u/DiegoArgSch

I'm one of those people who love tests. Things like questionnaires, projective tests (Rorschach, etc.). From those more intended to understand the emotional subjectivity of a patient, to those more focused on cognitive functions (memory, attention, etc.).

Have there been psychoanalysts who have developed different tests and structured techniques?

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For example, I know about Otto Kernberg's STIPO, although I still haven't been able to find the full version.

Part of the reason I'm asking is that I was thinking about the “un-scientific method of psychoanalysis.” I know that's a whole different discussion, but I was thinking, “Hey, I think it might be very possible to create a questionnaire to try to measure and capture psychic phenomena.” For example: ideas of omnipotence, different defense mechanisms, etc.

Because I think that many times we leave these things as “it's unconscious material; we can hypothesize about it, but we can't measure it.” But then I thought, “Wait a minute, maybe something can be done with all this.”

I don't mean being rigid about it, like other bad methods. I don't mean something like, “Okay, your results on the questionnaire were this, so that means this.” I mean it more as an approximation, of course, or as a way to guide the clinician, and even as a way to perhaps try to make at least some parts of psychoanalysis a little more scientific.

 

I have my own critiques of psychoanalysis, using “psychoanalysis” here to refer broadly to the whole body of literature and school of thought that has accumulated under the term "psychonalysis" over time, but I would like to hear yours.

Is there anything you feel psychoanalysis falls short of describing—or, rather, anything you think that, given the theoretical material currently available, psychoanalysis doesn't quite have the language to put into words?

Or are there aspects of psychoanalytic methodology where you feel it falls short, and that you have had to supplement on your own, outside what is commonly discussed by psychoanalysis and psychoanalytic theorists?

Do you ever feel that, at some point, the model becomes strained or reaches its limits when dealing with certain subjects?

And I don't mean genuine limitations, since obviously there are things we cannot reasonably expect psychoanalysis to address. I mean more whether you sometimes feel that there are “subjects psychoanalysis doesn't touch on” that should be explored further; whether you sometimes feel that the psychoanalytic vocabulary falls short when it comes to naming certain mental phenomena; or whether you feel that it doesn't provide tools you consider necessary for therapeutic work, forcing you to move beyond the psychoanalytic framework.

I'll read your answers.

I made a little “article” about a series of lectures I've found super interesting, but they are in Spanish, which is why I'm making these articles and transcriptions of them.

The series of lectures is called "10 Clinical Rules for Beginners", the one covered in this article is Rule 8: Clinical Categories Are Our Inventions.

I'll just paste the article here, but I think it would be too long, so I'll just share a bit of the introduction here:

In Rule 8, Clinical Categories Are Our Inventions, Álvarez argues that psychopathological categories should not be understood as natural entities waiting to be discovered, but as historical constructions developed by clinicians to organize and describe mental suffering.

He begins by observing that the study of psychopathology often leads students to assume that diagnostic categories correspond to objective facts of nature.

As he puts it, "when one studies manuals of psychopathology, one ends up thinking... that what is described there are facts of nature, that they are things that exist as such." He immediately challenges this assumption, stating that "what I propose in this Rule 8 is precisely the opposite."

According to Álvarez, this position does not deny the existence of mental illness or psychological suffering. Rather, it questions the ontological status of the categories through which clinicians describe these phenomena.

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You can see the full “article” here: https://www.reddit.com/user/DiegoArgSch/comments/1wlrpr5/rule_8_clinical_categories_are_our_inventions_dr/

 

I get the different ways in which “borderline” is and has been used, and I keep thinking: how did they end up transforming it into this (DSM-III and onward)?

I mean, it’s just nuts. Yesterday I was reading a book by Theodore Millon, and he explicitly says that he liked the idea of having a diagnosis that captured the population covered by DSM-III borderline personality disorder, but... he opposed calling it that. That’s exactly what I’ve been thinking. He even suggested a couple of different names.

Anyway, does anyone know which authors were ultimately responsible for pushing “borderline” toward this particular use? Impulsive, self-harming, chaotic, dramatic relationships, etc. — and why?

I kinda get the “why,” because I think historical borderline patients were quite disorganized in general.

Anyway, I’d love to hear your takes on this.

And I get that many don't even pay attention to the DSM, but I keep thinking about how the DSM pretty much excluded certain types of patients—the “historic borderlines.” Because I think borderline doesn't really represent that group, and schizotypal maybe does a little more, but not really. So that specific population kind of ended up without a diagnostic label. But I guess this is why many would defenestrate the DSM.

_ Pseudoneurotic Forms of Schizophrenia (1949), by Paul Hoch, M.D., and Phillip Polatin, M.D. – Part 1/3, Introduction and Summary: https://www.reddit.com/user/DiegoArgSch/comments/1w3uvc3/pseudoneurotic_forms_of_schizophrenia_1949_by/

_ Pseudoneurotic Forms of Schizophrenia (1949), by Paul Hoch, M.D., and Phillip Polatin, M.D. – Part 2/3, 3 of 4 case material: https://www.reddit.com/user/DiegoArgSch/comments/1w3uxz9/pseudoneurotic_forms_of_schizophrenia_1949_by/

_ Pseudoneurotic Forms of Schizophrenia (1949), by Paul Hoch, M.D., and Phillip Polatin, M.D. – Part 3/3, rest of case material: https://www.reddit.com/user/DiegoArgSch/comments/1w3uzxv/pseudoneurotic_forms_of_schizophrenia_1949_by/

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General Considerations on Pseudoneurotic Schizophrenia, the Borderline Concept, and Its Relation to Schizotypal

I

Paul Hoch and Phillip Polatin’s concept of pseudoneurotic schizophrenia emerged from Eugen Bleuler’s broad conception of schizophrenia, in which overt psychosis was distinguished from more fundamental basic symptoms involving associations, affect, ambivalence, and autistic or dereistic functioning.

Bleuler’s recognition of latent schizophrenia likewise allowed for schizophrenic features to appear in attenuated form without a fully developed psychotic illness. Building on this emphasis on the underlying organization of the patient, Hoch and Polatin described a distinct group whose clinical presentation was predominantly neurotic—marked by anxiety, phobias, obsessions, conversion symptoms, and other neurotic manifestations—yet who displayed subtle disturbances they regarded as fundamentally schizophrenic.

Their central concern was therefore not simply whether the patient appeared neurotic, but whether the underlying psychological organization was neurotic or schizophrenic.

Although these patients could remain relatively organized and nonpsychotic in everyday functioning, their more pervasive withdrawal from reality, diffuse ambivalence, subtle abnormalities of thought and association, and fluctuating relation to reality distinguished them from ordinary neuroses and could at times culminate in brief psychotic states. Thus, pseudoneurotic schizophrenia represented an attempt to identify schizophrenic organization beneath a predominantly neurotic clinical surface.

In this sense, Hoch and Polatin do not simply describe
a milder form of schizophrenia. They identify a particular clinical
configuration at the boundary between neurosis and overt schizophrenia: the
patient may remain relatively organized and nonpsychotic in everyday
functioning, while nevertheless exhibiting the fundamental disturbances that,
in their view, place the case within the schizophrenic domain.

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II

Long before Hoch and Polatin, many clinicians and authors had attempted to define a group of patients who appeared to cross the boundary of neurosis while falling short of overt psychosis. Such patients were increasingly described as “borderline”, and eventually as having “borderline schizophrenia”, although the term encompassed a highly heterogeneous range of clinical presentations.

Within this earlier clinical context, pseudoneurotic schizophrenia can be understood as an attempt to capture at least a portion of the patients who had previously been described under the broad and heterogeneous category of “borderline”.

The meaning of borderline would later undergo a major transformation with the introduction of the DSM-III.

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III

The cases described as pseudoneurotic schizophrenia were closely related to the later construct of Schizotypal Personality Disorder, particularly in their emphasis on subtle schizophrenic features in patients who did not present with overt psychosis. The significance of the pseudoneurotic schizophrenia concept can also be seen in the early work of authors seeking to validate the emerging schizotypal DSM construct, who frequently took these cases as an important point of reference.

