense against massive affect inhibition and its emptiness, echoing death. Were he able to enjoy smaller pleasures, the typical delinquent would not need such heroic forms of entertainment. Similar logic applies of course, to the sexual sprints and gymnastics of other persons, including hysterics with marked schizoid features.
   The schizoid youngster, like the detached infant, wards off feelings in order not to be overcome by his anger and despair. The cost of this defense is the desolation and emptiness that, in turn, demand another layering of defenses in order to overcome them. Stubbornness and negativism are frequently prominent in this character. Stubbornness has many roots, but one of them may well be the sense of emptiness. The client feels that if he permits himself to be influenced, something will have been taken away from him, and he already has too little to work with in any case.
   The negativism has a closely connected source. For a person who feels himself a vacuum, a nothing, to stand against something provides a sense of being. His firm grasp on futility, with its claim that no goal is worth the effort and no good can come of striving, affords him the luxury of avoiding failure and defeat. He can even surround the feeling with elaborations of superiority, telling himself that he is onto a secret other mortals have not penetrated. But again, the feeling of futility cannot be so successfully maintained if the youngster admits something matters to him, and takes a positive stance. The only way he can integrate himself into a person is through negativism. Paraphrasing Descartes, he says, "I oppose, therefore I am."
    Let us face it. Whatever his admirable qualities, the schizoid individual is typically an odd, gawky personality, rigid when yielding might be graceful, un-with-it. He knows this; he has known it since early childhood when he already had thoughts that he was not like other children. Indeed, he was not, for he had already suffered from a childhood neurosis. Such self-recognition is of course frightening to a child. Many of these patients reacted in the only way that must have seemed possible to their young minds. They hoped that by acting like other people, they would become like them.
    It is important to bear in mind that this struggle to break through his self-imposed barrier of detachment is no trivial matter in the life of such a child. Not to be like other people is to be less than human, an object in terror for his very existence because he is unlovable. No wonder, then, that the business of appearing to be human should be gone at with such dead seriousness, such solemn self-preoccupation and self-consciousness, such strained and rigid role-enactment. For this reason the schizoid adult seems mannered when he tries to be warm and spontaneous.
    Given any new role, each of us is likely to overplay it at first. This patient may well overplay being a person. Perhaps because of this I have often found that it may clear the air if both of us recognize sooner rather than later that much of how he acts with me is phony. It seems to help him to know that I know. And it helps me to like him in spite of his spuriousness--although he prefers to think he is engaged in an act he can turn off at will, I know better. I recall a patient who liked to think he was escaping unpleasantness at home by feigning being crazier than he was. In poignant truth, he was sicker than he pretended.
    We can list a number of other characteristics of this fascinating syndrome. Without training or therapy, such a youngster often exhibits and articulates an unexpected insight into others' dynamics. Repressive mechanisms normally to be anticipated simply do not exist in him, and their absence contributes to an excruciating sensitivity in limited spheres. The same absence may make him the more masterful manipulator, and it is not uncommon to find that the patient has been tyrannizing his whole family despite his own difficulties. In fact, when in the first interview you find a patient with no previous treatment already explicating his own dynamics with reasonable accuracy, it is likely he is fairly far out on the schizoid spectrum. Often this represents an overvaluation on his part of the contents of his own thoughts as compared with remaining open to the world about him. Like the Jews confined to European ghettos, he knows much about motives and feelings because that is all he has had to preoccupy his mind. He is Proust sans pen.  All these features of the schizoid personality are a woefully incomplete description if we leave out his characteristic inability to form warm human relationships.

