Schizophrenia

Schizophrenia (pronounced skit-suh-free-nee-uh or skit-suh-freen-yuh)

(1) In psychiatry (also called dementia praecox), a severe mental disorder characterized by some, but not necessarily all, of the following features: withdrawal from reality, illogical patterns of thinking, delusions, and hallucinations, and varying degrees of other emotional, behavioral, or in emotional blunting, intellectual deterioration, social isolation, disorganized speech and behavior, delusions, and hallucinations.

(2) A state characterized by the coexistence of contradictory or incompatible elements; informal behavior that appears to be motivated by contradictory or conflicting principles.

(3) In informal use, used to suggest a split personality, identity or other specific forms of dualism.  In popular usage, the term is often confused with dissociative identity disorder (also known as multiple personality disorder).

1908: From German Schizophrenie, from the New Latin schizophrenia and Coined by Swiss psychiatrist Eugen Eugen Bleuler (1857-1939) as an umbrella term covering a range of more or less severe mental disorders involving a breakdown of the relation between thought, emotion, and action and literally "a splitting of the mind", the construct being the Ancient Greek σχίζω (skhizein or skhízō) (to split), from the primitive Indo-European root skei (to cut, split apart), + φρήν (phrḗn) (genitive phrenos) (mind, heart, diaphragm) + -ia (the suffix from the Latin -ia and Ancient Greek -ία (-ía) & -εια (-eia), which forms abstract nouns of feminine gender).  It's from phrḗn that English gained phrenes (wits, sanity) and hence phreno-.

The adjective schizophrenic (characteristic of or suffering from schizophrenia) dates in the medical literature from 1912 (in English translations of Bleuler's publications) and was immediately adopted also as a noun (schizophrenic patient).  That survived but another noun formation in English was schizophrene which emerged in 1925, the construct presumably a tribute to Dr Bleuler's original work having been written in German.  As such things became more publicized during the post-war years (and picked up in popular culture including film and novels), the transferred adjectival sense of "contradictory, inconsistent" emerged in the mid 1950s, applied to anything from the behavior of race horses and motor-cycles to the nature of mucical composition.  The jargon of psychology also produced schizophrenogenic (tending to spark or inspire schizophrenia).  The adjective schizoid (resembling schizophrenia; tending sometimes to less severe forms of schizophrenia) dates from 1925, from the 1921 German coining schizoid (1921), the construct being schiz(ophrenia) + -oid.  The suffix -oid was from a Latinized form of the the Ancient Greek -ειδής (-eidḗs) & -οειδής (-oeidḗs) (the “ο” being the last vowel of the stem to which the suffix is attached); from εἶδος (eîdos) (form, shape, likeness).  It was used (1) to demote resembling; having the likeness of (usually including the concept of not being the same despite the likeness, but counter-examples exist), (2) to mean of, pertaining to, or related to and (3) when added to nouns to create derogatory terms, typically referring to a particular ideology or group of people (by means of analogy to psychological classifications such as schizoid).  Schizophrenia is a noun, schizophrenic & schizoids are nouns & adjectives and schizophrenically is an adverb; the noun plural is schizophrenics.

Madness

Within the profession of psychiatry, schizophrenia has a long (and technical) definitional history although, in essence, it’s always been thought a severe and chronic mental disorder characterized by disturbances in thought, perception and behavior.  Lacking any physical or laboratory test, it can be difficult to diagnose as schizophrenia involves a range of cognitive, behavioral, and emotional symptoms.  In the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5 (2013)), the lifetime prevalence of schizophrenia is noted as 0.3%-0.7%, the psychotic manifestations typically emerging between the mid-teens and mid-thirties, with the peak age of onset of the first psychotic episode in the early to mid-twenties for males and late twenties for females.  The DSM-5 editors also made changes to the criteria to make a diagnosis of schizophrenia, the most significant amendments since DSM-III (1980).

Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought (1992), by US clinical psychologist Louis A Sass (b 1949), was an exploration of why mystery continues to shroud schizophrenia, which, despite advances in biological psychiatry and neuroscience, appears little changed in the quarter-century since.  Sass quoted approvingly a description of schizophrenia as "a condition of obscure origins and no established etiology, pathogenesis and pathology…" without "…even any clear disease marker or laboratory test by which it can readily be identified."

