searles, harold - the effort to drive the other person crazy

8/13/2019 Searles, Harold - The Effort to Drive the Other Person Crazy

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hapter8THE EFFORT TO DRIVE THE OTHER

PERSON CRAZY AN ELEMENT INTHE AETIOLOGY AND PSYCHOTHERAPY

OF SCHIZOPHRENIA (1959) 1A oNo all the factors in the aetiology of schizophrenia,l"'l.factors which are undoubtedly complex and, further, considerably variable from one case to another, there appears to be

one specific ingredient which can often and even, I believe,regularly-be found to be operative. My clinical experience hasindicated that the individual becomes schizophrenic partly byreason of a long-continued effort, a largely or wholly unconscious effort, on the part of some person or persons highlyimportant in his upbringing, to drive him crazy.I well know that it would be inane to reduce the complexaetiology of schizophrenia to a simple formula stating that anindividual becomes schizophrenic because some other individualdrives him crazy. Such a formula would not do justice to the individual's own psychological activity in the situation, to the complexity of that particular interpersonal relationship, to the complex group-processes of the family situation, or to the largersocio-dynamic processes in which the family plays but a part-often a part in which the family as a whole is helpless to dealwith large and tragic circumstances quite beyond any family'scapacity to control or avert.

Previous LiteratureThe only writings about this subject which I have found in theprofessional literature are statements by Arieti (1955), and bythat group of researchers at the Mayo Foundation which isheaded by Johnson (Beckett et al. 1956; and Johnson, Giffin,Watson Beckett, 1956), and these statements have done littlemore than touch upon the subject, without exploring it in detail.

1 Firat published in the Brilisll ]< nwJ o tliul P ~ Vol. 3 2 ( 19 19),pp . 1-18.: 54


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DRIVING THE OTHER PERSON CRAZYArieti describes what he terms acted-out or externalizedpsychoses, explaining that: These persons often create situations which will precipitate or engender psychoses in otherpeople, whereas they themselves remain immune from overtsymptoms.Johnson and her co-workers, reporting upon the concomitantpsychotherapy of schizophrenic patients and the members ofthese patients families, emphasize that this experience confirmedthe authors initial impression that in some cases parentalexpression of hostility through a child might both determinepsychosis in the child and protect the parent from psychosis(Beckett t al. 1956). In many instances they found a history ofpsychological assault by the parent(s) upon the child, assault ofatype which was specifically reflected in the patient s earliest

delusions. It is of special interest here that among the varioustypes ofassault they describe were threats that insanity maydevelop in the patient .ill (1955), while nowhere formulating the particular conceptwhich I am here describing, presents a picture of a symbioticpatient-parent relationship which constitutes a conceptual background into which my concept fits, I believe, precisely. He saysthat the mother (or in occasional instances the father): . . .Makes the conditions for (the child s] security in living thosewhich meet her own defensive and aggressive requirements toavoid psychosis. One meaning of the futility of the depen

dence-independence struggle of the schizophrenic . is his belief,based upon his observations, that, i he should improve andbecome well in the normal sense, is mother would becomepsychotic. .Bowen (1956), as a result of concomitant psychotherapy ofschizophrenic patients and their families, has reached conclusions similar to those ofHill. Reichard and Tillman (1950), Lidzand Lidz (1952), and Limentani (1956) are among the otherwriters whose discussions ofsymbiotic relatedness are relevant tomy paper.My theoretical formulations will be presented, with such briefsamples of clinical documentation as space will allow, in thefollowing categories: modes of one s driving the other personcrazy; motirJeS behind the effort to drive the other person crazy;and t is mode of interaction in the patient therapist relalionship.

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SCHIZOPHRENIA AND RELATED SUBJECTSModes o Driving the Other Person Crazy

In trying to delineate the modes or techniques which are employed in one person's effort to drive another person crazy-orin our professional terminology, schizophrenic- cannot overemphasize my conviction that the striving goes on at a predominantly unconscious level, and my conviction that this is butone ingredient in a complex pathogenic relatedness which s wellbeyond the capacity of either one, or both, of the participants tocontrol fully.

In general one can say, I think, that the initiating o any kind ointe.rpersonal interaction which tends to foster emotional conflict in theother person which tends to c t i v t ~ various areas o his personali J inopposition to one another tends to drive him crazy (i.e. schi(.ophrenic) .For example, a man in analysis is reported by his wife to bepersistently 'questioning the adjustment' ofher younger sister, aninsecure young woman, until the girl becomes increasinglyanxious; he does this, evidently, by repeatedly calling herattention to areas of her personality of which she is at best dimlyaware, areas which are quite at variance with the person sheconsiders herself to be. The repressions which have been necessary for the maintenance of a functioning ego are therebyweakened (without actual psychotherapy being available to her),

and increasing conflict and anxiety supervene. Quite similarly, itcan be seen that the inexperienced or unconsciously sadisticanalyst who makes many premature interpretations is therebytending to drive the patient psychotic-tending to weaken thepatient's ego rather than, in l ine with his conscious aim, tostrengthen that ego by helping the patient gradually to assimilatepreviously repressed material through more timely interpretations.Or a person may stimulate the other person sexually, in asetting where it would be disastrous for that person to seekgratification for his or her aroused sexual needs; thus, again, aconflict s produced. We see this in innumerable instances fromschizophrenic patients' histories, in which a parent behaved in aninordinately seductive way towards the child, thus fostering inthe latter an intense conflict between sexual needs on the Onehand and rigorous superego retaliations (in line with the tabooof the culture against incest) on tthe other. This circumstance can

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DRIVING THE OTHER PERSON CRAZYalso be seen as productive of a conflict in the child between, onthe one hand, his desire to mature and fulfil his own individuality,and on the other his regressive desire to remain in an infantilesymbiosis with the parent, to remain there at the cost of nvestingeven his sexual strivings- which constitute his trump card in thegame for self-realization- in that regressive relationship.The simultaneous, or rapidly alternating, stimulation-andfrustration ofother needs in addition to sexual ones can have, Ibelieve, a similarly disintegrating effect. One male patient,emerging from a psychosis in which his intense ambivalentfeelings towards his mother played a central part became ableto describe something ofhis childhood relationship with her. Themother s rejecting attitude was highlighted by his recollectionthat he had never seen her kiss his father, whom the mother had

dominated and nagged mercilessly. The patient rememberedthat there was one occasion when the mother had st rted to kissher husband. This was at a time when, late in the son s childhood, his father was being rolled into the operating room of ahospital, for a major operation o l l o ~ i n g a car accident. Themother leaned down as though to kiss her husband and thepatient saw his face become suffused with joyous anticipation.Then the mother thought better of it, and straightened up. Thepatient described this with a desolate feeling-tone, as though hehimself had experienced this kind of frustration at her handsmany times in his own life.Similarly, with the child s desire, as well as felt duty, to behelpful to (for example) a parent: frequently we find in thehistories of schizophrenic patients that one or both the parentsmade chronic pleas for sympathy, understanding, and what wewould call in essence therapeutic intervention, from the child,while simultaneously rejecting his efforts to be helpful, so that hisgenuine sympathy and desire to be helpful became compoundedwith guilt, rage and perhaps above all a sense ofpersonal helplessness and worthlessness. In t is connexion, Bateson and hiscolleagues (I956) have described parental injunctions of amutually contradictory or double bind nature as being important in the aetiology of schizophrenia.Another technique, closely related to the stimulation-frustration technique just described, is that of one s dealing with theother person upon two (or perhaps even more) quite unrelated

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SCHIZOPHRENIA AND RELATED SUBJECTSlevels of relatedness simultaneously. This tends to require theother person to dissociate his participation in one or another (orpossibly both) these levels, because he feels it to be so crazilyinappropriate that he should find himself responding in terms ofthat particular level, since it seems to be utterly unrelated towhat is going on at the other, more conscious and overt, level.

