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A Review of Neuroses As Conceptualized
by David Shapiro
Jeffrey
W. Braunstein, Ph.D.
Neurotic styles are the
styles of thought, perception, and behavior that characterize various neurotic
conditions (Shapiro, 1965, 1981, 1991). David Shapiro has contributed extensive
information and literature to the psychoanalytic conceptualization of neuroses.
He continues to publish and practice, with his most recent work focusing on the
understanding of character development (Shapiro, 1996) and the psychotherapy of
neurotic character (Shapiro, 1989, 1996).
Shapiro’s early
studies of neuroses spawned his later interests in the subjective pathological
experience of autonomy (Shapiro, 1981, 1985). Autonomy is accomplished when one
both masters and achieves independence from their immediate environment. The
level of autonomy and independence that one achieves influences both the range
of a person’s ability to adapt to his environment and their level of
self-respect. Shapiro (1981, 1985) suggests that impairment of autonomy and
self-direction is evident in all psychopathology and its subsequent
symptomatology. “Every condition of psychopathology is characterized by modes of
action that in one way or another compromise volitional processes and distort
normal volitional processes” (Shapiro, 1981, p. 5).
Impairment of
autonomy and self-direction contribute significantly to the development of rigid
character and to the decline of self-respect (Shapiro, 1981, 1985).
Exaggerated, inflexible, and tense deliberateness of behavior are prominent
features of rigid character. Developmental conflicts have a profound impact on
both the disturbances of autonomy and the development of rigid character. The
styles and disturbances manifested from these deficiencies and conflicts are
reviewed in the following paper.
Obsessive-Compulsive Style
Shapiro
(1962, 1965, 1981) suggests that the obsessive-compulsive’s style of functioning
is composed of excessive rigidity, the distortion of their subjective experience
of autonomy, and the loss of reality. These aspects encompass the cognitive,
affective, and behavioral experiences of the obsessive-compulsive style.
The
obsessive-compulsive’s style of thinking is severely rigid. The
obsessive-compulsive’s rigidity of cognition affects his interpersonal relations
(Shapiro, 1965). His rigidity of cognition is characterized by a pervasive
inattention to others. The obsessive-compulsive is highly resistant to the
influences of others due to a restriction of cognition (Shapiro, 1962, 1965,
1981).
Shapiro (1962,
1965, 1981) compares the obsessive-compulsive’s style of cognition with the
organically brain damaged population with regards to their impairment in the
ability to shift attention. The obsessive-compulsive exhibits pervasive
difficulty with shifting attention, frequently requiring the influence of others
for redirection. Shapiro (1962, 1965, 1981) distinguishes between these two
populations, reporting that the obsessive-compulsive’s style of attention,
unlike the brain damaged population, is intensely focused and excessively detail
oriented. “They will notice a bit of dust or worry over some insignificant
inaccuracy that, everything else aside, simply would not gain the attention of
another person” (Shapiro, 1965, p. 27). Shapiro (1962, 1965, 1981) suggests
that this mode of cognition impairs the obsessive-compulsive’s ability to
receive indirect, casual impressions and also impairs their capacity to be
surprised. They tend to frequently miss important and obvious aspects of
reality (conversations, observations) due to their inflexible mode of cognition
and excessive concentration. Shapiro (1965) suggests that the
obsessive-compulsive is content and proud of their inflexible ideation and
concentration, fearing any distraction.
The
obsessive-compulsive’s need to function intensively significantly diminishes
their affective experiences (Shapiro, 1962, 1965, 1970, 1981). The
obsessive-compulsive actively suppresses and fears the experience of emotion.
They associate the experience of emotion with feelings of loosing control
(Shapiro 1981). “Such a person lives, therefore, in a state of continuous
tension between will and underlying inclination” (Shapiro, 1981, p. 86).
