u/DiegoArgSch

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.

----------------------------------------------------------

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.

----------------------------------------------------------

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.

----------------------------------------------------------

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.

----------------------------------------------------------

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.

----------------------------------------------------------

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.

----------------------------------------------------------

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.

----------------------------------------------------------

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).

-------------------------------------------------------------------------------------

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.

-------------------------------------------------------------------------------------

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.

-------------------------------------------------------------------------------------

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.)

-------------------------------------------------------------------------------------

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.

-------------------------------------------------------------------------------------

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.

-------------------------------------------------------------------------------------

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.

-------------------------------------------------------------------------------------

The following text is not from Claridge's book.

-------------------------------------------------------------------------------------

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.

------------

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

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.

Have any of you gone beyond a diagnostic evaluation and had genetic testing, brain scans, or anything like that? Would you be willing to share your results?

Did they show anything relevant, or did they not reveal anything noteworthy?

Thanks!

Does anyone deal with something like this?

It's long and difficult to explain, not because I don't know what's happening, but because it's hard to explain it in writing. You will see...

1. Let's say I'm folding something, like a napkin. I fold it in half until the size I want, but then when I have to put it on something, I feel one side is the "right side" and the other is the "wrong side". Sometimes I can't decide which one is the right side to put, and I think: "Hmm, this one seems like the right one, the other would feel odd. No, this side is better."

Sometimes it's visual, trying to decide which one looks "more perfect", with "less imperfections", maybe because one side has a coloration and the other does not (not talking about dirt, just the patterns), or one side has a little border that seems off, etc.

But it can happen with things where the visual component is not so important. When I put my phone on the table, there is "one right way to put it". Here it depends on the direction of the phone, like... I can put my phone in different rotations, perpendicular to the table, oblique, etc. I'm not thinking about how the lines of the rectangle of the phone match with the lines of the table. This can be very automatic: "it just feels right this way, and wrong this way."

Same with everything: a kettle, I rotate it until I find "the right spot", same with the TV remote and so on.

2. Now, sometimes I'm doing stuff at home, at the supermarket, etc., and at some point I have to turn my back 180 degrees. If I turn 180° turning to the right, it feels like something, and if I turn turning to the left it feels different. It's not that I always pick the same side to turn; it depends on many things (hard and long to explain, but nothing really having a practical meaning).

And it's not just when I have to turn 180°. Sometimes I have to turn to my left, and instead of doing that, I turn to my right and make a 310° turn; meaning instead of just going left, I go right and keep turning until I reach the same point I could reach if I just turned to the left. Just because "it feels right".

Sometimes I've tried to turn to the side that I don't feel is the right one, or put something not in the spot I wanted, and it gives me a weird feeling, like, "mm, no, this doesn't feel right". It's like my mind and body feel fizzy, like a weird aura or state that takes over me. Sometimes I've been doing something, and I start having the need to rotate 360°, because "I'm out of sync with some type of rotation". Like, I've made way too many turns to my left, so I have to compensate by making some turns to the right. So I just make a 360-degree turn to compensate.

3. With the cursor on the PC: when I'm using a computer I have a parallel talk in my mind. I start moving the cursor to the right until I touch the limit of the screen, then I touch the corners. Sometimes what I like to do is touch the bottom side until you can't see the cursor, touch the corner, and then go up until I touch the upper right corner. Sometimes I can't decide when to stop touching the sides; sometimes I touch endlessly a corner because "it feels right". It's like one of the first things I do when I turn on a computer, and while I'm working on it I do this, and if I don't do it I feel like something is bugging me. It's like I'm craving touching the corners; sometimes I need to do it a couple of times. It's like a drug.

4. Last one: this stopped happening to me, but I feel it's how it all started many years ago, like 12 years ago. Let's say I'm sitting at the table, I have a plate in front of me, a glass of water on my right, and I want to move the glass to the left side of the plate. It feels "wrong and odd" to move the glass passing over the plate because "they are crossing each other". So what I do is move it around the plate. But... if I move it around the upper side of the plate, my arm will pass above the plate, so what I do is take the glass, bring it closer to me, and move it to the left.

I know, it's a mess to explain. I could keep going, but I think I gave a good general picture. I also don't have weird movements with my hands and fingers.

I'm not really looking for treatment or recovery advice; I just want to see if other people experience the same thing. None of this really bothers me that much. I'm used to it, and it usually only lasts a few seconds. I can handle it.

How do Lacanians conceptualize this type of experience? And is there a tendency to think of these experiences as part of the psychotic structure?