For example, on one or two occasions in my years-long workwith a physically attractive and often very seductive paranoidschizophrenic woman, I have felt hard put to it to keep fromgoing crazy when she was simultaneously a) engaging me insome politico-philosophical debate (in which she was expressingherself with a virile kind offorceful, businesslike vigour, while I,though not being given a chance to say much, felt quite stronglyurged to argue some of these points with her, and did so); andb) strolling about the room or posing herself on her bed, in anextremely short-skirted dancing costume, in a sexually inflaming way. She made no verbal references to sex, except forcharging me, early in the hour, with having 'lustful', 'erotic'desires; from there on, all the verbal interaction was this debate

about theology, philosophy, and international politics, and itseemed to me that the non-verbal interaction was blatantlysexual. But nd here is, I think, the crucial point- felt noCOlliSensual validation (at a conscious level) from her about thismore covert interaction; this non-verbalsexual interaction tendedto appear as simply a 'crazy' product of my own imagination.Even though I knew there was a reality basis for my respondingon these two unrelated levels, I still found it such a strain that I

f l t ~ as I say, as though I were losing my mind. An insecure childengaged in such a broadly divided interrelatedness with a parentwould, I think, suffer significant personality trauma in an oftrepeated situation of this kind.Another technique, closely akin to that of relating to the otherper:son upon two or more disjointed levels at once, is the suddenswitching from one emotional wavelength to another, such asone finds so very frequently among the parents of schizophrenicpatients. For example, one deeply schizophrenic young man'smother, a very intense person who talked with machine-gunrapidity, poured out to me in an uninterrupted rush of words thefollowing sentences, which were so full of non sequiturs as regardsemotional tone, that they left me momentarily quite dazed: He258


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DRIVING THE OTHER PERSON CRAZYwas very happy. I can't imagine t is thing coming over him. Henever was down, ever. He loved his radio repair work at MrMitchell's shop in Lewiston. Mr Mitchell is a very perfectionistic person. I don't think any of the men at his shop beforeEdward lasted more than a few months. But Edward got alongwith him beautifully. He used to come home and say [the motherimitates an exhausted sigh], I can't stand it another minute " 'The patient, for several months prior to his hospitalization, hadspent most ofhis time at home in the company ofhis mother, andI thought it significant, in t is same connexion, that during the'early months of his hospital stay he showed every evidence (inhis facial expressions and so on) of being assailed by upsurgingfeelings which changed in quality with overwhelming suddennessand frequency. For example, one moment his face would show amixture of hatred and loathing, the ) he would suddenly jerk asthough struck by some massive object, while his face now showedan intense grief.

My implication, that t is phenomenon was partly a result ofhis long-continued exposure to his mother's poorly integratedpersonality, is not intended to rule out the possibility that theprocess worked in the reverse direction at the same time. On thecontrary, I was impressed with the mother's evidencing a betterintegration after the patient had been out of the home for :sometime, and thought it entirely likely that during my abovementioned interview with her, at the time ofher son's admission,she was showing some of the after-effects of years-long exposureto an extremely poorly integrated, psychotic penon, with whosecapacity to assault one's own integration I myself became mostuncomfortably acquainted n the course of my work with him.All t is touches upon the matter of struggle, between child andparent or between patient and therapist, to drive one anothercrazy; I shall go into this matter later on.

The now deceased mother of another schizophrenic man wasdescribed by the patient's siblings as having been completelyunpredictable in her emotional changeability; for instance, shewould return from the synagogue with a beatific expression onher face, as though she were immened in some joyous spiritualexperience, and two minutes later would be throwing a kitchenpot at one of the children. At times she was warm and tender tothe patient, but would suddenly lash out at him with virulent

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SCHIZOPHRENIA AND RELATED SUBJECTSaccusations or severe physical beatings. The patient, who at thetime of my beginning therapy with him had been suffering fromparanoid schizophrenia for some years, required more than threeyears of intensive psychotherapy to become free of the delusionthat he had had not one mother but many different ones. Hewould object repeatedly to my reference to 'your mother',protesting that he never had on mother; once he explained,seriously and utterly convincingly: 'When you use the word"mother':, I see a picture of a parade of women, each onerepresenting a different point of view.'A continual, unexpected switching from one conversationaltopic to another without, necessarily; any marked shift in feeling-content is in itself a mode of interpersonal participation whichcan have a significantly disintegrating effect upon the otherperson's psychological functioning, as can be attested by anytherapist who has worked with a patient who shows prolongedand severe confusion.Each of these techniques tends to undermine the otherperson's confidence in the reliability of his own emotionalreactions and of his own perception of outer reality (a formula-tion for which I am indebted to Dr Donald L. Burnham). In oneof the previously mentioned papers by Johnson t al (1956 wefind the following pertinent description of the schizophrenicpatients' childhood relationships with their parents: ' Whenthese children perceived the anger and hostility of a parent, asthey did on many occasions, immediately the parent would denythat he was angry and would insist that the child deny it too, sothat the child was faced with the dilemma of whether to believethe parent or his own senses. f he believed his senses, he main-tained a firm grasp on reality; if he believed the parent, hemaintained the needed relationship, but distorted his perceptionof reality. Repeated parental denial resulted in the child's failureto develop adequate reality testing.1

The subject about which I am writing in this paper ties in withone from a quite different field of human activity: internationalOne of my patienu who throughout his childhood was told, 'You're crazy'whenever he saw through his parents' defensive denial, became so mistnutful of hisown emotional responses that he relied heavily, for yean upon a pet dog to let himknow, by its reaction to thil or that other penon whom he and his pet encountered,whether the penon were friendly and trustworthy, or hostile and one to be onguard agaiNt.


