Harry came to see his family doctor because of symptoms of depression. He’d moved back in with his elderly parents 2 months earlier when his mother had been diagnosed with breast cancer. Harry was 45 years old and had never married. He’d lived in Europe for a decade, writing and performing in avant garde theatre. He’d returned to Canada and worked variously in theatre, as a product developer and inventor, and as a martial artist and stunt man. Harry had begun numerous relationships with women, but never seemed to be able to tolerate being close to them for a prolonged time. He was a slim, intense man who loved nature and was passionate about animals. When he was a child, his parents would have to stop the car if he spied any wounded or sick animal, so that he could tend to them.
Harry was typical of people with schizoid type personalities. Such people are often misunderstood and dismissed as ‘crazy’ because they’re eccentric and unconventional. The outside world is a threatening place to these people and their main defence is to withdraw into the world of their fantasy and imagination. They may intellectualize, and when under stress may withdraw so much from their feelings that they appear flat and wooden.
Schizoid is not schizophrenic
DSMIV has 3 personality diagnoses that are in the non-psychotic, schizoid spectrum. Schizotypal people are markedly odd and are often bizarre in appearance, showing no regard for social convention. The less disturbed end of the spectrum includes schizoid and avoidant characters. There is evidence that the schizoid character is most common premorbid personality of people who eventually are diagnosed with schizophrenia. The evidence also suggests, however, that most schizoid people never develop psychotic symptoms. Rather their unusual appearance and manner can be misunderstood as indicating an incipient psychotic illness.
Schizoid people tend not to be troubled by guilt or shame — they take life as they experience it and can be profoundly honest and clear in their observations about the world. Relationships are difficult for these people — though they deeply wish for closeness, they never feel far from either impingement or engulfment. This constant tension leads to a deep fragility. It’s been suggested that some of the unconventional behaviour of schizoid people is an attempt to create a space around them to prevent psychological intrusion.
There are many theories but little direct evidence about the origin of this type of character. There is evidence that some schizoid people are born with an exquisite sensitivity. It’s possible that the usual closeness with parents would be experienced as overwhelming by children with such a constitution. Other schizoid people seem to have come from bleak childhoods in which they were lonely and neglected. In such cases, retreat into the world of fantasy was a preferable adaptation.
One striking feature of people who are at the healthier end of the schizoid spectrum is their great capacity for creativity. Perhaps that capacity to disregard convention is adaptive for creative pursuits. The philosopher Ludwig Wittgenstein, who made many creative contributions to his field, is said to have been schizoid. The British psychoanalyst Harry Guntrip and American psychiatrist Harry Stack Sullivan have both written movingly about their growing understanding of their own schizoid nature.
Our own Harry was treated with antidepressants and psychotherapy. He started with cognitive therapy, but soon required therapy that could work with his character more specifically. At the heart of his treatment was a mutual relationship with a therapist who was accepting of his eccentricities and conveyed the feeling that his ways of being were meaningful and important. Some of his pain about his mother’s illness came from his difficulties knowing and finding the right distance to keep from her in order for him to feel intact. One clear sign that Harry was recovering came when he began to work on a new creative project — developing a device that could be used by people with his mother’s disabilities.
Barry L. Gilbert, MD, CCFP, FRCPC is a psychiatrist, psychoanalyst and Assistant Professor of Psychiatry at the University of Toronto.