9
THE PSYCHOTIC AND THE PSYCHOPATH
H
uman beings are unlikely to develop into either villains or heroes. Nor are we for the most part psychotic or psychopathic. Most of us spend our lives living and acting in that generously broad environment called normal. When confronted with the rare extremes of human perversity, we are forced to re-examine our attitudes about ourselves and our species. When we are exposed to true evil, our first tendency is to turn away or explain awayâto deny or rationalize. But true evil must be faced. We must examine the acts of terrorism and try to understand the kind of people who are prepared to commit them.
In this chapter I describe two sets of behavior that are beyond the borders of normalcy, psychosis and psychopathic behavior. Both are involved with hatred. These two behaviors are often conflated because of the confusing terminology. They must be differentiated. They represent entirely different conditions that
have different degrees of culpability and demand different forms of action.
I will not attempt to offer a definitive discussion of a paranoid psychosis here.
38
The appalling examples of hatred and human massacres witnessed in the past century and discussed in this book are not functions of rampaging madmen. Madness does not ordinarily lend itself to such organized behavior. It is the nature of the paranoid schizophrenic to avoid groupsânot organize them. The purpose of discussing the paranoiac is that, as is often the case, it is easier to grasp the fundamentals of a condition at its extreme. The terrorists of Al Qaeda have been indoctrinated with paranoid ideas, but they are for the most part not psychotic. The individual, “self-employed” terrorist is usually a paranoid schizophrenic.
The Psychotic
Paranoia is the psychosis that is involved with acts of hatred. It is characterized by the formation of delusions and, in rare cases, hallucinations. The delusions fall into two seemingly contradictory categories: delusions of persecution and delusions of grandeur. A delusion is a false
belief
that entails an abandonment of all reality testing. A hallucination is a false
perception
often auditoryâvoices or radio messages from another planetâor visual
and tactile hallucination, as with the creeping insects that plague an alcoholic in delirium tremens.
While many hallucinations are chemically triggered, a delusion can still be understood in the same model used for lesser symptomsâas a coping mechanism, a misguided repair. A genetic predisposition, a chemical imbalance, and a dynamic explanation are not mutually exclusive mechanisms. As described previously in my analogy with music (see chapter 3), they must be viewed as different frames of references, different languages, brought to bear in an attempt to shed light and bring understanding to a complex human experience.
A psychotic delusion is one of the most bewildering and intriguing of symptoms. Grotesque as it may seem, it still subscribes to the general rule of a symptom as an attempt to control overwhelming anxiety. The repair is a costly one; delusions are the most destructive of symptoms, since they demand a true suspension of reality testing. To be certain that God is directing you to a specific mission of destroying known agents of the devilâor to actually believe that you
are
Godâis to suspend belief in the real world beyond what normal self-deceptions require. Because this distortion in thinking is central to the various forms of schizophrenia, they have been referred to as thought (or thinking) disorders. Schizophrenia is one major subdivision of psychotic behavior. Affective (emotional) disorders, like depression, constitute the other category.
How could such bizarre ideation serve the purposes of daily life? It does so in the same way that avoidance serves the phobic. It offers a method of controlling, limiting, and rationalizing a free-floating and all-pervasive anxiety. Anxiety is the price we pay for the human capacity to anticipate the unknown future.
We tend to use words in everyday speech differently from the way psychiatrists use them. We say we feel anxious about an oral examination, job interview, or performance that is about to take
place. Psychiatry would consider that worry. Psychiatrists distinguish anxiety from worry, reserving the latter for the emotion consequent to some impending and potentially dangerous eventâa job interview, the need to enter a dark, enclosed space. Anxiety is reserved for a form of dread that has no immediately apparent stimulus. Since it exists without awareness of any threatening source or justification, it is labeled “free-floating anxiety.” At one time or another most of us have experienced free-floating anxiety, an unknown dread that produces an edginess or even agitation.