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DRIVING THE OTHER PERSON CRAZYpolitics and warfare. I refer to the subject of brainwashing andallied techniques. In reading a recent and valuable book uponthis subject by Meerloo, lu ape o tlu Mind (1956), I wasrepeatedly impressed with the many similarities between theconscious and deliberate techniques of brainwashing which hedescribes, and the unconscious (or predominantly unconscious)techniques of thwarting of ego-development, and underminingof ego-functioning, which I have found to be at work in the experiences, both current and past, ofschizophrenic patients. Theenforced isolation in which the brainwashed person existJisolated from all save his inquisitor(s)-is but one example ofthese similarities; in the life of the schizophrenic-to-be child, aregular accompanimentof he parent s integration-eroding kindsof behaviour is an injunction against the child s turning to otherpersons who might validate his own emotional reactions andassure him against the parent-inspired fears that he must becrazy to have such irrational reactions to the parent.Meerloo s book describes brainwashing and allied techniquesas occurring in the form of ) deliberate experiments in theservice of totalitarian political ideologies; and h) cultural undercurrents in our present-day society, even in politically democraticcountries. My paper portrays much these same techniques asoccurring in a thi rd area: the lives ofschizophrenic patientJ.

Motives behind the Effort to Drive the Other Person razymode of interpersonal participation which tends to drive theother person crazy can be based, seemingly, upon any one of awide variety of motives; in any single instance, probably a complex constellation of various motives are at work. These motivesrange all the way, apparently, from intense hostility at one endof the scale to desires for a healthier, closer relatedness with the

other person, and desires for self-realization at the other. I shallstart with those more obvious motives at the former end of thescale.(i) The effort to drive the other person crazy can consist,predominantly, in the psychological equivalent of murder; thatis, it can represent primarily an endeavour to destroy him, to getrid of him as completely as if he were physically destroyed. Inthis connexion, it is interesting to note that whereas our legalsystem reserves its severest punishment for him who commits

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SCHIZOPHRENIA AND RELATED SUBJECTSphysical murder, it metes out no or at most negligible-punishment for psychological murder , for destroying another personpsychologically by driving him crazy . In the knowledge of theaverage person who is unacquainted with the details of legalprocedure, the only legal penallty in this area is the tangentiallyrelevant and entirely unfrightening legal charge of mentalcruelty which, he knows, is not infrequently conjured up as anexcuse for a high percentage of divorces.I do not mean to imply that I wonder at this legal state ofthings, or suggest any change in the law in this regard; I think itwould be impracticable to set out to prove, legally, that oneperson had contributed significantly to another person s goingcrazy . My point is that this state of things does exist in our legalsystem, so that whereas one has a reason to feel deterred, by law,from physical murder, one has practically no reason to feelsimilarly deterred from what might be thought of as psychological murder.It should be noted, further, that a psychosis severe enough torequire yean-long hospitalization does indeed serve to bar thepatient from continued participation in the life of, for instance, afamily, almost as effectively as would death itself. t is not un-heard of or the parents ofa long-psychotic, hospitalized child tlet it be known that the child has died, and it is much morefrequent for the family members still at home to avoid makingreferences to the patient, in their everyday life with friends andassociates, and to avoid consulting or informing the patient concerning family crises, very much as though he had passed away .

an example of is kind of motive, I shall cite certain datafrom my work with a young woman who had been hospitalizedfor more than three yean for a schizophrenic illness, and who bythis time had become able to tell me some details about her lifein her family before its onset.She had one sibling; a sister two years younger than herself.Both girls were good looking; both had been strongly indoctrinated with the view, from their mother and father, that a girl s onlyr ison d tre is the acquisition of a socially prominent and wealthyhwband; both were much involved in fantasies of being the wifeof the father, since their mother accepted a much-derogated rolein the family. They were therefore intensely and openly competitive with one another.


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DRIVING THE OTHER PERSON CRAZYMy patient, in one of her psychotherapeutic sessiona, remi-nisced about a time (not more than two years prior to her firsthospitalization) when her sister had been jilted by a boy friendwhom the sister had introduced to a supposed friend, named

Mary. She said that for about a year after that, her sister woredark glasses and went around the house talking about suicide ,and weeping. The patient said that the glasses were driving her[i.e. the sister] crazy . She also added, My sister used to say sheread a lot so that she wouldn t go nuts , and commented to methat the jealousy and hatred and all the teasing make aperson wild . She spoke of how jealous Sarah [the sister] was ofMary , giving me to t ink that she was about to say ofme , butshifted to of Mary ; I got the distinct impression, from otherthings she said, that the jealousy between .herself and her sisterwas intense during that period. I noticed that when she spoke,from time to time, of the suffering her sister had evidenced, asadistic smile repeatedly came over her face. She said at onepoint that If two people each want the same thing they arebound to have hatred and jealousy towards one another, andlater spoke of how much hatred and jealousy one has towardssomebody who is standing in the way ofsomething or somebodyone wants. I commented, here, casually, that naturally one feelslike killing the other person, getting rid of them. She replied,Killing-that isn t allowed- , as if she had already consideredthat but had come up against the fact that, for some reason in comprehensible to her, this was forbidden.Parenthetically, this girl s case history describes her havingverbally threatened to murder her sister- I ll get you in the backwhen you re not looking -and having picked up a hammer andthreatened to kill her mother with it. The sister, who had beenmarried a few months after the patient s initial hospitalization,was afraid to let the patient visit her for fear the latter would k llthe sister s small baby; in short, the family took her threats ofmurder quite seriously.Now when she said thoughtfully, during this therapeuticsession, Killing-that isn t allowed- , she added significantly,-but there are other ways . On another occasion, while tellingof her sister s depressive symptoms, she fell to reciting the wordsof the nonsense song Mairzy Doats , which had been popularduring that era. She puzzled, in her chronically confused way,

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SCHIZOPHRENIA AND RELATED SUBJECTSover the word Mairzy , saying twice that sometimes the word isMairzy and sometimes it is Mary , giving me every impressionthat during the sister s depression she had tormented the sisterby asking her about this song, often using the hated word Mary ,the name of the sister s former friend who had taken from her,and eventually married, her steady boy friend.This material is too long to reproduce in full here; but inessence it should be reported that the patient had evidently feltherself to be in a desperate struggle with the sister as to whichwould drive the other crazy first. On one occasion the patientrecalled, with obvious anxiety, Sarah said I had something to dowith it , the it referring to Sarah s depression, and she quotedSarah as saying, I hope you never get this , which evidently hadan ominously threatening connotation to the patient. I got thestrong impression that she felt guilty about the sister s illness, feltthat the sister blamed her for it, and feared that the sister wouldvengefully cause her to be similarly ill in retaliation.