The
obsessive-compulsive’s mode of activity usually centers around technical work
(Shapiro, 1965, 1981). He is consumed with the need to be productive (Shapiro,
1981). He engages in excessive effort, regardless of activity, in all aspects
of life. “The compulsive person tries just as effortfully to enjoy himself at
play as he does to accomplish or produce at work” (Shapiro, 1981, p.81). The
obsessive-compulsive schedules all aspects of life and maintains an excessively
deliberate way of living. Shapiro (1965, 1981) suggests that the
obsessive-compulsive’s intense task oriented behavior is motivated by self
imposed commands, directives, warnings, and rigidly structured rules. They are
rarely interested in the actual task. The obsessive-compulsive’s harsh superego
generates repetitive cognitions that exert continuous pressure on his
functioning. “The obsessive-compulsive tells himself, “I should..., “ almost
continuously” (Shapiro, 1965, p. 34). They value long-range goals over
short-range accomplishments (Shapiro, 1981). “Thus these people frequently give
themselves deadlines for various activities, which logically may be quite
arbitrary. One patient decided that he must have a better job by his next
birthday or else he would regard himself as a failure.” (Shapiro, 1965, p. 33).
They frequently complain about the pressure of these self-imposed rules but
never complain about the rule itself (Shapiro, 1965). They fail to view these
rules as dysfunctional and maintain their excessive drive to accomplish
self-imposed tasks. The obsessive-compulsive values external pressures, such as
morality, criticism from figures of authority, and societal rules. He is driven
to fulfill these expectations (Shapiro 1965, 1981). Oppressive tension is
generated from an extreme awareness of duties and responsibilities. The
obsessive-compulsive seeks relief from his own self imposed tensions and not
from direct external pressures (Shapiro, 1981). The obsessive-compulsive person
views and respects himself only for his role in society, with failure and job
loss making him susceptible to depression. Shapiro (1981) suggests that the
obsessive-compulsive has more respect for his accomplishments and production
than he does for himself.
The
obsessive-compulsive fears impulsivity, perceiving it as a temptation against
his requirement for intensely focused concentration and rigid behavior (Shapiro,
1965). Despite the hardships of this type of functioning, the
obsessive-compulsive experiences less anxiety and functions relatively better
when he functions within a framework composed of pressures and directives rather
than when there is a lack of structure. The obsessive-compulsive avoids making
decisions and choices due to the ambiguity of decision making. He actively
searches for a rule to assist in the decision-making process (Shapiro, 1965,
1981). Shapiro (1981) suggests that as the obsessive-compulsive intensifies his
rigidity and becomes increasingly more estranged from his emotions, the less
ability he has to make decisions. Brooding, excessive rumination, and anxiety
usually accompany the decision-making process for the obsessive-compulsive.
Paradoxically, at the height of the obsessive-compulsive’s anxiety about a
decision, he will make an impulsive decision so that he can resume his intense,
rigid, restricted mode of functioning (Shapiro 1965).
Obsessive-compulsive people often experience a loss of reality fueled by
pathological doubt and uncertainty (Shapiro, 1962, 1965, 1981). They
excessively worry about the possibility of catastrophic events such as
contamination, failure, and disease despite their acknowledgment that these
events may not even exist. Shapiro (1965) suggests that the
obsessive-compulsive’s narrowly, focused attention and restricted subjective
experience of reality impair his ability to experience conviction, further
amplifying this loss of reality.
The
obsessive-compulsive assumes the worst but is not fully convinced of its truth
(Shapiro, 1981). The obsessive worrier is obligated out of duty and
responsibility to himself to worry about the worst case scenario. Mistakes and
errors are overestimated and worried about constantly as a means of punishing
the self.
Shapiro (1962,
1965, 1981) suggests that the obsessive-compulsive’s style of cognition and
impaired experience of reality is responsible for the display of ritualistic
behavior. Excessively rigid and dutiful behavior eventually becomes ritualistic
(Shapiro, 1981). Compulsive rituals are performed out of duty and requirement
and not for the achievement of an external goal. Compulsive rituals are
performed so that any chance, threat, or possibility of disaster can be
averted. Compulsive checking of gas stoves and locks, constant handwashing, and
the rearrangement of objects such as utensils are frequently observed in this
population. Shapiro (1981) suggests that the obsessive-compulsive is also
motivated to engage in rituals and routines due to his incessant avoidance for
making choices.
