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Factors Involved in the Genesis and Resolution of Neurotic Detachment

BY MONTAGUE ULLMAN, M. D.

108 East 81st Street New York 28, N. Y.

The Psychiatric Quarterly, Vol. 27, pages 228-239, April 1953. State Hospitals Press Utica, N. Y.

Although the term "detachment" is in fairly common use, both descriptively and dynamically, its precise implications still elude a complete understanding. It is the object of this paper to attempt a close scrutiny of this particular defensive reaction in a patient who presents many of the typical problems encountered.

Many terms are used in conjunction with and in close relation to detachment. A detached person is said to rely heavily on the mechanism of withdrawal from reality. Depending on the person and the situation, he may be regarded as distant, aloof, untouched, preoccupied, removed, or remote. When there is greater affective coloring, his detachment may lurk under the guise of arrogance, cynicism, superiority, or snobbishness. Autism and dissociation are other terms that are related to the problem. As considered here, detachment is a way of reacting to one's environment, based on the illusion that it is both possible and necessary to disregard the real needs of people and to exist in a state of isolated independence. Fundamentally, it is an attitude toward the self, projected onto others, of extraordinary disregard and unconcernedness. This definition can be made more specific by a comparison of detachment with other neurotic devices. Any neurotic trend implies a "detaching process." Through the particular trend, the individual detaches himself, or attempts to detach himself from what at the inception of the trend must have been a painful area of experience. In the case of neurotic trends other than detachment, however, there is an attempt to restore the equilibrium and compensate for the experiential handicaps by the use and misuse, manipulation and accentuation of real ways of influencing people. People retain their value, and it is still necessary to do things in relation to them. For the mechanism of detachment to come into being, the area of experiential injury must be so great that people are experienced as valueless, and for it to remain in existence, people must continue to be experienced as valueless. It is at great cost to the potential of the human being that this leap is made from the solid ground of human contact to the rarefied atmosphere of splendid (sometimes) but precarious (always) isolation. Once this leap is achieved, the road back entails all the difficulties of any other neurotic trend, in addition to the specific problems involved in countering the conditioned shrinkage from meaningful contact which these patients automatically experience. Having placed themselves beyond the pale, people are willing to pay any price but one, that of psychosis. Unchecked, the end-result of detachment is psychosis, and it is the fear of "insanity" which, when real and intense enough, creates for the first time for these patients an alternative which heretofore did not exist, namely, that of getting well.

As just stated, any neurotic development includes a "detaching process" in the sense of an alteration in the appropriateness and directness of the reaction elicited by the situation. But in these individuals the detaching process is a means to an end, the end being to reach people. In neuroses where the detachment is a significant feature, the detaching process is not only the means, but evolving out of its function, which is to delay or ward off appropriate contact becomes the end in itself. The demands for contact are so great in the genesis of human development that almost all of the creative potential has to be invested in the establishment of a character structure which can carry the burden of endlessly maintaining the fiction of isolation. Detachment is in essence a controlled experiment in mental derangement, and so dangerous that the focus remains only upon the experiment: At some point, either the test tube breaks, or one manages to divert some attention to the experimenter. Unfortunately, by the time these situations are ferreted out, the experimenter has become little more than an automatic vehicle attempting to breathe a semblance of human aspect into the facade he has created.

Detachment, then, involves a profound alteration in the perceptive processes, resulting in the substitution for "reality as it is" of a "reality which can be ignored." It results from facing serious deprivation, and once initiated, occasions serious deprivation. Threats to the maintenance of the detachment become the only serious reality; and since the detachment is so invincible a weapon, immediate realities succumb before it and, in so doing, strengthen the defensive structure.

What happens characterologically to these people when the injury is severe enough to result in detachment is still not clear. Although applicable in a meaningful way, the concepts centering around narcissism and the failure of libidinal cathexis serve more of a descriptive than an explanatory function, and seem too generalized for dealing with a condition which can be understood only when broken down, not only into complicated genetic factors, but also into operational techniques whereby it is maintained and propagated. Horney's evaluation of detachment, while stressing the resultant handicap and the compulsivity involved, does not sufficiently assess the unique qualities of this defensive maneuver, namely, the inexorable way in which the positive aspects of the personality are overshadowed, and the bearing this has on therapy - in short, the all-pervasive effect, the powerful, serious, and uncompromising break in the relatedness of the individual to his surroundings which is quantitatively, and eventually qualitatively, different than in the case of the other neurotic trends. The consideration given to the problem in this paper incorporates more of the serious implications of the Freudian views, namely, the earliness and severity of the causative trauma, with an outlook which is not so pessimistic as implied by Freud, nor so accessible and so manipulable as implied by Horney.