The DSM, however, would eventually move toward a more categorical separation between schizophrenia as a disorder characterized primarily by manifest psychotic symptoms

In doing so, it placed considerably less emphasis on the underlying psychological organization that authors such as Bleuler had considered fundamental to schizophrenia. In this context, schizotypal pathology came to be conceptualized increasingly as a personality disorder.

Another reason why the DSM-III did not retain the term pseudoneurotic schizophrenia was its departure from formulations that were heavily grounded in psychoanalytic theory. Although Hoch and Polatin provided remarkably detailed clinical and phenomenological descriptions of their patients, these observations were closely intertwined with a substantial psychoanalytic vocabulary.

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IV

Although Hoch and Polatin’s term pseudoneurotic schizophrenia provided a useful framework for conceptualizing patients similar to those described by authors such as Sándor Rado and Paul E. Meehl, the DSM ultimately favored the term schizotypal, derived from the work of Rado and further developed by Meehl. This terminology was less closely tied to psychoanalytic formulations and was more compatible with the constitutional, genetic, and psychobiological orientation that increasingly shaped the schizotypy construct.

The following paragraph is a direct quotation from Paul E. Meehl’s 1989 article, Schizotaxia Revisited.”:

“In Rado’s terminology, the schizotype is not a different category from the schizophrene. The schizophrene is a schizotype who is decompensated, either within the pseudoneurotic range, or disintegrated (that is, psychotic), and then, in the late chronic stages if he gets there, what Rado calls the deteriorated schizotype. The relationship of schizophrenia to schizotypy is represented by the word compensation by analogy to the extent to which the patient with kidney disease or cardiac disease is clinically compensated. As we think of symptomatic neuroses as always built on character neurosis in psychoanalysis, similarly we think of schizophrenia, whether of the psychotic or pseudoneurotic (“borderline”) variety, as built on the schizotypal personality structure. And the schizotypal personality structure has evolved by social learning processes when the schizotaxic CNS is subjected to the kind of stochastic schedule (variable and double sign) of rewards and punishment that care-givers, peers, and life generally provide all of us.”

Even so, the DSM did not retain Meehl’s theoretical model in its entirety. It separated schizotypal personality from schizophrenia as distinct diagnoses placed on different axes, whereas Meehl conceived them as more closely related along a continuum of schizotypal organization, compensation, and decompensation.

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V

The cases described by Hoch and Polatin also illustrate the very distinction that the DSM would later attempt to establish more explicitly. Their patients displayed a combination of features that would subsequently be associated with schizotypy, but also a broader disturbance of psychological functioning, often expressed through marked affective instability, at times highly effervescent emotionality, and chaotic or tumultuous interpersonal relationships.

In this sense, pseudoneurotic schizophrenia encompassed a heterogeneous range of phenomena that the DSM would later differentiate more sharply. The Schizotypal Personality Disorder construct was used to capture the more enduring subpsychotic and schizophrenia-related features, whereas Borderline Personality Disorder provided a separate framework for patients whose presentation was dominated by intense and unstable affect, chaotic interpersonal relationships, identity disturbance, and marked difficulties in maintaining a coherent sense of self

Thus, rather than simply preserving pseudoneurotic schizophrenia as a single diagnostic category, the DSM effectively redistributed aspects of this earlier clinical territory across distinct diagnostic constructs.

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VI

Otto Kernberg’s work provides another way of understanding the clinical territory that had previously been described through concepts such as pseudoneurotic schizophrenia, borderline schizophrenia, and borderline states. In Borderline Conditions and Pathological Narcissism (1975), Kernberg explicitly identifies the earlier descriptions of Zilboorg, Hoch and Polatin, and others as accounts of patients who would now be considered borderline. He nevertheless argues that these authors were mistaken in assuming that such patients were fundamentally schizophrenic.

Kernberg’s contribution was to organize a broad conception of psychopathology around three personality organizations: neurotic, borderline, and psychotic. These organizations are not themselves equivalent to particular diagnoses; rather, each may encompass a heterogeneous range of clinical conditions which, despite their differences, share certain core structural characteristics.

His formulation of borderline personality organization placed these patients between neurotic and psychotic organizations while distinguishing them structurally from both. Features such as identity diffusion, primitive defenses, splitting, and the persistence of dissociated primitive ego states and contradictory representations of self and others became central to his understanding of the pathology.

In this sense, Kernberg offers a different resolution to the problem that had confronted Hoch and Polatin. Rather than locating these patients within schizophrenia because of their subtle disturbances, or reducing them to a collection of neurotic symptoms, he understood them as representing a distinct level of personality organization. The historical territory occupied by pseudoneurotic schizophrenia could therefore be reconsidered not simply as attenuated schizophrenia, but as containing forms of psychopathology that required a different structural formulation.

Direct quote from Otto Kernberg (1975), Borderline Conditions and Pathological Narcissism:

“The early literature consists largely of clinical descriptions of patients who would now be considered “borderline.” Such are the descriptions by Zilboorg, Hoch and Polatin, and, from psychological testing, Rapaport, Gill, and Schafer. Zilboorg later expanded his description, and Hoch and Cattell elaborated on the diagnosis of “pseudoneurotic schizophrenia.” Other aspects of the symptoms of some borderline patients were studied by Bychowski, who also described important structural characteristics of these patients, such as the persistence of dissociated primitive ego states and the cleavage of parental images into good and bad objects. It is to be noted that both Zilboorg and Hoch, who made fundamental contributions to the descriptive analysis of borderline conditions, believed that all such patients were schizophrenic. They seem to have been unaware that they were confronted with a different form of psychopathology.”

In Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship (2004), Kernberg presents a scheme positioning several commonly used nosological diagnoses within his model of personality organization. Borderline personality, corresponding broadly to the DSM conception of Borderline Personality Disorder, is presented as the typical clinical profile of the broader borderline personality organization, then he places schizoid personality nearby, while distinguishing the two primarily along a dimension of introversion and extroversion. Schizotypal personality disorder, meanwhile, is positioned within the borderline organization but at its closest point to the psychotic organization, representing a condition that approaches the psychotic level of organization without crossing into it.

Thus, in Kernberg’s model, schizotypal pathology occupies a particularly intermediate position: structurally borderline, yet phenomenologically and clinically closer to the psychotic end of the spectrum.

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VII

Important considerations: Although the information presented here may suggest a connection between pseudoneurotic schizophrenia and the modern conception of schizotypal personality disorder, we should not automatically link every case or description of pseudoneurotic schizophrenia to the modern schizotypal diagnosis. Pseudoneurotic schizophrenia at the time was used to describe a broad and heterogeneous range of patients. Some of these patients could indeed be diagnosed with what we would now call schizotypal personality disorder, while others might be better understood as having borderline personality disorder or even other types of diagnoses.

Thus, although we can link pseudoneurotic schizophrenia to modern schizotypal personality disorder, we should not restrict the concept to it. Rather, pseudoneurotic schizophrenia described a portion of the patients who were previously considered “borderline.” At the time, however, “borderline” was not a diagnosis restricted to what we now call borderline personality disorder. Instead, it functioned as a broad way of grouping patients who were considered to be somewhere between neurosis and schizophrenia, including cases involving frank psychosis.