Paranoid Style
The paranoid
style is characterized by suspicious thinking and a loss of reality.
Projection, both cognitive and noncognitive aspects, is the paranoid persons’
primary defense (Shapiro, 1965, 1981, 1994). Perceived threats to their
autonomy pervade most aspects of their functioning (Shapiro, 1981, 1981, 1994).
Paranoid people
are chronically suspicious, contributing substantially to their loss of reality
(Shapiro, 1965). Shapiro (1965) regards suspicious thinking as excessively
rigid and highly resistant to influence. The paranoid actively scans his
environment, searches to confirm his suspicions, and disregards evidence that
contradicts what he suspects to be true. Shapiro (1965) suggests that the
paranoid person does not ignore evidence that contradicts his suspicions. He
instead prejudicially examines contradictory evidence, deems it superficial or
illusionary, and subsequently disregards it, resuming the quest for his
perception of the truth. Pent-up anticipation, concerning the confirmation of
his biases, enables him to disregard contradictory evidence (Shapiro, 1965).
“Acuteness and intensity of attention when it is this rigid, becomes exceedingly
narrow in its focus; and the ultimate object of the suspicious person’s intense,
narrowly focused, and biased search is what we commonly call a clue” (Shapiro,
1965, p. 60). The paranoid person demonstrates poor judgment due to his
selective, narrow attention (Shapiro, 1965, 1981,1994). Paranoid people are
constantly hypervigilant and are not capable of deviating from this mode of
attention. Unexpected and unusual events that are perceived by the paranoid are
met with hostility and fear until they are thoroughly examined. Shapiro (1965)
warns that people who try to influence or persuade a paranoid person frequently
become enmeshed within his suspicious ideation.
The paranoid
experiences a severe loss of reality due to his devaluation and disregarding of
the obvious and his overemphasis of material that confirms his biases (Shapiro,
1965, 1981, 1994). The paranoid experiences distortions of reality due to
constant hypervigilance and an active searching for confirmation of his
suspiciousness. “Projection distorts the significance of apparent reality; it
is an autistic interpretive distortion of external reality” (Shapiro, 1965, p.
70). The paranoid scans the external world in search of clues. He projects
internal conflict, tension, expectancies, and biases on these clues,
subsequently distorting their true meaning and significance. “It is commonly
observed that the paranoid person meets reality halfway (Shapiro, 1965, p.71).
Shapiro (1965) differentiates normal and paranoid cognition, explaining that
normal cognition is flexible and has the capacity to correct biases, whereas the
excessive cognitive rigidity of the paranoid is inflexible and lacks this
corrective ability.
Autonomy is a
central issue that affects the functioning of paranoid people (Shapiro, 1965,
1981, 1994). They view all situations as potential threats to their autonomy
and exert excessive control over all of their behavior to defend themselves from
this perceived fear. Social and interpersonal behaviors such as handshakes,
facial expressions, and other forms of expressiveness are carefully monitored
and controlled to defend against this fear. The excessive control he exerts on
his behavior restricts his range of affect and dampens his capacity to
experience spontaneity. Paranoid people experience increased anxiety whenever
they lessen their excessive control over themselves and when they are forced to
submit to an external authority (Shapiro 1965).
Shapiro (1965,
1981, 1994) suggests that paranoid people are globally insecure and lack
self-respect. Paranoid people usually hold external authorities, such as their
employer, in higher regard than they do themselves. Paranoid people frequently
experience shame and insecurities about their bodies. They are excessively
concerned with the size and shape of various parts of their body such as their
genitals and muscles.
Shapiro’s (1965)
conceptualization of the projective experience of the paranoid provides an
understanding of their internal experience and subsequent overt behavior. The
paranoid person’s experience of internal tension heightens his sense of
vulnerability. He defends against this internal tension by becoming excessively
hypervigilant and suspicious, resulting in a constriction of affective
experience. Once this defensive system has commenced, the paranoid person
constructs and projects external threats, based on internal and defensive
tensions, so that he can conveniently discover the clues to confirm his biases
and suspicions. Shapiro (1965) suggests that this projective process functions
to lessen internal tension by converting internal tension into defensive
tension, resulting in the projection of an external threat. Actual external
threats stimulate this projective cycle as well. The aforementioned process of
projection that the paranoid person engages in is a consistent and permanent
part of his routine functioning.
