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Introduction
Our
behaviors -- effective or not -- are learned. We do
not develop in a vacuum. Rather, we learn to act
and respond within a given context, and within that
context our behaviors make sense. If we continue to
use those same behaviors in new contexts the
behaviors may seem frivolous or ineffectual; they
may even be labeled as abnormal. Yet the behaviors
did make sense within the context in which they
were developed. In this paper I intend to explore
schizophrenia and the borderline personality from
the perspective of learned behaviors. I wish to
explore the kinds of early interactions and
influences that shape the individual who earns
either of these diagnoses.
Schizophrenia
The
classical approach is to view the schizophrenic in
isolation from his environment. It is assumed that
the schizophrenic is out of touch with "reality."
Those who adhere to this perspective suggest
that:
...
regression to more primitive levels of thinking
is a primary feature of schizophrenia. In
essence, more highly differentiated and
reality-oriented "secondary" thought processes,
which follow the rules of logic and take
external reality into consideration, are
replaced by "primary" thought processes which
involve illogical ideas, fantasy, and magical
thinking. (Carson,
330)
In
contrast, the interpersonal approach views the
schizophrenic in relation to his environment,
specifically his family of origin. In Steps to
an Ecology of Mind, Gregory Bateson discusses a
theory of schizophrenia which was the result of a
research project undertaken by Bateson, Don D.
Jackson, Jay Haley, and John H. Weakland. The
theory looks at the behavior of the schizophrenic
within the context of his or her family. They
suggest that schizophrenic behaviors "make sense"
when viewed from this perspective. In other words,
behaviors do not develop in isolation but as a
result of our interactions.
Bateson
suggests that the schizophrenic has "...trouble in
identifying and interpreting those signals which
should tell the individual what sort of message a
message is, i.e., trouble with the signals of the
same logical type as the signal `This is play.'"
(1,
194)
For
example, I ask my four-year-old stepson to hold his
glass of milk with two hands; he does not follow my
instructions, and he spills the milk. I call his
attention to the fact that he did not follow my
instructions. When he responds with, "I didn't
follow the rules!" I know he and I are not
communicating at the same logical level. My
experience was that I wanted to discuss a specific
incident in which he didn't follow my instructions
and he spilled his milk as a result. His experience
was that he seemed to be struggling with an
abstract concept of "rules." Ideally, children's
experience helps them learn to make those
distinctions. During the development of the
schizophrenic, however, something happens that
interferes with his ability to do the same. What is
it?
Bateson
et al. suggest that a person caught in a
"double bind" -- a situation in which no matter
what a person does, he "can't win" -- may develop
schizophrenic symptoms. In the double bind there
are two conflicting levels of communication and an
injunction against commenting on the conflict. The
following is an often-quoted example from their
paper, Toward a Theory of Schizophrenia,
which demonstrates this bind:
A
young man who had fairly well recovered from an
acute schizophrenic episode was visited in the
hospital by his mother. He was glad to see her
and impulsively put his arm around her
shoulders, whereupon she stiffened. He withdrew
his arm and she asked, "Don't you love me any
more?" He then blushed, and she said, "Dear, you
must not be so easily embarrassed and afraid of
your feelings." The patient was able to stay
with her only a few minutes more, and following
her departure he assaulted an aide and was put
in the tubs. (Watzlawick
12,
36)
In
this scenario, the mother is giving her son
conflicting verbal and nonverbal messages and he
seems unable to respond to the discrepancy.
According to Bateson's theory of logical types, the
schizophrenic cannot comment about the meaning of
his mother's communication.
According
to Bateson, "The ability to communicate about
communication, to comment upon the meaningful
actions of oneself and others, is essential for
successful social intercourse." In normal
relationships we continually comment about the
actions and communications of others, saying such
things as, "I feel uncomfortable when you look at
me that way," "Are you kidding me?" or "What do you
mean by that?" In order for us to accurately
discriminate the meaning of our own or another's
communication we must be able to comment on the
expression -- but the schizophrenic is effectively
enjoined from such commentary.