This touches upon the subject ofwhat I call psychosis wishes ,entirely analogous to death wishes . On several occasions, whenworking with patients who have had an experience, earlier in lifeprior to their own illness, ofa parent s being hospitalized becauseof a psychotic illness, I have found that the patients show guiltabout repressed psychosis wishes , entirely similar to deathwishes which are productive of guilt in persons who have lost ahated parent through death. The patients who show this guiltover psychosis wishes show every evidence of feeling that theywere once successful in a mutual struggle with the parent. inwhich each was striving to drive the other crazy, and the subsequent appearance of their own psychosis seems to be attributable in part to guilt, and fear of the parent s revenge, stemmingfrom that duel in previous years. In the case I have been describing, the sister was not act ally hospitalized; but in otherrespects the circumstances were those which I have just outlinedas regards patients whose mother or father, in their childhood,had been hospitalized with psychosis.In this girl s family life, the particular mode of interpersonalparticipation with which I am dealing in this paper- the effortto drive the other person crazy eems to have been a customarymode, over the years, of the various family members interactionwith one another. I shall cite but one more portion of the

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DRIVING THE OTHER PERSON CRAZYavailable data . During childhood and adolescence, she had experienced a great deal ofanxiety about her teeth, partly becauseshe had lost some of them in a playground accident. Her fatherused to frighten her, time and again, by telling her teasingly, I mgoing to take your teeth out and use them for golf tees. For thefirst several months after her admission to Chestnut Lodge shewas, in the words of the psychiatric administrator, crawling withterror , incessantly demanding reassurance that no harm wouldcome to her teeth and to various other body parts. After severalyears of therapy she made clear to me her conviction that herfamily members, each of them possessing much hatred and envyofher, had acted in concert to drive her crazy and thus rid theirhome of her presence, and although this is by no means anaccurate total picture, it is, I believe, an accurate description ofapart of what had happened.(ii) The effort to drive the other person crazy can be motivatedpredominantly by a desire to externalize, and thus get rid of, thethreatening craziness in oneself. It is well known that the familiesof schizophrenic patients have a proclivity for dealing with thepatient as being the crazy one in the family, the repository ofallthe craziness among the various other members. Hill s previouslymentioned book ( 955 ) contains some valuable observationswhich help us to grasp the concept that the patient s crazinessconsists, to a significant degree, in an introjected crazy parent(usually, in Hill s experience as in my own, the mother), a parentwho now, introjected, comprises the predominance of thepatient s own irrational and cripplingly powerful superego. Tothe extent to which this process takes place in the mother srelationship with her child, she succeeds, in effect, in externalizing upon him her own craziness . My concept of one s strivingto drive the other person crazy emerges naturally, as I mentionedearlier, from many of the interesting formulations at which Hillhas arrived.I have presented in chapter 7 my view that a most importantingredient in the above-described mother-child relatedness s thechild s genuine love and solicitude for the mother, love andsolicitude ofsuch a degree as to impel him to collaborate with herin this pathological integration. He loves her so deeply, in short,that he sacrifices his own developing individuality to the symbiosis which is so necessary to her personality-functioning.

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SCHIZOPHRENI ND REL TED SUBJECTS(iii) Another motive behind t is effort which I am describingis, in many instances, the wish to find surcease from an intolerablyconfiictual and suspenseful situation. f one s mother, forexample, recurrently holds before one the threat that she will gocrazy, with the implication that it will be catastrophic for oneself

i f is indispensable person were thus to remove herself from thesituation, one may well be tempted to do one s utmost to rive hercrazy and thus to cut, oneself, the thread that holds this sword ofDamocles over one s head; i f t is so apt to fall in any case, onecan at least salvage the satisfaction of feeling that it is one s ownhand which has effected the unavoidable catastrophe.

We see every day in our psychiatric work that patients tend tobring upon themselves any catastrophe which is sensed as beinginevitable, in their effort to diminish intolerable feelings ofhelplessness and suspense in the face of it.The tormentingly insecure nature of the ever-ambivalentsymbiotic relatedness which existed between the schizophrenic,n infancy and childhood, and his mother or father, hasbeen described by Hill (1955), Arieti (1955), Bowen (1956) andmyself (above, chapter r). Anyone who has participated. ina long-continued therapeutic endeavour with a schizophrenicpatient has experienced at first hand, re-enacted in the transference relationship between the patient and himself, theintensely a m b i v a l e n t - m u t u a l { ~ so-relatedness which existedbetween the patient and the pathogenically more significantparent.(iv) With surprising frequency one finds, both in patientshistories and, much more impressively, in the unfolding of theirchildhood relationships with the parents in the evolution oftransference phenomena, that they had come to the discovery,over the course of the years of their childhood, that one oranother of the parents was, so to speak, a little crazy. Theyfelt-often rightly, I think- that the evidence of the parent scraziness was so subtle, or so hidden from public display andreleased only in their own relationship with the parent, that onlythe. child himself was aware of the full extent of it. In thesecircumstances, t is knowledge remains a guilt-laden secret inthe child; he strongly tends to feel somehow responsible for thefact of the parent s craziness, and heavily burdened by both thecraziness-since the parent seeks.satisfaction for the psychotically

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DRIVING THE OTHER PERSON CRAZYexpressed needs from this child in particular and by his ownknowledge of its existence.Thus the setting is ripe for his becoming tempted to foster theparent s becoming sufficiently openly psychotic-tempted, that is,to drive the parent into craziness which will be evident to othersbeside himself-so that the family and the larger communitywillshare his own burden. The patients one encounters who havehad this kind of pre-psychotic experience are much morenumerous than those who have had the experience of one oranother parent s becoming openly psychotic and requiringhospitalization.In my presentation of this formulation, I do not lose sight ofthe likelihood that a patient who is himself struggling against adeveloping psychosis will project his own threatening crazinesson to one or another parent. This happens often and even,believe, regularly. But the process which have described occurs,not infrequently, in addition.(v) One of the most powerful and frequently encountered ofthe motives behind the effort in question is a desire to find a soulmate to assuage unbearable loneliness. In the case of every oneof he schizophrenic patients with whom have worked long andsuccessfully enough to perceive the childhood relationshipsrelatively clearly, this motive evidently had been at work inwhichever parent had integrated a symbiotic relatedness withthe child. The precariously integrated parent is typically avery lonely person who hungers for someone to share her orhis private emotional experiences and distorted views of theworld.

The following report y an attendant, concerning his conversation with a 28-year-old male schizophrenic patient, showsthis motive at work:Carl had been quiet-seemingly depressed all morning- when hesuddenly started to talk about his mother s illness. Said he enviedhis older sister because she didn t have to be r the brunt ofhis mother sillness. {The sister is not sick.) Said that his mother tried out herparanoid ideas on him. Would go around the house, pull down theblinds, check to see if anyone were near, then tell him what apparently 'A.re full-blown paranoid ideas about the neighbours andfriends. [He) very philosophically announced that he felt she needed

company in her illness that she felt so lonely that she had to use him267


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SCHIZOPHRENIA AND RELATED SUBJECTSin this way [He] has ideas people are talking about him, andvoices these ideas in a naive, forthright manner.

