COGNITIVE PERSONALTIY DISORDER

Thinking May Be Bad for You

This Section spells out the drawbacks of cognition. In its headlong rush to the oracle of science and technology, our society has, once again, made COGNITIVE synonymous with GOOD. Kanner (1943, p 216 [yes, 216]) warned us about our preoccupation with cognition in the introduction to his seminal paper on autism. He wrote:

The cultural standards of our civilization have for a long time been centered largely on the emphasis upon cognitive abilities and achievements. "Mind" has much too often been identified with "intelligence." The earliest scientific efforts made to study people individually resulted in the development of "psychometric" or "mental" tests that were concerned almost exclusively with the evaluation of cognitive potentialities. Psychology, education, and, to some extent, even child psychiatry, were dominated by homage to the I.Q. Schizophrenia was viewed predominantly as a condition leading to "dementia."

The advent of this century saw, under the leadership of Freud, Jung, Adler, Kretschmer, Meyer, and others, a significant departure from this attitude. The individual's relations to his family and to people in general, his emotional reactions to his specific life situation, his strivings and satisfactions based on his relationships, became items of serious investigation and the anchors of psychobiology, psychopathology, and psychotherapy.

This symposium deals with the consideration of children's abilities to form affective contact with people. . . .

History

In my work, I kept coming across clients with whom I was unable to sense emotionally who they were or where they were going. But these inscrutable clients were not the sickest clients I saw. With my sickest clients, I always could sense who they were and where they were going emotionally.

Worse still, some of these "emotionally inscrutable" clients killed themselves for no apparent purpose, either emotional or rational. I never saw their suicides coming even though I used my intuition to sense them emotionally and even though I used my knowledge to examine them thoroughly. In other words, I had no sense and no idea what made these people "tick."

Because I had no sense and no idea about how these "emotionally inscrutable" persons were living their lives, I would ask them directly, "Where is your life going?" Of course, some of these persons would give a flippant answer like, "Nowhere," or "Down the drain." But if such a person took my question seriously, he or she would become dumbfounded as if he or she had never heard such a question and, more important, as if he or she had never asked such a question of himself or herself.

I knew that these "emotionally inscrutable" persons had to have some sort of character pathology (that is, personality disorder). They were not all that sick and neither were they healthy, even though I could not say exactly how or why they were unhealthy.

Years ago, diseases of the mind (that is, psychopathology) were placed on a spectrum from the very sick to the almost well. The spectrum was simple:

• schizophrenia
• character pathology (personality disorder)
• depression

This spectrum followed the ideas of Melanie Klein: You started out in life as schizoid (or paranoid-schizoid). If you were lucky, you developed emotionally until you got depressed. Manic-depressive illness (bipolar disorder) and borderline personality disorder fit into the space between schizophrenia and character pathology. When making a diagnosis, I would ask two questions:

• 1. Is the client crazy (or manic)?
• 2. Is the client depressed?

If both answers were "No," then the client had some sort of character pathology.

This simple, three-part spectrum worked fairly well. But there were some problems. Where did autism fit? The question was avoidable because autism was labeled "developmental" so it didn't have to fit anywhere. And "emotionally inscrutable" persons felt very different from borderlines and regular personality disorders; with the latter I always got an emotional sense of who they were and where they were going. So, among the persons who had character pathology, where was dividing line between the "inscrutable" and the "knowable" persons?

A Case Study

For almost a full year I worked with a client who was a woman in her late forties. Let us call her Nena (which is not her real name). She was bright and engaging. She was married and worked as a professional in the health field. Nena had no history of severe mental problems like schizophrenia or bipolar disorder. She was a physically healthy and vigorous person.

In her mid thirties, Nena had two children, one after the other, one year apart. After her first delivery, she suffered a postpartum depression from which she was just beginning to recover when she found out that she was again pregnant. After her second delivery, she suffered a more severe postpartum depression which continued off and on until I saw her about 13 years later. Both of her children were healthy and were facing the normal difficulties of being teenagers.

Nena's "depression" was interesting. She never seemed all that depressed. She was never suicidal. But she did look anxious. I asked Nena how she knew she was depressed and she would reply, "I can't get out of bed and I have no energy to do anything." Then I would ask Nena how she felt inside when she was depressed. She would always respond, "Fine."

Nena and I worked well together. I could get her to express her difficult deep feelings like fear, loneliness and pain. She would tremble and sob freely. Then I would ask her how she felt inside. She would always say, "Just fine." I would tell her that I saw tears streaming down her face so she must be feeling something in her body. She would say, "My nose is full and I feel the tears on my cheeks but otherwise I feel OK inside." Then, in desperation, I would ask her, "Alright, what are you THINKING?"

The imagery of Nena's thoughts always matched the deep feelings on her face exactly. But she "felt" nothing inside herself. Psychoanalysts would say that Nena was using isolation in which the thoughts in her conscious mind were completely divorced from her feelings. However, I could see that her thoughts and deep feelings were perfectly connected at some unconscious level because her imagery always matched the emotion I read on her face.

My year's work with Nena accomplished almost nothing in spite of her intense expression of deep emotion. Somehow, she could never acknowledge the deep feelings within herself. So all her sobbing and trembling made no sense to her.

Nena's case gives us an extreme example of a phenomenon I will explore later: living in one's head. By the way, in spite of extensive practice with her deep feelings, I did not dare to make deep-feeling contact with Nena for fear of precipitating an emotional crisis which she could not handle except by killing herself.