According
to Carlos
Sluzki
the double bind has the following
characteristics:
(1)
two or more persons; (2) repeated experience;
(3) a primary negative injunction; (4) a
secondary injunction conflicting with the first
at a more abstract level, and like the first
enforced by punishments or signals which
threaten survival; (5) a tertiary negative
injunction prohibiting the victim from escaping
from the field; (6) finally, the complete set of
ingredients is no longer necessary when the
victim has learned to perceive his universe in
double bind patterns. (9,
209)
Looking
more closely at the double bind, Paul Watzlawick
has described four variations on the theme. The
first and probably the most frequently used is what
he calls the "Be spontaneous" paradox. The wife who
wants her husband to surprise her with flowers is
experiencing this sort of dilemma. She is asking
him to do something which by its nature must be
spontaneous. "It is one of the shortcomings of
human communication that there is no way in which
the spontaneous fulfillment of a need can be
elicited from another person without creating this
kind of self-defeating paradox," says Watzlawick.
(12,
15-26)
A second
variation of the double bind involves a situation
in which a person is chastised for a correct
perception of the outside world. In this situation
the child will learn to distrust his own sensory
awareness in favor of the parent's assessment of
the situation. One example would be the child who
is raised in a violent household but is expected to
see his parents as loving and peaceful. In later
life this person will have a difficult time
determining how to behave appropriately in a
variety of situations. Indeed, this person will
spend an inordinate amount of energy trying to
decipher exactly how he "should" interpret the
situation.
The third
variation on the theme is one in which a person is
expected to have feelings other than those he
actually experiences. The mother who wants her
child to "want" to do his or her homework falls
into this category. The child will often end up
feeling guilty when he or she cannot achieve the
"proper" feelings.
The fourth
variation, according to Watzlawick, occurs when we
demand and prohibit at the same time. The parent
who demands honesty while encouraging winning at
any cost is placing the child in this kind of bind.
The child is placed in a position of having to
disobey in order to obey.
How will a
person be affected by growing up in an environment
where he or she cannot comment on these perceived
discrepancies? Does that person eventually learn to
trust only one part of their experience and to deny
or distrust the rest?
In 1967 a
team of researchers published the results of their
further investigation of the double bind. They
proposed that the operational component of the
double bind is its pattern of disqualification --
the means by which one person's experience is
invalidated as a result of the imposed bind. They
cited five methods for disqualifying the previous
communication. Evasion or a change of subject is
the first method of disqualification. If the
previous statement (a) does not clearly end a topic
of discussion, and the next statement (b) does not
acknowledge the switch in topic, then the second
statement disqualifies the first statement:
a.
Son: Can we go to the park and play
soccer?
b.
Father: What a beautiful day for working in the
garden.
The second
method of disqualification is sleight-of-hand.
Sleight-of-hand occurs when the second response (b)
answers the first (a) but changes the content of
the previous statement:
a.
Daughter: We have always gotten along
well.
b.
Mother: Yes, I've always loved you. . .
In the
above example, the mother has responded to her
daughter but has switched the issue from getting
along well to love.
Literalization,
the third type of disqualification, occurs when the
content of the previous statement (a) is switched
to a literal level in the second statement (b) with
no acknowledgment of the change of frame:
a.
Son: You treat me like a child.
b.
Father: But you are my child.
The fourth
method, status disqualification, happens when a
person uses either personal status or superior
knowledge to imply that the previous message is not
valid:
a.
Mother: I have observed that he doesn't play
very well with the other children.
b.
Son: But I do, Mama!
a.
Mother: He doesn't realize because he is so
little . . .
Redundant
questions are used to imply doubt or disagreement
without openly stating it:
a.
Daughter: I get along well with
everybody.
b.
Mother: With everybody, Cathy?
