Understanding and Treating Patients in Clinical Psychoanalysis

Lessons from Literature

Sandra Buechler

• Publisher: Routledge
• Year: 2015
• Topic: Psychology
• eBook ISBN:
  9781317594055
• Subtopic: Abnormal Psychology
• Index: Psychology

Understanding and Treating Patients in Clinical Psychoanalysis: Lessons from Literature describes the problematic ways people learn to cope with life's fundamental challenges, such as maintaining self-esteem, bearing loss, and growing old. People tend to deal with the challenges of being human in characteristic, repetitive ways. Descriptions of these patterns in diagnostic terms can be at best dry, and at worst confusing, especially for those starting training in any of the clinical disciplines. To try to appeal to a wider audience, this book illustrates each coping pattern using vivid, compelling fiction whose characters express their dilemmas in easily accessible, evocative language. Sandra Buechler uses these examples to show some of the ways we complicate our lives and, through reimagining different scenarios for these characters, she illustrates how clients can achieve greater emotional health and live their lives more productively.

Drawing on the work of Dostoevsky, Tolstoy, Munro, Mann, James, O'Connor, Chopin, McCullers, Carver, and the many other authors represented here, Buechler shows how their keen observational short fiction portrays self-hurtful styles of living. She explores how human beings cope using schizoid, paranoid, grandiose, hysteric, obsessive, and other defensive styles. Each is costly, in many senses, and each limits the possibility for happiness and fulfillment.

Understanding and Treating Patients in Clinical Psychoanalysis offers insights into what living with and working with problematic behaviors really means through a series of examples of the major personality disorders as portrayed in literature. Through these fictitious examples, clinicians and trainees, and undergraduate and graduate students can gain a greater understanding of how someone becomes paranoid, schizoid, narcissistic, obsessive, or depressive, and how that affects them, and those around them, including the mental health professionals who work with them.

Chapter 1 Schizoid Relating

10.4324/9781315745060-2

Mare, or Amarantha, is the passive, becalmed main character in William Daniel Steele’s heart-rending story “How Beautiful With Shoes” (1952). When we first meet her, going through the motions on her family’s farm, doing her chores as though hypnotized, moving through one dazed day after another, she is trying to avoid the attentions of her betrothed. But soon a stranger, a “loony” who is poetically passionate about Mare, kidnaps her. She is terrified. The “loony,” Humble Jewett, is being hunted down by her fiancé, and half the rest of the town. Meanwhile Humble, who has trapped Mare in an old farmhouse, confesses to her that he has never really lived, or loved, until now. When she is finally rescued, and Humble is killed, all she can do is sit in her house and stare at the wallpaper. Her feet know her shoes hurt, but she doesn’t know it. Her mother asks her if her poor feet are dead, as though intuiting that, in fact, for her daughter a familiar kind of death has returned. Mare wonders if only “loonies” feel passion. When her fiancé visits, expecting her to resume their business as usual, she finds a kind of passion in her determination to keep him at bay, slamming the door in his face and wanting only to be left alone. No matter how crazy Humble was, he felt her, touched her, wanted her. He was alive. He was poetry, intensity, passion, worship. When he died, Mare resisted going back to sleepwalking, though she also cried because she knew that her beautiful feet were doomed to plod unrecognized through the rest of her days.

Mare’s emptiness, at the two ends of the story, expresses schizoid depression. She functions behaviorally but is disconnected from herself. The person suffering from schizoid depression doesn’t see the point of living. She feels nothing intensely and seems to be an observer of her own life, getting through it, rather than living it. She does what is expected of her, dully, carefully, dutifully. She knows something is missing from her life. It tastes bland, as though the spices were accidentally left out. She observes others and tries to copy their recipe, but it never comes out right. Here are some aspects of schizoid living as I understand it (for a discussion of some pertinent literature, see Buechler, 2002):

• Muted, camouflaged emotionality; it is as though the feelings are all there, but hidden and without intensity;
• A need to keep functioning, no matter what it takes;
• An ability to forge stunted, but serviceable, relationships with others;
• An unacknowledged, vivid fantasy life, or dream life, that profoundly contrasts with relatively sterile external relationships.