Distance Maneuvers
We have already described at length the early experiences leading to alienation among persons with markedly schizoid features. To help us understand the schizoid's fear of closeness, let us add a characteristic of mental functioning discussed earlier, looseness of ego boundaries. When he begins to form a tie to another person, the schizoid youngster tends to "go all the way." It is not enough to approach each other as two loving but independent beings. Out of greed founded in his deep sense of emptiness, and indefiniteness of the outline of himself in his own mind, he has a tendency not so much to relate as to want to absorb the other person into himself, or to lose himself in the other.
    For many such persons, talking is simply not enough: there must also be physical contact, cuddling, caressing, often sex relations. Because of such needs, the schizoid youngster may mistake his therapist's interest in him as a homosexual pass. Adding to the projection of his own desires into the relationship is his feeling of unworthiness: "What could possibly make me of interest to you unless it is my body?" Similar feelings exist in the pseudohysteric nymphets one encounters in high schools. One cannot help also but remark the emphasis in hippie cults on total fusion between two people--intellectually, but also preverbally, physically, and erotically regardless of the sex. In such a subculture, the desire to fuse physically with the other is permitted full expression. For most schizoid youngsters, however, the childlike needfulness and desire to be cuddled which they experience on coming close are embarrassing and disconcerting. They are also dimly aware of the ravenous orality that makes them wish to devour the people to whom they are attached. Hence, such a youngster signals, more in kindness than in anger. "Stay away, or I will hurt you." There follow from these dynamics a group of mechanisms calculated to keep other people at arm's length. We call these, graphically, distance maneuvers.
   Distance maneuvers make up one of the most interesting collections )f psychological operations identified and associated with ego psycholgy, and we have had frequent reference to them already throughout his book. Now we shall bring them together into a more compressed outline.
1.  Flight: An obvious way to prevent others from coming too close is literally to flee them physically. There are various way of doing this, some more obvious than others, some offering evidence of severe disturbance. Boy runs wildly into the woods and disappears out of fear of his growing dependence on this therapist. The chronic "loners," hermits of the lakes and seas, and forest cruisers. Professors comfortable only in their studies; teachers who hate to teach. Youngsters who cross the street rather than greet a person. The girls who shrink from touch. are physical forms of withdrawal.
    Psychological withdrawal is more subtle, but it can usually be easily sensed. I have commented on the "schizophrenic handshake" in which the schizoid person goes through the motions of sociability while shuddering from relating. The most frequent withdrawal, however, is found in the person who, in the midst of his family or other company, simply is not there. He is said to be absent minded, and there is no doubt he is absent, in thought and spirit.
2. Fight: Bion, who brought some of these formulations into the area of group therapy, described phases through which a group might pass as "fight, flight, and work" (1951). "Fight and flight" are highly visible in the schizoid pattern of operating, and the fighting serves some of the same purposes as fleeing. Not all aggression, of course, is in the service of running away: far from it! But squabbling and battling can facilitate taking distance.
    I have seen a number of patients who, after involving themselves in a reciprocal love relation, nearly always provoke the person they love. The usual reason for this goes back to the basic ambivalence we often feel toward those on whom we are most dependent. We form a love/hate relationship, and as we love, we also begin to get somewhat hostile. This is but part of the explanation in cases where the pattern is fixed; to label it a hostile-dependent relationship may obscure its full meaning. There is the person who, having become attached, becomes frightened. If he is unable to leave the one he loves, he provokes the other to take the initiative of breaking off. The fight is a distance maneuver.
    Others fight as their peculiar way of resolving the schizoid dilemma. They want to be in contact, but they cannot tolerate the open expression of affection and caring. So they camouflage their loving behind a good deal of bickering, thus keeping their feelings at just that state of ambivalence which makes affection possible for them. Nagging, querulousness, teasing, or even good-humored kidding suffice to dilute the degree of warmth they are feeling. Others require so strong a camouflage against open recognition of their tenderness that the resulting battles may become physically dangerous. Wilde said, "You always hurt the one you love." Yes, if you are Oscar Wilde.
3. Emotional Coldness: A socially acceptable form of withdrawal is contact without feeling. I have mentioned the intellectualized college professor; I also mentioned the doctor, or other professional, who can tolerate impinging on fellow humans so long as he is relating from within a professional role. Quite a few schizoid individuals, by the way, resolve the dilemma between the Scylla of being engulfed and the Charybdis of loneliness by finding positions in which they too can "meet the public" without getting too involved. This group includes waitresses, sales personnel, clergy, hospital attendants, secretaries. You do not have to have a doctorate to barricade yourself behind occupational status while maintaining fleeting and stereotyped contacts with your clientele. Who else but a doctor can absent himself from wife and family during all but minimal time for sleeping and eating, while seeing people and serving humanity at the same time?
    In such desiccated relationships, money need not always change hands. The friendly, impersonal prostitute can use her occupation to earn an emotional living in the same way as does the reservations clerk. In my observation, many schizoid young men are needlessly concerned about whether they will be sexually capable. Often, so long as the relationship is primarily erotic, sex without affection, they are quite adequate at achieving satisfaction.
    It is much easier for the schizoid adolescent to rail against his parents than to confess the rest, which is that he loves them very much. Once, for instance, we needed to measure openness of communication of children in an institution for the treatment of the emotionally disturbed. Ratings of the children's hostility proved relatively meaningless. Angry expressions toward adults in the institution were common and even more or less encouraged by the therapeutic atmosphere. Hence, the readiness to express hostility did not discriminate among our subjects. A measurement based on willingness to verbalize liking or affection, on the other hand, proved much more valid as an index of verbal accessibility (see below), since it came harder and reflected individual differences. The open expression of tenderness is most devastating; such admission may be accompanied by tears and genuine sadness.
4. Noncommittment: The schizoid individual finds it very hard to become committed to another person. When the tie becomes closer than he can bear, he finds ways of breaking loose, for example, by precipitating a fight and being ejected. As he feels himself being committed, his discomfort increases. It is her schizoid element that often leads the thirty-year-old mother of two, so apparently hysterical in other ways, to come for marital counseling with the announcement, "I am trapped." There are other variations on this theme. One of the more interesting, and amusing, is the verbal denial of commitment. At the same time as the patient is arriving early for his appointment, and otherwise showing his attachment to you, he will have to take time out to let you know that all this means very little in his life and he has been thinking about quitting treatment. He needs words discrepant from his actions. These are the same sort of men who must soon announce to their girl friends, "I am not ready to get involved, so I hope you will not take all this seriously." Such a young man may be terribly chagrined should the girl take him at his word and begin to date others.
    The fear of commitment afflicts men who in other respects seem rather intact personalities. Many stories are told about reluctant swains. One is of the maid, Mathilda, who had been dating Jasper for fifteen years. Finally, one night she said, "Jasper, don't you think it's about time you and me was marrying up." Jasper reflected for five or ten minutes before replying, "Tillie, I believe you're right. But at our age, who'd have us?"
    Commitment to another person is dangerous because it makes the schizoid patient aware of his extreme vulnerability. He who loves has given hostages to fate. The schizoid person, therefore, feels lonesome at times, but he also has a smug feeling that he will keep secret even in therapy. Making a virtue of necessity, he believes, "Nothing ventured, nothing lost." While the young caseworker tires himself encouraging him to find outside interests and companions, he barely conceals his conviction that he is much smarter, he knows a better way.
    Because of their fear of closeness, schizoid persons, as we have reiterated, keep their distance. For persons with schizoid elements in otherwise intact personalities, we see a related mechanism. To play it safe, and avoid becoming vulnerable, they must remain in control of the relationship. To love and feel love is to risk becoming unloved, because of something over which you may have no control. This they cannot stand. Consequently they are preoccupied, at the beginning of a relationship, about the circumstances of its termination. just as it is easier to take leave on the train than stand on the platform and wave good-bye, so they much prefer any rupture to occur at their initiative. Therefore they repeatedly play out the scene, "You can't fire me; I quit!"
    By controlling the timing of the ending, the schizoid feels at least somewhat more the master of his fate. By meeting the rupture actively, the weakened ego is somewhat better able to tolerate the anxiety. All this has a logic and a purposiveness. What is not purposeful, unfortunately, is the repeated tendency to break off ties at the least threat. In this way friendships are broken needlessly by a person who yearns for friends. The same mechanism, of course, can easily invade the treatment, spoiling the patient's chance of getting help because of just the thing for which the help is needed! And I have alluded to the jockeying for position from the beginning of therapy.
    The difficulty of commitment is most visible in relation to personal objects, but it typically pervades the personality. There may be fear of becoming tied to a place or to a job: hence, a drifting existence. During World War II, I worked in an Army Disciplinary Barracks. We saw many soldiers charged with AWOL or desertion. A fair proportion of them had no civilian record. They were now in legal difficulties because, for the first time in their adult lives, they were required to remain in one place, among one group of people, and this they found intolerable. When we received our first shipment of General Prisoners at the disciplinary barracks, we were still (unknown to them) desperately closing gaps in its barbed-wire wall, on a distant side of the compound. While we sweated in the midday sun, we heard our blithe, former comrades caroling, "Don't Fence Me In" as armed Gl's herded them into our care.
    There is usually an associated noncommittment in attitudes and beliefs, with the exception of a few rigidly held for defensive purposes. The schizoid man or woman professes no opinion on so many aspects of living. This includes religion, which otherwise might have been a considerable solace against self-imposed isolation. Naturally, one will find many evidences of what Erikson (1959) has so marvelously described as identity diffusion. Along with other problems, the schizoid young woman may have avoided deciding which sex she really wants to claim as her own. Homosexuality and bisexuality often occur. Even more frequent, however, is the sexual neuter, the person permanently poised in preadolescence-the man who feels he somehow is not yet mature enough to take command among other men, or the lady golfing champion.
5. Selfishness: Alienation, isolation, detachment, preoccupation are some of the words we have used to describe this syndrome. To these I must add another: A striking feature of the constellation is selfishness, in just about the meaning we attach to it in everyday speech. The ability to love others has been shunted backward: the love is turned toward the self in a combination of primary and secondary narcissism. Primary narcissism refers to the infant not even aware there is anyone worth attending to but himself; secondary, to the infant who has started to be attached to his mother but who, out of disappointment, has made the defensive switch, "If no one else loves me, then I will."
    The selfishness became markedly visible to me in hospital work. Whatever the parents' defects, and they were manifold, they had tried to provide their daughter with treatment and to help with the treatment as they could. The patient, on the other hand, patently could not care less about the expense, or their feelings, or their fate. Indeed, it is a mark of success in treatment when one notices a letup in selfishness and a developing considerateness for others. Some withdrawal, for instance, is within the patient's control; that is, he can make an effort to pay attention to his wife and children if he will bother, rather than be so obsessed with "work" whose main aim is to increase his status in his own eyes. Even though he may need to withdraw, he can fight against it rather than yield to the symptom without a struggle. His wife's complaint, that he simply does not care, may have more justification than she dares to know.
    Similarily, if you are the caseworker or therapist for such a person, you may be concerned for him, even go out of your way to see him. Do not be surprised if he repays you, for a very long time, by scarcely noticing your existence beyond the times he needs you. He is truly incurious about your life except as it impinges on his. He can transfer from one therapist to another with equanimity. Whereas an adult depressive whom you saw briefly and helped with little effort will write you at Christmas time for years afterward, the schizoid adolescent whom you labored and fought for 2 years to drag back from the brink of psychosis often sends no word until there is something he wants. In seducing the schizoid personality into treatment, the path to follow is the same as for any other extremely narcissistic person. There is no point in appealing to his love for his family or his duty to some higher ethic. His interest in change derives from the questions: "What is there in it for me? Now?"
    Should the schizoid personality succeed completely with his distance maneuvers, he will have failed. For the price of freedom from the threat of separation and from the more current anxieties of intimacy is utter loneliness. Thinking to play it safe, he wants to "quit before I'm fired." Refusing to take a chance on losing, he only guarantees his loss. After all, the person who has never loved, nor ever dared to seek to be loved, is as much alone as if he had been loved and then abandoned. Indeed, most of us would think him worse off. His life, too, passes just as inexorably as if he had lived it with pleasure.