The
authors conclude their paper with the following
observation:
We
are consistently finding, in families with a
schizophrenic member, disqualifications followed
by special types of sequences, such as the ones
described, which tend to consolidate the bind
and hence reinforce idiosyncratic modes of
interaction. In this process, which implies a
whole style of relation with the world and in
which certain stimuli are systematically denied,
certain meanings are systematically repressed,
lack of recognition is reinforced and rewarded,
and clarification is punished -- in this, we
concur in believing, might rest the pathogenesis
of schizophrenia. (Sluzki
9,
228)
The
Zen master holds a stick over his pupil's head and
says, "If you tell me this stick is real, I will
strike you with it. If you say to me this stick is
not real, I will strike you with it. If you don't
say anything, I will strike you with it." Bateson
suggests this is exactly the sort of situation a
schizophrenic continually experiences. The Zen
pupil may achieve enlightenment by taking the stick
from his master's hands. The schizophrenic, by
contrast, experiences disorientation and confusion,
once again finding his way inexplicably blocked.
Taking the stick away is not an option for the
schizophrenic -- he is helplessly caught in another
"can't win" situation. Through repeated experience
with the double bind the schizophrenic finds
himself limited in the options he has available to
him.
Jay Haley
takes a further look at schizophrenia from an
interpersonal perspective. There is a basic rule of
communications theory which maintains that it is
virtually impossible for a person to "avoid
defining, or taking control of the definition of,
his relationship with another." In any
relationship, one of the first things that needs to
be adressed is what kind of relationship it will
be. Relationships are defined as complementary or
symmetrical. A symmetrical relationship is one in
which the two parties match behaviors. If one
person tells about a vacation he has had the second
person responds by telling of a vacation he or she
has just taken. What is emphasized here is the
symmetry, how they are alike. These relationships
tend to be competitive.
A
complementary relationship is one in which the
behaviors complement each other. One person teaches
and the other learns; there is a give and take
between behaviors. After listening to the first
person tell about his vacation the second person
would press for further information.
Over time
the nature of relationships will shift. As a child
matures he evolves from a complementary
relationship with his parents to a more symmetrical
relationship.
A
complementary relationship usually exists between a
teacher and the student. But, when the student asks
a question which implies that he knows more than
the teacher he is maneuvering to shift that
relationship. The teacher can choose to
re-establish the old relationship or allow the
interaction to shift. "Such maneuvers are
constantly being interchanged in any relationship
and tend to be characteristic of unstable
relationships where the two people are groping
towards a common definition of their relationship."
(4,
11)
It has
been suggested that schizophrenics, as children,
experienced a great deal of confusion in regards to
defining their relationships as complementary or
symmetrical. In other words, there was a great deal
of mismatch between child and caretaker regarding
the definition of their relationship. An example is
the child who perceives the relationship as
complementary and responds accordingly -- only to
have the caretaker switch to a symmetrical
relationship.
Is it any
wonder then, that schizophrenic interactions, as
described by Haley, are an attempt to avoid
defining the nature of those relationships:
A
person can avoid defining his relationship by
negating any or all of these four elements. He
can (a) deny that he communicated
something, (b) deny that something was
communicated, (c) deny that it was communicated
to the other person, or (d) deny the
context in which it was communicated.
(4,
89)
People
communicate at a multitude of levels. We can
communicate with much more than just words. For
example, our physical posture and gestures provide
another level of communication as well as the
pitch, tone and tempo of our speech. There are
myriad possibilities for simultaneously relating to
and denying relationship with another person.
Schizophrenics are decidedly the masters at this
craft, but examples abound in everyday life to
demonstrate how this is done.
We are all
familiar with mixed messages. The dog who
simultaneously wags his tail and growls is one
example. The man who responds to his wife's request
that he help her in the kitchen by saying "Sure,
I'll be happy to help you," as he settles deeper
into his easy chair, is at once accepting her
request for assistance and simultaneously
communicating that he will not help her. The woman
who says "I would love to help you but I have a
headache," is defining her relationship as
cooperative, while using her headache to negate the
relationship.