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Direct quote from Karen O. Connor et al. (2009), Pseudoneurotic schizophrenia revisited:

‘Borderline’ was a term that originally arose in the late 1800s to denote conditions in the borderland between psychosis and the milder neurosis [6]. The evolution of the ‘borderline’ concept, however, has seen it largely lose this original meaning. In the 1920s ‘borderline’ was used to refer to the perceived unalysability of patients with psychosis versus those with a neurotic illness [7]. Only with the publication of Kernberg’s paper ‘Borderline personality organization’ (BPO) in 1967 was the term ‘personality’ introduced [5]. Kernberg described a condition that was distinct from both higher neurotic functioning and lower psychotic functioning. In BPO, reality testing was preserved (albeit with a tendency to over-valued ideas in certain emotionally laden areas) but identity-sense was weakened. ‘Borderline’, and the terms with which it had become synonymous, including ‘pseudoneurotic schizophrenia’, had now become completely decoupled from psychosis and schizophrenia. When borderline personality disorder was finally introduced into the DSM-III in 1980 the diagnosis was formulated predominantly in terms of mood and behaviour, distinguished from subsyndromal schizophrenia, which was termed ‘schizotypal personality disorder’ [8].

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Keep reading about the concept of "borderline" and it´s relation with Schizotypal: https://www.reddit.com/r/Schizotypal/comments/1tu6q8w/two_articles_on_the_historical_use_of_the_term/ - https://www.reddit.com/r/Schizotypal/comments/1jz8ggv/brief_summary_of_schizotypal_personality_disorder/

The Changing Meaning of Schizotypal: From Rado and Meehl to DSM and Dimensional Models

The terminology surrounding schizotypal and schizotypy has changed substantially across different models of schizophrenia-spectrum pathology. In Rado and Meehl, schizotypal primarily belongs to a broader schizophrenia-spectrum conception in which an individual may range between compensated and decompensated forms, become progressively decompensated, or eventually reach schizophrenic disintegration.

In contemporary DSM usage, by contrast, schizotypal is primarily attached to a specific personality disorder diagnosis. More recent dimensional models have expanded schizotypy even further, using it to describe schizophrenia-spectrum characteristics distributed throughout the general population.

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Sándor Rado (1890 – 1972)

Schizotype: For Rado, the schizotype is an individual who constitutionally possesses the organization underlying the schizophrenic phenotype. The term therefore does not refer exclusively to a person with manifest schizophrenia, or to any particular type of schizotypal symptomatology.

Thus, schizotype is fundamentally a designation of the person, rather than of a particular symptomatic state.

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Latent schizophrenic: In Rado's terminology, a latent schizophrenic refers to a schizotype whose underlying schizophrenic organization remains relatively compensated and has not developed into manifest schizophrenia.

The term therefore describes a particular state or phase of a schizotype, rather than a distinct constitutional category. It refers to an individual who possesses this liability, while the associated symptomatology may or may not become manifest in the future.

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Schizotypal organization: Rather than using schizotypal as the name of a specific diagnosis or a particular set of symptoms, Rado uses the term to designate a broad psychodynamic organization underlying the entire schizophrenia spectrum. This organization is the characteristic structure of the schizotype and represents the psychodynamic expression of the schizophrenic genotype.

Within this framework, schizotypal does not primarily describe whether a person is psychotic or non-psychotic. Instead, it refers to an underlying organization characterized by features such as integrative pleasure deficiency, a distinctive pattern of emotional and interpersonal functioning, and a characteristic system of adaptation (schizo-adaptation).

The same underlying organization may remain well compensated throughout life, become progressively decompensated under stress, or eventually reach schizotypal disintegration and overt schizophrenic psychosis. Thus, for Rado, schizotypal is fundamentally an organizational concept rather than a diagnostic category.

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Schizo-adaptation: Rado describes the characteristic adaptive system developed by the schizotype as schizo-adaptation, or a schizotypal system of adaptation. This includes the individual's characteristic compensatory solutions to the underlying integrative deficiency.

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Compensated schizo-adaptation: refers to a state in which the schizotypal system of adaptation remains sufficiently effective to maintain the individual's functioning despite the underlying schizotypal organization.

A schizotype can therefore remain well compensated, with no overt psychosis and potentially without progressing to more severe disturbance. Compensation does not imply the absence of schizotypal organization; rather, it indicates that the individual's adaptive resources remain sufficient to manage its demands. Rado explicitly allows the schizotype to remain in such a compensated state throughout life.

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Decompensated schizo-adaptation: When the compensatory system becomes insufficient, the schizotype may enter decompensated schizo-adaptation. The individual remains organized within the same broader schizotypal structure, but his or her adaptive capacity is increasingly threatened.

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Schizotypal disintegration: At the extreme of this process lies schizotypal disintegration, characterized by severe adaptive incompetence and corresponding to overt schizophrenic psychosis.

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Paul E. Meehl (1920 – 2003)

Meehl retains much of Rado's terminology but places it within a more explicitly etiological and taxonomic model.

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Schizogene: The schizogene is Meehl's hypothesized genetic factor initiating the causal chain toward schizophrenia-spectrum pathology. . It belongs to the etiological level of the model.

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Schizotaxia: is the fundamental inherited neurological disposition postulated by Meehl. He describes it as a subtle neural integrative defect and emphasizes that this is what can properly be regarded as inherited.

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Schizotype: Meehl explicitly adopts Rado's term schizotype to refer to the individual whose personality organization develops on the basis of schizotaxia through social learning. The schizotype therefore represents the personality-level expression of the underlying schizotaxic condition. A schizotype may remain well compensated, develop varying degrees of schizotypal manifestation, or eventually decompensate into schizophrenia.

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Latent schizotype/schizotypy: In Meehl's framework, the latent schizotype refers to a schizotype whose underlying organization and liability remain largely compensated, with schizotypal manifestations being minimal, subtle, or not readily apparent. The concept is related to the older notion of latent schizophrenia, but does not imply that schizophrenia is already present in a hidden form. Rather, it describes a schizotypic individual in whom the underlying condition has not developed into overt schizophrenic decompensation. The associated manifestations may remain limited throughout life or become increasingly apparent under conditions that favor decompensation.

Thus, the latent schizotype possesses the underlying schizotypic organization and liability for decompensation, while the degree to which these become phenotypically manifest may vary considerably.

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Schizotypy: Meehl uses schizotypy to refer to the broader schizotypal condition or phenotype associated with the schizotype. His formulation of the relationship between schizotaxia, schizotypy, and schizophrenia is explicitly one of class inclusion: schizotaxic individuals become schizotypic in personality organization, most remain compensated, and a minority progress to clinical schizophrenia.

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Schizotypal: Rather than referring primarily to a single diagnosis or to overt psychotic symptomatology, schizotypal in Meehl is a broad term for characteristics belonging to, or arising from, the schizotypic condition. It is therefore primarily a phenotypic and descriptive term, rather than the name of a specific diagnostic category. Meehl applies it to the personality organization, traits, behavior, and other observable or measurable characteristics associated with schizotypy.

At the same time, Meehl's use of schizotypal is broader and more empirically oriented than Rado's use of the term. Whereas Rado's concept is centered on schizotypal organization as a broad psychodynamic organization, Meehl increasingly uses schizotypal to designate the phenotypic manifestations and measurable characteristics of the schizotypic condition. He consequently speaks of schizotypal source traits, schizotypal individuals, schizotypal behavior, and, in his taxonomic work, the schizotypal latent taxon.

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Schizotypal personality / schizotypic personality: Refers to the personality organization or personality condition associated with schizotypy. This is the level at which Meehl's schizotype is located: a personality organization developing in the schizotaxic individual through social learning.

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Schizotypal subject / individual: Refers to an individual who possesses or manifests schizotypy, understood as the phenotypic expression of the underlying schizotaxic condition.

The term does not imply any fixed form, degree, or level of phenotypic manifestation. It may refer to an individual who shows only subtle or barely detectable schizotypal features, as well as to an individual whose schizotypy has decompensated into schizophrenia.

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Compensated schizotypy: Like Rado, Meehl explicitly allows for compensated schizotypy. A person can be a schizotype and possess the underlying schizotypal organization without developing manifest schizotypal manifestations. He describes the possibility of a well-compensated or even apparently normal schizotype.

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Decompensation: Decompensation represents the failure of sufficient compensatory resources, allowing the schizotype's latent vulnerabilities to become increasingly manifest. Meehl emphasizes that the probability and severity of decompensation depend on additional constitutional and environmental factors.