Hysterical Style
The hysterical
style’s primary mode of cognition facilitates repression (Shapiro, 1965). He
lacks objectivity and experiences the subjective world as romantic, displaying
affective liability.
Shapiro
(1965) suggests that the hysterical person’s mode of cognition facilitates the
repression of memories. Hysterical people perceive information as impressions,
usually disregarding or vaguely remembering detailed information. The
hysteric’s focus of attention is diffuse and impressionistic. Hysterical people
typically respond quickly without much contemplation. Hysterical people
experience difficulties with concentration and are highly distractible. They
are highly impressionable, and are easily surprised. “But, for the hysterical
person, the hunch or the impression is the final, conscious cognitive product”
(Shapiro, 1965, p.114). Hysterics typically are deficient in knowledge due to a
lack of motivation to pursue intellectual material (Shapiro, 1965). Original
cognition is poorly defined due to its poverty of factual information and is
poorly coordinated with other information. This results in the diffusion of
memory. The passive, impressionistic, diffusely focused, and distractible style
of cognition exhibited by the hysteric contributes to the impairment of the
retrieval of information and facilitates repression.
Hysterical people
are overly subjective and generally view the world with a romantic, sentimental
attitude (Shapiro, 1965). Their impressionistic mode of cognition influences
them to construct idealized recollections of people and objects. They
experience the world as fantasy and generally display indifference but react
with surprise when reality actually occurs. Hysterical people display
exaggerated emotionality, displaying dramatic gestures and voices. They are
usually not aware of their ungenuine display of emotionality. Hysterical people
demonstrate quick shifts in emotions and are affectively disconnected. They
display outbursts of emotion but react with indifference when confronted about
these outbursts. They take little responsibility for their actions, and
generally disown their feelings. Despite the occurrence of these emotional
outbursts, “They are, in their regular behavior, usually quite mild-mannered”
(Shapiro, 1965, p.128). Shapiro (1965) attributes the hysteric’s quick shifts
of emotion and impressionistic cognitive style to their inadequate processing,
organizing, and integration of information. “This insufficiency of integrative
processes and development causes their affects to be explosive, abrupt, and
labile, on the one hand, and relatively undifferentiated, gross, and black or
white, on the other” (Shapiro, 1965, p.131). Hysterical people avoid and fear
meaningful emotions and cognitions. “Thus, the most sentimental hysteric will
often be inhibited in love and would not think of having a political conviction”
(Shapiro, 1965, p.133). Shapiro (1965) suggests that these people have an
unstable self-identity.
Impulsive Styles
Shapiro (1965)
conceptualizes the impulsive character as a heterogeneous population. This
population is comprised of psychopathic characters, passive-neurotics,
narcissistic characters, alcoholics, substance abusers, and certain kinds of
male homosexuals. Impulsive people typically have few interests, values, and
goals. They rarely become emotionally involved with others. Traditional
conceptualizations view impulsivity as a dysfunction in the mental apparatus,
whereas Shapiro (1965) views impulsivity as a style of functioning. Shapiro
(1965) describes two types of impulsive styles, the psychopathic character and
the passive character.
Impulsive people
experience their behaviors as not completely deliberate and unintentional
(Shapiro 1965). Their subjective experience of whims, impulses, and urges are
distortions of the normal experience of wanting. They perceive their impulsive
behavior as acceptable, disowning and externalizing responsibility, because of
its lack of deliberateness. The relative short time between impulsive thoughts
and behaviors intensifies this lack of deliberateness and interferes with the
development of anxiety. “This understanding suggests that the typical statement
of an irresistible impulse - “I don’t want to do it, but I just can’t control my
impulse” - may usually be translated as, “I don’t feel I ought to do it, and I
would shrink from doing it deliberately, but, if, quickly and while I am not
looking, my feet, my hands, or my impulses just do it, I can hardly be blamed”
(Shapiro, 1965, p.137). Many impulsive people typically explain to others that
a reflex-like response to an external stimuli or situation is responsible for
their behavior (Shapiro, 1965).