Essential to the understanding of defense by detachment, is the realization that neurotically detached patients have been subjected to environments where their treatment and recognition would have been far more appropriate had they been objects rather than developing human beings. The child encounters rigidity in the human environment to the point where his relatedness is contingent upon automatic conformity. The parental influence, appropriate for an imaginary "animate object," is totally inappropriate for the needs of the child. When the pressure for conformity is so great that the possibilities for genuine spontaneity are wholly lacking, there is an effort on the part of the child to adjust at the level of being an automaton or, in effect, a human object. Since this is impossible, he can only reach his goal by a process of simulation, based on his ability to disguise, ignore, or restrain all impulses that would be incongruous with this goal. Detachment, then, is the general term encompassing those characterologic changes designed to establish and maintain the profound degree of self-alienation necessary to, make this type of adjustment.

Detached patients fall into two main, although not sharply defined, categories, depending upon the severity of the syndrome. In the first group the child is hit tangentially by the neurotic conflicts in the home. Although he may be exposed to them in the most devastating fashion, his own existence is not significant to the operation of the neurotic drives of either or both parents. He is the innocent bystander who gets hurt. He is hurt, but not crushed completely. When the situation in the home approximates the conditions outlined here, the hurt results in detachment, but the injury, since it is partial, does not preclude some area of activity capable of yielding gratification. We see in these patients the severe handicap of detachment, side by side with the potentiality for growth and an almost indestructible optimism. The patient to be presented here typifies this group.

In the second group, the child not only experiences the impact of the neurotic conflicts in the home, but actually bears the brunt of the disorder. His existence forms the focal point of a destructive, neurotic fixation on the part of one or both parents. In the face of unrelenting pressure of this type, character development can take place only in defensive patterns. The total creative drive of the personality is spent in the service of maintaining the one mechanism par excellence capable of meeting this type of threat, namely, detachment. Any tampering with the detachment results in paranoid hostility and suspicion. Owing to the limited scope of this paper, this latter type of development - seen in psychotics and borderline psychotics - will not be illustrated by case material.

CASE PRESENTATION

Analysis in Progress 16 Months

The patient is a 30-year-old man who came to analysis in the midst of the following life situation:

He is an artist of a modern school whose work had achieved considerable recognition during the previous five years. About a year prior to coming to analysis, his first marriage had broken up, and the ensuing months had been characterized by feelings of despair, confusion, and frustration. Anxiety had become intense, and the patient had sought some relief through alcohol. Involved as he was, not only in painting and exhibiting, but also in writing, editing, and lecturing, he was forced, with great reluctance on his part, to participate in a round of social activities and parties which had come in the wake of his recent successes. He was beset with almost unbearable feelings of awkwardness and self-consciousness in these situations, as well as in his ordinary dealings with people. He began to feel more and more harassed and was finally incapacitated by a prolonged bout of chest infections. At the time of his first visit to the analyst, he had begun to recuperate a bit from a morass of physical and mental debility, though he still had considerable anxiety. He was concerned about his drinking and frightened lest the old feelings of confusion and panic return.

The patient's father had been an eminently successful business man. The patient recalls his childhood as characterized by a profound sense of isolation and the feeling that he simply did not belong. Both parents were concerned with possessions to the point where their protective attitudes seemed to operate more spontaneously in relation to possessions than in relation to the needs of their child. Orderliness, neatness, cleanliness, and conformity seemed to comprise exclusively all that was virtuous. The father's drive for power and prestige in the business world was matched by the mother's efforts to mold the home life in accordance with the pressures and demands of her husband's activities. She was a highly imaginative woman who in her ordinary dealings with people was flighty and ineffectual. The patient has often characterized her emotionality as primitive. The patient was an only child.

