“Schizoidia Everywhere” by Dr. W

#Solitary individuals may experience a variety of different emotional experiences & internal conflicts that would not be readily observable from behavior because generally the #solitary look they same because they are #solitary.

However, clinical experience & empirical research have shown that distinctions among #solitary types in connection to emotional functioning, social needs, and attachment-related dynamics vary considerably and have diagnostic implications.

Some #solitary individuals desperately want to belong but fear rejection and embarrassment so strongly that they isolate. This is what is commonly known as #shyness from a normative view & social #anxiety through a pathology lens in children.

Other #solitary children are rather unaware, if not indifferent to or aggravated by the social interpersonal world of feelings and communication. These children were once considered to have #schizoid personality disorder of childhood

but have later been relabeled as #Aspergers and now, High Functioning #Autism. They are solitary and indifferent if not happy about this state of affairs. In adulthood, this #solitary style can be described by the diagnosis of
#schizoid personality disorder.

w/or w/out ASD-schizoid PD comorbidity. Then, there are solitary folks who remain untouched by social relationships because they are suspicious, hostile, and mistrusting of others. Solitary hostility is best captured by the diagnosis of paranoid personality disorder.

For many #solitary individuals who enjoy and prefer their alone time, interpersonal attitudes and affective experience is more complicated, nuanced, contradictory, and intense. For those folks, #solitude may be an escape from overwhelming affective-interpersonal experience.

Their emotional experience may not be exactly fear of rejection or apathy but something more primal like a fear of enmeshment, of losing oneself, of being devoured by or devouring the other. They often crave intimacy but fear & loathe it at the same time.

Now that several solitary styles have been elucidated in terms of interpersonal attitudes and affective experience, it’s time for the name game (when psychologists come up with acronyms and use alliteration to coin clever labels for constructs) so here go 9/
In thinking about solitary styles, several dimensions/categories emerge as categorically consequential. Known syndromes map nicely onto this solitary nosology as described below:

1. Anxious Solitude (AS): Social Phobia, Avoidant PD, Schizotypal PD

2. Hostile Solitude (HS): Paranoid PD

3. Indifferent Solitude (IS: Post DSM-III Schizoid PD

4. Solitary Ambivalence (SA): Pre DSM-III/Psychodynamic Schizoid PD

5. Sad Solitude (SS): Depression; negative symptoms

6. Positive Symptom Solitude (PSS): solitary loss of reality testing.

Any respectable psychometric measure of psychopathology should delineate scales to assess each of these dimensions. Perhaps, a 6 factor measure of solitude is too much but I think 3-4 is workable & overdue /12
Probably just should be 4: anxious, apathetic, ambivalent, and aggressive.

The measure will be called the 4ASSS (4-A Solitary Style Scale)

It will cost $7.20 and will be available in 6-12 months maybe.

Maybe never.


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More from @DrWinarick

Aug 24
The capacity for guilt, ambivalence, agency, empathy, and being alone are core concepts in psychodynamic theory. These are always the “goals” of #psychodynamic therapy regardless of what DSM symptom profile a patient may display.
1. Enhance meaning-making & the capacity to symbolize experience by using techniques aimed at getting someone curious about their own mental life (clarify, paraphrase, validate, explore, interpret) by being curious about their mental life & modeling reflective functioning.
2. Encourage empathic abilities by getting someone interested in the mental lives of people they are in close interpersonal relationships with.
3. Facilitate the expression & analysis of mixed feelings aka in vivo ambivalence tolerance skills training.
Read 5 tweets
Aug 22
Some controversy over the historical record here. Did Freud get passes for his sisters to leave Nazi Germany?

Word on the street is yes but it was a luke warm effort and too late by the time he did try to get them out.

Maybe Freud hate-scholar @PeterDKramer knows more on this?
A few other questions:

1. What was Freud’s perception of rising authoritarianism-fascism-genocide in Germany and Vienna before he left for London?

2. How did it show up in his writing other than as a mangled concept known as the death instinct?
3. What - if any - antifascist actions did Freud take leading up to or after his fleeing Nazi Germany?

4. Did the Nazis really let him transport his entire office - furniture and all etc?
Read 6 tweets
Aug 22
One major difference in clinical training for ppl who go to CBT oriented versus psychodynamic schools is in connection to the supervisory process which has implications for therapist skill and ability at the post doctoral level & beyond. The difference involves process notes.1/n
In hardcore psychodynamic supervision, you might be asked to write a process note for each session which just about the worst possible task ever. It involves literally writing down every thing, every utterance from the session you can remember in like movie script form.2/n
Each process note should be long enough so that when read aloud verbatim, it can consume 45 minutes of a supervision session if need be. Usually 10 min or less of a note is read before an issue get identified, processed, & worked though. 3/n
Read 5 tweets
Aug 22
While everyone loves the throw shade on the chemical imbalance theory of depression, I would like to remind everyone that neurotransmitters are chemicals & balance refers to their activity in the brain. Greater or lesser activation of a neurotransmitter refers to differences

in levels of that neurotransmitter (ie its balance.) Aside from physiological activity like action potentials and volumetric changes in matter in different regions, the list of physical substrates one can point to in the brain is limited.

Unless you think your non physical, mystical soul is pulling the strings behind your life, then you better think mental disorders like depression have a physical basis. What could that basis be?

Read 6 tweets
Aug 22
“Daniel, have u been to the unit yet?”
“No. Why? Should I have?”
“Yes you should go there now. They may need to call on all available on your patient, XXXX.”
[hurries to unit. Patient is standing on the couch screaming & sees me]: “Fuck my coordinator, white devil. White devil!!”
Me: [back at rounds]. “It didn’t go that well. He called me a white devil and was screaming, cursing at me so I left.”

Attending: [looking down at unrelated notes; monotone] “alright.”
Also XXXX [every damn day]: “is my mom coming? Did you call her? What do you do for me anyway! Get the keys out!”

Me [didn’t call his mom because he doesn’t have one]: [fumbling to find the keys to his unit] want to play basketball?
Read 10 tweets
Aug 21
Integrative model of #psychopathology - bridging the gap b/t categories & dimensions:

Two broad categories of functioning - (a) self-regulation and (b) attachment - with sub-facets that covary in specific patterns representing pathological syndromes with a categorical quality.
(A) Self-regulation
A1. defense styles
A2. coping skills
A3. Emotional functioning
A4. Self-control skills

(B) Attachment
B1. Attachment style
B2. Interpersonal Patterns
B3. Object-relations

Need to add other dimensions tbh. TBC.
Actually that’s all
Read 6 tweets

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