The Schizoid Position
I have tried to concretize and illustrate with trait names an image of the schizoid personality formed from experiences in practice. We may say that the schizoid individual personifies the pursuit and the dread of love. But, how shall we explain such a personality? We turn for insight to the theories of the Scottish psychoanalyst, W. Ronald D. Fairbairn (1952) and to the brilliant exegeses of his theories and others by Harry Guntrip (1961, 1969) who, analyzed by Fairbairn, has contributed two fine books on the theory of object relations.
    Which characteristics of the schizoid personality need explaining? Several come to mind which were not covered by previous theory. We think of the schizoid's typical unrelatedness, his fleeing of closeness and treating of other people as less than persons; we think of his flatness of affect, in which he neither shows nor seems to experience much emotion; indeed, the most prominent feeling expressed or implied is futility, "What good will that do?"; and we think of the emptiness of which such patients complain. Fairbairn hypothesized a process that accounted parsimoniously for these phenomena. Although his theory is not without major faults, I have found it extraordinarily helpful for dealing with these patients.
    Fairbairn began as a quite orthodox analyst. Initially, he followed the standard formulations about neuroses, which explained them mostly in terms of the vicissitudes of the sexual or libidinal drives. However, his own patients, and his acquaintance with the ideas of Melanie Klein, led him to differ from traditional theory in several important ways.
    Fairbairn placed great emphasis on the role of aggression. Although the Death Instinct, aggression, had long been recognized in analytic theory, its vicissitudes had not received the attention Fairbairn proposed. To him, it appeared that directing, sublimating and controlling aggression is the chief problem a young child faces in achieving emotional development. Yet, nothing in the early literature on the vicissitudes of aggression matched the model of psychosexual development proposed for the libido. I found Fairbairn's focus on the fate of aggression enormously fruitful for understanding patients ill enough to require hospital treatment. Older theorizing about sexual impulses did not match it.  Take spite, for instance, one of the few outlets for aggression available to people in weak positions. One can make a botch of one's own life to get even with one's parents through a negative identity. We see spite all the time in our work with clients and patients, though it was never mentioned in my original training.
    The other fundamental on which Fairbairn carved out his own line had to do with the need for a "good object." A "good object" would be an image of someone you love and who loves you; such an image, would be in the back of your mind saying, "You are a lovable person; you are going to be all right." Now, previous analytic theory, which was heavily biological, assumed that the infant begins with eroticism, the drive to achieve pleasure. If the mother's breast gave oral gratification, then it--and eventually the mother--became associated with reducing tension of this drive (drive reduction). Hence, one's fondness for mother derived from associating her with drive discharge. Fairbairn on the other hand saw the relationship the other way around: "The ultimate goal of the libido is the object" (Guntrip 1961, p. 288). The baby wants the mother for a good object, and then channels his pleasure seeking in her direction--a major change in theory.
    Commenting on a case, Guntrip wrote, "So basic is the object-relations need that a human being can die in consequence of the complete frustration of the primary libidinal need for a basic parental good-object relationship during the developmental period" (1961, p. 254). The reader will recall the related work of Spitz, cited earlier. Many of us have noted that some "hysterical" women, for example, protested their sexual involvements were coincidental; they had really wanted to be held and cuddled and were surprised when their male friends pushed for intercourse. Even if the sexual urge was denied, an interest in being comforted might well also have been present. Indeed, sex itself may be used as bait to achieve this more basic goal. In short, the patient's conscious version of the events was partially accurate.
    But, if there is a need to be loved and loving, why do some people dread closeness? The answer, for Fairbairn, stems from the infant's helplessness and enormous need of the mother as primary caretaker. She is the source of all goodness: from her comes water, from her comes food. The mother is also the natural person to whom to look as "good object." Yet this woman who loves you and keeps you alive is also inevitably frustrating. No mother can be so perfect as to anticipate every infantile need. By the time the mother gets the signal that the baby is hungry, he is already crying and demanding food. Even then, she may be delayed by having to care for others in the household, or her own urgencies. So each of us without exception experiences deprivations in infancy. Everyone has angry feelings toward mother, mixed in with the loving.
    Some infants undergo far more deprivation than most. Extended deprivation, however, is more than angering; it is frightening. For, the gaping void portends death by desiccation or starvation. The emptiness the adult schizoid complains of, "I feel all empty inside; I feel dead," perhaps derives in part from these very real early experiences. The emptiness also seems to derive from massive affect inhibition (see below).
    Even more destructive from Fairbairn's standpoint, is the fact that the depriving mother does not make her child feel loved for his own sake, as a person in his own right. Such a mother may be preoccupied with her own needs. We have described the infantile person who openly talks about having babies because they make her feel so good nursing them. Or the mother may in fact dislike having the baby. Such rejection is usually repressed, of course, and may show itself as a reaction formation, which Levy (1943) called maternal overprotection. The mother's harsh, penetrating tone of voice, clumsy touch, her obliviousness to the real needs of her squirming infant all contribute to the baby's anger and fear. Still, to Fairbairn, the fact that one does not feel loved as a person for one's own sake predominates over these other life mishaps (see also Kohut, above).
    Certainly patients often complain bitterly of such feelings. "My playing the piano so well gave her something to brag about; she did not notice what I got out of it. Finally, I didn't care whether I ever played again." Note the disappointment of this good little girl's best efforts to be loved for herself. Given her mother's limitations as a person, her attempts all proved futile. One would not require Fairbairn's insight to remark, as we sometimes did, "But, you're sucking on a dry tit!" Patients, by the way, prefer to see the parent as unwilling to meet their needs, rather than unable. For, if one's father is unwilling to love one, one might be able to change his mind. But if he is a man with nothing to give, where are you then? If feels better to be angry at him than to be understanding." The latter implies that you have given up hope.
    So, the massively deprived infant is disappointed in the search for a good object. And is likely also to be severely frustrated in oral needs very early in life, so much so that besides being angry, s/he feels empty and downright frightened. Such gaping hunger when fused with aggression gives rise to a ravenous, oral aggressive (oral-sadistic) impulse toward the mother. Guntrip has aptly termed this state, "Love made hungry." This stance presents the patient with an insoluble dilemma. "Love made hungry is the schizoid problem . . . the fear that one's loving has become so devouring and incorporative that love itself has become destructive" (Guntrip 1969, p. 24). If you gobble up the mother, you will not have her any more; you will be alone. So, you take distance, let us say, and urge her to "Keep away lest I destroy you, for both our sakes." You will in fact, now perish of loneliness.