However, in a departure from most writings on mental illness, Sass explored the "striking similarities" between the seemingly bizarre universe of schizophrenic experiences and the sensibilities and structures of consciousness revealed in the works of modernist artists and writers such as Kafka, Valery, Beckett, Robbe-Grillet, de Chirico and Dali.  Applying the techniques of psychology to modernism, he traced similar cognitive configurations reflected in schizophrenia and modern art & literature, finding both artist and schizophrenic characterized by a pronounced thrust to deconstruct the world and subjectively to reconstruct human experience without reference to objective reality.  Layers of reality, real and constructed, co-exist and interact, frequently fusing into each-other, producing an acute self-awareness Sass called "hyperreflexivity", as well as a profound sense of alienation from the empirical world.  Sass allowed his analysis to reach its logical conclusion, that there is a tenuous, though clearly discernible, connection between modern culture and madness, speculating that insanity might be “…a disease of certain highly advanced forms of cultural organization, perhaps a part of the price we pay for civilization?"  His thesis wasn’t without critics although most acknowledged Madness and Modernism was a literary classic.

Duncan's Ritual Of Freemasonry (2021 edition) by Malcolm C Duncan, Lushena Books, 288 pp, ISBN-10-1631829904.

As the DSM makes clear, not all schizophrenics are the same.  In 2011, Lindsay Lohan was granted a two-year restraining order against alleged stalker David Cocordan.  The order was issued some days after she filed complaint with police who, after investigation by their Threat Management Department, advised the court Mr Cocordan (who at the time had been using at least five aliases) “suffered from schizophrenia”, was “off his medication” and had a "significant psychiatric history of acting on his delusional beliefs.”  That was worrying enough but Ms Lohan may have revealed her real concerns in an earlier post on twitter in which she included a picture of David Cocordan, claiming he was "the freemason stalker that has been threatening to kill me- while he is TRESPASSING!"  Being stalked by a schizophrenic is bad enough but the thought of being hunted by a schizophrenic Freemason is truly frightening.  Apparently an unexplored matter in the annals of psychiatry, it seems the question of just how schizophrenia might particularly manifest in Freemasons awaits research so there may be a PhD there for someone.  

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).  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.

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

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.

The Scream (1893) by Edvard Munch.

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.

Lindsay Lohan in a theme of blue, following Edvard Munch.

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.”

Anhedonia

Anhedonia (pronounced an-hee-doh-nee-uh)

In psychiatry, the lack of desire for or the capacity to experience pleasure.

1896: From the French anhédonie (an inability to feel pleasure (and an antonym of analgesia)), the construct being the Ancient Greek ἀν (an) (in grammar, the privative prefix, indicating negation or absence) + ἡδονή (hēdonḗ) (pleasure) + -ia (the abstract noun ending).  Hēdonḗ’s better known gift to the language was hedonist (one who seeks pleasure).  The an- prefix was an alternative form of on-, from the Middle English an-, from the Old English an- & on- (on-), from the Proto-Germanic ana- (on).   It was used to create words having the sense opposite to the word (or stem) to which the prefix is attached; it was used with stems beginning either with vowels or "h".  The word was coined in either 1896 or 1987 by French psychologist Professor Théodule-Armand Ribot (1839-1916).  Anhedonia is a noun and anhedonic is an adjective; the noun plural is anhedonias.  Unexpectedly, given the profession's propensity to intricate categorization, anhedonism seems not to exist.

Lindsay Lohan and her lawyer in court, Los Angeles, December 2011.

The term anhedonia encompasses a range symptoms related to a reduction in desire for or ability to experience pleasure.  It is a generalized condition which is diagnosed only in those where the experience is universal and does not apply to those with aversion to specific activities, this something (usually) considered healthy and not unusual.  The original model in clinical psychiatry was limited to an inability to experience pleasure but this was later extended to a reduction in motivation even to seek experiences which most would find pleasurable.  The fifth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR (2022)) defines anhedonia as a “lack of enjoyment from, engagement in, or energy for life’s experiences; deficits in the capacity to feel pleasure and take interest in things”.  In modern practice, clinicians distinguish between anticipatory and consummatory anhedonia.  Anticipatory pleasure involves the prediction of pleasure from future reward and the experience of pleasure associated with a positive prediction while consummatory pleasure involves the reward that is the actual moment of experience.  Thus, anticipatory anhedonia is reflects an inability to predict the future experience of pleasure as well as lower motivation to take action toward achieving pleasure and consummatory anhedonia is the lack of pleasure in what’s experienced (ie synonymous with the original definition of anhedonia).