Deficiencies in
both the active organization of information and integrative mental functioning
are responsible for the experience of impulsivity observed in this population
(Shapiro, 1965). Shapiro (1965) suggests that the impulsive person’s behavior
is unplanned, contributing substantially to their deficiency in mental
function. They typically experiences a deficiency in the integration of an
impulse due to the impulse’s failure to accumulate affect (due to a lack of
affective structures) or additional support, subsequently impairing the
development of a normal want or desire. The impulse remains undeveloped,
unstable, and susceptible to being acted upon. A lack of internal structure
provides little resistance against impulses. The lack of deliberateness of
behavior that the impulsive person experiences is due to this deficiency.
Deficiencies in
integration are responsible for the impulsive person’s disinterest in external
objects that do not provide immediate gratification (Shapiro, 1965). Their
tolerance for frustration is low due to their need for immediate satisfaction.
“Hence, his interests also tend to be labile and erratic, shifting according to
the mood, personal requirements, or opportunities of the moment” (Shapiro, 1965,
p. 146). The impulsive’s primitive integrative process involves the
over-rehearsal of techniques aimed at the achievement of immediate
accomplishments and gratification (Shapiro, 1965). They are efficient in the
accomplishment of short-range goals but demonstrate severe impairment in the
performance of long-range goals (Shapiro 1965).
The impulsive
person demonstrates cognitive and affective impairment of mental functioning
(Shapiro, 1965). Shapiro (1965) describes the impulsive person’s mode of
cognition as concrete, focused solely on the present. He lacks the capacity to
contemplate the future.
Impulsive people exhibit
impaired concentration and have difficulty with long-term planning (Shapiro,
1965). Their capacity for abstraction and reflectiveness is also significantly
impaired, contributing to their lack of resistance to unstable impulses.
Deficits in the impulsive’s integrative process are responsible for the poor
judgment routinely demonstrated by this population (Shapiro, 1965). The
impulsive person perceives initial impressions, whims, and guesses as final.
They avoid the consideration of alternative possibilities despite often having
the information necessary for making informed decisions. “From the viewpoint
that such cognition provides, the world can only be seen as discontinuous and
inconstant - a series of opportunities, temptations, frustrations, sensuous
experiences, and fragmented impressions” (Shapiro, 1965, p.154).
Shapiro (1965)
emphasizes that the psychopathic character demonstrates deficiencies of
conscience and has a proclivity to lying and insincerity. Impulsive people lack
the capacity to develop moral values due to deficiencies in affective and
cognitive development. Emotional involvement, reflectiveness, and the capacity
to have long-range viewpoints are prerequisites for the development of
morality. The psychopaths awareness is fixated on immediate and concrete
accomplishments. Their emotional involvement is minimal. The egocentricity and
lack of self-critical examination displayed by the psychopathic character
provides an explanation for their deficiencies and lack of interest in
morality. Psychopathic individuals rarely experience doubt and worry, further
demonstrating the limitations of the development of a conscience. Shapiro
(1965) emphasizes that the psychopath cannot be expected to have a sense of
moral responsibility because they do not assume responsibility for their
actions.
Shapiro (1965)
suggests that the psychopath’s general mode of functioning contributes to their
routine display of insincerity. The insincerity and lying commonly observed by
the psychopath is directly connected to both their deficient moral values and
conscience. The psychopath functions exclusively for immediate gain and is
concerned only with situations that benefit him. He is proficient at achieving
short-range goals. Long-range behavior and planning ability are usually
unstable and impaired.
Passive and weak
impulsive character styles are commonly observed in alcoholics and substance
abusers (Shapiro, 1965). Impairment of deliberateness, intention, and affective
structure contributes to their subjective experience of being unable to resist
temptation. External pressures are overemphasized due to a lack of internal
guidance. Externalization of responsibility, due to an impairment of integrative
processes, contributes to their inability to resist temptation and pressures.