    These are powerful and frightening conflicts for the severely deprived child. Fairbairn postulates that under their impact the infant "splits." By this he means that the infant tries to wall off all these feelings in his mind, and keep them rigidly out of consciousness. There is a terrible price for such splitting, however, because-- in addition to the oral aggression--many other feelings like love and joy are also walled off. Splitting may result in massive affect inhibition, a self-induced numbness to one's own emotions that comes across in interviews as flatness of affect. It is not, of course, that such a person has no feelings; she/he is not conscious of her feelings. No wonder she/he complains of being "all dead inside." How does one know she/he is alive except from inner emotions? From this numbing, I believe, comes the craving for excitement found in at least some hysterical men and women, the same numbing found rather widely among delinquents, most of whom idealize their mothers. Also, many schizoid patients have body-images lacking depth. As one told me, "I picture myself as a silhouette."
    The proclivity of severely deprived youngsters to commit crimes against persons when they are teenagers and older derives, in part, from their distancing; they treat others as nonpersons as they often do themselves. But, the massive affect inhibition also contributes, since it limits their ability to empathize with another's pain (Polansky et al. 1981).
    Fairbairn's powerful set of formulations explains most of the schizoid syndrome. By a line of reasoning with which we already are familiar, he went further. The unfortunate may emerge with a schizoid stance toward life, it is true, but each of us passes through a developmental phase when schizoid issues are in crisis. Occurring in the first six months of life, this phase is labeled the schizoid position. It parallels Klein's paranoid position and, indeed, she began later to speak of a paranoid-schizoid position. Most children, fortunately, resolve this life crisis happily and end with a few or no schizoid elements. But just as remnants of the various psychosexual phases may be discerned in many of us, so unresolved remnants of the schizoid phase are also present.
    For example, most of us are capable of feeling futile. We do not feel that way much of the time, but the feeling can be brought to the surface--for example by contact with another person in whom it is conscious and manifest. We have written elsewhere about women who neglect their children. Many neglectful mothers show the Apathy-Futility Syndrome, as we have called it. One of its features is that protective services workers find the futility contagious; after some time in the presence of such a mother, you begin to wonder not only whether it is worthwhile to keep trying to reach her, but whether anything is worth doing. A feeling like that obviously cannot be suddenly injected in you by the client. The feeling must be present but well defended. The client's pattern, and skill, bring it to our conscious awareness (Polansky, Borgman, and DeSaix 1972, pp. 54ff).
    From dealings with patients, Guntrip (1962) has aptly sketched what he calls the schizoid dilemma. Should the schizoid person begin to feel involved with another, powerful feeling are stirred in him. Some make him feel childishly needful and ashamed; other, aggressively demanding and frightening. So he tries to evade the anxiety by fleeing to aloof isolation. There, he is overtaken by devastating loneliness. Torn between Scylla and Charybdis, the patient desperately tries to strike a bargain among the forces competing within him, and works out the schizoid compromise. The compromise consists in finding the optimal distance between perishing of loneliness, or of coming too close. just as people tend to get involved with others of the same psychosexual stage as themselves, I have noticed that in quite a few couples, regardless of surface differences in sociability, there is a likelihood to have picked each other out to maintain the mutual distance each finds optimal.
    The schizoid compromise reminds us that taking distance is a particular kind of defense, a security maneuver. A therapist actively encouraging a patient's involvement with others out of pity for the isolated life is met with polite disbelief. "I've got a secret" is the attitude. The therapist may be urging, in effect, "Nothing ventured, nothing gained"; the patient is smugly paraphrasing "Nothing ventured, nothing lost," and feeling superior while doing so. Alas, the confidence is mistaken. Thinking that by keeping distance one can avoid turmoil that goes with closeness, the possibility of ending up all alone, patients reduce the risk by remaining aloof. In so doing, the gamble is limited--such patients guarantee that they will be alone.
    For schizoid persons to break out of their shells requires, among other things, that there be an admission of fondness for, or commitment to, another person. It is easy for such clients to bawl you out; it is very hard for them to say, "I like you." For expressions of affection create vulnerability and sadness by reminding clients of early yearnings and disappointments. Such an expression may be accompanied by an urge to cry. In my experience, unless sad tears occur in treatment in discussing feeling toward the therapist or toward others in the client's life--not once, but repeatedly--the schizoid individual is likely to remain immured behind the brittle battlements we have described. How one gets such a person to risk is not well understood. Success has as much to do with the client's stance as with our skills, at this stage of our knowledge.
    Guntrip has also attempted a kind of synthesis of the theories of Fairbairn and Klein showing the relationships between the schizoid and depressive stances. The schizoid stance reflects major early deprivation-love made hungry, in Guntrip's telling phrase. The depressive stance reflects a much less severe deprivation, and leads to love made angry. Here, the urge is to attack an object perceived as actively refusing to meet one's needs, a rejecting, bad object. "It leads into depression for it rouses the fear that one's hate will destroy the very person one needs and loves, a fear that grows into guilt" (Guntrip 1969, p. 24). Guntrip in effect identifies two kinds of bad objects, one you want to devour, the other you want simply to attack. Clinically, one has the impression that the schizoid stance is more pervasive, earlier in origin, more ominous than the depressive. Depressives are usually related to people; their anger is against a particular object that may have been lost, for example. But, other than this, I am not sure whether Guntrip's distinction clarifies our understanding very much.
    Fairbairn's interesting ideas have not had the popularity in England that Klein's enjoyed. Serving to integrate new information, his formulations create major problems of theoretical parsimony. If you alter emphasis as he did, it becomes incumbent on you to show its effects elsewhere in the theory. Otherwise, your colleagues may discount your ideas and go on as before.
    There is a second reason for reluctance in adopting Fairbairn's and Guntrip's ideas. The citations from adults they use to illustrate their points are well taken and credible. But as with Klein, one is hard put to think of a way of testing, through the direct observation of tiny infants, whether the imagery is anywhere near what goes on in those developing minds. Now, as a tiny house-fly can elude swatting for twenty minutes on end, the fragile human neonate is surely capable of sensing its survival needs and the danger of death it faces from being uncared for. What greater danger does the human infant face, really, than being "unlovable?" No wonder we fear it though out life! But how much of the rest of the theory applies? Fraiberg (see Chapter 8) and her colleagues would find it rather hard to believe it all happens in the first year. So again, we are in the position of observing psychoanalytic theory in the process of becoming, but not yet achieving final synthesis. Meanwhile, as sources of insights into the dynamics of clients with very severe anxiety about human intimacy and commitment, the writings of Guntrip are unsurpassed.