Contrast
these behaviors with that of the man who
congruently says, "No, I won't help you," as he
sits down in the chair. He has clearly defined his
relationship as one in which he will not be told
what to do. Similarly, how is a person to make
sense of my communication if I say "I love you" in
a flat voice while gazing in the other direction?
The man says, "This subject is fascinating," while
checking his watch. The woman asks her child if he
wants to give her a hug as she pulls him toward her
for a hug. These sorts of interactions are common
in every day life. Much of our ability to make
sense out of the world depends on our being able to
recognize and comment upon the conflicting messages
we receive.
The
schizophrenic, on the other hand, is faced with the
dilemma of deciphering to which part of the message
he can safely respond, since commenting upon the
discrepancy is not in the repertoire of behaviors
available to him. I would imagine it is much like
living in a battle zone where every communication
is a threat to my personal safety. Faced with the
task of discovering the meaning of another's
communication while being prohibited from
commenting on or acknowledging my own confusion
seems like a terrifying proposition. Is it any
wonder that schizophrenic communications are
structured to avoid defining that a relationship
exists?
It appears
that, because of the early influence of repeatedly
being caught in double binds, schizophrenics
develop a defensive approach to communication which
is tenacious in its ability to say something and
say nothing at the same time. Their goal in life is
not to be pinned down on any front. Unfortunately,
they are as hopelessly trapped in their web of
confusion as the people who come in contact with
them.
Borderline
Personality
According
to James Masterson (The Search for the Real
Self: Unmasking the Personality Disorders of Our
Age), the borderline personality is also a
learned response to the childhood environment.
Masterson contends that as a result of childhood
influences a person can develop what he has termed
a "false self" in order to protect the "real self"
from further trauma. He suggests that the real self
is oriented toward mastering reality; but once
those efforts have been thwarted the false self
shifts the orientation from that of mastering the
environment to one of avoiding bad feelings.
In their
book, I Hate You -- Don't Leave Me:
Understanding the Borderline Personality,
Jerold J. Kreisman, M.D., and Hal Straus identify
five dilemmas which plague the borderline
personality. They call the first "Damned if you do
and damned if you don't." This refers to the kinds
of communications borderlines give other people.
The title of this book is a good example of this
predicament. Another example is a woman I know who
asked her boyfriend about his impressions of her
amateur public performance about which she had
misgivings. He replied "do you really want my
honest opinion?" She insisted that she did. But
when he told her his assessment of the performance
-- which was not particularly encouraging -- she
responded by telling him how wrong his perceptions
actually were. Her communication was typical of the
kind of confusing message that plagues the
borderline's relationships.
A second
tendency which they cite as typical of the
borderline is "feeling bad about feeling bad."
Rather than attempt to understand or cope with
feelings, the borderline tries to get rid of
unwanted feelings. The person who "should" be happy
adds additional layers of guilt and other difficult
emotions to an already depressed or angry persona
-- contributing to a seemingly endless spiral of
feeling bad about feeling bad.
The
perennial victim is the third pattern they have
observed. The borderline perceives herself at the
mercy of the events and people around her. The
woman whose happiness depends on her husband's
financial success is one example of victim. The
person who organizes his life such that the
solutions to his problems lie in other people's
hands is exhibiting a borderline tendency. "If only
she understood me better ..." is one way that the
victim puts the responsibility for his or her
happiness on another person.
Fourth is
the quest for meaning in life. Borderlines
continually search for that which will fill the
emptiness they experience. Relationships and drugs
are two common solutions for filling this
void.
The
borderline's perennial search for constancy is the
fifth behavior observed. The borderline exists in a
world that is untrustworthy and inconsistent.
Friendships, jobs, and skills are always in
question. The borderline lacks the ability to
experience consistency and predictability. It is as
if all their experience is for naught. A woman I
know has taken dance lessons for almost fifteen
years and still she cannot see herself as a dancer;
she seems to lack an ability to trust and rely on
her skills.