The patient was much alone during his formative years, with no close friends and very little group activity. At college be proved to be a brilliant student whose chief interest was philosophical theory. Following his graduation he studied both in this country and abroad, and finally accepted a teaching position in a leading eastern university. He held this position for a short time, and it was during this period that his interest turned to painting. In his middle twenties he left the university post and came to New York. He became acquainted with artists and soon began to paint on his own. He had had no previous experience in painting. When he did begin to paint, it was with an intensity and fervor he had never before experienced. Within a few years his work drew serious attention and at the time he came to analysis he was considered one of the leading "avant garde" artists in the country. He was continually in economic jeopardy despite a monthly check from his mother, which provided for his basic needs, and despite occasional sporadic financial returns from his paintings and writings.

His first marriage took place three years prior to the start of therapy. It seemed to come about with the same suddenness and intensity that had characterized his plunge into the world of art.

His wife was strikingly beautiful. She was rather distant and unresponsive, and it was only after a good deal of persuasion and initiative on the part of the patient that she agreed to marry him. She was untutored and unsophisticated, and much of the initiative that he showed in the marriage was devoted to cultivating her interest in art and literature. In many ways she seemed more naive, impractical, and withdrawn than he. She shunned his social life and seemed actually unable to share in any social responsibilities. The relationship had a static and stagnant quality which eventually led to its termination by mutual consent. He experienced this break as both necessary and beneficial. He spoke of his wife with fondness, but also with a profound critical perception of her limitations in the marriage, as well as of his own, and of the impossibility of the relationship.

The early analytic situation was as follows: The patient had a very pleasant, agreeable approach. He was over-polite, however, almost to the point of obeisance. He would say "thank you" at the end of each analytic session. Anxiety about the therapy manifested itself by concern with the duration of treatment, efforts to manipulate the hours, and the repeatedly expressed hope that the treatment could be terminated in three to six months so that he could embark on a projected European trip. Analysis of these early features brought out his fear of involvement, his immediate reaction to a new situation as limiting and restricting, and his need to control, manipulate, and delimit any situation that was not of his own creation. He then began to focus more clearly on what heretofore had been but dimly sensed, namely, the feeling that there was something basically wrong with himself (something about himself which he characterized as inhuman) which filled him with a feeling of futility and at times desperation. He was referring to his detachment and the resultant inability to enjoy direct, relaxed contact with other people. This seemed in marked contrast to the optimism and inspiration he consistently felt in relation to his work. Despite his growing respect for the analytic process, his deferential, formal manner persisted, and there was little affective coloring to his productions except for the feeling of being trapped and helpless.

Several months after the start of the analysis, he began to broach the question of divorce. He struggled with considerable inertia evolving out of his reluctance to sever even for a brief time the round of activities in which he was engaged in New York, to hazard a trip to Reno by himself. In addition to this, he was hampered by inflated notions of his responsibilities to his wife. He had little money of his own, and her support would devolve upon his mother. Despite these difficulties, it was felt that the move was not only right, but necessary at this time to clear the path for his own future development. He was actively encouraged, and finally did make the trip. He returned to New York two months later, having successfully carried through the arrangements with regard to the divorce. He had withstood the onslaught of his family, and he had in the interim become interested in a young woman, herself recently divorced.

During the next few weeks he spoke a great deal about this girl. Several things became apparent. She herself had just emerged from a very restricting and conventional marriage and had fallen deeply and genuinely in love with the patient. He found himself drawn to her for qualities which he had either never noticed or which were not there in the other women he had known. He was greatly taken by her warmth, her directness, and the undemanding nature of her attachment to him. There were moments when he would experience a positive sense of responsibility and commitment in relation to her, but these were, at least in the beginning, lost sight of in his fear of treading outside the sphere of art and art personalities. He feared the reaction of his friends to someone who had no special interest in art. For a time the relationship was stalemated and almost completely lost sight of.