In Mary E. Wilkins Freeman’s story “A New England Nun” (1965), Louisa Ellis lives a narrow life, but within its confines it is graced with dainty delicacy. Her china is just so, as is her sewing basket. For 15 years, she has been engaged to Joe Dagget. Joe spent most of that time in Australia, making his fortune. They had agreed to marry upon his return. Now, with him back, the wedding date is one week away. Neither would even think of disappointing the other. But when they are together, the rough and ready Joe feels confined, like a bull in a china shop. And Louisa experiences him as disrupting her calm, ordered world. She feels she must be loyal and go through with the marriage, but she realizes that, years ago, her feet “had turned into a path, smooth maybe under a calm, serene sky, but so straight and unswerving that it could only meet a check at her grave, and so narrow that there was no room for anyone at her side” (p. 114). Louisa mourns as she imagines what it will be like to leave her possessions and live with Joe and his mother. She foresees disorder and confusion taking the place of her life of quiet harmony.

A chance encounter tells Louisa that Joe is struggling with attraction to another woman. She finds a way to break the engagement, much to their mutual relief. That night, alone, she cries a little, but the next morning she feels like a queen newly restored to her rightful place. As she thinks about her future, “She gazed ahead through a long reach of future days strung together like pearls in a rosary, every one like the others, and all smooth and flawless and innocent, and her heart went up in thankfulness … Louisa sat, prayerfully numbering her days, like an uncloistered nun” (p. 123).

Louisa epitomizes the schizoid’s deal with life: Live small but safe. Constrict relationships, adventure, and feeling. Nest. Pour your love into the inanimate. Live in a painting by Chardin, and polish the silverware to a high sheen. Love sameness. Cling to it. Forgo surprise. Keep your blood pressure steady. No thrills, but, also, no shocks. Make your future into a succession of days just like the past and the present. Louisa worships her tea set and pours her soul into every hem she sews. Her passion is spent in avoiding the experiences most of us would call passionate. In exchange for these sacrifices, Louisa achieves a height from which she can survey her world in utter peace. She is like a nun, forsaking most worldly pleasures, but she has not married Christ, or anyone else, except, in a sense, her static world. She is as devoted as any nun, as loyal, observant, industrious, caring. She has gained equilibrium and a pleasant life. She depends only on herself, and on the sun to come up every morning. She will never know powerful, full-blooded desire. She has invested all her resources in a bank account that yields small but steady returns.

There are many versions of the schizoid bargain. Some are much less extreme than Louisa’s. We see people inhabiting only a limited range of their potential, blending in, or, as I would suggest, “blanding” in with their interpersonal surround. We notice subtly muted affects, limited dependence, passion felt mostly in observing the passions of others. There are legions of human beings who experience life at a remove. They may cry the hardest at a sad movie, since it is in this form that they can allow themselves to feel the tragic dimension of life. They are the onlookers, observers, on the rim.

Henry James, certainly one of the finest chroniclers of schizoid lives, has given us a precise picture of them in his story “The Tree of Knowledge” (1954). We are introduced to Peter, who exists in a delicately balanced relationship with his artist friend, Morgan Mallow, and Morgan’s wife. Peter is described as “a man who had reached fifty, who had escaped marriage, who had lived within his means, who had been in love with Mrs. Mallow for years without breathing it” (p. 201). Morgan is a sculptor of statues who thinks himself a genius but who, in Peter’s opinion, lacks genuine talent. However, in this paragon of schizoid compromise situations (for a discussion of this term, see Guntrip, 1969), Peter must keep mum about this judgment, and much else.

The subtle balance is threatened by Lance, the Mallows’ son, who is thinking of following in his father’s footsteps. Peter senses that this might somehow upset the applecart. He tries to pressure Lance: “Well, we’re so right—we four together—just as we are. We’re so safe. Come, don’t spoil it” (p. 206). Peter is afraid of change. For years, he has joined with Mrs. Mallow to oversee Lance’s development. This project has brought them together in countless ways. Lance’s wish to go to Paris, pursue art, and become a master like his father confronts Peter with difficult choices. Does he confess to Lance that Morgan’s genius has been exaggerated, to keep all the interpersonal balances intact?

Surely, this confession would unleash disaster. When Lance guesses the truth on his own, he manages to have time alone with Peter to wonder “how the deuce then for so long you’ve managed to keep bottled” (p. 213). This is just what an analyst might ask. Peter confesses his fears to Lance and gets him to promise never to reveal the secret of Morgan’s mediocrity.