The sixth
and last element of the borderline personality is
what the authors characterize as the "rage of
innocence." Borderline rage is unpredictable and
intense when it surfaces. Sparked by seemingly
insignificant events, it can appear without warning
and often carries the threat of real
violence.
In
considering the roots of the borderline
personality, Masterson suggests that John Bowlby's
research into the infant-caretaker attachment is
significant. Bowlby studied the mourning process
that children aged 13-32 months experienced when
they were separated from their mothers as a result
of hospitalization for physical illness.
Bowlby
noted three stages of mourning that these children
went through as a result of the separation from
their caretaker. The first stage is protest and can
last a few hours up to several weeks. In the second
stage, hopelessness, the child:
sinks
into despair and may even stop moving. He tends
to cry monotonously or intermittently, and
becomes withdrawn and more inactive, making no
demands on the environment as the mourning state
deepens. (6,
58)
In
the third stage, detachment, the child no longer
rejects nurses, but when the mother returns to
visit, the strong attachment to the mother typical
of children this age is strikingly absent. Instead
of greeting her, he may act as if he hardly knows
her; instead of clinging to her he may remain
remote and apathetic; instead of dissolving in
tears when she leaves, he will most likely turn
listlessly away. He seems to have lost all interest
in her.
Masterson
realized that these same three stages of mourning
and the defenses they produced were evident in his
own adolescent and adult borderline
patients:
I
came to recognize that when my patients go
through a separation experience that they have
been defending themselves against all their
lives, they seem to react just like Bowlby's
infants in the second stage of despair. The
separation brings on a catastrophic set of
feelings, which I have called an abandonment
depression. To defend against this mental state,
they retreat into the defensive patterns
encouraged by the false self, which they have
learned over the years will ward off this
abandonment depression.
In
adults without a sense of their real self, the
abandonment depression symbolizes a replaying of
an infantile drama: The child returned for
support and encouragement, but the mother was
unavailable or unable to provide it. The
acknowledgment and approval, so crucial to
developing the capacities of expression,
assertiveness, and commitment, were simply not
there. (6,
59)
Masterson
suggests that what characterizes the borderline
personality is an over-reliance on primitive
defense mechanisms learned in early childhood:
denial and clinging, avoidance and distancing,
projection and acting out.
"In
order to establish a coherent sense of self, the
child in the first three years of life must learn
that she is not a fused, symbiotic unit with the
mother" says Masterson (6,
51). How is this to be accomplished? In his book,
A Secure Base, Bowlby discusses the elements
he considers most necessary to allow this process
to take place in children:
.
. . the ordinary sensitive mother is quickly
attuned to her infant's natural rhythms and, by
attending to the details of his behaviour,
discovers what suits him and behaves
accordingly. By so doing she not only makes him
contented but also enlists his
cooperation.
. .
.
This
brings me to a central feature of my concept of
parenting -- the provision by both parents of a
secure base from which a child or an adolescent
can make sorties into the outside world and to
which he can return knowing for sure that he
will be welcomed when he gets there, nourished
physically and emotionally, comforted if
distressed, reassured if frightened. In essence
this role is one of being available, ready to
respond when called upon to encourage and
perhaps assist, but to intervene actively only
when clearly necessary. (2,
9-11)
What
happens in early development to interfere with the
child's efforts to develop a sense of self -- an
identity which is separate and distinct from that
of the caretaker? Kreisman and Straus contend that
a large amount of anecdotal and statistical
evidence exists to demonstrate that children who
have been abused or neglected can be linked to
borderline tendencies as adults.
Masterson
suggests that many of his borderline clients had
mothers who themselves had an impaired sense of
self. Consequently the mothers are not able to
provide the secure base from which the child can
venture out and explore the world. He cited one
example of a mother with low self esteem and a fear
of separation who tended to foster this fear of
separation in her child. She encouraged him to
remain dependent on her in order to maintain her
own emotional equilibrium:
She
seemed to be overwhelmingly threatened by her
child's emerging individuality, which sounded as
a warning that he was destined to leave her
eventually forever. Not being able to handle
what she perceived as abandonment, she was
unable to support the child's efforts to
separate from her and express his own self
through play and exploration of the world. Her
defensive maneuvers to avoid her own separation
anxieties entailed clinging to the child to
prevent separation and discouraging his moves
toward individuation by withdrawing her support.