A New Spectrum for Diseases of the Mind

In Section Seven of these Web pages, I put forward a new spectrum for diseases of the mind. Here is a shortened form of that spectrum:

• autism
• cognitive personality disorder
• schizophrenia
• emotionally turbulent personality disorder
• depression

Note that the new spectrum divides character pathology into two different sorts. The table below summarizes the differences between the two sorts of personality disorders.

Living in Your Head

A person with CPD lives in his or her head. That is, the self is centered and experienced in the mind as opposed to the body. Laing (1960, p 174) gave us a beautiful account of living in one's head:

The individual's being is cleft in two, producing a disembodied self and a body that is a thing that the self looks at regarding it at times as though it were just another thing in the world.

Persons who have CPD may ignore their bodies to such an extent that they contract a serious physical disease which arose "from nowhere" because its early signs and symptoms never entered awareness. They may fail to enjoy sex because of its connection with the body. Similarly, they lack awareness of deep feelings because these are centered in the body.

Diagnosis

CPD has not gone unnoticed. DSM-IV describes CPD as Cluster A personality disorders. Three personality disorders are grouped under Cluster A: schizoid, paranoid and schizotypal. Many cultures divide all behavior into three sorts: good, bad and crazy. I believe that DSM-IV has followed this cultural trend and has divided Cluster A into three categories:

• good or schizoid
• bad or paranoid
• crazy or schizotypal

However, I believe that DSM-IV has merely described three extreme subtypes of CPD. I suspect that there are vast numbers of CPDs most of whom lack the exact set of characteristics that would put them into one of the extreme subtypes of Cluster A. So DSM-IV has described the narrow fringes but has overlooked the huge center of cognitive personality disorder.

Prolonged Crisis and Changed Thought

As described elsewhere, crisis happens when a person's cloaking rituals fail to cover up his or her difficult deep feelings. If the crisis persists, the person may use changed thought to keep difficult deep feelings out of awareness. Two forms of changed thought are psychosis and pre-social cognition. (Pre-social cognition was presented elsewhere.)

Both psychosis and pre-social cognition cover up runaway deep feelings. And both are altered states of consciousness, that is, trances. Psychosis is a new cloaking ritual which lies outside the range of the person's culture. Psychosis renders the person non-functional in his or her cultural milieu. Pre-social cognition is an old cloaking ritual which also lies outside the range of a person's culture. But pre-social cognition allows a person to remain functional because it still organizes his or her world but without using language. The following table summarizes the differences.

A Metaphor for Pre-Social Cognition

Pre-social cognition is like a house built by a man who had no prior knowledge whatever of houses or their construction. Would the naive builder's house withstand the onslaughts of cold, contamination, dampness, earthquakes, fire, flood, gravity, heat, lightning, particulates, precipitation, predators, sunlight, time, vermin and wind? It's highly unlikely.

On the other hand, his house might be exquisitely suited for something we seldom associate with houses such as providing a sanctuary for birds or viewing the nighttime sky. Though his house may function less effectively than one of ours, it would be coherent within itself because there is nothing wrong with the man's mind or his ability to organize his work. One more step: Imagine our naive builder constructed his house before he learned to talk.

Let me summarize the characteristics of pre-social cognition:

• Pre-social cognition is a valid and self-coherent organization of the real world.
• Though different and generally inferior to our received (societal) organization of the real world, pre-social cognition may be exquisitely suited to some narrow purpose in the real world such as arithmetic, artistic, mnemonic or musical feats. (These are savant phenomena.)
• Pre-social cognition arises independently of, actually prior to, language.
• Pre-social cognition is incomprehensible.

An Understanding of Understanding

Before we get into incomprehensibility, let us take up understanding. The "under" prefix of the word does not mean "beneath." As with two words and a phrase, namely, "undergo," "undertake" and "under way," the "under" prefix means "completely." So the word "understand" means "to stand completely." That is, if I understand you, I stand completely where you stand and tell you what I experience. Note that I tell you what I experience rather than what I think you experience. Saying what I think you experience is simple mirroring or reflecting. You already know what you experience. If you learn what I experience when I stand completely where you stand, then you get a two-person, three-dimensional view of the world you face which resembles looking at that world with two eyes rather than only one.

Incomprehensibility of Pre-Social Cognition

This the hardest thing to grasp about pre-social cognition. It is an alien organization of reality which is impossible to understand. Certainly, we can make models of the behaviors driven by pre-social cognition and those models may have excellent predictive value. But we will never truly understand a specific person's pre-social cognition for two reasons:

• It arose outside of acculturation.
• It operates without language.

Pre-Social Cognition and Language

Having emphasized the disconnection between pre-social cognition and language, I found two rare glimpses of language associated with pre-social cognition.

Sheila Brown (1998, p 20) says this about her son's language:

Whether he was hallucinating or whether this was just our interpretation of his inexplicable language, we will never know. This strange phase of his language disintegration lasted about 18 months. His language was still grammatically correct and clearly enunciated, but often not related to anything we could comprehend.... Once he started to throw the kitchen mop around, wailing "I had killed the floor mop" and "it [the floor mop] should be growing younger."

Blossom wrote this about his son:

. . . My wife and I were talking about our 12-yr old Aspergers son last night, and we were reminiscing about his early speech, which was highly metaphoric, and yet extremely insightful. Different aspects of Autism exhibit different ways of dealing with language, of course, but I am oftentimes struck by the sometimes poetic clarity of what comes out of our son's mouth! As we often say, it is as if he learned English, his native tongue, as a second language, and translates it from on inner form of speech, the true nature of which can only be guessed at.

	An Emotion-Based Spectrum of Mental Illness
	A Five-Step System for Exploring Deep Feelings

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