Psychosis

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).

In clinical use there are many derived forms (with meanings more precise than is often the case when such words migrate to general use) including antipsychotic, micropsychotic, neuropsychotic, nonpsychotic, postpsychotic, prepsychotic, propsychotic, protopsychotic, quasipsychotic, semipsychotic & unpsychotic.  The useful portmanteau word sarchotic (the construct a blend of sarcastic +‎ psychotic) is used to describe a statement so distrubingly sarcastic it can't be certain if the remark is intended to be humerous or the person making it genuinely is psychotic and even then there are graduations for which the adverb is used, the comparative being "more psychotically" and the superlative "most psychotically".  Psychosis & psychoticism are nouns, psychotic is a noun & adjective and psychotically is an adverb; the noun plural is psychoses.

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 (DSM-I (1952)) of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) 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 (1968) was released, 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 etc) 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 art".

My Eyes in the Time of Apparition (1913) by August Natterer (1868-1938).

The life of German artist August Natterer 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 (Napoleon Bonaparte (1769–1821; leader of the French Republic 1799-1804 & Emperor of the French from 1804-1814 & 1815)) 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.

The Scream (1893), oil, tempera & paste on cardboard, by Edvard Munch (1863-1944), National Gallery of Norway.

Norwegian Edvard Munch 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.”  The idea of affliction as a source or artistic inspiration appears often in the literature of art, music and such and in that it's something of a parallel with those who produce their finest work while living under political oppression; unpleasant as that can be, reform can see careers suffer, famous dissidents abruptly left as "rebels without a cause" after the fall of the Soviet Union (1922-1991) and a generation of the UK's activists found grist for their mills less prolific after the Tory Party had Margaret Thatcher (1925–2013; UK prime-minister 1979-1990) walk the political plank.  Where one door closes however, another sometimes opens and in John Major (b 1943; UK prime-minister 1990-1997) the comedians found a rich vein of material.    

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 style “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.

Lindsay Lohan, following Edvard Munch, rendered by Vovsoft in comicbook style.

Endlessly reproduced, the subject of numerous memes and the inspiration for many re-interpretations, The Scream is Munch’s most famous work and the most emblematic of what now casually is called “schizophrenic art” (unfortunately often conflated with “art by schizophrenics”).  For decades it has been the chosen artistic representation for the angst-ridden modern human condition, the artist in 1890 noting in his diary a still vivid memory: “I was walking along the road with two friends—the sun went down—I felt a gust of melancholy—suddenly the sky turned a bloody red... I felt this big, infinite scream through nature.”  That entry was written some years after the sight and before painting The Scream in 1893 but the moment stayed with him because his vision of the sky caused him to “tremble with pain and angst” and he felt he heard his “…scream passing endlessly through the world.”  For historians those fragment of memory proved of interest and in his book Krakatoa:The Day the World Exploded (2003), detailing the 1883 eruption of the Indonesian volcano Krakatoa, Simon Winchester (b 1944) connected the “blood red” Norwegian sky with the fiery sunsets created by the ash from the explosion circulating the planet, high in the atmosphere.

Krakatoa: The Day the world exploded.

The idea of a link between the catastrophic geological event and the painting had long intrigued art historians who understood such a sight would have appeared “surreal”, decades before the surrealism movement became established and that it was a natural phenomenon is well-supported by theoretical modelling.  Between 20 May-21 October 1883, Krakatau, a volcanic island in the Sunda Strait, erupted, the “main event” happening on 27 August, during which over two-thirds of the island and its surrounding archipelago was destroyed, the remnants subsequently collapsing into a caldera (in volcanology, a large crater formed by collapse of the cone or edifice of a volcano).  The event created a large tsunami which, much diminished, reached the Atlantic and it’s believed that day’s third explosion was history’s loudest known sound.  What Edvard Munch is thought to have seen is the evening light of the sun being colored by the millions of tons of sulfur dioxide and volcanic dust blasted high into the atmosphere, circulating there for years including over Oslo when the artist was taking his walk.  Nor was he wholly wrong in suggesting “a scream passing” because such was energy generated by the explosion, the acoustic pressure wave circled the globe at least three times.