But the threat of change grows greater as his father pressures Lance to make a success like his own, lecturing him from on high about the road to fame and fortune. Mrs. Mallow recognizes the strain this places on Lance and comes to him privately to tell him she does recognize her husband’s limitations. Lance believes that Peter cares about his mother so much that he has done everything to spare her from disillusionment. What Lance doesn’t fully understand is Peter’s personal stake in keeping the status quo.

Peter’s relationships with Lance and his parents could be read out of Guntrip’s (1969) description of schizoid compromises. They share some intimacy, but no one is able to be their full selves. Peter doesn’t have his own partner or child, but he does get a portion of Morgan’s family, in return for his pretense that he admires Morgan’s work, and his limited expression of his passion for Morgan’s wife. He sees truth and change as his enemies, to be deeply feared. This makes Peter’s position precarious. I think it is implied that it is ultimately untenable, although this is not spelled out. But the fragile tissue of lies has been rent, and it seems likely to be eroded further in the future.

Sometimes a limited schizoid relationship seems to work, at least for a while. This is the case in Bobby Ann Mason’s short story “Shiloh” (2008). Leroy used to drive a truck, and his wife, Norma Jean, worked in the Rexall drugstore. Leroy did long hauls, so he was away from home about half the time, until four months ago, when he had a highway accident that changed their lives. Now Leroy is at loose ends, staying at home and occupying himself with craft “projects.” Norma Jean makes it all too clear that she yearns to have more time to herself again. At an outing they take together, Norma Jean tells Leroy that she wants to leave him, not because he has done anything wrong, but just because she can’t have people, like Leroy and her mother, around her so much. Leroy is frantic. He realizes that he doesn’t understand his marriage at all. He doesn’t know why it seemed to work before and why it has stopped working now. He thought his wife would be happier with him home more, but instead, she is miserable. Norma Jean doesn’t really understand her own feelings, but she knows she isn’t happy. Their inability to “get” each other is succinctly described in just a few lines of dialogue, “‘Didn’t I promise to be home from now on?’ he says. ‘In some ways, a woman prefers a man who wanders,’ says Norma Jean. ‘That sounds crazy, I know’” (p. 178). The story ends with Leroy literally hobbling to try to catch up with his sprinting wife: “Now she turns toward Leroy and waves her arms. Is she beckoning to him?” (p. 279). Leroy can’t grasp how to approach a woman who passionately wants to be left alone. Norma Jean can only bear bouts of relating interrupted by stretches of rejuvenating peace. Like Louisa (see above), she is an onlooker, happiest watching life at a bit of a remove.

Unlike Norma Jean and Louisa, the anti-hero in Dostoevsky’s “Notes from the Underground” (1972) extravagantly protests against his outsider status, but also fervently clings to it. His nose is permanently out of joint. He complains that he is not invited to join his old schoolmates for a farewell dinner, but dreads the social contact when he does attend. He mutters in a corner, refusing to share the merriment, but also refusing to leave.

The “Notes” are reflections 20 years after the events in the story. They are a loner’s resentful account of feeling snubbed by people he loves to snub. He certainly would never want to be a part of a club that would have him as a member. But, along with his infinite irritation, there are moments of exquisite yearning. He allows himself a brief fantasy about an officer who refused to acknowledge his existence: “Oh, how wonderfully we should have got on together! He would have protected me by his rank of an army officer, and I would have enlarged his mind by my superior education and—well—by my ideas, and lots of things could have happened” (p. 156).

But, for the underground man, “lots of things” happen mainly in his fantasies and dreams. He passes most of his time watching from the sidelines, full of criticism and equally full of longing. He spends months engineering a brief encounter with the officer, hoping to force a moment of mutual regard. He squanders his last rubles to join the farewell dinner, fully realizing what a miserable evening it will be. Going one step further, as if to prove to himself that he is not fit for human company, he follows the group to a house of prostitution. With Lisa, a struggling runaway assigned to him by the madam, he attempts flickers of connection but then feels compelled to destroy any hope of intimacy.

