When we say that the psychotic is out of contact with reality, we do not necessarily mean that he is unaware of what is happening around him. The catatonic, for example, is fully aware of what one says or does to him. And the girl in the above illustration, I am sure, knew what I was doing and heard my questions. I asked her what was troubling her. But she couldn't answer this question. She was reacting to a situation inside herself, that is, to certain feelings and body sensations which she did not understand and which were overwhelming her. It is not a question of the intensity of the feeling. The grief of a mother who has just lost a child would be equally intense. She, too, could ignore her environment temporarily. But she would be capable of describing her feelings and of relating them to an immediate cause.
The psychotic person is out of contact with his body. He does not perceive the feelings and sensations in his body as his own or as arising from his body. They are alien and unknown forces acting upon him in some mysterious way. Therefore, he cannot communicate them to us as meaningful explanations of his behavior. He feels terrified, and his behavior expresses this feeling, but he cannot relate it to any specific event.
The schizophrenic acts as if he were “possessed” by some strange force over which he has no control. Before the advent of modern psychiatry it was customary to regard the insane as being “possessed by a demon,” or “devil”—for which he was to be punished. We have rejected this explanation of his illness, but we cannot avoid the impression that the schizophrenic is “possessed.” No matter what the outward expression of the psychotic—whether comic, tragic, delusional or withdrawn—this impression is always present. It still serves as a valuable indication of the illness for today's observer.
It is significant that we use the concept of “possession” in our language to designate sanity. We describe a person as being “in possession of himself” or “in possession of his faculties,” or oppositely, we say that he has “lost possession of himself.” Possession in this sense refers, of course, to the control of the ego over the instinctual forces of the body. When possession is lost, these forces are out of ego control. In the psychotic individual the ego has disintegrated to a point where it can be compared to a state of anarchy in which one doesn't know what is going on and is terrified because of it. On the other hand, the loss of control which occurs in a hysterical outburst can be compared to a riot. One knows that ego authority will soon be restored and the rioting emotions brought under control. Self-possession can be gauged by the person's ability to respond appropriately to his life situations. The schizophrenic lacks this ability completely. The schizoid individual is handicapped in his responsiveness by the rigidity of his body.
THE SCHIZOID MASK
The first feature which strikes the observer as odd about the appearance of the schizophrenic or schizoid individual is the look of his eyes. His eyes have been described as “off,” “blank,” “vacant,” “out of touch,” etc. This expression is so characteristic that it alone can be used to diagnose the presence of schizophrenia. It has been commented on by a number of writers. Wilhelm Reich, for instance, says that both the schizoid and schizophrenic personalities “have a typical faraway look of remoteness…. It seems as if the psychotic looks right through you with an absent-minded but deep look into far distances.”19 This special look is not always present. At other times, the eyes just look vacant. Reich observed that when emotions well up in the schizophrenic, his eyes “‘go off,’ as it were.”
Silvano Arieti refers to an “odd look or expression in their eyes,” which he credits to many observers. He himself describes a retraction of the upper lid that produces a widening of the eyes. He relates it to the common expression in schizophrenics of “bewilderment and withdrawal.” Arieti also comments on a so-called look of “madness” that he attributes to the lack in some schizophrenic eyes of normal convergence and constriction.20 I believe this look is an expression of terror that can be interpreted as madness because it is unrelated to any known cause. Most commonly, one sees either the “faraway” look Reich describes or an expression of fear and bewilderment. The common denominator in all cases, however, is the inability of the schizophrenic to focus his eyes with feeling upon another person. His eyes may be wide with fear, but he does not look at you with fear; they may be full of rage, but it is not directed at you. You are uneasy in his presence because you sense an impersonal force in him that could break out and shatter you without acknowledging your existence.
One of my patients, whose eyes became glassy as he went into a catatonic state, told me later that he saw everything that took place.
Though he appeared to be “gone,” he saw my hand as I waved it before him. The mechanical function of vision was intact; light entering his eyes impressed his retina in the same way it acts on the sensitive film of a camera. When the patient came out of his catatonic state his eyes lost their glassy quality and resumed a more normal appearance. This patient's catatonic experience developed after an exercise of striking the couch with his fists while saying, “No!” The exercise evoked feelings that the patient couldn't handle and to which he reacted by “going dead.” His apparent deadness was a defense against his feelings of rage. He suppressed this rage by withdrawing from almost all contact with the external world; the withdrawal produced the glassiness of his eyes.
The subjective impression that the schizoid is unable to make contact with your eyes is the most disturbing aspect of his appearance. You do not feel that he looks at you or that his eyes touch you, but that he stares at you with seeing but unfeeling eyes. On the other hand, when his eyes focus on you, you can sense the feeling in them; it is as if they touch you.
Ortega y Gasset makes an interesting analysis of the function of vision in his essay, “Point of View in the Arts.” He notes:
Proximate vision has a tactile quality. What mysterious resonance of touch is preserved by sight when it converges on a nearby object? We shall not now attempt to violate this mystery. It is enough that we recognize this quasi-tactile density possessed by the ocular ray, and which permits it, in effect, to embrace, to touch the earthen jar. As the object is withdrawn, sight loses its tactile power and gradually becomes pure vision.21
Another way of describing the disturbance in the schizophrenic's eyes is to say that he “sees but does not look.” The difference between seeing and looking is the difference between passivity and activity. Seeing is a passive function. According to Webster's New International Dictionary, seeing refers to the faculty of vision “where the element of attention is not emphasized.” To look, on the other hand, is defined in this dictionary as “to direct the eyes or vision with a certain manner, purpose or feeling.” Because the schizophrenic cannot direct his vision with feeling, he lacks the full possession of this faculty or the normal control of this bodily function. His self-possession is limited.
We look at people's eyes to learn what they feel or to sense their response to us. Are they happy or sad, angry or amused, frightened or relaxed? Because the schizoid's eyes tell no story, we know he has repressed all feeling. In treating these patients I pay very close attention to their eyes. When I reach them emotionally, that is, when they respond to me as a human being, their eyes light up and come into focus. This also happens spontaneously when a patient gains more feeling in his body as a result of therapy. The color of his eyes becomes more vivid, and they look more alive. The blankness or emptiness of the eyes is thus an expression of the relative unaliveness of the total personality. The responsiveness or lack of it in the eyes of the schizoid patient gives me a clearer indication of what is going on with him than any verbal communication. More than any other single sign, the expression in the eyes of a person indicates to what extent he is in “possession of his faculties.”
Everyone senses that the eyes reveal many aspects of the personality. The eyes of a zealot burn with the fire of fanaticism, and the eyes of a lover glow with the warmth of his feeling.