The Interpersonal Perspective

For the schizotypal, interpersonal behavior and cognitive style are closely tied and work together to perpetuate the disorder. The disorder mixes social communication with personal irrelevancies. Nonproductive daydreaming contributes to magical thinking and irrational suspicion, further obscuring the line between reality and fantasy. Paired with an absence of social interaction that might provide the corrective feedback of normal human relationships, the schizotypal can exhibit only socially gauche habits and peculiar mannerisms. In turn, this estrangement from self and others contributes to experiences of depersonalization, derealization, and dissociation. A preference for privacy and isolation drives schizotypals toward secretive activities and peripheral roles. As such, they often lack any awareness that their actions are inappropriate, and they may not understand why their actions are inappropriate even when the reasons are explained to them. Unable to grasp the everyday elements of human behavior, they misconstrue interpersonal communications and impose personalized frames of references, circumstantial speech, and metaphorical asides.

Although schizotypals often seem content to remain socially eccentric or odd, in fact, many are simply oblivious to implicit codes of conduct and subtle behavioral norms. Socially savvy individuals have a broad awareness of social scripts. Normal persons are aware of the internal emotional states of others and work to smooth over the rough edges of interpersonal encounters, an attribute called poise. Even relatively unpoised individuals, however, universally engage in impression management to optimize outcomes. In contrast, schizotypals do not understand implicit social codes and behavioral norms. The value of appearing composed and competent during a job interview may be lost on them, for example. Their social categories and scripts are simply coarse and incomplete. Knowledge of the nuances of everyday social interaction, the ability to read the intentions of others accurately and respond appropriately, and an awareness of the biasing effects of mood on cognition—all things that the social savant assumes—are either deficient, fraught with gaps, or simply absent.

Instead, schizotypals miss signals and social cues, chronically misdiagnose social situations, commit terrible gaffes that make others feel awkward, and even inadvertently insult those who might control their destiny. They not only impute wrong motives to others but also gear their own interpersonal responses to these misunderstandings. Thus, conversations meander unpredictably; get lost in vague, abstract metaphors; fail to rise above the concrete; are polluted by irrelevant intrusions; or seem burdened by a baggage of unintended connotations. No wonder, then, that schizotypals are experienced by others as being strange or weird.

The most unfortunate consequences, however, derive from the vicious circles such behavior creates. By responding to consensual social reality in nonconsensual ways, schizotypals lose the ability to drive social encounters in directions that are constructive or satisfying for either party. Recall from Chapter 2 that in the ideal interpersonal interaction, each person seeks to pull responses that validate his or her self-image. In effect, interpersonal communication confirms us to ourselves. Schizotypals do not invalidate others; they simply fail to validate them. As a result, others feel confused and awkward. Therapists know that they must function as a secondary ego for their schizo-typal patients, bringing the conversation back to what is appropriate, allowing the schizotypal to test reality through the clinician, and so on.

For the average person, however, the schizotypal is surprising and confusing. Normals eventually get lost in the convoluted mass of digressions and lose track of the conversation. They may have no idea what the schizotypal is talking about or why. Eventually, normals either terminate the encounter abruptly or simply ignore what cannot be understood. The implicit message is either dismissiveness or disgust: "You are a nonentity, and I will ignore you," or "I don't like you. You make me feel strange. There is something wrong with you." A long history of such encounters may explain why schizotypals find interpersonal interactions vaguely punishing and exhibit such intense social anxiety. Most deeply wish to be left alone.

The existential consequence of this vicious circle is the deconstruction of a coherent self. As emphasized by symbolic interactionists and social psychologists, the self is a construct like any other construct but finds its content through interaction with others. Given their cognitive aberrations, schizotypals are likely to be as ineffective at relating to and understanding their own needs as they are oblivious to those of others. That is, the same kinds of cognitive errors that lead to mistakes in decoding the significance of events in the external world probably apply to the internal world as well. When schizotypals communicate with themselves through introspection or reflection, their self-talk suffers the same kinds of errors and distortions as when communicating with anyone else.

As a result, schizotypals never achieve the solid sense of identity associated with normal development. Their tendency to intrude tangentialities and irrelevant associations and to become inappropriately metaphorical or concrete makes the schizotypal self a particularly porous construct riddled with the products of these distorted reflections. Their intuition of self—their understanding of the essence of who they are—probably seems strange, foreign, even alien, in ways that normal persons cannot comprehend. For most of us, the intuition of our identity is so immediate that the self is an almost physical, vibrant presence, not a construct at all (hence Western dualism and the mind-body problem). For the schizotypal, however, the very processes that guide self-insight are distorted, and the content of the self is distorted as well. When combined with internalized feelings of self-neglect that the dismissiveness of others engenders, many schizotypals are left with a profound head start toward depersonalization and self-estrangement, even feelings of existential terror produced by feelings that the self might simply dissolve.

