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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