The pressure to establish himself on more secure economic grounds - a theme which had recurred from time to time since the start of the analysis - was again considered, but this time was followed by definite action on his part. He had in the past received offers of academic posts, one of them as a professor of art, but he had rejected all of them, as he considered himself ill-suited for the quiet, and what he regarded as the restricting conventionality, of academic life. He did aspire, however, to have his own school of painting, although he had, up to this point, shied away from the idea. He greatly feared his own awkwardness and impracticality in effecting even the simplest and most ordinary business affairs. In addition to this, all the advice he received indicated that setting up his own school was the sort of venture in which only an older and more established painter could hope to succeed. On the other hand, he did enjoy teaching and was successful at it, and he felt that he had original and significant ideas to present.

Again it was felt that the movement here was in the right direction, despite the fact that the outcome could not be certain. Analysis of the factors in his way, and encouragement and reassurance resulted in his taking the first steps. Within a few months, the school was a going concern and working out more smoothly than had been anticipated. Once this was accomplished, he seemed eager to resume and come to grips with the relationship with his girl. The two things about himself which disturbed him most - his compulsiveness about his work and his general aloofness and lack of concern for people and activities unrelated to the art world - now began to disturb him more than ever because of their specific destructive potential in relation to this girl. It was at this point that the fetishistic nature of his attachment to his own talent specifically, and to the world of art in general, was developed as a central analytic theme. His compulsive and all engrossing concern with the art world was seen as a substitute means, although a necessary one, of relating himself to other people, a means born out of revulsion to, and intolerance of, the world as he had experienced it.

Although his talent was recognizable and real, he seemed to relate to it as if he himself were helpless, insignificant, and virtually nonexistent. He actually seemed to be trapped by the pleasure he experienced in the act of painting, a pleasure which seemed so all-consuming and powerful that it excluded any concern with the painting itself, that is, with the finished product. Whenever he discussed his work it was in terms of the act of painting; and only an occasional reference was made to a finished picture. He was impervious to the impact of his paintings on others (aloof and indifferent to his critics and his followers alike) and showed no genuine concern with an effort to harness some of the fruits of his creative energy in stabilizing his own life from the financial point of view (his economic situation having been precarious until he opened his own school). In short, he was relating in an unhuman and slavish way to his own creativity.

Once these matters were established, he began to struggle less against the recognition of his own need for the qualities which the girl had to offer. They were married within a year after his return from Reno. The marriage took place during the summer and he was seen two months later. Despite the fact that he was still profoundly disturbed over his conflicts, the early period of his marriage had resulted in greater closeness with his wife, more real respect for her, and a greater eagerness to achieve some mastery over his own problems.

In the fall, he was again faced with the mounting pressures of preparing for exhibits, meeting editorial deadlines, arranging his school program, and participating in numerous other ventures in which he had become involved. In addition to this, there was the problem of setting up a home and studio. He became more and more aloof and distant toward his wife, lost interest in their sexual activity, which up to that point had been highly gratifying, and even at times felt reluctant to return home at the end of the day. His need to reject, withdraw, and remain uninvolved gave rise intermittently to almost paralyzing feelings of hostility. He felt discouraged and futile in the analysis. The stage was thus set for a renewed effort on his part - although at a different level, by virtue both of his marriage and the self-confidence attendant, upon his venture into teaching - to achieve his neurotic goal, namely, the pursuit of gratification in art at the expense of self-effacement and through the relinquishment of all responsibility in relation to other human beings. This attempt was again subtle and, like the initial attempt, became manifest by his efforts to control and delimit the analysis. He became preoccupied with the idea of moving to the West to free himself from the tensions and pressures. which he experienced in New York, and thus be in a position to devote himself to painting in a total and more sustained way.

This material was analyzed as follows: It was pointed out to what extent his drive both toward marriage and toward analysis had incorporated within it the effort to become more human by osmosis, so to speak. Still laboring under the oppressive influence of his detachment, he had not relinquished the hope that his attachment to another human being in a passive, helpless, self-effacing sort of way could substitute for the task he faced, and conceived of as impossible - that of overthrowing his detachment and becoming a human being. Interpretations along these lines took the edge off the escapist impulses and brought out into the open his hope that what he had failed to do by himself, namely, to work out a way of life that would leave him unhampered and unfettered, he could now accomplish with his wife by severing all their ties here and attempting a more simplified existence away from the pressures of civilization.