Consider the case of Matthew, the night watchman (see Case 12.2). Like many schizotypals, he seems to expect criticism and negativity, chronically misreads the motives of others, misdiagnoses social situations, and imbues interactions with malevolent intents. Nevertheless, Matthew has found a niche for himself that compensates for the social anxiety and suspiciousness that plague the schizotypal mind. He states frankly, "People make me nervous," and says that his night watchman job spares him the crowds and noise of the daytime. His only real human contact is with his brother, whom he sees sometimes over the holidays. Drifting over time into increasingly peripheral vocations, he has also worked as a janitor and a driver. The immediate problem, however, is his bizarre behavior: Matthew has been observed "skulking" around corners, muttering to himself, and cutting the back of his hand. After extensive probing, he admits that he sometimes feels dead and nonexistent. The cutting serves a functional role in his life, providing a strong, concrete counterpoint to the emptiness of his own identity. By reminding himself that he is real, Matthew is able to pull back from the brink of self-diffusion.

A developmental account of the schizotypal from an interpersonal perspective has been presented by Benjamin (1996). All children eventually develop their own autonomy, an important part of developing an identity that exists as separate from the caretaker. However, the parents of future schizotypals, according to Benjamin, send contradictory, illogical messages by punishing their children for taking autonomy while taking autonomy themselves in the very same way. She gives the example of the father who is rarely home but beats his child for not being home. Because such parents fear autonomy in their children, they imply that they somehow have access to information that exceeds what is empirically possible, perhaps a sixth sense about what the child might be doing wrong, for example. The parent might say, "You know that if you do that, I can see you. I'll know what you've done." Magical, detached observation from afar thus substitutes for real caring and parenting, modeling both magical thinking for the future schizotypal as well as how the schizotypal should care for others.

As adults, these individuals gravitate toward marginalized professions that assume privileged access to other modes of information or experience, perhaps fortune telling or astrology, for example. As they divine their special knowledge, they present it to their clients with a detachment modeled by their own parents: "Do what you will, the tea leaves say such and such." At the same time, Benjamin states, the parents controlled the child in bizarre ways that held the power of life or death over the destiny of the caretaker. Perhaps the mother or father would die unless certain household tasks were performed. The result, Benjamin states, is that behavior beyond what would be devel-opmentally appropriate was required for the child to contain his or her own incredible power of destruction. This further distorts the basic experience of relating to others and eventually gives rise to superstitious beliefs and rituals about the power of the self and how it can be used, channeled, and controlled.

Although weird behavior necessarily requires a weird explanation, Benjamin (1996) explains the paranoid and socially withdrawn aspects of the schizotypal straightforwardly. Many schizotypals, she states, can be expected to have a long history of abuse. Paranoid symptoms develop in response to the intense experience of attack that this abuse generates. Fears of engulfment arise because schizotypals repeatedly experience themselves as having been invaded and co-opted. Retreat into time spent alone becomes

Matthew, age 37, works the night shift for a large security firm. Although he has guarded the same large food warehouse night after night for 13 years, he seldom interacts with other employees, preferring instead to spend time alone. Recently, however, his coworkers have been complaining of his strange behavior.1 Matthew has been muttering incoherently and "skulking" around corners. After Matthew was seen cutting the skin on the back of his hand with a pocketknife, his supervisor made arrangements for a psychological evaluation.

During the clinical interview, Matthew answered questions with either one-word responses or very short phrases, usually waiting to be asked a second time before responding and refusing to make eye contact with the examiner. His answers were short and bizarre and gave insight into a life devoid of any human connectedness. In fact, his only real personal contact is his older brother, whom he sometimes sees during the holidays. His only significant relationship, he states, was with a girl in high school. "We graduated and I didn't see her any more," he says, beginning with almost no emotion and then trailing off into silence, with an occasional misplaced giggle.

When asked why he likes his work, Matthew replies that the night shift spared him the crowds and noise of daytime. Moreover, he can be by himself during his patrols and is not required to talk with anyone else. "People make me nervous," he states, smiling. When asked about past employment, he notes that he has worked as a janitor and a driver but has been homeless for a period of time, though it did not appear to worry him. Throughout the interview, he shows neither understanding nor curiosity about the events that led to the evaluation, instead answering questions mostly in monotone. He seems impervious to the world around him.

After extensive probing and rephrasing, Matthew discloses that he sometimes fears that he is dead or nonexistent, that he feels more like a thing than a person. Accompanying this revelation is his first genuine emotion of the interview. "I get terrified," he states. When these feelings occur, he quiets the dread by cutting himself. If he truly did not exist, "the cuts would not hurt, and he would not bleed." He is also helped by "mind messages." He calls out to the "protective spirits," who answer his call, thus reaffirming his existence. Matthew seems undisturbed by the peculiarity of his statements or by his idiosyncratic lifestyle. Although his self-mutilation obviously requires treatment, in his view, it is a positive force that contributes to his comfort.

1Numbers mark aspects of the case most consistent with DSM criteria, and do not necessarily indicate that the case "meets" diagnostic criteria in this respect.

Schizotypal Personality Disorder DSM-IV Criteria

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

(1) ideas of reference (excluding delusions of reference)

(2) odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations)

(3) unusual perceptual experiences, including bodily illusions

(4) odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)

(5) suspiciousness or paranoid ideation

(6) inappropriate or constricted affect

(7) behavior or appearance that is odd, eccentric, or peculiar

(8) lack of close friends or confidants other than first-degree relatives

(9) excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

Reproduced with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.

the most adaptive strategy. In the final analysis, Benjamin's model seems consistent with the famous double-bind theories of schizophrenia that evolved from Sullivan's original contributions, first put forward by Bateson and colleagues (1956). However, Benjamin's model offers additional specificity through the principles of interpersonal communication encoded in her SASB model.

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