Attachment and Detachment
All who aspire to advance the basic sciences of human behavior must be impressed by John Bowlby. Consider his professional biography. As a still young child psychiatrist, he became widely known after World War II for a most timely study. Conducted for the World Health Organization of the then brand new United Nations, the study concerned the effects of physically separating a child from his mother--a condition to which the Nazis gladly contributed on numerous occasions (Bowlby 1959). At the time, maternal deprivation, or insufficient nurturing, was being lumped together in research with mother-infant separations (Ainsworth 1984). Bowlby focused on the issue of separation, as such, and on the processes aroused by it. He noted early in his work that anxiety was a nearly universal concomitant (Bowlby 1960a). But the significance of separation anxiety was not accepted in analytic theory. Instead, it was formulated about as follows: separation leads to anger, which leads to guilt, which leads to guilt anxiety. To Bowlby, this seemed clumsy and forced. Why not just postulate that separation anxiety is, itself, an automatic reaction to loss of the object? (Bowlby 1961). But if this form of anxiety is inborn, "comes with the package" as it were, then the tie being ruptured must also be inborn; logically, then, Bowlby was led to study attachment (Bowlby 1960b).
    Humans are not the only animals who show attachment behaviors. So Bowlby, while continuing his clinical practice of psychoanalysis at the Tavistock Institute in London, began to delve into the field of ethology, the study of animals under natural conditions. A number of reactions found in humans parallel attachments and responses to ruptures of attachment in dogs, wolves, bears, even chickens. Bowlby has also spent years exploring clinical manifestations of attachment and loss, trying to draw inferences that might make treatment more efficient (Bowlby 1969, 1980). There are not many examples of such theoretical breadth coupled with coherence and tenacity of purpose. In part because of his collaboration with the psychologist, Mary Ainsworth, attachment theory has been provocative of testable hypotheses and a fruitful source of ideas for empirical research (Ainsworth 1984).
    Bowlby remains an admirer of Freud's contributions, but has seen himself as trying to update Freud's theory in the light of advances in related sciences and new evidence. For instance, the older conception of instincts has now been supplanted by more precise terms such as fixed action pattern, and behavior system. Rather than being in a constant state of readiness (the reservoir model), "instinctual" energies are thought to be turned on (and off) by fairly specific environmental events. Analysts also assumed that the infant's tie to his mother was because the mother is associated with satisfying more basic needs for food and pleasure. But in classic experiments with infant monkeys, Harlow et al., (1961) found that seeking contact was directed to a surrogate mother comfortable to cling to rather than the one supplying milk. The comfortable, soft figurine was also preferred when the infant monkey was frightened. Ainsworth (1967) also found many infants are attached to their fathers even when the latter play no role in feeding them. Reality has proven less parsimonious than the original Freudian formulations. Bowlby believes they need to be updated.
    Attachment theory is, of course, taught in many psychology courses, and does not need detailed explication here. But even though his ideas have still not gained wide acceptance in the analytic movement (Dinnage 1980) how can one discuss the pursuit and dread of love without reference to Bowlby?  Separation anxiety can be typified by this scene. Imagine a small child, helpless, easily damaged, being held to the mother's breast. Should the mother suddenly let go, the child would find itself wrenched from security, falling alone through space-as many of us did in desolating nightmares in childhood. Or in adult life, try to magnify the sensation you have when the floor of a high speed elevator drops beneath youagain, the terror of falling through space. To Bowlby, this terror is the primordial form of all anxiety. That is, the various other meanings such as guilt anxiety, or the fear of internalized punishment by the superego, and ego anxiety, the sense of being overwhelmed by stimuli, all derived ultimately from basic separation anxiety.
    Bowlby became interested in the reactions of infants old enough to be attached to their mothers (more than six months old) when the mother left. He found a regular sequence of events. First, the infant looks uncomfortable, and thrashes around. Next, if she does not return, he becomes angry, and protests. If his wailing does not bring about the mother's return, the infant lapses into despair in which he looks and acts depressed. Eventually, this too seems to pass, and the infant seems resigned to his fate. He comes to terms, but sullenly and without joy. To Bowlby, the infant is now detached.
   The phases following separation from the attachment object are protest, which has to do with anger, despair, which has to do with depression, and detachment, which is a defense. That this detachment represents repression rather than a final resolution is readily demonstrable. Imagine a woman you once loved, whom you have not consciously thought of in years. Should you suddenly confront her, you are swept by unexpectedly powerful emotions. As one of my students suggested, detachment is a reaction formation against attachment; it represses separation anxiety, anger, and depression.
    Now, detachment is a wonderful, merciful mechanism. Without it we could hardly bear the deaths, the partings, the disappearances from life of all those we have loved but lost. But, like many useful coping mechanisms, it may become pathological and symptomatic. Children, who have had to use it over and over in life, beginning very early, seem to become addicted to detachment. Almost before a bond with someone has started to form, the adult who was a disappointed child begins to pull away. One reason we social workers are so concerned about children with undependable parenting, or who have to be placed and replaced constantly in early childhood, is fear that they will emerge as detached adults unable to form close ties with anyone. My generation saw a lot of this in youngsters from large, congregate child-caring institutions, and spoke of institutionalism as a pathology.
    Let me now briefly summarize Bowlby's theorizing, from various sources. From the standpoint of ethology, there are three common responses to fear: withdrawal from the situation; freezing into immobility, like a startled rabbit or deer; retreating to the attachment object. Young primates, as soon as they can move, physically cling to their mothers when in fear, and try to reach them if they are not already close. This impulse to find someone to cling to in the face of danger is innate. It is readily visible in the reaction of green troops to artillery fire, for example. Why has it been bred into the species? Because the trait had survival value in our long evolution. Fleeing to the shielding mother gave the young animal protection from other predatory animals who wanted to catch him alone and eat him. The evolutionary function of attachment behavior is protection from predators.
    The danger of predators is seen, as a matter of fact, in a number of other situations leading to fear responses, although none of these is dangerous, in and of itself. These situations include darkness, sudden large changes of stimulus level (sudden noise, sudden quiet, flash of light), strange people, strange places, sudden movements, looming objects. Each of these frighten most young children, at least at first; each situation can be readily associated to a position where something very large might pounce on you. Separation, then, is but one of a class of situations experienced instinctively as dangerous.
    Why, then, do some children emerge relatively secure and able to leave their parents while others continue anxious clinging? What happens when a youngster is taken to nursery school for the first time? At first, she/he stays close to mother, clutching tightly to her skirt or blue jeans. S/he looks fearfully out at the other children, and finally moves to join them. But from time to time she comes back to mother. After a while, s/he has assured herself that the way back to the attachment object is clear. At this point, s/he can comfortably leave the mother for longer periods. Indeed, within a short time, usually several days at the most, s/he becomes (1) attached to a substitute object, one of the adults in the nursery school and (2) confident that the mother will reappear and take her home after a few hours. Over a period of time, Bowlby believes, all fortunate children develop confidence that the attachment object will be accessible when needed. They also internalize an image of a good object. This mental image has the enormous advantage of being portable. In effect, one is now able to offer one's own psychological source of security derived from the internalized good object. Children who have experienced separation or threats of separation from their parents do not develop this kind of confidence, according to Bowlby.
    To bring separation phenomena under more controlled study in the child development laboratory, Ainsworth devised what she calls her strange situation. A one year old and his mother are brought into an unfamiliar room containing a large array of toys designed to elicit exploratory behavior. "A series of episodes followed: First, baby and mother were alone together; then they were joined by a stranger; then there was a separation episode in which the mother left the baby with the stranger, followed by an episode of reunion with the mother; a second separation followed in which the baby was first left entirely alone and then rejoined by the stranger; finally, the mother returned for a second reunion episode" (Ainsworth 1984, p. 572f). The infant's responses to being in a strange setting, approached by the friendly stranger, being left by his mother, and reuniting with her are closely observed, recorded, and coded and scored. Three patterns have emerged describing groups of infants: securely attached, anxiously attached and resistant, anxiously attached and avoidant. In a so-called normal population, secure attachment was by far the most common pattern. But what kind of nurturing produces the others?  From hours of observation in their homes, mothers of securely attached babies appear to be more sensitively responsive to infant signals and less rejecting, interfering, and ignoring than mothers of the anxiously attached. Mothers of avoidant babies showed an aversion to close bodily contact with the infant, also in the home situation.
    Why do mothers show patterns that seem less than optimal for their toddlers? Main and Goldwyn (1984) reported the results of interviews in depth with a series of thirty California mothers whose children had been tested in the strange situation some years earlier. They found that the mother's rejection by her own mother in childhood was strongly correlated with her own infant's avoidant behavior with her in the strange situation. In another study, ten infants who had been battered were being seen in a nursery school with others who had not been. The battered toddlers, aged one to three, showed avoidant behavior to friendly overtures from both caretakers and other children. Most shocking were observations of how they reacted when another youngster showed distress (e.g., crying) in their presence. Unlike the other toddlers, they seldom showed empathy. A number of the abused reacted, instead, with fear, anger, and even physical abuse of the distressed peer. We see, then, that the study of toddlers may be revealing of the roots of behaviors later observed in parents. Avoidance of contact with one's baby can be a reaction formation or phobic defense against impulses to hurt the child that stem, in turn, from abuse experienced in one's own childhood. Fraiberg, Adelson, and Shapiro (1975) describe a heartening success in treating such a potentially tragic outcome of a mother's identification with the aggressor through analytically oriented social casework.
    If anger, despair, and detachment regularly follow separation from the attachment object in infancy, one wonders whether the theory might not also be applicable to clinical work with mourning in bereaved adults. As we remarked earlier, depression is typically preceded by loss of the object (Brown and Harris 1978). Bowlby has pursued this subject, too, in the latest of his trilogy on attachment (1980).
    Bowlby's theorizing has much in common with that of Klein, Fairbairn, and Winnicott, but differs in a couple of critical respects. First, he places less emphasis on internal transactions within the ego but thinks that a child's degree of confidence is a "tolerably good reflection" of actual life experiences. Second, Bowlby does not think that the processes he describes leave fixed effects in the first three or four years of life, but that the period during which these "representational models," these favorable or unfavorable expectations, are still subject to change goes on until around adolescence.
    In terms of clinical practice Bowlby asserts that attachment processes represent a class of behavior independent of--but as significant as other drives such as sex or feeding. Therefore, each patient's experiences around attachment need to be explored. Difficulties with relating to the therapist may well reflect expectations of disappointment. The job of the therapist is also to interpret the model the patient seems to follow, calling attention to inappropriate clinging, or his detaching himself from those to whom he might want to become close. As do other therapies in the analytic tradition, Bowlby's aims to free the patient from archaic responses that cripple him in his present reality.
    In terms of this chapter's theme, what may we derive from Bowlby's work? If there is, indeed, an attachment behavior system, the need certainly accounts for some of what we observe as the "pursuit and dread of love." With due regard for the rule of parsimony, we must add attachment to our list of sources of psychological energy. And what of those who do not form attachments? Bowlby's theory implies there may be at least a few unfortunates so deprived in infancy that the attachment system was never turned on, just as it was not in Harlow's monkeys reared in isolation. However, for most clients with related problems, the need is present, but it has been blunted. In effect, the attachment process is invaded by conflict. What of those who remain studiously detached? It is as if, in the act of becoming involved, they already anticipate the pain of abandonment which, to them, is how things inevitably work out. They keep their distance to avoid the pain.
    If you go on a trip and leave your dog in the kennel for several days, he will probably jump all over you with delight when you return. Should you leave him for several months, when you come back he will act as if he does not really recall who you are. He will stare away from you, and act indifferent. It takes several days before he lets himself dare to enjoy being near you once again. Something like this is found in the complaints of parents whose emotionally disturbed child must be taken for in-patient treatment. "It's nice to have her home, but things are just not the same." This may mean they are becoming detached. Parents of children in placement, including those who have madly fought their removal, sometimes visit less and less often and, after a matter of months, act as if the children no longer were theirs. We are learning to observe these phenomena in our practice: we owe much to Bowlby's insights into attachment and detachment.
    The attachment need seems operative in most reasonably normal people. In our university, freshmen are placed more or less at random in huge, impersonal dormitories. Nevertheless, they carve the mass into people-sized units. How are groups formed? Primarily, on the basis of sheer contiguity--"the fellows on the south end of the fifth floor." Before individual transportation became so matter of course in the United States, studies of marital choices used to find, touchingly (no pun intended!), that propinquity of residence was a major factor. I believe it was Mark Twain who remarked, "Familiarity breeds children."