Consequently, not every schizotype is equivalent in clinical severity.

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DSM: Schizotypal Personality Disorder

The term schizotypal first entered the DSM as a formal diagnostic category in DSM-III (1980). Its inclusion reflected the DSM-III's broader effort to develop a more explicit, operationalized, and clinically recognizable system of diagnostic categories, with clearer criteria intended to improve diagnostic reliability and consistency.

While the DSM drew on various theoretical conceptions of schizophrenia-spectrum conditions, including those developed by Rado and Meehl, the diagnostic category of Schizotypal Personality Disorder was intended to remain relatively independent of such hypothetical etiological models. Concepts such as the schizotype, schizogene, and related constructs could inform the broader understanding of these individuals, but the DSM diagnosis did not require adherence to any of these theoretical assumptions. Instead, the aim was to identify individuals who displayed a sufficiently recognizable and clinically significant pattern of schizotypal characteristics to constitute a diagnostic category, thereby providing a more clearly defined population for clinical observation and empirical research, including future investigations into its etiology, development, and relationship to schizophrenia.

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The DSM introduces a significant shift in the use of schizotypal.

In Rado and Meehl, schizotypal belongs to a broad schizophrenia-spectrum construct that can encompass individuals ranging from highly compensated to severely decompensated. The term therefore does not inherently mark a particular diagnostic threshold.

DSM Schizotypal Personality Disorder, by contrast, is a specific clinical diagnosis. It identifies individuals whose schizotypal characteristics have become sufficiently persistent, pervasive, and clinically significant to constitute a personality disorder, while the person remains outside the threshold for schizophrenia or another psychotic disorder.

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This produces an important semantic shift:

_ Rado/Meehl: schizotypal can characterize an entire underlying organization across different degrees of compensation and decompensation, ranging from individuals who show barely observable symptomatology to individuals who are overtly schizophrenic.

_ DSM: schizotypal primarily identifies a particular clinically significant personality-disorder presentation, making schizotypal a distinct diagnostic category from schizophrenia, rather than a broader category that contains or encompasses it.

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In this sense, DSM's Schizotypal Personality Disorder can be understood, in the vocabulary of Rado and Meehl, as approximately corresponding to a semi-decompensated schizotype, but not fully disintegrated schizotype: the individual displays sufficiently prominent schizotypal phenomena to be clinically recognizable, but has not reached the level of schizophrenic disintegration.

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This also means that a highly compensated schizotype in the sense of Rado or Meehl need not qualify for DSM Schizotypal Personality Disorder. The older concept can therefore encompass individuals who are constitutionally or organizationally schizotypal but whose manifestations remain too subtle, too well compensated, or insufficiently impairing to cross a contemporary diagnostic threshold, whereas the DSM diagnosis of Schizotypal Personality Disorder requires manifest symptoms reaching a certain clinical degree.

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Dimensional Schizotypy

More recent dimensional models introduce yet another shift, particularly in the meaning of schizotypy.

In the Rado–Meehl framework, schizotypy is fundamentally tied to the schizotype and therefore to a schizophrenia-spectrum organization. In contemporary dimensional approaches, however, schizotypy is often conceptualized as a continuum of schizophrenia-spectrum characteristics distributed throughout the population.

This is a substantial expansion of the concept.

The distinction is that dimensional schizotypy no longer necessarily presupposes the existence of a schizotype. A person can display a measurable degree of schizotypal characteristics without being conceptualized as belonging to a discrete schizotypal class or possessing the personality organization described by Rado or Meehl.

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Conclusions:

Rado's schizotypal refers primarily to an organization; Meehl retains this organization but embeds it within a constitutional-developmental model; the DSM turns schizotypal into a specific clinically recognizable personality-disorder category; and dimensional models subsequently extend schizotypy from the categorical schizotype and distribute it across the general population.

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 Keep reading: https://www.reddit.com/r/Schizotypal/comments/1q84az1/a_little_bit_of_history_about_the_term/

When I started getting in touch with Kernberg's theory about borderline personality, I couldn't believe splitting had such a key role.

Much more if borderline was meant to be thought of as a broad organization, and not a specific type of case profile (like obsessive neurosis, schizoid, and so on).

I mean, I think splitting plays a role in some cases, but making it the cornerstone of the range of what's between neurosis and psychosis is too much, I think.

I think he kinda abandoned putting splitting in such a role, right?

I haven't read many other authors who talk about borderline after Kernberg, so I'm not sure how important the role of splitting is for other authors.

I enjoyed more reading André Green and his concept of negative narcissism more.

I see splitting as just another symptom that can occur in the neurotic, borderline, or psychotic organization, with more importance or presence depending on the case.

What do you think?

If anyone wants to talk about psychoanalysis, I’m up for a chat.

I consider myself an amateur because I’m not a professional who works in this field, nor have I formally completed any training in it.

Although I don’t consider myself a newbie to psychoanalysis.

I did two years of a psychology degree in Argentina, at a university with a very clear psychoanalytic orientation. I learned the basics of Freud, Kleinian and post-Kleinian object relations, Winnicott, Piaget, Lacan, and other authors I don’t remember right now. As a side note, I didn’t love such a strong focus on Lacan for such a career, because they taught Lacan over biological or Piagetian approaches. It’s a valuable approach to me, but I wouldn’t consider it my main theoretical orientation. Then I read on my own, and I attended some extracurricular talks.

I’m looking for someone who isn’t too new to psychoanalysis. I attended university several years ago, so I’m a bit rusty on some things, but I think I have a pretty good overall map of the field.

I think replies to posts are sometimes quite short, for different reasons, of course, so I thought maybe others might be interested in having longer conversations and exchanging perspectives.

Open to DMs.

Schizotaxia, schizotype, and schizophrenia

Paul E. Meehl’s conception of schizotypy is best understood as a model operating at several different levels rather than as a simple list of schizotypal symptoms. At its foundation is schizotaxia, which Meehl conceptualizes as a hypothetical neurointegrative abnormality associated with a specific genetic predisposition. Schizotaxia is therefore not itself a personality disorder or a clinical syndrome. It represents the underlying constitutional condition from which a characteristic personality organization develops through interaction with the social environment. Meehl explicitly distinguishes what is inherited from what is learned: the neural defect is the inherited component, whereas the psychological and interpersonal characteristics that subsequently emerge are acquired through development.

The resulting personality organization is what Meehl calls the schizotype. In this sense, the schizotype is not simply a person who happens to display a certain number of schizotypal traits. It is the individual-level manifestation of the schizotaxic disposition after development, and it constitutes a characteristic organization of personality. Meehl describes four principal “source traits” associated with this organization: cognitive slippage, anhedonia, ambivalence, and interpersonal aversiveness. He nevertheless emphasizes the remarkable phenotypic heterogeneity of this tetrad, particularly because cognitive slippage is difficult to reduce to the same descriptive basis as the other traits. Thus, the schizotype should not be understood as a rigid clinical picture in which every individual displays the same observable configuration.

Schizotypy, consequently, refers to the broader condition or taxonomic domain constituted by these schizotypic individuals. Meehl’s model is fundamentally different from a purely symptom-counting conception in which “schizotypy” means possessing more or fewer schizotypal characteristics along a continuous dimension. His central theoretical claim is that schizotaxia, schizotypy, and schizophrenia stand in a relation of class inclusion: schizotaxics develop a schizotypic personality organization, most remain compensated, and only a minority proceed to clinical schizophrenia. Schizophrenia therefore occupies a particular position within this model. It is not synonymous with schizotypy, nor is schizotypy simply a mild form of schizophrenia. Rather, schizophrenia represents the decompensated form of an already existing schizotypic organization. Only a subset of schizotypic personalities, under additional constitutional and environmental conditions, undergo this transition into clinical schizophrenia.