The fantasy of "one against the world" had evolved into "two against the world." It became apparent to what extent he was buffeted about by the importance to him of the act of painting, and to what extent this forced him to maneuver and overpower those to whom he felt closest. This understanding eased the situation in the analysis; but it was not until a short time later, that a very intuitive observation on his wife's part eased the tension at home. It occurred in the course of a conversation which took place at a time when their relationship had deteriorated to a critical level. She succeeded in pointing out to him that she did not take exception to his interest in and enjoyment of painting, but that she was puzzled by two things, first the fact that this interest seemed to be exclusively centered in the preparations and arrangements that went into the making of a picture, and not in the picture itself, and second, that it seemed to crowd out the possibilities of any other interests. It was the first time for the patient that what was most important to him was shared, accepted, and critically evaluated by a significant person. It also fanned the first genuine sparks of hope in his struggle to change himself.

The attitudes with which this patient will ultimately have to come to grips have to do with his concept of people either as dehumanized automatons, ruthlessly pursuing their predatory impulses and relating to others as if they were capable of being owned and manipulated (his perception of his father), or as basically parasitic and venting their emotionality in an aimless and uncontrollable way (his perception of his mother). His real impotence as a child in relation to this state of affairs gave rise to a negativism which, coupled with his sensitivity, resulted in a critical rejection of his own human environment and the values it represented. His existence seemed to hinge upon his ability to subjugate, not other people, as in the case of the powerful adults who surrounded him, but himself. The waste, the cruelty, and the alienation wrought upon himself and others by this attitude make a virtue of unawareness, blind him to the vulnerability of his detachment, and make an inexorable necessity of it. His talent and creativity, in forcing their way through these barriers, are cast out with little direction or goal, in hateful defiance of the oppression and melancholy that pervade his life. In rejecting the values about him, he devotes himself to a search for absolute values. His sensitivity to line and color is a real attribute developed in his struggle to abstract beauty from the world of objects.

In summarizing the analytic process thus far, one sees that despite the fact that there has been very little analytic activity in the ordinary sense of the term, and despite the fact that the detachment is still operating, although not so effectively as it did in the beginning, the analysis has witnessed and supported some measure of real growth.

1. In the step toward marriage, the patient risked the first definite break with the kind of relatedness he had with the art world.

2. In the establishment of his school, he made the first wholehearted attempt to alter for the better the financially precarious, socially irresponsible, and generally unstabilized character of his earlier mode of existence.

3. The fact that both the analysis and his marriage have withstood his subtle but powerful efforts to manipulate and abort them has made him somewhat less fearful of his own destructive potential. It is this fear which must be mastered before he can experience his own neurosis as a reality rather than an abstraction, and can come to grips with his own terrible distorted attitudes toward people, attitudes which his detachment serves.

Although the detachment has not been fully resolved in this patient, it is no longer a bulwark against analytic progress, and some inferences may be drawn as to the factors involved in its resolution.

It is important to note that in the case of the more benign syndromes, the analysis itself actively challenges the defensive structure. In the case of the detached patient, the elements of struggle can be successfully hidden, at least in the beginning. In fact, the analysis is set up as a citadel against struggle. The analyst is not a significant figure to the patient. The latter is capable of experiencing people as significant only when they directly relate to his own area of creative function, and here their significance as people is overshadowed by their significance as manipulable and maneuverable objects. In the light of this, the steps in the process of resolution may be outlined as follows

1. In a situation where no genuine human relationships have previously occurred, the analyst can only ally himself with a reality tool rather than a real ego. In the patient presented, this would refer to his talent and sensitivity.

2. Relatedness to people must be initiated by someone significant to the patient in relation to this reality tool. In the case of the patient presented, the neurotic component of his marriage (and by far the strongest component) was the hope of solving his human needs by blind, passive attachment to his wife. His wife thus became a significant figure to him. It is the pressure of this relationship, interpreted and handled within the therapeutic situation, which undermines his detachment and necessitates an active struggle against it. Not until the patient can actively identify himself with this struggle does the therapist become a truly significant figure for him.

SUMMARY

1. Genetically, detachment develops as a defense against the enforced transformation of human potential into automatic, mechanical responsiveness.

2. Resolution depends on the full understanding of the fragmentary means of contact established by these patients and the ruthlessness with which it is protected.

3. A case is presented illustrating the analytic problems encountered in the therapy of a severely detached personality.