The Fusion Fantasy
We have covered a number of theoreticians who have remarked on the intense loneliness found among the emotionally ill: Spitz, Mahler, Fairbairn, Guntrip, and Bowlby--each with very diverse conceptual preoccupations. Yet, regardless of viewpoint, the encountering of yearning isolation demanded clinical attention and understanding. Of course personal qualities and the Zeitgeist affect individual sensitivity. Guntrip, for example, remarked that if Freud had not had such a schizoid cast to his own personality, he might have paid more attention to such feelings in patients.

Freud said he employed the couch technique because he could not stand being looked at by his patients for eight hours a day.... He showed fairly clear signs of a resistance against the 'human closeness' involved in the kind of work for which at the same time he had such extraordinary gifts. (Guntrip, 1961, p. 250)

None has focused the issue more forcibly than Hellmuth Kaiser. The Nazis gutted the middle years of his professional life, so Kaiser has left only a few posthumous writings (Fierman, 1965). He fled Germany to Majorca, was driven out by local Fascists, and went to France where he lived for many months under the Petain regime, without papers and supporting himself by teaching figure skating when he could. Having failed to gain refuge in England, he eventually escaped to Israel where, unable to acquire fluency in Hebrew, he made his living as a woodcarver. One wonders how much need there was for yet another psychoanalyst in that young, embattled country! After World War II, David Rapaport was sent on a mission to Israel to recruit Jewish refugees who were analysts to join the staff of the Menninger Foundation, in Kansas. The Foundation had received governmental support to train a large number of young physicians in psychiatry. Kaiser was one of those recruited. Most of the refugees had been living hand to mouth in Israel, but after some years in Topeka, they realized how cheaply they had been hired by American standards: most left for other settings. Kaiser, whose doctorate was in philosophy and mathematics, came to Hartford, Connecticut, where I saw him for analysis. Already an older man suffering from angina, he eventually moved to the warmth of the Los Angeles area where he died.
    Kaiser was apparently always something of a loner, an original and critical thinker. Trained in psychoanalysis in Berlin before World II, he had not been long in practice as an analyst when he began to wonder what was "therapeutic" about what he was doing for patients. Conferences with senior colleagues were not reassuring, for he found they did not agree among themselves about which aspects of the complex analytic encounter were actually specifically geared to curing patients. The usual explanation, of course, had been that the cure depended on insight. When the patient was able to recognize consciously why he was doing what he was doing, he would lose the desire to do it. Yet, as Kaiser reasoned, to be capable of having an insight means the patient can now stand to be conscious of an idea or impulse that he could not tolerate before. This means that in order to have an insight, one must already be somewhat better, "a little bit cured," shall we say? Hence, Kaiser had a major question: Is insight the cause of cure, or one of its effects--a reflection of the fact that the patient is already somewhat better? And, if encouraging insight is not the specific in treatment, what is?
    Having arrived at such questions while still in practice in Berlin, Kaiser continued to mull them over during his long years of exile from the work. As a person, he was tough, bright, engaged. The most helpful thing I found about treatment with him was that I had, this time, full permission to speak freely all I really thought, including my ideas critical of the treatment and the theory behind it. Rightly or wrongly, many of us in classical analytic treatment had the impression that if you did not "believe," you could never get well. Of course, this was nonsense since believing is not something you choose or refuse; you believe or you do not, just as you trust or you do not. With Kaiser, all such reservations were up front and if you were too polite to raise them, they came out anyhow. For one thing, disbelieving the whole theory can be an elementary intellectual form of resistance. What, then, did Kaiser finally distill?

Patients are lonely persons ... even those who move in a circle of friends . . . are at least alone with their neurotic problems.... However painstakingly the patient may describe his symptoms to his wife or his friend, he will never feel completely understood; for good reasons: He cannot tell what makes it all so hopelessly complicated because he does not know himself. What drives him into the office of the psychiatrist is not so much the realistic hope of getting cured as the wish to step out of his isolation....  As long as the patient's interest in the therapist is not too intense, the patient can behave in an approximately adult fashion. When his interest increases beyond a certain limit, the adult relationship becomes intolerable for the patient. Closeness, as it is accessible for an adult, illuminates more than anything else could the unbridgeable gap between the two individuals and underlines the fact that nobody can get rid of the full responsibility for his own words and actions.... The patient tends to form with the therapist what one could call "a fusion relationship...... It is characteristic for transference behavior (or, in my terminology, for an attempt at a fusion relationship) that the patient is not really interested in communication (sharing of thought, feelings, experiences) but has to do things which create in him the illusion that there is some subterranean connection between him and the therapist. (Fierman 1965, p. xixf)

    Kaiser does not attempt a theory of personality, nor anything like one. What he offers is a rationale for his therapy, a theory covering just those aspects of mental functioning which seemed most crucial for effective treatment. Fierman has abstracted Kaiser's formulation about people with psychological disorders as follows:

The universal triad consists of the universal psychopathology, the universal symptom and the universal therapy. The universal psychopathology is the attempt to create in real life the illusion of the universal fantasy of fusion. The universal symptom is duplicity in communication. The universal therapy is the communicative intimacy offered by the therapist. (p. 207)

Kaiser's work is memorable because he has traced out a series of defensive operations patients use to deal with existential loneliness. One might say, he starts with an "awareness of separateness" anxiety and then considers some neurotic ways of handling it which worsen one's existential condition. Each of us is, after all, an isolable biological unit. Each is born alone and will die alone. This truth is hard for most people to face, but for persons with certain types of emotional problems it is unbearable.
    Detailing his observation on psychopathology, Kaiser sees a conflict ("the universal conflict") between recognizing one's aloneness and the need to deny it. "The struggle against seeing oneself as an individual is the core of every neurosis" (Fierman 1965, p. 135). "Being 'an individual' entails a complete, a fundamental, an eternal and insurmountable isolation" (p. 126). What brings one's essential aloneness most forcibly to attention?