This distinction is important because clinical schizophrenia cannot itself be regarded as the inherited phenotype. Its concrete phenomenal and behavioral contents are learned and shaped developmentally. As Meehl notes, one cannot inherit a particular delusion or other learned psychological content. What is inherited is instead the underlying disposition that makes the subsequent schizotypic organization possible. The relationship between schizotypy and schizophrenia is therefore developmental and hierarchical: the schizotype is the broader organization, while schizophrenia represents its possible pathological decompensation.

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Compensated and decompensated schizotypes

This immediately creates a crucial distinction between compensated and decompensated schizotypy. The decompensated schizotype is the easier case to recognize because the underlying organization has become clinically conspicuous. Cognitive slippage may become overt, interpersonal aversiveness may be pronounced, and other manifestations associated with schizophrenia may become sufficiently visible to attract a psychiatric diagnosis. Yet Meehl does not define the schizotype by the presence of these overt manifestations.

Indeed, his model explicitly allows for a well-compensated “normal” schizotype. Under favorable interpersonal conditions, together with relatively low anxiety readiness, good physical resistance, and other protective constitutional factors, the schizotaxic individual may remain sufficiently compensated that no obvious mental disorder develops. Meehl compares such a person to someone genetically predisposed to gout who never develops clinical gout. At the opposite extreme, unfavorable developmental conditions and additional vulnerabilities may potentiate the schizotypic organization into clinical schizophrenia.

The distinction therefore cannot be reduced to the presence versus absence of schizophrenia-spectrum symptoms. The compensated and decompensated schizotype are different expressions of the underlying schizotypic organization. What differs is the degree to which that organization has become clinically manifest and the extent to which compensatory processes and environmental conditions have contained or amplified its expression.

Meehl even considers an extremely favorable developmental situation in which the individual might show only “the faintest signs of cognitive slippage” and minimal neurological or proprioceptive deviations, without the interpersonal aversiveness that he regarded as central to the clinical picture. This possibility is theoretically important because it demonstrates that, in Meehl’s framework, the schizotype cannot be equated with an overtly peculiar clinical presentation.

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Schizotypy: More Than a Collection of Symptoms

For Meehl, schizotypy is not simply a collection of symptoms. The distinction lies precisely between organization and manifestation. The compensated and decompensated forms share an underlying schizotypic organization that develops from schizotaxia. They differ in the degree to which this organization becomes behaviorally and clinically expressed.

Thus, a schizotypal individual is not defined simply by having paranoia, magical thinking, odd beliefs, perceptual abnormalities, or any other particular symptom. Such phenomena may be important manifestations, but they are not what establishes the person's membership in the schizotypic class.

This is why Meehl's four source traits are important. Cognitive slippage, anhedonia, ambivalence, and interpersonal aversiveness are not merely four interchangeable symptoms to be counted. They are attempts to identify the characteristic psychological consequences of the schizotypic organization. Yet Meehl himself recognizes that their phenotypic expression is heterogeneous and that no single behavioral manifestation is likely to function as a pathognomonic marker.

Consequently, being a schizotype means something closer to belonging to a particular latent organization than to possessing a particular collection of overt symptoms.

The relevant question is not simply, “Does this person have paranoia?” or “Does this person have bizarre ideas?” It is instead: What pattern of relatively independent psychological, behavioral, and potentially neurological indicators would justify inferring that this individual belongs to the schizotypic class?

This distinction is especially important because the same overt phenomenon can theoretically occur for different reasons. A person may be suspicious, socially withdrawn, anxious, or unusual in thought without necessarily belonging to the schizotypic class. Conversely, an actual schizotype may not display these phenomena in a clinically obvious form. The task is therefore not to identify a checklist of symptoms but to determine whether a broader latent organization is present.

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The compensated schizotype as a methodological problem

This creates one of the central methodological problems in Meehl's theory. If schizotypes can remain compensated, and if their molar behavior does not contain a pathognomonic sign, how can they be identified?

Meehl is remarkably explicit about this difficulty. He states that it would be highly desirable to have a pathognomonic sign for identifying the schizotype, but considers such a sign unlikely to be found at the level of ordinary psychological and psychiatric behavior. Even a sufficiently coherent pattern of symptoms may be difficult to establish. Instead, he anticipates having to work with a loose cluster of fallible indicators, including the subtle neurological signs that clinicians had historically observed in nonpsychotic schizotypes.

This is why Meehl's discussion of compensated and semicompensated schizotypes is not merely a clinical curiosity. It represents a serious problem for the entire scientific investigation of schizophrenia. If research identifies schizotypes only when they have already decompensated into recognizable schizophrenia, then genetic and developmental studies are systematically selecting the endpoint of the process rather than the underlying class. Meehl consequently argues that one of the major research needs is the development of high-validity indicators of compensated schizotypy.

The problem becomes even clearer in family studies. Meehl points out that conventional psychiatric diagnoses may classify the relatives of schizophrenic patients as unaffected even when they display subtler schizotypic characteristics. He cites findings involving subclinical thought disorder and argues that such observations might reveal schizotypic relatives who would disappear entirely from a study based only on formal diagnoses. The issue, therefore, is not merely that compensated schizotypes are “milder.” They may be misclassified altogether because the diagnostic indicators are inadequate to detect the underlying class.

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What could identify a compensated schizotype?

Meehl's proposed solution is consequently not to search for one hidden “schizotypal symptom,” but to construct a multimodal set of indicators that tap different manifestations of the hypothesized underlying disposition. His illustrative indicator set includes a psychometric measure of subclinical cognitive slippage, a physiological abnormality involving post-rotatory nystagmus after alcohol ingestion, and a personality measure of pleasure deficit or anhedonia. These indicators are deliberately drawn from different domains because Meehl wants them to be relatively independent except insofar as they are influenced by the hypothesized underlying schizotypic disposition.

The objective is to obtain convergent evidence for a latent taxon from indicators that are themselves imperfect. If no single sign is pathognomonic, several relatively independent indicators may nevertheless provide sufficient evidence that an individual belongs to the schizotypic class. Meehl's taxonomic discussion explicitly frames the problem in these terms: different indicator distributions may overlap between schizotypes and non-schizotypes, so no single cutoff will perfectly separate the two groups.

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The DSM-III and the Shift Away from Meehl’s Organizational Model

The inclusion of Schizotypal Personality Disorder in the DSM-III represented an important step in the formalization of the schizotypal concept. The DSM-III drew on an existing theoretical and clinical tradition concerning schizotypal individuals, including the work of Meehl, while seeking to translate such formulations into a more practical, operational, and inter-rater reliable diagnostic language. Rather than requiring clinicians to determine the presence of a particular underlying psychological organization, the diagnostic system emphasized observable and reportable symptoms and behavioral characteristics that could be identified with relative consistency across clinicians.

From this perspective, the clinician did not primarily need to determine whether a patient possessed a particular latent schizotypic organization in Meehl’s sense; rather, the task was to establish whether the individual met a specified set of recognizable diagnostic criteria.

This made schizotypal pathology more clinically usable and reproducible, but it also introduced a difference between identifying a schizotypic organization and identifying its observable manifestations.

This distinction has an important consequence: A symptom-based diagnostic framework may potentially miss highly compensated individuals whose schizotypic organization produces few overt manifestations, while also including individuals who display recognizable schizotypal symptoms without necessarily sharing the broader underlying organization that Meehl had conceptualized as characteristic of the schizotype. Thus, the DSM-III did not simply reject Meehl’s organizational conception; rather, its operationalization of schizotypal pathology placed greater emphasis on the observable manifestations through which such an organization might be expressed.

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The Contemporary Dimensional Model

Contemporary dimensional approaches introduce another important transformation. Rather than treating schizotypy exclusively as a categorical question of whether an individual belongs to a particular schizotypal organization, schizotypal characteristics can be conceptualized as continuously distributed across the population.

Traits such as unusual perceptual experiences, magical or unusual thinking, social/interpersonal difficulties, suspiciousness, and related characteristics may occur at relatively low levels in the general population and increase in intensity or combination toward more clinically significant forms.