Imagine a person, however, whose life is suffused with an overwhelming, constant, and pervasive free-floating anxiety. His life will be almost unmanageable. Here is where psychotic delusion formation may offer relief. If the psychotic makes the break from reality, he may delusionally decide, for example, that the person he most trusts, his mother, is not the person he thought she was, but an agent of his enemies. She is trying to poison him. This delusion rationalizes his anxiety. He is not crazy. It is logical and natural to feel frightened in the face of direct attempts on one's life.
In addition, the delusion universalizes his experience, thereby relieving his feelings of being strange or different; any rational person would feel anxious in these circumstances. Finally the symptom controls the anxiety by limiting its locus and focus. He need not feel anxious except when he is home and even then only when he is eating. He can control the anxiety by not eating the food prepared, or by taking precautions to make sure that his portions were not tampered with. This salvages time and energy to pursue his other normal activities. He controls the formerly all-pervasive anxiety by focusing it into one area of life rather than allowing it to spill over and contaminate all areas.
A delusion need not be simply the product of anxiety. It may be triggered by an immense rage, an overwhelming sense of
shame and guilt, and what is most likely, an amalgam of all these emotions that leave the subject feeling impotent, helpless, and hopeless. This can produce the nightmare known as clinical depression, but in a person with a paranoid personality or a schizophrenic capacity to suspend reality, a delusional alternative is available.
The paranoid shift starts as a means of salvaging some self-respect out of humiliating circumstances. This shift allows the paranoid to view his misery as a product of the willful acts of some alien others. This shift allows the individual to view himself as a victim rather than a failure; guilt and fear are converted into rage, and shame is transformed into indignation. In the process, the individual is often transformed into a noble martyr chosen by God or some other higher source. It is this that links the delusions of persecution to the delusions of grandeur.
Sylvia Nasar in her biography of John Forbes Nash, Jr., a Nobel Prize winner in economics, presented an intriguing modern view of a paranoid schizophrenic.
39
The successful movie adapted from the remarkable book made the workings of the paranoid mindâand the ways in which they are first incorporated into and eventually become destructive of the person's lifeâunderstandable to a vast audience. Nash, a brilliant mathematician teaching at Princeton, was plagued with persecutory delusions, which led him to construct a complex view that placed him in a heroic struggle against evil, in which he was the secret agent of the CIA.
Freud's attention was drawn to paranoia by the publication of another remarkable book. In 1903, Daniel Paul Schreber, a former presiding judge of the appellate court in Dresden, Germany, published his autobiographical book,
Memoirs of a Neurotic.
Freud, not being an institutional psychiatrist, had little access to patients suffering from “dementia paranoids,” the term then
used. Freud had certainly treated patients that by today's standards would be diagnosed as schizophrenics, but he tended to consider them as suffering from “hysteria” or “obsessional disorders.” None of these patients had classical paranoid delusions; therefore, Freud based his pioneering and brilliant study of paranoia on Schreber's memoir.
40
The parallels between the suffering of Schreber and that of Nash, separated by almost a century, reveal the power of good clinical observation and the ability of the paranoid mechanism to bridge time and culture
.
The differing details are reflections of the differing cultures from which the two men came. In general, nineteenth-century delusions like Schreber's were likely to stress God, spirits, and religion. The twentieth century substituted the powers of the state for that of religion, and invasive forces were less likely to come from Hell than from outer space. Whereas it was the CIA that was informing Nash, God, himself, directed Schreber.
Freud placed conflicts over what would later be defined as latent homosexual impulses at the heart of Schreber's psychosis. The illness, he postulated, was an attempt to control impulses that, in those days, and in this manner of man, would have been frighteningly humiliating. From this rather brief case, Freud illuminated the paranoid process and the relations and connecting links among (1) unconscious fears, humiliation, feelings of impotence; (2) ascribing these feelings to some identified enemies through projection; (3) delusions of persecution by those enemies; and finally (4) formation of delusions of grandeur. In this process weakness is converted into strength, degeneracy into honor, and shame into glory.