Three mental activities--very ordinary activities, indeed--seem especially conducive to producing this fateful inner experience: first, and perhaps foremost, is making a decision; second, in reaching a conviction by thinking; and third, in wanting something.... Whenever the patient comes close to having it driven home to him that it is he, himself who is going to make a decision ... a piece of delusional ideology rolls like a fog over the mental scenery, softening or even obscuring the lines of the picture.... Of course, what is necessary to make the inner experience of deciding, thinking or wanting so potent that it needs obscuring is not a routine decision expected and approved by the patient's environment. (Fierman 1965, p. 133f)

    The "universal" defense to which Kaiser points is what he terms the "delusion of fusion," the mental game that you and another are somehow connected--two bodies with a single mind. A lady in your office has been complaining about her husband's inattentiveness. "I love the movies, but he never offers to take me." Without thinking, you ask, "Well, have you asked him?" "No, of course not. If I have to ask him, that will spoil it." What would be spoiled: the fantasy that, "Since he loves me, we are as one, and he knows what is in my mind."
    In writing about the obsessive-compulsive personality, I mentioned the need to feel forced, giving the example of the man who "Has to go to the great sale and buy a new suit." Why the need to feel forced by something bigger than, or outside oneself? In terms of Kaiser's theory, the feeling serves to help you obscure that recognition that you are choosing. And, in the long run, everyone does this all the time. Indeed, not to act is also a decision! Even inmates in concentration camps exercised choice: some chose death as the punishment for a quick act of defiance. Feeling forced also gives the person the feeling he is not alone. Someone, somewhere cares enough to look over his shoulder at what he is doing, and this is better than feeling totally on one's own.
    The "universal symptom" is duplicity in communication--appearing to be involved in sharing ideas and facts, but actually being preoccupied with maintaining connection to your hearer. But, the effect of duplicitous communication is usually to increase, rather than reduce, one's isolation. If, for example, it becomes terribly important to you that the other person completely adopts your opinion--so you can feel at one with him--you may argue so long that he never wants to see you again. Preoccupation with the impression you are making certainly does not make for lively, attractive conversation.
    And yet, human speech may be the channel by which the greatest closeness between adults can be achieved. No wonder we get the complaint, "The sex is fine; but, she never talks to me." (Not only women file this grievance.) To Kaiser the universal therapy consists in helping the client stand behind his words. In part, this emerges naturally from the therapist's example in making possible a relationship in which the equality and the autonomy (one's being in charge of oneself) of the patient are respected. In part, of course, it emerges from refusing to go along with the patient's fusion-fantasy as expressed in the interview. As in other analytically derived psychotherapy, one may from time to time use clarification and even interpretation--"You seem to mean you do not agree with me, but you are putting it in the form of a question."
    Kaiser's method of doing treatment may be easily condensed, but not so easily described. There is a critical shrewdness in his approach worth remarking. After all, what behavior by a patient is most directly observable and most directly at stake in any talking treatment? The patient's use of the speech function. One can hear, in person, how it has been invaded by conflict and neurotic defenses. Treating the ego function of speech gives us a point of leverage by which to treat the whole neurotic structure. And as we have noted earlier, those able to talk directly and meaningfully put themselves in a position to achieve the degree of closeness realistically possible among adults. Such closeness may not promise as much fantasy of fusion, but it will not be as ultimately disappointing, either. We cannot really fuse ourselves with others, but can comfort each other with talk against the darkness and the void. And the effort to talk directly heals splits within the ego.
    In my experience, Kaiser's approach is an effective talking treatment for patients diagnosed as having many schizoid or borderline elements. Though a severely limited theory of personality, it has been used successfully in treating neglectful mothers with problems in these realms. Freud said that the denial of one's mortality was universal in man. The denial of one's ultimate aloneness must be nearly as ubiquitous. Kaiser has given us the most complete statement of the various situations we find ourselves in--deciding, taking responsibility--that exacerbate the loneliness and awareness of separateness anxiety. And he has provided an analysis of various defenses people use to allay loneliness. Some of these make it worse (Polansky 1980, 1985).
    Kaiser's formulation refers to that "eternal and insurmountable isolation" which is Everyman's fate. Given that the reality is universal, one may expect to find at least some traces of the fusion fantasy in almost anyone. For example, the intolerance that cohesive groups show toward persons holding opinions that break the consensus may be traced to a need to sustain the unconscious idea that all are mentally connected, and as one. Yet, only a minority of people are obsessively involved in fusion-fantasy maneuvers. Why do they suffer more awareness-of-separateness anxiety than others? Kaiser was silent on this issue. He had some interest in characterology, but very little in historical causation. Although we have emphasized his contribution to object relations, Kaiser reflects many existentialist elements.

The Lonely Children of Divorce
While Kaiser has given us a creative understanding of defenses against existential loneliness, a longer list can be made of the various ways people go about coping with loneliness in general. A rich lode of insights is to be mined from the writings of Judith Wallerstein and Joan Kelly on the children of divorce (1980). Wallerstein was trained initially in social work and later in child analysis; Kelly, in clinical psychology. They studied 131 children ranging from 2 1/2 to 18 years of age from 60 families in Marin County which had recently been, or were in process of being, broken by divorce. Marin County is an upper-income San Francisco suburb, predominantly white with one of the highest divorce rates in the world.
    The project had several aims. One was, "The teasing out of the intricate patterning of defensive, restitutive, and coping mechanisms employed successfully or unsuccessfully in response to the parental separation and the post-divorce family structure" (Wallerstein and Kelly 1975, p. 601). Referred by lawyers, pediatricians, and teachers, the children and their parents were seen individually for five or six individual clinical interviews in a preventively oriented planning service for divorcing families. All were followed up about one year later. Children determined to have had previous contact with a psychiatrist or psychologist were excluded from the study.
    "Since 1962 there has been a 135% increase in the number of divorces. The steady rise in the divorce rate, from 2.2 per 1000 population in 1962 to 4.6 per 1000 population in 1974 is a national trend that shows no sign of diminishing" (Kelly and Wallerstein 1976, p. 20). As a study of typical responses to be found among a segment of the community confronted by the same life disaster, the study by Wallerstein and Kelly is reminiscent of Lindemann's (1944) classic paper on grief (see Chapter 4). These authors point out, however, that although reactions by children to divorce have often been treated in terms of object loss and mourning, more is involved. The missing parent--usually the father--is typically still in touch with the child; divorce also induces other major life changes. Many mothers must resume full-time employment, for example, and the same menage must be run with one less pair of adult hands.
    Wallerstein and Kelly were especially interested in how children respond at differing developmental stages. In their youngest sample, 2 1/2 to 3 1/4 years, all nine children reacted with:

Significant behavioral changes, which included acute regressions in toilet training ... increased irritability, whining, crying, general fearfulness, acute separation anxieties, various sleep problems, cognitive confusion, increased autoerotic activities, return to transitional objects, escalation in aggressive behavior, and tantrums ... In the main, these children possessed very few mechanisms for relieving their suffering. (Wallerstein and Kelly 1975, p. 602)