This makes schizotypy more flexible than a strict categorical conception: an individual may display an isolated schizotypal trait without necessarily constituting a “schizotypal person” in the stronger organizational sense.

The focus therefore shifts from asking exclusively “What kind of organization does this person have?” to also asking “Which schizotypal characteristics does this person possess, and to what degree?” In this contemporary framework, isolated traits are not merely imperfect indicators of an underlying schizotypal class; they can themselves become legitimate objects of study.

This broadens the construct considerably, allowing schizotypy to function simultaneously as a description of subtle characteristics in the general population, a higher concentration of schizotypal traits associated with personality pathology, and, at its most extreme, a phenotype related to the schizophrenia spectrum.

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Primary literature used

Meehl, P. E. (1973). Psychodiagnosis: Selected papers. Minneapolis: University of Minnesota Press.

The following text is taken from Gordon Claridge’s book Origins of Mental Illness: Temperament, Deviance, and Disorder, 2nd edition (1995).

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Our second line of enquiry into the nature of the psychotic nervous system has taken a somewhat different direction, though it too has used a similar strategy; namely, examining selected normal individuals to see whether on certain experimental measures they behave like schizophrenics. The focus for this research has been the extensive evidence, described in the previous chapter, that schizophrenics show unusual patterns of hemisphere organisation. Is this also true of some normal people?

Recent results we have obtained suggest that it is. Here the subjects were chosen according to their scores on the new questionnaire of 'borderline' characteristics mentioned above. Comparisons made on a variety of hemisphere function tasks have demonstrated, almost without exception, that people with high scores on the questionnaire do differ in performance in a way that is compatible with their having schizophrenic-like nervous systems.

Thus, a general finding that emerges is that schizotypal individuals, like schizophrenics, show weakened, or even reversed, laterality of function as measured on standard divided visual field tasks. This is particularly evident for the processing of verbal material - nonsense syllables or letters - where the left hemisphere's usual superiority is diminished in schizotypes. We have also found that they differ when examined in the auditory modality: the task used here was the same as that referred to earlier as showing effects in both schizophrenics and their children; namely the comprehension of stories played either to one ear or to both ears simultaneously.

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Although these unusual brain asymmetries are most clearly observable with respect to verbal processing - and, for that reason, least ambiguously comparable to those found in schizophrenics - other differences in hemisphere function can also be observed among individuals who score highly on our questionnaire of 'borderline' characteristics. Thus, we have found that they differ, too, in the relative extent to which their hemispheres are engaged during simple perceptual processing; specifically when asked to do a task which requires them to process stimuli either 'locally' or 'globally'. These two abilities are known to be partly hemisphere dependent, the left brain for example, normally being better at detailed or local analysis of a stimulus. In schizotypal individuals, however, the reverse seems to be true. This may be significant because several psychologists who have explained schizophrenia as a disorder of information processing have suggested that a crucial features may lie in the schizophrenic's inappropriate use of 'local' and 'global' modes for analysing perceptual data.

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Note: In these passages, Claridge uses the term borderline in the broader, historical sense of borderline states, referring to a range of conditions and characteristics situated at the boundary between personality disturbance and full-blown psychosis, rather than simply to what is now termed borderline personality disorder.)

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Clearly we have a long way to go before we can arrive at a precise description of the schizotypal nervous system. But, as a general principle, the idea of a continuity between the normal and the psychotic - long considered likely by those outside the arena of academic debate - seems to be well supported by experimental evidence. In this respect, it is especially satisfying that at the biological level the continuity should be evident for both aspects of brain activity that have proved useful in describing schizophrenia itself; namely, in dynamic process variations - as reflected in patterns of psychophysiological response - and in hemisphere organisation.

There is thus a remarkable similarity in the pieces of the two jigsaws - that for schizotypy, on the one hand, and that for schizophrenia, on the other. In each case we find evidence for a tendency towards instability of brain activity from which, in schizophrenia, we inferred that there may be a relative lack of homeostasis in the nervous system - both vertically and horizontally - and it seems that this might also be true, to a lesser degree, of the schizotypal or psychotic personality.

At a psychological level there is also a parallel, in the normal schizotype's readiness to admit to perceptual aberrations, unusual thought styles and beliefs, openness to experiences, disharmony of personality structure, ambivalence of emotional response to others, and an uncertainty about the self-concept. All of these features could be said to mirror the 'psychotic' form of brain organisation found in the schizotype. As, extrapolating from theories about the illness itself, could other probable characteristics: an unusual sensitivity to events in the internal and external environments, a heightened Id awareness of the contents of consciousness, and a highly tuned selectivity of attention.

Returning to schizophrenia itself, let us now see whether it is possible to construct a plausible account of how, in this case, illness might proceed from the dispositional characteristics that underlie it. A convenient place to start is at the point of contact between the schizotypal individual and his social environment. For it is the interaction and communication with others that almost certainly place the greatest demands on the kind of nervous system just described. The idea that social, or more narrow family influences can by themselves cause schizophrenia now flies in the face of considerable evidence to the contrary, some of which we referred to briefly in the previous chapter. However, it is the case that the immediate family environment of the schizophrenic can, once the illness has started, worsen the condition and cause relapse into further psychotic episodes. This conclusion is clearly supported by the work of Leff and his colleagues, who have demonstrated that the schizophrenic is extremely sensitive to the amount of face-to-face contact and level of expressed emotion he encounters from close relatives. Now Leff and his co-authors studiously avoid inferring from this that similar effects may be at work prior to the onset of illness or that they could, through prolonged exposure to such influences, contribute to subsequent breakdown. However, I would suggest that indeed may be the case and that the overall vulnerability to schizophrenia consists of a genetic disposition, compounded by a particular form of interaction between the schizotypal nervous system and the family environment. How, in detail, might this work?

Part of the clue, on the biological side of the equation, might lie in what we have seen to be the unusual manner in which schizophrenics (and schizotypal individuals) process events around them. The way they deploy their attention is certainly odd, two particular features which I would like to emphasise here being as follows:

_ one is the tendency to utilise local and global perceptual strategies in a peculiar fashion

_ and probably to rely much of the time on detailed, rather than holistic, modes of analysis; the other is to do so especially in the analysis of social stimuli, such as facial - and therefore non-verbal - expressions of emotion in others.

Given that the latter are among the most elaborate stimulus configurations encountered in life - but also vital to social development - it seems probable that the schizotype, merely because of the arrangement of his nervous system, will be at greater risk of misinterpreting non-verbal social signals, because of his tendency to focus on, or attend selectively to, their constituent parts rather than consider them in a total context.

Put more generally, he might just have more difficulty sorting out meaning in the complicated flow of verbal and non-verbal interchange that makes up social communication, particularly if this signifies strong emotion, and especially so given the unusual organisation of both the expressive and receptive aspects of language in the schizotypal brain. Occurring from childhood onwards this form of interaction with others could exacerbate a pre-existing genetic disposition, to produce a cognitive and personality style that is vulnerable to schizophrenic breakdown.

So much for the contribution of the individual's nervous system 'type'. What about family influences that may interact with it? If, as suggested, recent work on 'expressed emotion' in schizophrenia can be generalised to childhood, we could conclude that particular kinds of family milieu, because of their emotional climate of criticism, overinvolvement and so on, might be especially powerful in bringing about the effects just described. Here, incidentally, there may be something to be said in favour of the old idea of 'double-bind', as a pathological form of communication in which the sender in a social interaction emits verbal and non-verbal messages of conflicting meaning: a typical example is the parent who, aggressively hugging the child, simultaneously says 'I love you'. The theory that such interactions by themselves can cause schizophrenia is now discredited. On the other hand, they would present to the schizotypal child a particularly difficult example of the kind of interpersonal situation with which his nervous system is ill-equipped to deal. The double-bind aside, there is considerable evidence that the communication patterns in schizophrenics' families are abnormal. Undoubtedly these partly arise as a reaction to the schizophrenic or potentially schizophrenic family member. But another important element, often overlooked, is that the parents will, through genetic affinity with their offspring, share some of the temperamental makeup of the vulnerable child and therefore some of his or her difficulties with social interaction. This would mean that communication within the family may be mutually ambiguous or otherwise unusual, biological and social factors operating synergistically to push the most genetically prone individual towards schizophrenia.