Passive-impulsive
people vaguely plan their future. Their perception of external pressures and
temptations combined with their vague style of planning predispose them to be
highly suggestible. The passive-impulsive is rarely cognizant of alternatives
and choices. Impulsive people typically report that they have no choice when
confronted with pressures and temptations. Shaprio (1965) emphasizes that
impulsive people generally have a loss of interest for resisting temptation and
do not want to help
themselves.
Sadism and Masochism
Sadists are
concerned with rank, obedience, discipline, authority, membership, and the
hierarchical structure of power (Shapiro, 1981). They exhibit respect for
superiors and subsequently loath the weak. Sadistic people typically choose
weak, suggestible, and powerless individuals to prey on. They derive pleasure
from the suffering of others. The sadist’s goal is to humiliate, degrade, assert
authority, and inflict suffering on his victim. The sadist is primarily
motivated by the experience of power and the achievement of complete control
over another person. The sadist becomes increasingly more authoritarian and
punitive towards their victim when their personal authority is diminished. The
sadist becomes more aware of rank during the experience of inferiority and
humiliation and subsequently punishes his subordinate with even greater
harshness.
Masochists derive
pleasure and eroticism from physical suffering, coercion, and humiliation
(Shapiro, 1981). Humiliations, defeats, and injustices are exaggerated.
Discomfort and suffering may be self-inflicted. Shapiro (1981) suggests that
masochists achieve both moral victories and superiority by exaggerating and
increasing the burdens placed upon them by their aggressors. Masochists
exaggerate their suffering to both themselves and others, hoping to evoke
sympathy and recognition. Their language and general presentation is theatrical
and artificial. Shapiro (1981) suggests that masochistic people obsessively
recall unrectified past suffering, assuming the role of the martyr, when a moral
victory has not been achieved. Their acceptance of these past situations
without moral victory is equated with admitting defeat.
Masochists
exaggerate, admit, and anticipate their perceived inadequacies (Shapiro, 1981).
They accentuate the superiority of others so that they can counteract and defeat
possible admonishment. “He defeats the humiliation of this inequality by his
exaggerated humility; he defeats insult by the prior admission of inadequacy; he
defeats rebuff by withdrawing any claims to acceptance” (Shapiro, 1981, p.116).
Shapiro (1981) suggests that the masochist exaggerates their inadequacies so
that they can present doubt to others about their own inequality. Masochists
exaggerate their inadequacies as a means of diminishing and protecting
themselves from the power of others, hoping to achieve a moral victory.
Shapiro (1981)
suggests that the sadist and masochist are similar and that these styles
typically exist within the same individual. The sadist and masochist are
motivated by a their perception of shame, inferiority, and humiliation. These
styles are both concerned with rank, position, superiority and inferiority.
Sadists perceive themselves as primarily superior whereas masochists view
themselves as mostly inferior. Despite their individual tendencies, sadism and
masochism usually inhabit their same person.
The sexual
attitudes of sadist and masochists are exceedingly detached. Sexual
relationships provide the sadist with the experience of power.
References
Shapiro, D.
(1962). Aspects of obsessive-compulsive style. Psychiatry, 25, 46-49.
Shapiro, D.
(1965). Neurotic styles. New York: Basic Books.
Shapiro, D.
(1970). Motivation and action in psychoanalytic psychiatry. Psychiatry, 33,
329-343.
Shapiro, D.
(1975). Dynamic and holistic ideas of neurosis and psychotherapy. Psychiatry,
38, (3), 218-226.
Shapiro, D.
(1981). Autonomy and rigid character. New York: Basic Books.
Shapiro, D.
(1985). Psychotherapy and subjective experience. Psychiatry, 48, (4),
311-317.
Shapiro, D.
(1989). Psychotherapy of neurotic character. New York: Basic Books.
Shapiro, D.
(1994). Paranoia from a characterological standpoint. Madison, CT:
International Universities Press.
Shapiro, D.
(1996). Character and psychotherapy. American Journal of Psychotherapy, 50,
(1), 3-13.
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