This parental motive is reflected in patients fanatical loyaltyto the parent, a loyalty which gives way, n the psychotherapy ofchronic schizophrenia, only after years of arduous work bypatient and therapist. One finds evidence of it, too, in thefrequency with which deeply l l patients hallucinate this parentin an idealized form, an idealized parent often, from what havediserned in my own work, split into two, one the personificationof evil and the other the personification of loving protectiveness.With the most deeply l l patients it may require many months ofstressful therapeutic labour before the therapist begins to assume,in tthe patient s view of him, a degree of libidinally cathectedreality which can compare with that of the hallucinatory, but tothe patient immediately and vividly real, parent-images. Andone finds evidence of it, of course, as has been indicated earlier,in the parent s fighting tooth and nail, by every means at his orher disposal, against the patient s and therapist s collaborativeeffort towards the patient s becoming free from his magicallyclose , magically mutually understanding , two-against-theworld relatedness with the parentIn what I have just said, no acknowledgement has been paidto the parents contrasting, and healthy, desire to help their childreach true maturity, a fulfilment so at variance with the kind ofsubjectively mutually omnipotent and celestially loving, but inactuality intensely ambivalent and psychotic, relatedness whichI have described. Parents are never devoid of such a healthyparental desire and often, in my experience, that desire is strongenough to enable them to make indispensable contributions tothe endeavour in which patient and therapist are engaged. Butit remains true, none the less, in my experience, that thisinfantile-omnipotent relatedness between the sickest , leastmature areas of the parent s personality on the one hand, andthe patient s personality on the other, constitutes the greatestobstacle to the patient s becoming well.

All this becomes reproduced iin the transference-developmentof an ongoing patient-therapist relationship, and the therapistinevitably becomes deeply immersed in the subjective experienceof magical closeness and shared omnipotence with the patient.

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SCHIZOPHRENIA AND RELATED SUBJECTSconfirmation': and he expresses his conviction that ' The helpthat men give each other in becoming a selfleads the life betweenmen to its height .To put it in other words, it seems to me that the essence ofloving relatedness entails a responding to the wholeness of theother person-including often {particularly in relating to a smallchild or to a psychiatrically ill adult, but to a lesser degree inrelating to ll other persons also) a responding in such fashion tothe other penon when he himself is not aware of his own wholeness, finding and responding to a larger person in him than hehimself is aware of being.

Thus, to focus again more specifically upon the seeming effortto drive the other person crazy, we find that this effort can bevery close to, and can even be comprised of, an effort to help theother person towards better integration, which latter effort canbe considered the essence of loving relatedness. A genuine effortto drive the other person crazy- to weaken his personal integration, to diminish the area of his ego and increase the area ofdissociated or repressed processes in his personality- can beconsidered, by contrast, precisely the opposite of the kind ofloving relatedness which Buber describes.I surmise that in many instances of a parent's fostering is orher child's 'going crazy', the psychosis in the offspring representsa miscarriage of the parent's wish, conscious or unconscious, tohelp the child towards better, more mature integration. Onecannot always know the precise ego-capacities of the otherperson, as any therapist can attest, and it may well be thatparents often perform acts analogous with those interventions ofa therapist which are ill-timed or otherwise ill-attuned to theneeds of the patient's ego, and which have, instead of the desiredeffect offurther integration in the patient, a disintegrating effect.I think it significant in this regard that, in very many instancesof the outbreak of psychosis, the precipitating circumstances,whatever they may be, have led the patient to become aware oftruths about himself and his relationships with others in thefamily, truths which are actually precious and long-needed,truths which could provide the basis for rapid ego-growth, rapidpersonality-integration. But they come too fast for the patient'sego to assimilate them and the ego regresses, recoiling from whatis now, in its effect, an opened Pandora's box. Thus what could

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DRIVING THE OTHER PERSON CRAZYhave become-and what in probably a great many instances doesbecome, in persons who never get to a psychiatrist-a valuable,creative, integrative growth experience, becomes an experienceof developing psychosis, as various pathological defences(delusions, hallucinations, depersonalization, and so on) becomeerected against the awareness of those truths.In psychotherapy the therapist is often called upon to contribute in skilfully dosed and skilfully timed increments, the verykind ofparticipation which would, ifgiven less skilfully (whetherby reason of nexperience or by reason of his orientation towardsthe patient being a predominantly hateful rather than a predominantly loving one), have an effect precisely opposite to thattherapeutically desirable. For instance, premature interpretationsmay have a disintegrating rather than an integrating effect uponthe patient.vii) The next motive which I shall discuss can be seen inconnexion with a point made prominently by Hill, the point thatthe mother of the schizophrenic keeps before the child the threatthat she will go crazy i he becomes an individual by separatinghimself, psychologically, from her.

The relevant motive, then, s this: the child s own desire forindividuation may be experienced by him as a desire to drivethe mother crazy. The mother reacts to his desire for individuation as an effort to drive her crazy; so it seems to me entirelynatural that the child himself should be unable to distinguishbetween his own normal and precious striving towards individuation, on the one hand and on the other hand a monstrousdesire-which latter the mother repeatedly reacts to im asevidencing-to drive his mother crazy.Such a state of psychodynamic affairs is entirely analogous, Ithink, to that which obtains in a situation where the mother indicates that i he child really grows up it will kill her; there, asone finds in clinical .work, the child comes to experience hisnormal desires to become an individual, as being monstrousdesires to murder is mother. ill makes this latter point in hisvolume.If, in looking a bit further into the child s relation with such amother as i l l describes, we shift the frame of reference tovisualize the struggle etwem mother and child to drive oneanother crazy, another interesting point emerges: the mother s

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SCHIZOPHRENIA AND RELATED SUBJECTSostensible efforts to drive the child crazy can be seen as containing, probably, a nucleus of laudable motivation, though unformulated as such by her, to help her child become an individual.t s probable that, n the mind of such a mother, the concept ofpsychological separateness, of individuality, is to such an extentequated with craziness, that she cannot conceptualize thismotive as a wish to help her child to become an individual. But

it may well be that some bit of healthy mother in her senses thatthe child needs something which she is not providing, somethingutterly essential, and that it is this part of her which ostensiblytries to drive the child crazy-tries, in actuality, to help the childto become an individual.

In the psychotherapeutic relationship we find that, as anatural consequence of this past experience of the patient, hetends to react to his own developing individuality, his own egogrowth, as anxiety-arousing craziness; and the therapist (in thetransference position of the mother at t is phase of the work)tends to experience this anxiety also. Thus both participantstend unconsciously to perpetuate a symbiotic relatedness withone another, out of mutual anxiety lest the patient go crazycompletely- lest, in truth, he emerge from the symbiosis into astate of healthy individuality. This formulation is in line withSzalita-Pemow s comment (in a personal communication) thatThe [schizophrenic] patient s individuality resides partly in hissymptoms .

viii) The final motive is actually, in my experience, mostoften the most powerful ofall these motives; my mention of it atthis juncture is brief because it has already been touched uponin discussing motive v) above, and because so much of thischapter s final pages will be devoted to it. This motive is theattainment, perpetuation, or recapture of the gratifications inherent in the symbiotic mode of relatedness. More often thannot, the effort to drive the other person crazy, or to perpetuatehis craziness, can be found to rest primarily upon both participants unconscious striving for the gratifications which the crazysymbiotic mode of relatedness, despite its anxiety-and frustrationengendering aspects, offers.I shall not attempt to discuss other possible motives behind theeffort to drive the other person crazy. Others can undoubtodlybe found, and some of them may be of as widespread importance

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DRIVING THE OTHER PERSON CR ZYcu those I have described. But the eight which I have mentionedare, in my experience at least, the most frequently occurring andpowerful.

