The Schizoid Patient - A Case Study

Notes of first therapy session with Mark, male, 36, diagnosed with Schizoid Personality Disorder

Mark sits where instructed, erect but listless. When I ask him how he feels about attending therapy, he shrugs and mumbles "OK, I guess". He rarely twitches or flexes his muscles or in any way deviates from the posture he has assumed early on. He reacts with invariable, almost robotic equanimity to the most intrusive queries on my part. He shows no feelings when we discuss his uneventful childhood, his parents ("of course I love them"), and sad and happy moments he recollects at my request.

Mark veers between being bored with our encounter and being annoyed by it. How would he describe his relationships with other people? He has none that he can think of. In whom does he confide? He eyes me quizzically: "confide?" Who are his friends? Does he have a girlfriend? No. He shares pressing problems with his mother and sister, he finally remembers. When was the last time he spoke to them? More than two years ago, he thinks.

He doesn't seem to feel uneasy when I probe into his sex life. He smiles: no, he is not a virgin. He has had sex once with a much older woman who lived across the hall in his apartment block. That was the only time, he found it boring. He prefers to compile computer programs and he makes nice money doing it. Is he a member of a team? He involuntarily recoils: no way! He is his own boss and likes to work alone. He needs his solitude to think and be creative.

That's precisely why he is here: his only client now insists that he collaborates with the IT department and he feels threatened by the new situation. Why? He ponders my question at length and then: "I have my working habits and my long-established routines. My productivity depends on strict adherence to these rules." Has he ever tried to work outside his self-made box? No, he hasn't and has no intention of even trying it: "If it works don't fix it and never argue with success."

If he is such a roaring success what is he doing on my proverbial couch? He acts indifferent to my barb but subtly counterattacks: "Thought I'd give it a try. Some people go to one type of witch doctor, I go to another."

Does he have any hobbies? Yes, he collects old sci-fi magazines and comics. What gives him pleasure? Work does, he is a workaholic. What about his collections? "They are distractions". But do they make him happy, does he look forward to the time he spends with them? He glowers at me, baffled: " I collect old magazines." - he explains patiently - "How are old magazines supposed to make me happy?".