(6,
54-55)
Consider
what Masterson has suggested about the possible
roots of the borderline personality: it looks like
the ultimate double bind -- a world that expects
one to grow up and become self sufficient while the
caretaker is rewarding that same person for
remaining dependent and helpless.
Twenty
years after the double bind theory of schizophrenia
was published, one of the authors, John Weakland,
published a paper in which he suggested that
perhaps they had focused too closely on
schizophrenia. He suggests that the real
significance of the theory was its viewpoint that
behavior and communication are closely tied. This
theory was diametrically opposed to the established
paradigm that emotional problems are a response to
intrapsychic conflicts. Perhaps, he suggested, the
double bind has far reaching effects in many kinds
of emotional disturbance, and its explorations
should not be limited to cases with a diagnosis of
schizophrenia. Carlos Sluzki seems to have come to
the same conclusion in his paper with the
provocative title The Double Bind as a Universal
Pathogenic Situation.
Sluzki
notes that a child passes through three
evolutionary stages:
(1)
infantile dependence, marked by a relative lack
of differentiation between the self and the
non-self and a preponderance of the
incorporation or the "taking" of objects; (2)
transition; and (3) mature dependency,
characterized by "relations between two
independent beings who are completely
differentiated; and by a predominance of giving"
in object relations. (10, 231)
The
transitional stage ushers in the core dilemma of
all mental development: Dependence versus
independence.
The
child's developmental task is to balance the need
for security and dependence with his or her need to
move toward independence. If the parents are to
facilitate the child's emergence from dependence to
independence they will need "to stimulate the
impulse towards independence and to neutralize the
needs for dependency." (10, 231) Without the
parents' encouragement, it is difficult for the
child to face the uncertainty and risks along the
road to independence.
Sluzki
describes three modes of relationship between
parent and child; this includes those areas of a
child's life where he is dependent, independent or
moving from dependence to independence with
parents' help and supervision. For example,
dependence is when a child cannot get to school
without his parents' assistance. Independence is
when the child can get himself to school without
assistance. The third area entails that point in
time where perhaps the child, with parents'
assistance and encouragement, is learning the route
to and from school but is not ready to do it for
himself.
As a child
proceeds through life he and his parents must
constantly redefine where those boundaries are. At
best this is a very complex task; if parents are
unclear themselves about these boundaries, then
their children will have to contend with a great
deal of confusion about what they can and cannot
do.
One
example of a double bind that inhibits the child's
growth toward independence is a parent who is in
conflict about the desire for the child to be
independent and the desire for the child to "be
perfect." A child's ability to think and behave
creatively will become increasingly limited if, for
example, he is told to think for himself and then
second-guessed as to his choice of actions. I know
an otherwise responsible young man who spilled
paint thinner and just walked away from it because
he didn't know what he should use to clean it up.
He seemed to be caught in a "damned if I do, damned
if I don't" kind of experience. He seemed to think
it would be better to walk away from the mess then
to be criticized for using the wrong implement to
clean it up. He has found it safer to retreat into
helplessness and dependence rather than risk making
a mistake on his road to independence.
Exploring
these kinds of common binds may give us useful
insights into the behavior of the borderline
personalities and schizophrenics. Could it be that
the behavior which we see exhibited by each
diagnosis is a different manifestation of the same
communications knot -- the double bind? If so, then
it may be that a major role of therapy is to
unravel the conscious and unconscious double binds
so that the individual can reorient himself toward
more useful goals and motivations.
|
References
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Steps to an Ecology of Mind. New
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Watzlawick, Paul and John H. Weakland.,
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Watzlawick, Paul. The Language of
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Weakland, John H.
"`The Double-Bind Theory' By
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241-248
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