The Patient- Therapist RelationshipA considerable portion of he clinical experience which has led tothis paper s central hypothesis has consisted in reports about, andobservations of patients relatedness with their parental familygroup and with the group of patients and personnel on theirhospital ward; if space allowed, I could present data indicatingthat in each of these areas, the patient s integration with thegroup takes the form, in many instances, ofa mutual struggle todrive the other person crazy.But, since I consider that fundamentally the same psychodynamic processes are at work there, the only fundamentaldifference being that they are there operative in a group ratherthan a dyadic setting, and because my main interest is in individual psychotherapy, I shall confine my remaining remarks to thecontext of the patient-therapist relationship.In my experience, it is in the patient-therapist relationshipthat we can discern most clearly this mode of interaction, theeffort to drive the other person crazy. Specifically, we can findt is type of relatedness predominating during one particularphase of the schizophrenic patient s evolving transference to thetherapist, a phase in which there is reconstituted, between patientand therapist now, an earlier struggle between patient and parentto drive each other crazy. From my own therapeutic work, andfrom what I have observed of other therapists work at ChestnutLodge, I have obtained the impression that any successful courseof psychotherapy with a schizophrenic patient includes such aphase. During it the therapist becomes, in most instances Ibelieve, deeply involved in this struggle, so that he does indeedfeel that his own personal integration is in real jeopardy of agreater or lesser degree. The therapist s necessary participationin this phase of the transference-evolution is one of the main elements in psychotherapy with schizophrenics which make thiswork at times so stressful to pursue.One of my male schizophrenic patients expressed his conviction to me, for more than two years, that, as he put it, You rekind ofstrange Dr Searles ; You re crazy, Dr Searles ; You think


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SCHIZOPHRENIA AND RELATED SUBJECTSpeculiarly ; and he would say knowingly, You don t expressyourself to other people the way you do to me, do you? In thedevelopment of his mans transference to me as a mother-figure,there was beautifully revealed the fact that, in earlier years, hehad repeatedly tested his mother s sanity by leading her intovarious situations and then seeing whether she reacted in anormal or abnormal fashion. The mother, who had died a fewyears before the patient s hospitalization, had been a highlyschizoid individual with whom he had been involved, over manyyears, in a typically symbiotic relationship. The other familymembers, highly prestige-conscious people, had maintained abarrier of protectiveness and scorn around the eccentric motherand this son, so like the mother in that eccentricity.In my work with this man, the struggle to drive one anothercrazy was re-enacted with unusual intensity. He did an almostincessant amount of testing of me, such as he evidently had donein earlier years with his schizoid mother, in such a way as tobring out evidence to support his persistent suspicion that I wasslightly, or more than slightly, cracked. He reiterated, for years,maddeningly bland stereotypes,, labelling himself as thoroughlyhealthy and good, and myself as warped and evil, with a kind oferoding tenacity; and at times he picked on me in the samebaiting, sarcastic, accusing way that his mother evidently hademployed towards him, to such a degree that I could scarcelymake myself remain in the room. He accused me, time and timeagain, of driving him crazy; after my having gone through anumber of hours with him in which I had to struggle with unaccustomed effort to maintain my own sanity, it began to occurto me that this oft-reiterated accusation of his- that was tryingto drive im crazy-might involve some projection.In the course of an hour with a 24-year-old schizophrenicwoman I became assailed with feelings of confusion and unreality, when she, a luxuriantly delusional person, was readingto me from an instruction book concerning the Japanese game of

A IChizophrenic man, after teVcral montha of mutism, when he began talkingto his theraput aaid, repeatedly, in anxiow protest, You t lk too queer You retoo eruy. Following a visit from his mother, he anxioualy aaertcd that his motherwanted to kill him, and declared that his mother h d m de him lick and h ddriventhe patient brother (a monk) to the monutery. A few montha later on, the tamefeelings came out in c c u s t i o n ~ to the therapist. You wanted to kill me. You mademe aiclt crazy thoughts. You talk too queer.

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DRIVING THE OTHER PERSON CRAZY'Go'. She appeared to find some hidden meaning in almostevery word and even in almost every syllable, looking at mesignificantly, with a sarcastic smile, very frequently, as thoughconvinced I was aware of the secret meanings which she foundin ll this. The realization came to me, with a temporarily quitedisintegrating impact, of how threatened, mistrustful, andisolated this woman was. What she was doing with me comparesvery closely with her mother's taking her to movies, during herchildhood, and repeatedly commanding her, 'Now, think 'which the patient took-correctly, I believe-as the mother'scommand for the daughter to perceive the same secret, specialmeanings in the course of the movie which the mother, anactively psychotic person throughout the girl's upbringing, foundin it. The patient had been quite unnerved by this impossibletask (whose 'successful' accomplishment would have meant hersharing her mother's psychosis), just as I felt unnerved duringthat session with her reading. Also on a later occasion shedescribed how she had read to her mother in exactly such afashion for hours on end while the mother was doing housework,and it was evident to me that she had derived much sadisticsatisfaction from having been able to drive her mother todistraction by that method. Many times, similarly, I saw her sitback with a triumphant smile after she had succeeded in makingme thoroughly bewildered, and more than a little insecure, withher chaotic verbalizations of delusional material.

his woman had been told over and over again, by variousmemben of her family ever since she was a small child, 'You'recrazy '-whenever, as she herself remembered it, she pressed anyone of them for information to resolve the confusion which, tosome extent, all children often experience when they are exposedto unfamiliar and complex situations. She said to me once that:'Whenever I d open my mouth, six or eight of them [i.e. othermemben of her unusually large family] would jump down mythroat and tell me I was crazy, until I began to wonder whetherI really was losing my mind.' It became quite clear that amutual struggle to drive one another crazy had gone on betweenher and other family members. t had ensued with particularintensity between herself and her mother, an extremely changeable penon (as corroborated by one of the patient's brothen)whom the patient was convinced, for yean after beginning75


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SCHIZOPHRENIA AND RELATED SUBJECTStherapy with me, was not one person but many. f his mother,she once made to me this statement, significantly indicative ofthe kind ofstruggle I have described: 'They used to say, You'repsychosomatic If you don't watch out, you'll wind up in amental hospital " That's the way they were and they wouldn'tadmit it.''There were hints in my work with this woman, however, thather efforts to drive me (as a mother-figure in the transferenceduring this phase of the therapy) crazy were motivated at timesnot primarily by sadistic pleasure in rendering me more or lessdisorganized, or by a need to externalize upon me her ownpsychosis, but rather by genuine solicitude for me. At suchmoments the interaction between us was such as to make clearthat I was in the position, as she saw me, ofa mentally i l l motherwho needed treatment which she herself felt helpless to providefor me-entirely similar to the situation which had obtainedduring her childhood, in her relatedness with a psychiatrically illmother who never obtained the benefit of professional treatmentfor her chronic 'ambulatory' schizophrenia.On one occasion when this facet of the transference was inevidence, the patient protested, late in a session in which we hadbeen exchanging views quite actively: 'Why don't you go to astate hospital?-that's what you've been asking for, all the timeyou were talking.' She said this in a tone not of hostility but ofsolicitude and helplessness, as if she were being held responsiblefor placing me in a state hospital, and felt utterly helpless tocarry out this obligation. In another hour two weeks later shedemanded, 'When are they going to send you to a state hospital? I know you're trying to get to one.' In these instances, Iassume that one factor at work was a projection of her own unconscious desire to be sent to a state hospital. None the less, allthis fits in so precisely with the relatedness which had obtainedbetween herself and her mother, and moreover there were suchnumerous additional indications that she was responding to meas being her mother from her ch.ildhood, that I was convinced ofthe above-described transference significance of her responses.