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According to some opinion it might be said that what I have just described is schizophrenia, especially if one sees that condition as part of a broad spectrum of deviance. For the above account does not depart too drastically from the explanation offered by those with Laingian and other radical psychiatric views - even though it does introduce a much more biological emphasis than they would prefer. On the other hand, even they would recognise that as a full-blown illness, schizophrenia involves a very marked discontinuity of function, a recognisable break into bizarre, and apparently incomprehensible symptoms. It is therefore still necessary to explain how and why this occurs. A crucial factor here, I believe, is the other unusual feature of the psychotic brain; namely the relative instability of mechanisms responsible for central nervous arousal. As we have seen, this can result in marked shifts in physiological state which will, inevitably, cause the individual to respond inappropriately - and on occasions strongly - to situations that evoke arousal. Now it can be stated as a general principle, which applies to all organisms, that excessive arousal will disrupt psychological functions, finding the weakest point in potential sources of abnormality and throwing these into sharp relief: in the schizotypal person this would seem to be the arrangement of the higher nervous system as it relates to the organisation of language, thought, attention and social perception. It is not difficult to see how such psychological functions might become deranged under conditions of particularly acute stress. To take a highly specific example, the pre-schizophrenic's tendency to 'read 7 the behaviour of others in an unusual way may only take on pathological valence at times of heightened emotional arousal. Only then perhaps is he likely seriously to misinterpret and attach sinister significance to perceived non-verbal (or verbal) signals which otherwise may remain below the threshold at which they disturb consciousness: the road from there to elaboration through delusional thought is a short one.

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Let us now turn upside down some of the questions being addressed over the last few pages and consider another set of issues raised by the continuity view of schizophrenia. If the predisposition to schizophrenia varies in a graded fashion among the general population, why is it that, relatively speaking, only a few become ill? Certainly an important factor, strongly indicated by the genetic evidence, is the difference between individuals in their degree of inherited liability to schizophrenic breakdown. Interacting with this will be their amount of exposure to critical influences that either further increase overall vulnerability or, alternatively, allow what might otherwise be a strong genetic predisposition to lie dormant. Such influences include biological hazards, like minimal brain damage at or soon after birth, life events in childhood and adolescence, and the quality of the family environment during upbringing. Another important, though less definable, factor is undoubtedly the extent to which even highly schizotypal individuals are protected from breakdown by intellectual and other personality resources - their 'ego-strengths' - which enable them to cope with, and sometimes profit from, unusual, psychotic, states of mind.

An illuminating example of this last point is Jung who, after his break with Freud just before the start of World War I, entered what can only be considered a period of schizophrenic turmoil - or, as he himself, recalling it years later in Memories, Dreams, Reflections, referred to as his 'confrontation with the unconscious. He describes the experience in a vivid detail that accurately recapitulates many features of the psychotic state, which he, as a psychiatrist, felt compelled to explore:

“An incessant stream of fantasies had been released, and I did my best not to lose my head but to find some way to understand these strange things. I stood helpless before an alien world; everything in it seemed difficult and incomprehensible. I was living in a state of tension; often I felt as if gigantic blocks of stone were tumbling down upon me . . . But since I did not know what was going on, I had no choice but to write everything down in the style selected by the unconscious itself. Sometimes it was as if I were hearing it with my ears, sometimes feeling it with my mouth, as if my tongue were formulating words; now and then I heard myself whispering aloud. Below the threshold of consciousness everything was seething with life . . . When I was writing down these fantasies, I once asked myself, 'What am I really doing? Certainly this has nothing to do with science. But then what is it?' Whereupon a voice within me said, 'It is art.' I was astonished. It had never entered my head that what I was writing had any connection with art. Then I thought, 'Perhaps my unconscious is forming a personality that is not me, but which is insisting on coming through to expression.' I knew for certainty that the voice had come from a woman. I recognised it as the voice of a patient, a talented psychopath who had a strong transference to me. She had become a living figure within my mind.”

Jung leaves us in no doubt that he was aware of the schizophrenic quality of his experience, for he goes on to note that at every stage of it he had 'run into the same psychic material which is the stuff of psychosis and is found in the insane . . . the fund of unconscious images which fatally confuse the mental patient/ Yet he had retained his sanity and indeed it was on the basis of the fantasies he encountered during that period that he went on to formulate his own, very influential, theory of the psychology of Man.

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The following text is not from Claridge's book.

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Breakdown:

For Claridge, schizotypy is best understood as part of a continuity between normality and psychosis: a neuropsychological organisation that shares important features with schizophrenia, but can remain relatively stable and adaptive rather than necessarily progressing to psychosis.

• Continuity with psychosis. Schizotypy lies on a continuum between normality and schizophrenia. The distinction is therefore not simply between having and not having psychotic characteristics, but between different degrees and forms of an underlying organisation.
• A schizotypal nervous system. Claridge proposes that schizotypal individuals show aspects of nervous-system organisation resembling those found in schizophrenia, although generally to a lesser degree. Evidence includes atypical hemispheric organisation, weakened or reversed lateralisation, differences in perceptual processing, and possible instability of brain activity and reduced neural homeostasis.
• Unusual information processing. This organisation is reflected in the way schizotypal individuals process information. They may show unusual local/global processing strategies, a tendency toward detailed rather than holistic analysis, highly selective attention, and heightened sensitivity to events in both the internal and external environment.
• Psychological manifestations. At the psychological level, this may be expressed through perceptual aberrations, unusual thought styles and beliefs, openness to unusual experiences, uncertainty about the self-concept, ambivalence in emotional responses to others, and some disharmony in personality organisation. These characteristics can be understood as psychological expressions of the same organisation that, in a more extreme form, appears in psychosis.
• Heightened awareness and attention. Claridge also emphasises a heightened awareness of the contents of consciousness and an unusually selective deployment of attention. Thus, schizotypy involves not only unusual beliefs or perceptions, but differences in what enters awareness and how experience is processed.
• Social perception. Social interaction may be a particularly demanding domain because it requires the integration of complex verbal and non-verbal information. A schizotypal individual may be more likely to focus selectively on particular components of social signals rather than apprehending them as an integrated whole, increasing the risk of misinterpreting facial expressions, emotional cues, and other interpersonal signals.
• From vulnerability to psychosis. Schizotypy constitutes a vulnerability to schizophrenia rather than an inevitable progression toward it. Genetic predisposition interacts with developmental, biological, environmental, and interpersonal factors. Under conditions of heightened emotional arousal or stress, normally manageable peculiarities in perception, thought, attention, or social interpretation may become increasingly disorganised and acquire pathological significance.

Adaptation and protection. Highly schizotypal individuals do not necessarily become psychotic. Intellectual and personality resources—what Claridge calls “ego-strengths”—may protect against breakdown and may allow unusual states of mind to be integrated into relatively stable, or even productive, functioning.

Hi guys, you know I like to collect different information about schizotypal. I just want to create a whole topic about identity in schizotypal. So, you can comment here about anything you want related to the topic, especially your own identity and anything you find related to it.

(Please if you participate specify if you been formally diagnosed, not diagnosed but you feel all matches, or just think you could have schizotypal although not so sure about it)

Because I see this as a theme that keeps coming up over and over again in relation to schizotypal, I think it would be nice to try to condense it all into one topic.

Then I guess I'll pin it in my megathread about schizotypal so others can read about it too.

Key words: identity, sense of self, sense of one’s own identity (or lack thereof), etc.

I think this is one of the less explicitly discussed topics in the literature. There are some cues here and there, but not as much as I think it should be addressed.