Specific instances usually are not of necessity anhedonic (although an inability to derive any enjoyment from listening to country & western music seems indicative of little more than good taste).  The exception to this seems to be the range of activities clinicians have on their “suspect categories” list including things like sex and human friendship and this view may reflect the long shadow Sigmund Freud (1856-1939) has cast over the profession.  Although in both Western theology and philosophy there's a discernible tradition of what verges on an insistence that humans are social creatures and that interaction with others should be both sought and enjoyed, Freud raised the bar by suggesting every form of sexual behavior among humans was "natural" (though some might be neither lawful or desirable) except the absence of such interest.       

Anhedonia accompanies a range of neuropsychiatric conditions and is frequently associated with depression although it’s not an essential component.  Clinically, anhedonia needs to be suffered as a generalised condition, not as the common phenomenon of losing interest in something specific, something a normal part of the human condition.  There are no specific treatments for anhedonia and there are some dissident psychiatrists and psychologists who suggest this is a tacit admission it may be a normal part of the spectrum of human behaviour.  It is commonly treated alongside the condition of which it’s a part including depression, bipolar disorder (the old manic depression), schizophrenia, post-traumatic stress disorder (PTSD) and the various anxiety disorders.  This association with schizophrenia is striking, the medical orthodoxy being that up to 80% of those with schizophrenia may experience anhedonia and because it’s classified as a negative symptom (indicative of the absence of something that occurs in most healthy individuals), it’s considered more difficult to treat.

Rorschach

Rorschach (pronounced raw-shack)

(1) A canton and town in Switzerland.

(2) A personality test using ink-blots

1927: The ink-blot based personality analysis was first published in codified form in 1927, the genesis of which was a 1921 paper by Swiss psychiatrist Hermann Rorschach (1885-1922).  Rorschach (Wahlkreis) is a constituency of the canton of Saint Gallen, Switzerland and Rorschach is its largest town.  The town lies on the Swiss side of Lake Constance, the construct of the name an early form of the German Röhr (reeds) + Schachen (lakeside).

The Rorschach test was for some time a standard clinical diagnostic tool in psychology & psychiatry.  It was a collection of ten “ink blots”, five rendered in grey scale, two in grey & red and three in color, all printed on separate cards and presented to the subjects who were asked (1) What might this mean? & (2) What parts of the card made you say that?  The usual protocol was to provide a pencil and have the subject write their responses in the space underneath the image although, depending on the circumstances, a clinician might engage with the subject and obtain more of their thoughts or the tests could immediately be taken for analysis.  Fond of jargon, the profession even took the opportunity to coin a word to describe specific responses, a subject thought to be especially demonstrative in their response to a Rorschach ink blot said to be exhibiting "extratensive" tendencies.  As an adjective it was thus a synonym of "extroverted" and is occasionally seen outside of psychology where it probably adds little but confusion.  It served also as a noun, the relevant subjects being labelled "extratensives".

Lindsay Lohan in Rorschach Ink-Blot Test inspired gold beaded cocktail dress at the Source Code premiere, Crosby Street Hotel, New York City, March 2011.  The dress was paired with black patent ankle strap platform pumps shoes and matching opaque tights.

The idea of using indeterminate and ambiguous shapes as a way of assessing an individual's personality had been around for centuries before Dr Rorschach began his research and in the nineteenth century there were even popular parlor games which used the idea although they were designed to amuse rather than analyze.  What made Dr Rorschach’s work different was the sheer quantity of the data with with he worked, his research encompassing some 300 patients in mental institutions (with a control group of 100 “normal” subjects) to whom to he exposed over 400 ink-blots before selecting the ten which had proved to be of the greatest diagnostic utility.  Although the method was not greatly different from the games, the Rorschach test was genuinely scientific in its design and the systematic approach linking impressionistic responses to ambiguous shapes, this producing evidence of certain tendencies.  Within the still embryonic psychiatric profession, his approach was thought novel and initially received little support.  His book (a 174-page monograph Psychodiagnostik (Psychodiagnostics)), when eventually published in 1921 contained the structure of the ink-blot tests and the results of the 300 patient survey yet it attracted more interest from intrigued literary reviewers than the medical journals and he died little more than a year after its release.  Even the appearance of reviews in the odd literary magazine however did little to stimulate appeal because the book was very much a work by a scientist for other scientists and Dr Rorschach had made no attempt to make his findings accessible to a general audience.  It wasn’t until the work was republished and others began to refine the methodology that others saw potential, especially after professional mathematicians added rigor to the statistical models used to generate the scores from which conclusions were drawn.