The above examples are predominantly illustrative ofpatientsefforts to drive their therapist crazy. My clinical material, fromboth my own therapeutic work and my observations of that offellow-therapists, indicative of the therapist s own comparable

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DRIVING THE OTHER PERSON CRAZYeffort, suggests that therapists utilize (largely unconsciously, Iagain emphasize), just s do patients, the whole gamut of modesor techniques which have described earlier in this paper; andthe range of underlying motives is seemingly s widefor therapists s for patients.In any single instance, the therapist s striving in this directioncan be found, believe, to arise from two sources: a) the natureof the patient s transference-namely, a driving-and-beingdriven-crazy type of relatedness.- to him, such that he is inevitably drawn, to some degree, into a state offeeling, and a mode ofovert relatedness, which is complementary to that transference;and b) a character-trait in the therapist, transcending hisrelationship with this particular patient, in the form of an unconscious tendency (of, undoubtedly, widely varying strengthamong various therapists, but probably not totally absent fromthe enduringconstellation of penonality-traits of any therapist),to drive the other person crazy-wluzJever other person, that is,with whom he establishes a significantly close relationship.So then, when we find, upon examining any particular patienttherapist relationship, that it is characterized at this stage predominantly by a mutual struggle between the two participantsto drive one another crazy, it is probable that the therapist sbehaviour of this kind is based partially-and, I think, n mostinstances predominantly-on the first-described kind of normaltherapist-responsiveness to the patient s transference. .

But in, I think, a significant percentage of such instances, thesecond of the sources which I have mentioned-sources for thetherapist s behaviourally participating in this struggle-alsoplays a greater or lesser part. I discovered conclusive proof ofsuch a character-trait in myself,, to my great dismay, late in mypersonal analysis (about seven years before I write)-a traitwhich I found to be in operation not only with regard to one ortwo of the patients with whom I was working at the time, butwith regard to all of them, s well as with regard to innumerable other persons-relatives, friends, and acquaintances. Thefollowing general considerations are suggestive of a fairly widedistribution ofsuch a character-trait among psychotherapists andpsycho-analysts:(i) An obsessive..compulsive type ofbasic personality structureis certainly not rare among therapists and analysts. I am not


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SCHIZOPHRENIA AND RELATED SUBjECTSconvinced that such a personality structure predominates amongus; but anyone s informal observationssuggest that it is probablyto be found at least as frequently among us as among the members of the general population, in our culture which places somany premiums upon such obsessive-compulsive character-traitsas orderliness, competitiveness, intellectualization, and so on.It is well known that one of the major defence mechanisms ofthe obsessive-compulsive is reaction formation. It should not besurprising, then, to find that the choice of a profession, on thepart of a significant number of psychotherapists and psychoanalysts, has been founded partially on the basis of reactionformation against unconscious wishes which run preciselycounter to the conscious endeavour which holds sway in theirdaily work. That is, just as we would not be surprised to find thata surgeon brings forth, in the course of his psycho-analysis,powerful and heretofore-deeply-repressed wishes physically todismember other people, so we should be ready to discern thepresence, n not a f w of us who have chosen the profession oftreating psychiatric illness, of similarly powerful, long-represseddesires to dismember the personality structure of other persons.(ii) To extend the line of-admittedly hypothetical-reasoningwhich has been presented in (i) above, it is understandable thatin the training analyses of persons who have chosen psychotherapy or psycho-analysis as a profession, the analysand wouldencounter great resistance to the recognition in himself of suchdesires as those in question here-desires to drive other personscrazy ince these desires run so directly into conflict with hisgenuine and powerful interests in helping to r s o l r ~ psychiatricillness. Hence such unconscious desires-such a personality-trait,that is might understandably tend to escape detection, andthoroughgoing resolution, in the training analysis, and thechoice of a profession might never be revealed as constitutingpart of the analysand s struggle against his unconscious wishesto foster personality disintegration in other persons.I t ink all this might be described most accurately as follows:desires to drive the other person crazy are a part of the i m i t l s s ~ yvaried personality constellation of emotionally healthy humanbeings; therapists and analysts choice of a profession is suggestive that, at least in some instances where the personalitystructure is of an obsessive-compulsive type, the individual is

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DRIVING THE OTHER PERSON CRAZYstruggling against more than normally strong unconsciousdesires of this particular kind; and finally, because therapists andanalystsare engaged in the particular life-work to which they aredevoting themselves (the relief of psychiatric illness), it isespecially difficult for them to allow themselves to recognize thepresence, n themselves, of these gualitati e{yMmuzl desires.iii) So many of us show a persistent readiness to regard thisor that kind of functional psychiatric illness, or this or thatparticular patient, as incurable in the face of, by now, convincingly abundant clinical evidence to the contrary that onemust suspect that this proclivity for the adoption of an unscientifically hopeless attitude may mask, in . actuality, an unconscious investment in keeping these particular patients fixedn their illnesses. In raising this point, I do not wish to minimizethe very great difficulties which stand in the way ofrecovery formany psychiatric patients; on the contrary, it is my first-handexperience with facing such difficulties, in work with chronicallypsychotic patients, that makes me feel it all the more importantfor us to bring into this formidable task as few additionallycomplicating factors of our own as possible.I have seen, by now many times over (in my work withchronically psychotic or neurotic patients, n my supervisoryexperience with approximately twenty other therapists atChestnut Lodge and elsewhere, and in listening to staff orseminar presentations by many additional therapists), how veryprone we are to the development ofan attitude ofhopelessness inthe courseofour work with a patient, as a meansofunconsciouslyclinging to the denied, but actually profoundly valued, gratifications which we are obtaining from a symbiotic mode ofpat ienttherapist relatedness. In this phase, we tend to fight tooth andnail, however unwittingly, against the patient s making a majorstep forward a step which something in us senses to be in theoffing. Time after time, a major forward move in therapy ispreceded by such a phase of hopelessness on the part of bothpatient and therapist, a hopelessness which can now be seen, nretrospect, as a matter of heir mutual clinging to their symbioticmode of relatedness with one another.Many articles and ooks have been written which emphasizethe pathogenic significance of such a mode of relatedness in thepatient s-especially the schizophrenic patient s-upbringing; but