You can write as much as you want, and come back later to add more information, etc. It’s all for you.

I know some analysts who don't like talking about the theory with their analysands. They don't even want to bring that kind of terminology into the discussion.

But then I've heard stories of other analysts who are willing to talk with their analysands using theoretical concepts.

What do you think about all this?

It also makes me curious: is there a line of psychoanalysis that tries to help the analysand understand some concepts from the theory? Like something you can discuss directly with your analyst.

There are pros and cons, of course.

Personally, I've always wanted to discuss the theory directly with an analyst, because that's the only way things make sense to me. It's the way I have that "aha" moment, and I understand what is actually going on, or at least I have the words to think about it.

But, at the same time, it can really confuse certain people.

For example, I heard a story some time ago, from a woman who was diagnosed as schizoid (at least that's what I understood), and their therapist told her that she was “still in the paranoid-schizoid position, and bla bla…”. But then she explained what they understood about all that, and I thought, "Hmm... I'm not sure this person really understands all this."

Putting aside what I prefer, because the idea isn't to make this all about me, I was just curious: is there a line of psychoanalysis that allows talking with the patient using these terms? Is there another line that kind of prohibits it? What you think about all this. Etc. Thank.

Concept from Hoch & Polatin (1940s or 1950s).

I've been interested in subclinical psychotic symptoms for a long time.

When I came across the term "pseudo-neurotic schizophrenia," I thought, "Oh yes, I totally get why they picked that wording. I'm sure they're talking about exactly what I've been thinking."

What I want to ask you is: how much is this term used in psychoanalysis? Was it an important term where you were taught psychoanalysis? Is it still pretty much in use? Is it a term you have encountered many times while reading texts? Etc.

I'm just curious, that's all.

But today I was thinking... when I've been thinking about psychodynamic sub-psychotic symptoms, I've actually been thinking the other way around. Doesn't the idea of "pseudo-schizophrenic neurosis" make just as much sense?

What I mean is: mild versions of schizophrenic symptoms that were formed through very neurotic mechanisms in origin.

Because I don't think we can deny that this occurs.

I know this question may be, for many, unrelated to the field of psychoanalysis, but it's something like this: does the person have an attenuated schizophrenic nucleus from which sub-psychotic symptoms emerge and are expressed through their personality? (Paul E. Meehl would talk about the taxon and schizotaxia).

Or is there no such inherent schizotaxon, and are these just symptoms that emerged due to mental dynamics linked to neurotic mechanisms?

Anyway, I just wanted to open a debate. Feel free to write what you think about this.

Of course, every case is different, but I'm trying to think about how it would be conceptualized, in a nutshell, let’s say.

When paranoid ideation occurs in interpersonal relationships, it's relatively easy to think in terms of internal object representations and how internalized object relations come to shape the perception of external people, with external figures becoming experienced through the lens of these internal representations. I have in mind projection and projective identification for this of course.

But what about when it is not directly related to social relationships? For example, a person is alone at home and feels that "something" is watching them, yet there is not always a clearly defined figure. It's not necessarily that the person says, "People are watching me," or even, "A spirit is watching me." Rather, it is simply "something"—some vague sense of a presence.

I can understand what's happening, but I'd like to know how this is commonly theorized.

Also, how would you theorize it when the person does not experience these "presences" as hostile?

For example: "Something is watching me, but to guide and protect me.". In the interpersonal domain, it could be, "People are talking about me because they think I'm great; they value me very highly."

I'm not so much asking about how these symptoms develop, but rather how you would conceptualize them theoretically.

I have some thoughts of my own, but I'd really like to hear yours!

I'm also open if anyone wants to recommend something different from object relations theory.

(I don't know if this needs clarifying, but I'm not asking because of a personal issue. I'd just like to see how these kinds of experiences are generally theorized.)

Pretty much what the title says.

My main area of interest is Schizotypal Personality Disorder, but books about it tend to focus too much on the personality itself rather than its underlying causes.

For a while, I've been thinking that schizotypal traits could be the product of neurodevelopmental issues. Although I know schizotypal PD is highly heterogeneous.

So I'm approaching it the other way around now: looking for books about neurodevelopmental disorders in general and seeing whether they mention schizotypal traits as a result of neurodevelopmental problems.

But neurodevelopmental disorders are such a broad topic.

Any recommended literature? Also leave this open for the debate and opinions. Thanks.

I'm looking for literature talking about an experience that I think resembles identity diffusion, but seems more pervasive.

The person, rather than being experienced as an enduring subject, is experienced as unusually insubstantial, with little sense of an underlying continuity that gives coherence to one's personality, preferences, values, or way of being. These aspects are often experienced as detached from any deeper sense of "me," as if they were characteristics that happened to accumulate rather than expressions of a persisting self.

it is a weakening—or even absence—of the subjective sense of one's identity is experienced. The person experiences a diminished sense that there is a coherent sense of who it is. Their own concious and subjectivity becomes and object of confussion, there is almost an ominous feeling about their own sense of experience.

Even sometimes, the person can feel that their way of being and existing is artificial, as if they could simply choose the way they could be, rather than it being naturally inscribed in their sense of self.

I'm not sure to what extent this experience is already encompassed by the concept of identity diffusion. Many descriptions of identity diffusion that I've come across seem less severe than the kind of experience I'm trying to describe. That's why I've sometimes thought of it as a kind of "severe identity diffusion."

Also, what I see as different from identity diffusion is that this experience starts taking on quite a lot of weight for the person. The person can sometimes isolate this experience, even visualize it and verbalize it. The experience can become quite absorbing, so it becomes one of their main preoccupations, rather than just an isolated or silent symptom.

The thing is, of course, that this experience is not isolated; it is also related to other aberrant experiences the person has. However, this is one of its manifestations, and this type of "confusion" about their own self is also reflected in the way they comprehend and process their relationship with the external world.

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So, I'm trying to find out whether there is already an term used to describe this particular type of experience, more or less.

I guess dissociation could be used to talk about what I'm describing, because the person starts feeling some distance from themselves. Their thoughts, actions, preferences, and the reasons why they do or do not do things begin to be experienced from a distance. The person could also starts ruminating quite a bit about themselves without feeling very connected to who they are. Sometimes, they feel like a "blank sheet" that has yet to be filled, whereas for many other people, the sheet already seems to be filled, allowing them to simply live according to what is already written.

Books, terms, what you think about this?

For those who are interested in psychology/psychiatry/psychoanalysis.

I wrote a short article/summary based on part of a lecture series by a psychiatrist from Spain. The seminar is called Ten Clinical Rules for Beginners. The article is about Rule 9, The Triple Diagnosis.

Link: https://www.reddit.com/r/Schizotypal/comments/1ulykog/rule_9_the_triple_diagnosis_by_dr_jos%C3%A9_mar%C3%ADa/

This psychiatrist has a very unique approach because he is neither a mainstream DSM-oriented psychiatrist nor a rigid psychoanalyst. He draws heavily on psychopathologists from the early 1900s, mentioning authors such as Griesinger, Schüle, Schneider, Minkowski, Kraepelin, Blankenburg, Bleuler, among others. At the same time, he also takes into account concepts from Freud, Lacan, Klein, and the psychoanalytic tradition, while remaining critical of them, especially when their theories become overly categorical—for example, rigid Lacanian structures, or the idea that if repression is operating, then foreclosure cannot operate at the same level, and vice versa.

It's amazing to listen to him. He seems to be able to read German and appears to have read extensively from many pre-psychoanalytic authors. Now YouTube has the option to change the audio to different languages. This option is available for some of his videos, in case anyone wants to listen to his lectures.

I'm currently working on a summary of Rule 8, Clinical Categories Are Our Own Inventions, where he discusses, among other things, unitary psychosis and the early history of this concept. He asays that psychosis was initially considered a form of neurosis, and that the separation between neurosis and psychosis came later. More than that, says that psychosis was once thought of as the most extreme form of neurosis