Psychosis (pronounced sahy-koh-sis)
In psychiatry, a severe mental
disorder (sometimes with physical damage to the brain), more serious than
neurosis, characterized by disorganized thought processes, disorientation in
time and space, hallucinations, delusions and a disconnection from
reality. Paranoia, manic depression,
megalomania, and schizophrenia are all psychoses.
1847: From the New Latin & Late
Greek psȳ́chōsis,
the construct being psycho- + -osis, the source being the Ancient Greek ψύχωσις
(psúkhōsis) (animation, principle of
life), psych from the Ancient Greek ψυχή (psukhḗ or psykhē) (mind, life, soul).
The suffix –osis is from the Ancient Greek -ωσις (-ōsis) (state,
abnormal condition or action), from -όω (-óō)
(stem verbs) + -σις (-sis); -oses was the plural form and
corresponding adjectives are formed using –otic,
thus respectively producing psychoses and psychotic. The Ancient Greek psykhosis meant "a giving of life; animation; principle of
life". In English, the original
1847 construction meant "mental affection or derangement" while the
adjective psychotic (of or pertaining to psychosis) dates from 1889, coined
from psychosis, on the model of neurotic/neurosis and ultimately from the
Ancient Greek psykhē (understanding,
the mind (as the seat of thought), faculty of reason). The adverb was psychotically, the comparative
of which is more psychotically and the superlative most psychotically, both
occasionally useful.
Psychosis and the DSM
The word psychosis was a
mid-nineteenth century creation necessitated by early psychiatry’s separation
of psychiatric conditions from neurological disorders. Originally a generalized concept to refer to
psychiatric disorders, gradually it became one of the major classes of mental
illness, assumed to be the result of a disease process, and, more recently, to
a symptom present in many psychiatric disorders. During this evolution, the diagnostic
criteria shifted from the severity of the clinical manifestations and the
degree of impairment in social functioning to the presence of one or more
symptoms in a set of psychopathological symptoms. By the early twentieth century, the concept
of neurosis (which once embraced both the psychiatric and the neurological
disorders), became restricted to one major class of psychiatric disease whereas
psychosis (which once embraced all psychiatric disorders) became restricted to
the other.
The first consensus-based
classification with a description of diagnostic terms was in the first edition
of the Statistical Manual of Mental Disorders (DSM-I (1952)) in which mental
disorders were divided into two classes of illness: (1) organic disorders, caused
by or associated with impairment of brain tissue function; and (2) disorders of
psychogenic origin without clearly defined physical cause or structural changes
in the brain. When DSM-II was released
in 1968, the classifications were revised with mental disorders now classed as
(1) psychoses and (2) neuroses, personality disorders, and other non-psychotic
mental disorders. Psychosis was defined
as a mental disorder in which mental functioning is impaired to the degree that
it interferes with the patient's ability to meet the ordinary demands of life
and recognize reality.
Advances in both neurology and
psychiatry led to an extensive revision in DSM-III (1980). Radically, all traditional dichotomies
(organic versus functional, psychotic versus neurotic et al) were discarded
with psychiatric syndromes assigned to one of fifteen categories of
disease. At the labelling level, the
term psychotic was used to describe a patient at a given time, or a mental
disorder in which at some time during its course, all patients evaluate
incorrectly the accuracy of their perceptions and thoughts but the editors emphasized it should not be applied to patients suffering only minor
distortions of reality, regardless of how exactly they might fulfil the
clinical criteria. The revisions in
DSM-III-R (1987) extended only to slight changes in terminology.
Mirroring the changes in diagnostic
criteria published by the WHO, DSM-IV (1994) noted the diagnosis of psychosis
should no longer be based on the severity of the functional impairment but
rather on the presence of certain symptoms which included delusions,
hallucinations, disorganized speech and grossly disorganized or catatonic
behavior. This emphasis on psychoses
being spectrum conditions was continued in DSM-5 (2013) with schizoid
(personality) disorder and schizophrenia defining its mild and severe
ends. Additionally, a more precise
diagnostic framework was defined in which patients were assessed in terms both
of symptoms and duration of suffering.
Two examples of schizophrenia in
art.
The life of German artist August Natterer (1868-1938) began innocuously enough, studying engineering, travelling extensively, marrying and building a successful career as an electrician. However, in his thirties, he began to experience anxiety attacks and delusions and in 1907 suffered a hallucination in which thousands of images flashed before his eyes in little more than thirty minutes. So affected by the experience that he attempted suicide, he was admitted to an asylum and would spend the remaining quarter-century of his life in and out of institutes for the insane. In the literature, Natterer is referred to as Neter, a pseudonym used by his psychiatrist to protect patient and family from the social stigma then associated with mental illness. He described the 1907 hallucination as a vision of the Last Judgment which he described as:
"...10,000 images flashed by in
half an hour. I saw a white spot in the
clouds absolutely close – all the clouds paused – then the white spot departed
and stood all the time like a board in the sky. On the same board or the screen
or stage now images as quick as a flash followed each other, about 10,000 in
half an hour… God himself occurred, the witch, who created the world – in
between worldly visions: images of war, continents, memorials, castles,
beautiful castles, just the glory of the world – but all of this to see in
supernal images. They were at least twenty meters big, clear to observe, almost
without color like photographs… The images were epiphanies of the Last
Judgment. Christ couldn't fulfil the salvation because he was crucified
early... God revealed them to me to accomplish the salvation."
After his suicide attempt and
committal to the first of what would be several mental asylums, Natterer
thereafter maintained that he was the illegitimate child of Emperor Napoleon I
and "Redeemer of the World".
The vision inspired Natterer to a prolific production of drawings, all
documenting images and ideas seen in the vision, one especially interesting to
those studying psychosis and schizophrenia being My Eyes in the Time of Apparition (1913), two eyes bloodshot and
wide-open eyes staring from the page.
The irises of the eyes do not match.
Norwegian Edvard Munch (1863-1944)
was one of a number of artists modern psychiatrists have written of as having
both genetic and environmental predispositions to mental illness, schizophrenia
in particular; one of Munch’s sisters had schizophrenia, his father suffered
from depression, his mother and another sister dying from tuberculosis when he
was young. Munch though was a realist,
once telling an interviewer, “I cannot
get rid of my illnesses, for there is a lot in my art that exists only because
of them.”
His was a troubled life and in 1908,
following a psychotic break exacerbated by alcoholism, Munch was admitted to a
mental health clinic, later diagnosed with neurasthenia, a clinical condition now
known to be closely associated with hypochondria and hysteria. Adding to his problems, the Nazis labelled
Munch’s work as “degenerate art” and in 1937 confiscated many of his works but
their disapprobation had less of an influence on his painting than his schizophrenia,
his output continuing to feature figures obviously tortured by anguish and
despair. The apparently frantic strokes of
the brush and his seemingly chaotic pallet of colors have long intrigued both
critics and clinicians seeing insight into his state of mind, the idea being
his paintings provide something of a visual representation of how schizophrenia
might lead individuals to see the world.
Endlessly reproduced, the subject of numerous memes and the inspiration for many re-interpretations, The Scream is easily Munch’s most famous work and probably the most emblematic of what now is called “schizophrenic art”. For decades it has been the chosen artistic representation for what is regarded as the angst-ridden modern human condition and when discussing it, Munch once described walking with two friends when the sky suddenly turned blood red, causing him to “tremble with pain and angst”, and he felt he heard his “…scream passing endlessly through the world.”
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