Dostoevsky has so beautifully captured the schizoid dilemma, that I have often found myself juxtaposing the anti-hero’s words with passages from Guntrip (1969). For example, for Guntrip, the schizoid person has renounced relationships but still needs them_ “There is a constant oscillation between hungry eating and refusal to eat, longing for people and rejecting them” (p. 31). Similarly, Dostoevsky’s anti-hero describes his periodic bouts of social activity:

I was never able to spend more than three months of dreaming at a time without feeling an irresistible urge to plunge into social life. To me, plunging into social life meant paying a call on the head of my department, Anton Antonovich Setochkin. He was the only permanent acquaintance I have had in my life. (p. 164)

Guntrip sees the schizoid person as caught in a perpetual dilemma, needing human connection but believing his love to be fundamentally dangerous. In Guntrip’s words, “love made hungry is the schizoid problem and it rouses the terrible fear that one’s love has become so devouring and incorporative that love itself has become destructive” (p. 24). Dostoevsky’s character describes his certainty that his love would inevitably hurt the prostitute, Lisa: “Could I make her happy? Had I not learnt today for the hundredth time what I was really worth? Should I not torture her to death?” (p. 238). Ultimately, the underground man has to destroy connection because, in his experience, it threatens to overwhelm him and to make others suffer.

When I was a candidate, my first analytic supervisor, Ralph Crowley, M.D., described schizoid functioning as living in the head, using real events in the outside world as furniture for the life of the mind. Guntrip (1969) calls this “introversion.” The underground man calls it a solution: “But I had a solution which made up for everything, and that was to seek salvation in all that was ‘sublime and beautiful,’ in my dreams, of course. I would give myself up entirely to dreaming” (p. 161). The most vivid feelings are experienced in fantasies and dreams, not in real life. Dostoevsky’s anti-hero explains that the vivid dreams made actual relationships unnecessary:

But how much love, good lord, how much love I used to experience in those dreams of mine … there was so much of it, so much of this love, that one did not feel the need of applying it in practice afterwards; that would indeed have been a superfluous luxury. (p. 163)

Guntrip describes schizoid functioning as regressed: “The schizoid person at bottom feels overwhelmed by the external world, and is in flight from it both inwards and, as it were, backwards, to the safety of the womb” (p. 44). The underground man sees himself as having retreated to a “little corner.” He hides “in that conscious burying oneself alive for grief for forty years” (p. 110).

For Guntrip, the quintessential schizoid feeling is a sense of futility. This is the essence of schizoid depression. There is just no point in going on. Thus, this type of depression is an expression of utter despair. Dostoevsky’s character is constantly shadow boxing with his own sense of being meaningless. Nothing really counts and no one really matters, which means that his own life has no worth. Spitefully, he destroys the prostitute’s hope that their contact could have significance for them both. He tells her that all he wants is peace, that to be left alone he would “sell the whole world for a farthing. Is the world to go to rack and ruin or am I to have my cup of tea? Well, so far as I’m concerned, blow the world so long as I can have my cup of tea” (p. 232).

For me, the most poignant moment in the story occurs just after this hateful speech. Lisa sees through it to his suffering. She tries to embrace him, and for one heart-wrenching moment, he lets himself sob, “They—they won’t let me—I—I can’t be good!” (p. 234). But the moment passes, and he crushes her by trying to pay her for her “services,” once again reducing the meaning of their intimacy to a business exchange. He just can’t let it matter any more than that. In a schizoid state, the world is empty and the self is hollow. The only substance exists in dreams. The underground man insists on keeping it that way.

How does someone become schizoid? Of course, there is no definitive answer to this question. McWilliams (2011) highlights two routes: an early life threatened by over-stimulating adults and an empty, bleak life deprived of interpersonal connection. Although these alternatives are opposite, it makes emotional sense to me that, in either case, the child does not develop faith that others will usually increase, rather than decrease, his or her security. In both cases, the threat of traumatic engulfment is present. The child who is over-stimulated may be traumatically deluged by intense reactions to other people’s needs, while the und...

Table of contents

• Cover Page
• Half Title Page
• Frontmatter
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Credit Lines
• Introduction
• 1 Schizoid Relating
• 2 Paranoid Processing
• 3 Humiliated Suffering
• 4 Grandiose Posturing
• 5 Hysterical Bargaining
• 6 Obsessive Controlling
• 7 Anguished Grieving
• 8 Depressive Self-Harming
• 9 Generative Aging
• Index