So, despite the continuing presence of the mother, this group shows the full impact of the object disruption. Pain is very great because it is unbuffered by the ego. Yet even at this age there are efforts at restitution, that is, replacing what has been lost through transitional objects and autoeroticism.
    I have preferred to cut across the various reports of differential response in order to abstract the ego mechanisms that seem to have most to do with handling loneliness. Here then is a partial listing of the coping mechanisms identified, commencing with defenses commonly employed.
Denial: Denial may distort the actuality of, or the degree of the disruption. Very typically, it involves renunciation and splitting-off of the feeling involved. "I don't mind; it's just as well."
Reaction-Formation: Sadness may be overlaid by a kind of manic, brittle cheerfulness. "Everything is just great." Tendencies toward immobilization and regressive disorganization may be countered by becoming galvanized into business and involvement in projects and structured extracurricular activities. Through such participation, even fairly young children were seen to "provide themselves with needed supports and, in effect, construct their own support systems" (Wallerstein, 1977, p. 287).
Restitution: The impulse to reinvest an object may be expressed as a regressive neediness, sothe child clings to relative strangers. Urges toward restitution also came out in fantasies (e.g., "My Daddy sleeps in my bed every night"). Some youngsters made efforts at reconciling their parents, all the more pathetic when the adults were glad to be rid of each other. One workable form of restitution occurs in instances in which the departed father actually has a more loving relationship with his child after leaving home. The father who unconsciously resented his child for tieing him into a frustrating relationship may change his feeling after divorce. And we have noted above that many children achieve some restitution by forming important relationships outside the family. From my sister, Adele Polansky, I have learned that many, many teachers are sensitive to the needs of the children and burdened mothers involved in a divorce, and make extra efforts to reach out helpfully toward them. So, realistic restitution depends in part on the readiness of the child to form new ties; it also depends on how lucky she/he is in surroundings.
Detachment: Adolescents were interesting in the way they used detachment to heal the pain of loss. It is the developmental stage where they begin to detach from their parents; but the divorce process actually speeded the developmental work for many and stimulated a surge toward growth and maturity (Wallerstein and Kelly 1974). Deidealization of the parent is part of the expectable maturational process and it too may be hastened because divorce encourages the child to individuate his parents. So, the process may advance the adolescent's phase-specific effort to achieve a workable identity. One suspects, however, that whether detachment becomes addictive (because it works so well) and therefore generalizes to hinder attachments to new persons, or proves, instead, to encourage growth largely depends on how much anxiety is in the picture. As with defensive progression, detachment too far out of phase with development can prove crippling. That was how it seemed to us in the personalities of neglectful parents (Polansky et al. 1981).
Mastery Through Repetition: The urge to repeat an anxiety-laden experience in order to "wear out" the anxiety will be remembered as an explanation for the recurring nightmares of childhood-- and adulthood, for that matter. Children of divorcing couples may need to reenact situations in which they became helpless and vulnerable, and this can become an additional impulse toward regression. At a later stage in life, the person who repeatedly makes but breaks relationships may also be in the grip of the repetition compulsion.
Mastery Through Converting Fate into Activity: Closely related is the other generalized coping mechanism, described by Rapaport (1967b). Self-blaming by the child and taking responsibility for the divorce was often noted. Wallerstein and Kelly see its role just as we depicted it in relation to grief. "This loss could not have just happened to me; I must have had some control over what took place." Thus the little girl or boy achieves a bit of mastery, but at the cost of creating a new source of guilt. "I had control but I let it happen." The ego's search for mastery also seems present in efforts made by some children to find a principle by which to explain to themselves what must otherwise seem an arbitrary disaster. Small children adopt a querulous, confused questioning: "Why? What goes with what?"
Cognitive Restructuring: Some youngsters on the other hand were able even in preschool to develop a fairly good understanding of the divorce-induced changes in their lives, and this seemed to help. Not only did this lend meaning to the experience, it must also have provided a map from which predictions could be made, which also added to feelings of mastery. While the ability to verbalize feelings of sadness and longing is ordinarily regarded as useful for advancing one's realistic restructuring of his map of the world, Wallerstein and Kelly did not find that the preschool child's ability to verbalize necessarily prognosticated better adjustment a year later.
Withdrawal: As with the defenses in general, the distinction between coping and defense mechanism is partly a matter of how avidly and rigidly the maneuver is pursued, and partly of the purpose served. Withdrawal in the younger preschool children usually seemed pathological. But a number of adolescent children simply distanced themselves from their parent's struggles in a way that, at least for the moment, seemed to alleviate pain and forward growth. Similarly, the ability to "take distance" which we have seen as essential to accurate self-observation also proved useful for children in their attempts to get a realistic handle on what they were facing in their parents.
    As always, it is hard to determine whether the happy choice of a mechanism protects health, or healthy people are more likely to use the coping mechanisms available to the ego in effective ways. In any event those engaged in family counseling will obviously want to read and reread the work of Wallerstein and Kelly in the original. Their study has been drawn upon here to illustrate the point made by Kaiser, from another vantage point. Life repeatedly injects loneliness into our lives unbidden; but chronic loneliness is often self-imposed. The persistence of efforts at adaptation into later life stages where they do not really fit may interfere with the effort to remain involved with people, and to cure loneliness after it has been visited on one by the ill luck of the draw. These are persistent mechanisms which, in fact, subserve the "dread of love."
    Wallerstein, incidentally, has since done a ten year follow-up of children in her original sample (1989). The divorce remains a sad disaster in the lives of the majority. And there is an ominous addition to the original findings. In a number of cases, the divorce had sleeper effects. That is, the resultant disturbance in the child did not show itself until years after the event.

Motivations for Keeping One's Distance
By way of a quick review, let us now put together what various theoreticians have told us about the reasons behind clients' taking distance, fleeing closeness. In each case, I will present what the patient seems to be saying from the viewpoint of particular theoreticians:

Mahler: "As we get close, I lose track of where you end and I begin; I cease to exist. Let me out of here."
Klein: "As I get closer, I get angrier at you. So, let's not get involve and end in a tangled mess." Also, "As I get close, I fear you will hurt me."
Fairbairn and Guntrip: "If I come close, I will devour you. Please stay away from me for both our sakes.
Bowlby: "As soon as I start to love you, I can already foresee how bad I'll feel when we break up. So, leave us not get started."
Kaiser: "I'd rather have the delusion that we are as one, which cheats me, than to give it up for the limits of a real relationship."

A Note on Theory
We have now reviewed a series of theories of object relations. I included them all because, in my opinion, each offered insights somewhat different from the others. Klein and the Fairbairn-Guntrip pair teach us about the instinct of aggression and its vicissitudes; Fairbairn-Guntrip, Winnicott, and others about the need for a good object; Mahler, Bowlby, and Kaiser about separation-individuation, about separation anxiety, and about the dread of separateness. It is fair to wonder whether these various conceptions could not somehow be synthesized into one unified theory.
    The task is not easy. Take, for example, the matter of depression following loss of the object. Bowlby suggests that the depression is one of a series of automatic reactions following loss of the object, along with anger and anxiety. Spitz, who encountered the same issue in the 1940's and identified anaclitic depression followed the classical formulation in explaining it: orality, incorporation of the object, loss of the object, oral aggression directed at the object, guilt anxiety, and anger turned against the subject (the self). Bowlby's formulation of an instinctual response seems much more simple and direct. Why not simply adopt it? Well, consider which is actually more parsimonious. Other problems to be explained require we assume an instinct of aggression; many observations make us aware that there is guilt involved in most depressions. If one assumes, with Spitz, that even a young infant is capable of guilt, one can get by with just these concepts adding nothing to the theory to explain anaclitic depression. But if one adopts Bowlby's idea, one adds to the theory another form of anxiety, and another instinctive response. This is not what we mean by parsimony!
    Why then have I assumed two forms of anxiety thus far? Consider the possibilities. A type of anxiety often mentioned has to do with situations like this: the young man is sensitive about being short, and erects defenses against realizing it. What is the nature of the anxiety? It is hard to find guilt in this picture; no one is being injured and therefore likely to retaliate, symbolically or otherwise. It is more credible to presume he is anxious about being unlovable, which, to the human infant, portends death. We can think of this as separation anxiety. A further idea occurs. Is not being rejected the ultimate punishment? In other words, does not guilt anxiety come down to separation anxiety? A case can be made, as Bowlby makes, for presuming the latter form of anxiety is the primordial form of all anxiety. We can confront this now. But if I had begun with this more complicated notion in the second chapter, the person new to Freudian theory would have had a nearly impossible time understanding the conflict theory of defense, and the conflict theory of neurosis as they were being presented at that point. Freudians assume that there is one form of anxiety, that it signals danger, and that is has something to do with being overwhelmed. But they do not follow Bowlby's reasoning, cogent as it is.
    In short, whoever attempts to integrate the theories of object relations with the main corpus and biologically oriented sides of psychoanalysis faces an extremely difficult task. There are those who have attempted it, but the efforts I have read thus far have been marked more by obsessive rumination than elegance in formulation. So, we shall have to live this way, for the time being, lacking a more satisfying synthesis. Freud never promised us a rose garden.