Many people today, examining Schreber's account, might choose to reject Freud's dynamic interpretationâthe struggle against latent homosexual desiresâascribing quite different meanings to the same symptom. But Freud's description of the psychic maneuversâthe defense mechanismsâwhereby the paranoid manages to salvage self-respect out of humiliation became a blueprint that guided generations of psychiatrists to an understanding of the seemingly grotesque and self-defeating ideations of their paranoid patients. These defensive maneuvers mirror the kind of cultural paranoia that has gripped many modern states. By insisting that symptoms have meanings, Freud encouraged taking seriously the rants and seeming gibberish of the psychotic patient.
It is significant that Schreber suffered his breakdowns in anticipation of elevation to a higher office. Classically, the stress of increased expectations or honors perceived as undeserved triggers episodes of decline. It is the anticipated humiliation, the public disclosure of inadequacy, that is dreaded. These days, the role of public humiliation is perceived as the common factor binding one paranoid fantasy to another.
Schreber went on to recover from his first illness rather quickly, but his second illness, some eight years later, became the subject of his extended autobiographical sketch. His earlier symptoms were “hypochondriacal ideas.” But they were of such severity that we are likely these days to see them as delusional: He believed that he was dead and decomposing. Almost simultaneously, a paranoid shift occurred, and he saw these effects as something being done to him by his enemies rather than something happening to him through the unfortunate, but disinterested, course of disease. His physician from his first illness, a Dr. Flechsig, was responsible for this disease. Flechsig, as his tormentor, had now become a part of a more grandiose religious formulation, involving a struggle between God and the devil.
To transform one's daily miseries and humiliation into a symbol of a universal battle of the forces of good versus evil is only too reminiscent of the patriotic cry, “God is with us,” that seems to accompany all wars. It is particularly prominent in the holy jihads pursued by the Muslim world today. Part of the human coping mechanism is an attempt to find purpose in the seemingly meaningless, and therefore unbearable, tragedies that befall us. Those who have a religious bent might comfort themselves over the loss of a child by viewing it as God's will and, as such, part of an inexplicableâsince we are not delusionalâgrand design. However, religion itself would come to be viewed by Freud as a self-serving “illusion.” Religious ideas were born from human needs to make an awareness of our fragile existential state seem less hopeless. That could be accomplished by converting life's inevitable end to a mere transition to a better world. Mortal creatures can become immortal by “discovering” an afterlife.
Schreber, after feeling maligned and persecuted, went on to the next step. He transformed his persecutory delusions into delusions of grandeur. The humiliating attempt to convert him into a woman, to emasculate him, was only an intermediary step to his becoming the redeemer of the human race. Rather than a humiliation, Schreber concluded that it was a sign that he had been chosen to be God's companion. He was no longer “the play-thing of the devils” but an instrument of God's will. “He believed,” Freud stated, “that he had a mission to redeem the world and to restore it to its lost state of bliss. This, however, he could only bring about if he were first transformed from a man into a woman.” The physician then in charge of his case, a Dr. Weber, stated:
It is not to be supposed that he
wishes
to be transformed into a woman; it is rather a question of a “must” based upon the order of things, which there is no possibility of his evading, much as he
would personally prefer to remain in his own honorable and masculine station in life. But neither he nor the rest of mankind can win back their immortality except by his being transformed into a woman . . . by means of divine miracles. He himself . . . is the only object upon which divine miracles are worked, and he is thus the most remarkable man who has ever lived upon earth.
Thus, that which started as a humiliationâhis homosexual impulsesâbecame a source of glory, a device to permit him to serve as the redeemer of the human race. The psychotic can, thus, be seen as confirming the rule that even the most outlandish and bizarre of symptoms must be understood as an example of misguided repair. He can live with his delusion better than he can with the constant torment that results from overwhelming anxiety from unrecognized sources.