I’ve been doing some reading about personality disorders, and I came across the contribution of one Harry Guntrip to definitions of the schizoid personality type. There are nine alleged characteristics of this personality type which Guntrip pulled out of his arse described, one of which is withdrawnness:
While there are many schizoid individuals who will present with obvious withdrawnness (a clear and obvious timidity, reluctance, or avoidance of the external world and interpersonal relationships), this defines only a portion of such individuals. Many fundamentally schizoid people present with an engaging, interactive personality style. Such a person can appear to be available, interested, engaged, and involved in interacting with others; however, in reality, he or she is emotionally withdrawn and sequestered in a safe place in an internal world. […] withdrawnness or detachment from the outer world is […] sometimes overt and sometimes covert. When it is overt it matches the usual description of the schizoid personality. Just as often, it is a covert, hidden internal state of the patient.
Isn’t that just marvellous? If you’re shy, timid, introverted, emotionally unavailable, withdrawn from the world and reluctant to engage with others then you have a schizoid personality. On the other hand, if you’re the exact opposite – if you’re bold, outgoing, extroverted, emotionally available, engaged with the world and keen to interact with others – then you still have a schizoid personality. This is because all your clearly-not-schizoid behaviour is just a front for your ‘covert, hidden internal state’, which you give no sign of.
This is patently, inescapably nonsense (I mean that quite literally – it is non-sense). It’s a recipe for a psychologist to take any behaviour pattern whatsoever and cite it as evidence for a diagnostic decision s/he has made in advance, and irrespective of the patient’s actual behaviour. In no other branch of medicine would this deliberate falsification of diagnostic criteria be tolerated; a patient presenting with consistent hypotension (low blood pressure) would not be diagnosed with hypertension (high blood pressure) anyway, just because the doctor had decided that this patient must have hypertension, and no amount of evidence was going to persuade them otherwise. (Or, at least, a doctor who behaved in this way, and caused damage to the patient as a result, would face disciplinary proceedings.)
It’s this kind of non-sense that gives psychology and psychiatry such a bad name. The empirical basis for personality disorders is weak in any case – many of the personality disorders overlap significantly, and the same patterns of behaviour also fit comfortably within the schemata for many full-blown psychiatric illnesses – but it becomes non-existent when the carefully precise criteria are abused in this way.
I have an uneasy relationship with psychiatric diagnosis at the best of times. There are times when I’m powerfully attracted to the argument that diagnosis is largely irrelevant, and that treatment would be better focussed on identifying specific symptoms and working to resolve them. I’m also well aware of the fact that the symptoms of hysteria were at one time commonly displayed by psychiatric patients, but almost never now, and that this suggests that the kinds of behaviour psychiatrists expect to find in their patients strongly influences the kinds of behaviour their patients are found to display. At the same time, I’m not blind to the fact that there are particular patterns of behaviour and symptoms that recur with remarkable frequency, and that there is emerging evidence that some of these patterns may be associated with particular genetic patterns. (Though there is also emerging evidence that these genetic patterns may be associated with mental ill-health in general, rather than specific manifestations of illness, and the evidence for either proposition remains wildly inconclusive.)
The whole area is messy, and complicated, and I think anyone who claims to know exactly what they are doing should be regarded with suspicion. I do, on balance, think that there are particular clusters of symptoms that very often occur together, and I can see that diagnosis has a place, even if only as a descriptive shorthand for these clusters of symptoms. I become much more uncertain when diagnoses seem to proliferate, and the diagnostic criteria overlap significantly, and descriptive precision seems almost impossible. I can’t escape the thought that the many, many gradations of personality disorders are rather like mediaeval ideas about the hierarchy of angels – interesting to read about, fantastically (one might almost say obsessively…) detailed, but having no basis in anything that’s actually real.