by Patrice Guillaume
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
1. Bateson, Gregory. Steps to an Ecology of Mind. New York: Ballantine, 1972.
2. Bowlby, John. Secure Base: Parent-Child Attachment and Healthy Human Development. New York: Basic, 1988.
3. Carson, Robert C. and James N. Butcher and James C. Coleman. Abnormal Psychology and Modern Life. Eighth ed. Glenview: Scott, 1988
4. Haley, Jay. Strategies of Psychotherapy. 2nd ed. Rockville: Triangle, 1990.
5. Kreisman, Jerold J., and Hal Straus. I Hate You - Don't Leave Me: Understanding the Borderline Personality. New York: Avon, 1989.
6. Masterson, James F. The Search for the Real Self: Unmasking the Personality Disorders of Our Age. New York: Free, 1988.
7. McKellar, Peter. Abnormal Psychology: Its Experience and Behaviour. London: Routledge, 1989.
8. Sluzki, Carlos E., and Janet Beavin, "Symmetry and Complementarity: An Operational Definition and a Typology of Dyads." The Interactional View, Ed. Paul Watzlawick and John H. Weakland. New York: Norton, 1977. 71-87.
9. Sluzki, Carlos E., Janet Beavin, Alejandro Tarnopolsky, and Eliseo Veron, "Transactional Disqualification: Research on the Double Bind." The Interactional View: Studies at the Mental Research Institute, Palo Alto, 1965-1974. Ed. Paul Watzlawick and John H. Weakland. New York: Norton, 1977. 208-227.
10. Sluzki, Carlos E., and Eliseo Veron. "The Double Bind as a Universal Pathogenic Situation." The Interactional View: Studies at the Mental Research Institute, Palo Alto, 1965-1974. Ed. Paul Watzlawick and John H. Weakland. New York: Norton, 1977. 228-240.
11. Watzlawick, Paul., Janet Beavin Bavelas., and Don D. Jackson. Pragmatics of Human Communication: A Study of Interactional Patterns, Pathologies, and Paradoxes. New York: Norton, 1967.
12. Watzlawick, Paul. How Real Is Real: Confusion, Disinformation, Communication. New York: Vintage-Random, 1977.
13. Watzlawick, Paul and John H. Weakland., eds. The Interactional View: Studies at the Mental Research Institute, Palo Alto, 1965-1974. New York: Norton, 1977.
14. Watzlawick, Paul. The Language of Change: Elements of Therapeutic Communication. New York: Basic Books, 1978.
15. Weakland, John H. "`The Double-Bind Theory' By Self-Reflexive Hindsight." The Interactional View Studies at the Mental Research Institute, Palo Alto, 1965-1974. Ed. Paul Watzlawick and John H. Weakland. New York: Norton, 1977. 241-248
No comments:
Post a Comment