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SCHIZOPHRENIA AND RELATED SUBJECTSI think we have underestimated the intensely gratifying elementsof that mode of relatedness, a kind of relatedness which allowseach participant to luxuriate in feelings of infantile satisfactionas well as in omnipotent-mother fantasies. I think that one of thegreat reasons why schizophrenia is so difficult to resolve is thatthe therapist finds so much inner resistance against helping thepatient to move out ofthe reconstituted patient-parent symbioticrelatedness in the transference. Not only the patient, but thetherapist also, tends to find the prospective fruits of a moremature relatednessju.rt barery-ifeven that-worth the relinquishment of the symbiotic relatedness which, despite its torments,affords precious gratifications also.Whenever I have been able to acquire up-to-the-minute,detailed data about these situations I have found, as one mightexpect, that the mutual struggle between patient and therapistto drive one another crazy occurs on the threshold of what, aslater events prove, is an unusually big forward step for the patientin therapy. It is as though both of them fight, via a recrudescenceof their mutual driving-crazy, symbiotic techniques, against theupsurge of this favourable step in the therapy.I do not wish to leave the impression that the therapeuticroad, after one such break-through, is nothing more than astraight, wide, smooth home-stretch. In the working through, inthe transference, of the patient s symbiotic relatedness with themother, this same struggle has to be gone through again andagain. Although in subsequent repetitions it tends to occur withless disruptive severity, the therapist regularly finds himselfsusceptible to feeling the same black despair, the same sensationofbeing driven utterly mad by this impossible patient, time aftertime at the thresholds of successive stages in the loosening of thesymbiotic relatedness. This may be compared with the foetusbecoming anatomically separate from the mother: not merelyone, but a long series of labour pains is necessary before the babyfully emerges. Of tangential interest, here, are the followingremarks by Margaret Little in a paper entitled Counter-Transference and the Patient s Response to it (I 95 I).

Consciously and surely to a gre.at extent unconsciously too we allwant our patients to get well, and we can identify readily with themin their desire to get well, that is with their ego. But unconsciously wetend to identify also with the patient s superego and id, and thereby1 8o


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DRIVING THE OTHER PERSON CRAZYwith him, in any prohibition on getting well, and in is wish to stayi l l and dependent, and by so doing we may slow down his recovery.Unconsciously we may exploit a patient s illness for our own purposes,both libidinal and aggressive, and he will quickly respond to this.

A patient who has been in analysis for some considerable time hasusually become his analyst s love object; he is the person to whom theanalyst wishes to make reparation, and the reparative impulses, evenwhen conscious, may through a partial repression come under thesway of the repetition compulsion, so that it becomes necessary tomake that same patient well over and over again, which in ejftct meansm king him ill over nd over again in order to have him to m ke well [italicsmine- H. F. S.].Rightly used, this repetitive process may be progressive, and themaking ill then takes the necessary and effective form ofopening upanxieties which can be interpreted and worked through. But thisimplies a degree of unconscious willingness on the part of the analystto allow his patient to get well, to become independent and to leavehim

In my own experience (see chapter 3 above), by contrast tothat of Reichard and Tillmann (1950), Lidz and Lidz (1952),Limentani (1956), and many other writers, I find that what thetherapist offers the patient which is new and therapeutic, in t isregard, is not an idance of the development of symbiotic,reciprocal dependency upon the patient, but rather an ac-ceptanee of this-an acceptance of the fact that the patient hascome to mean a great deal to him personally. It is this acceptanceofone s own dependency upon him that the mother had not beenable to offer him.I believe that in the great majority of instances where apatient and therapist have worked together long enough for thissymbiotic relatedness to become well established, and where wefind that both are feeling hopeless about the work, we can findmuch evidence that each is unconsciously struggling to drive-orperhaps, more accurately, to keep-the other person crazy, sothat he can cling to this highly immature and therefore sick,but deeply gratifying, symbiotic mode of relatedness with theother.

t may well be that the need-widespread not only amongschizophrenic patients but also among the professional personawho treat them- to deny the gratifying aspect of the symbioticrelatedness, accounts for some of the persistent viability of the

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SCHIZOPHRENIA AND RELATED SUBJECTSirrational, name-calling schizophrenogenic mother concept.That is, it may be that we are so powerfully drawn, at an unconscious level, towards the gratifications which such a motheroffers, with her symbiotic mode of relatedness, that we have todeny our regressive urges in that direction, and thus consciouslyperceive, and in scientific writings describe, her as a quitetotally unappealing schizophrenogenic mother with whom itwould e pure hell to relate oneself closely.(iv) So many therapists and analysts personally characteristicways of responding to patients communications sound, not infrequently, as ifcalculated to drive the patient crazy (or crazier),that it is difficult to attribute this phenomenon entirely to lack ofclinical experience, skill, and perceptivity. That is, I surmise thatmany instances of awkward therapeutic technique, techniquewhich fosters further disintegration rather than integration inthe patient, may be due to chronically repressed (and thereforechronically present) desires in the therapist to drive the otherperson crazy.

u one frequently encountered example, we therapists have astrong tendency to react to only oneside ofa patient s ambivalentfeelings. Thus when a hospitalized schizophrenic patient, forinstance, is evidencing grossly disturbed behaviour such that weare given to know that he has an unconscious need for thesecurity of continued hospitalization, but he is conscious{ expressing to us a strong, verbalized demand that he be allowed tomove out, we may reply, I realize that you real{ wanJ to stay inthe hospital, and are afraid of moving out, in a reassuring tone.This example involves a crudity of therapist technique which wedo not encounter with extreme frequency in quite so stark a form,although I have observed, not uncommonly-and retrospectivelyhave realized that I was using in my own work with patients-just as crudely untherapeutic a technique as this. But lesserdegrees of this kind of untherapeutic therapist participation(throughout this paper, the points made are considered asapplying in psycho-analysis as well as in psychotherapy, althoughwith especial prominence in the latter) are observable with verygreat frequency indeed. Surely many a neurotic patient nanalysis, for example, finds himself maddened on frequentoccasions by his analyst s readiness to discount the significanceof the patient s conscious feelings and attitudes and to react to

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DRIVING THE OTHER PERSON CRAZYpreconscious or unconscious communications as though theseemanated from the only real and genuine desires and attitudes.

The therapist s or analysts growing out of such ways of responding is not simply a matter ofhis learning a technique moreappropriate to the patient s genuinely ambivalent, poorly integrated state. To become more useful to his patients he must inaddition be prepared to face his own conflict between desires tohelp the patient to become better integrated (that is moremature and healthy) and desires, on the other hand, to hold onto him, or even to destroy him, through fostering a perpetuationor worsening of the illness, the state of poor integration. Onlythis kind of personal awareness prepares him for being ofmaximal use to patients- above all, to schizophrenic andborderline-schizophrenic patients-and, particularly, for helpingthem through the crucial phase of the transference which I havebeen describing here.

The following therapists have given me their kind permiion to use data eoncernin( their patieota: n ecil C. H. Cullander, Jarl E. Dyrud, John P. Fort,Lealie Schaffer, Roser L. Shapiro, Joeeph H . Smith, and Naomi K. Wenner. Forthe theoretical formulations concerning thete data, I alone am responaible.

searles, harold - the effort to drive the other person crazy

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