I don’t mean that these experiences only happen to persons who can be thought of as fitting in the psychotic structure, but more that these types of experiences are often common in people with a psychotic structure, or maybe are very related to this structure.

I am talking about depersonalization, where the person expresses the feeling of being distant from their own body, feeling the body as an external object, or something to which they are attached, perhaps feeling the body as something alien to them, etc.

And derealization, where the person feels the external world (other people, and whatever they see) seems to be perceived through a lens of uncanniness. The external world can feel flat, almost dreamy, distant, unreal, inaccessible, strange, etc.

I’m not interested in dissociative amnesia.

Also, not including these experiences as delusions or psychotic in the mainstream psychiatric sense.

And, more importantly, when these experiences seem to have crystallized in the subject, meaning not being occasional experiences, but rather the person experiences this type of phenomenon persistently.

Open to hearing your thoughts and also wanting to see if there is some literature on this.

Thanks.

I'm looking to read about dissociative experiences in psychoanalysis, mainly derealization and depersonalization.

I already know about these experiences, but I've never read about them through the lens of psychoanalytic authors.

I guess many of these experiences are described while discussing schizoid personalities. I think Laing talks a lot about this in The Divided Self.

I was reading Some Forms of Emotional Disturbance and Their Relationship to Schizophrenia (1942), the text in which Helene Deutsch describes the as-if personality, and she says:

"Those forms of the disturbance in which the individual himself is conscious of his defect and complains of it belong to the picture of “depersonalization.” This disturbance has been described by many authors. In the analytic literature the reader is especially referred to the studies of Oberndorf, Schilder, and Bergler and Eidelberg. (...)

Most of the psychoanalytic observations in this paper deal with conditions bearing a close relationship to depersonalization but differing from it in that they were not perceived as disturbances by the patient himself."

And she gives these sources:

_ Oberndorf, C. P. (1934). Depersonalization in relation to erotization of thought. Int. J. Psychoanal., 15: 271-295; (1935) Genesis of feeling of unreality. Int. J. Psychoanal., 16:296-306.

_ Schilder, P. (1939). Treatment of depersonalization. Bull. NY Acad. Med., 15: 258-272

_ Bergler, E. & Eidelberg, L. (1935). Der Mechanismus der Depersonalization. Int. Ztschr. f. Psa., 21: 258-285.

So these are on my reading list.

I'm mostly looking for authors who discuss experiences involving a disconnection from the body, as well as experiences in which the external world feels unreal or uncanny. I don't care very much about dissociative amnesia.

Thanks.

I say this because, mm... I don’t want to dismiss anyone, but many times topics like this get mixed very much with personal opinions, or lack grounding in real psychiatric methods.

I mean, it's OK — we all can have opinions about these topics, but... some things are way too specific...

Now going to the topic... I posted this in another subreddit, I'll copy-paste the same here, so if anyone wants to talk about it that would be cool, but again, please, people who are more into how psychiatry is really working, not just "I guess it's like this...". I post this here because I’d like to get opinions from autistic people, but in a more informed way. It doesn’t have to be professionals, but it would be good if they’re well-read and actually knowledgeable about the topic.

---

Best books about autism (without sugar coating)

We know how complex the debate about autism has become.

I really like taxonomy, so I’ve been looking for books on autism from that perspective (if that’s something that can actually be done with autism, of course).

Because this whole idea of a “spectrum” makes sense to me, but then I notice a couple of things…

I’m not sure whether autism is currently being used as a category that encompasses different observable traits, meaning that autism is now a more constructed category where different mental profiles can be described as autism, or whether authors think of it more as a coherent psychopathological entity with variations in its underlying components.

I’m trying to understand whether “autism” today functions mainly as an umbrella label that groups together a wide range of partly independent traits that can appear in different combinations across individuals, or whether it is still conceptualized as a single underlying disorder with a shared core structure, where the observed variability reflects different expressions or degrees of the same fundamental condition. In other words, I’m interested in whether the field treats autism more like a descriptive category built from phenotypic clustering, or like a coherent entity that is internally heterogeneous but fundamentally unified.

---

Discussion:

Because this has recently become my main approach to understanding different diagnostic labels, such as schizotypal disorder, for example. The other day I was watching an interview about a child who was initially diagnosed with autism, but later doctors discovered a rare genetic condition. So I thought: “Does this rule out the autism label?” Because, basically, are they focusing on observable autistic traits, and then, when a very specific and highly probable cause of the person’s symptoms is discovered, does the use of what counts as autism shift, or is the diagnosis ruled out altogether?

I’m not sure how much the conception of idiopathic and non-idiopathic autism is being used now, and how.

Something like: is autism meant to refer to a single mental condition with variability, or to a set of different traits that are collectively labeled and described as autism?

---

Although I think both approaches can coexist under the same label, meaning that the label functions as an umbrella that contains different but related pathologies. In that sense, there is a coherent form of autism, such as what used to be called Asperger’s, but also other conditions that share a prototypical set of autistic characteristics. This makes autism a very heterogeneous label, not only in terms of the degree and variety of symptomatology and clinical presentations.

---

Also leave this post open for the debate.

We know how complex the debate about autism has become.

I really like taxonomy, so I’ve been looking for books on autism from that perspective (if that’s something that can actually be done with autism, of course).

Because this whole idea of a “spectrum” makes sense to me, but then I notice a couple of things…

I’m not sure whether autism is currently being used as a category that encompasses different observable traits, meaning that autism is now a more constructed category where different mental profiles can be described as autism, or whether authors think of it more as a coherent psychopathological entity with variations in its underlying components.

I’m trying to understand whether “autism” today functions mainly as an umbrella label that groups together a wide range of partly independent traits that can appear in different combinations across individuals, or whether it is still conceptualized as a single underlying disorder with a shared core structure, where the observed variability reflects different expressions or degrees of the same fundamental condition. In other words, I’m interested in whether the field treats autism more like a descriptive category built from phenotypic clustering, or like a coherent entity that is internally heterogeneous but fundamentally unified.

---

Discussion:

Because this has recently become my main approach to understanding different diagnostic labels, such as schizotypal disorder, for example. The other day I was watching an interview about a child who was initially diagnosed with autism, but later doctors discovered a rare genetic condition. So I thought: “Does this rule out the autism label?” Because, basically, are they focusing on observable autistic traits, and then, when a very specific and highly probable cause of the person’s symptoms is discovered, does the use of what counts as autism shift, or is the diagnosis ruled out altogether?

I’m not sure how much the conception of idiopathic and non-idiopathic autism is being used now, and how.

Something like: is autism meant to refer to a single mental condition with variability, or to a set of different traits that are collectively labeled and described as autism?

---

Although I think both approaches can coexist under the same label, meaning that the label functions as an umbrella that contains different but related pathologies. In that sense, there is a coherent form of autism, such as what used to be called Asperger’s, but also other conditions that share a prototypical set of autistic characteristics. This makes autism a very heterogeneous label, not only in terms of the degree and variety of symptomatology and clinical presentations.

---

Also leave this post open for the debate.

I still haven't read much about ordinary psychosis, only short fragments here and there to familiarize myself with the term and think about it, but I still haven't sat down to read Miller's actual texts.

But let's discuss it.

Lately I've been encountering many concepts and labels intended to point out mental profiles that are neither neurosis nor florid psychosis or schizophrenia, such as Simple Schizophrenia (Blankenburg) or Blank Psychosis/Psychose Blanch (André Green).

One of my main doubts with terminologies like this, is about how to think on this profiles, when these authors use terms linked to psychosis, are they describing a personality configuration, or a genuine pathological condition that affects the mind in a way more comparable to schizophrenia than to "ordinary" personality differences? I´ll explain...

Where the former seem to be much more determined by nature, while in the latter nurture plays a much more predominant role. An extreme example would be Down syndrome, where, I guess we would all agree, we cannot compare it to a classical neurosis, anxiety disorders due to trauma, post-traumatic stress disorder, etc. Also, within the type of mental disorders I am trying to define, one could include florid and chronic schizophrenia, hebephrenia, or even Alzheimer's disease.

I hope I explained myself well. I'm also trying to figure out whether there are terms in psychoanalysis to distinguish these two types of mental afflictions, so that I can have a shortcut and not have to give this kind of explanation every time I want to talk about this.

Coming back to the topic, what could you tell me about ordinary psychosis in relation to what I'm describing? And if you could tell me something about blank psychosis and simple schizophrenia, that would be great too.

I'm also looking for important texts on ordinary psychosis. As far as I understand, Miller doesn't seem to have a single foundational text where he lays out his main ideas about this profile. Rather, in a Lacanian fashion, the concept seems to be scattered across multiple texts, and one has to reconstruct its meaning from them, right?

I've also been wondering whether Miller might be referring to something similar to schizotypal personality disorder, but without using that kind of model.

Thanks.