However, those who inherited the work also shifted the goal posts.  While Dr Rorschach had always intended the ink-blots to be only a helpful tool in the diagnosis of schizophrenia, such was the expansion of the profession in the inter-war years that many became interested and, by 1938, the test had been adapted and was being promoted as a kind of “personality testing kit”.  It was quite a departure from Dr Rorschach’s original vision which had been designed deliberately to maintain some ambiguity in the images, his belief that the diagnosis of schizophrenia lay in the margins between the possible responses whereas when used as a personality testing tool, the answers took on the character of a parameter which, when collectively assessed with the provided statistical tool, placed patients in categories.

The Rorschach cards

The test in that form proved highly successful, its proliferation assisted by the demands of wartime and the military’s need for psychological testing, the Rorschach kit easily produced, more popular with subjects than many other methods and, as a piece of mathematics, able easily to be collated into the big data sets electronic machines were beginning to make possible.  It had that those qualities the military so adore: Speed, standardization and simplicity.  It was therefore by the mid 1940s a standard part of psychological testing, used in everything from job applications to assessing an inmate’s eligibility for parole so it was perhaps inevitable it would be applied to the defendants in the Nuremberg trial (1945-1946).  Even before the International Military Tribunal (IMT; which would conduct the trial) assembled, the authorities in charge of the Nazis in custody insisted on psychiatrists and psychologists being available as soon as the prisoners had been assembled.  There were a number of reasons for this, notably that they wanted to ensure the prisoners had the support necessary to dissuade them from attempting suicide and there was the need also to ensure all were mentally competent to stand trial.  Additionally, there was genuine curiosity about the Nazis because never had there been such an opportunity to subject to tests two-dozen odd who were responsible for what was becoming clear were the greatest crimes in history.  The question then, as now was: Are “normal ordinary people” able to be drawn to commit evil acts or are some people evil.

The Rorschach tests were of course only one of the tools the clinicians assigned to Nuremberg used and the conclusion drawn was that all defendants were sane in the sense they were legally sane and thus mentally competent to stand trial even if they were depressed psychopaths (that seemed to be the most common phrase).  Quite what part the tests played in this isn’t clear but the test results themselves assumed a life independent of the trial because of a dispute between the two clinicians most involved in the testing and it wasn’t until the 1990s they were (almost) all published.  This psychological time capsule proved irresistibly tempting for one of the US’s foremost Rorschach experts who over the years had assembled records which could be used as an extraordinarily diverse control group which included (in the hundreds) medical students, Unitarian ministers, psychology students, criminals, business executives and random patients from private practice.  From this were selected the clerics and psychiatric outpatients, the purpose of a comparison with the Nuremberg Nazis being a critique of a recently published analysis of the test results which had concluded the defendants (as individuals and a representatives of the whole Nazi hierarchy) were “cursed beyond redemption” and thus profoundly of “the other”.  Their work was not entirely conventional by accepted scientific standards and they tacitly acknowledged some of the long acknowledged limitations of the test but never wavered from their finding “…the Nazis were not psychologically normal or healthy individuals”.

Defendants in the dock, Palace of Justice, Nuremberg, 1945-1946.

That was as controversial a view in the 1990s as it had been fifty years earlier and if a blind test could not distinguish of the Nazi’s data from the two control groups, at least some doubt would be cast.  Accordingly, ten Rorschach experts were assembled and asked to assemble them into three groups.  All that did was identify the high, medium and low-functioning of each group but there was nothing in them which separated the Nazis.  That was interesting but what was probably definitive was that even when told the nature of the data, the experts were unable to discern any difference between the responses which would enable the Nazis to be identified.  Perhaps sadly, the Nazis may have been as ordinary as they appeared in the dock, the implication being we're all capable of evil, given the right temptation, a nod to an earlier memorable phrase spoken of them: "The banality of evil".  

As that might indicate, like many tests in psychology, the Rorschach is probably useful if its limitations are recognized and the interpretations thought valid decades ago are no longer treated as proven science.  For example there may be something which can be deduced from a subject assessing the whole image in their response which is different for one who picks just a section or who finds something different in different parts but whether there’s anything substantive in the difference between seeing moth and a butterfly may be dubious.  The test is still widely used although many have abandoned it though it’s famously a cult in Japan where it’s one of the profession’s standard tools.  Elsewhere use is mixed.  Interestingly, while the fourth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV (1994) did not endorse or recommend the use of any particular projective test, it did note many were used in clinical practice but cautioned that the validity and reliability of these tests had not been firmly established, urging caution.  Neither the DSM-5 (2013) nor DSM-5-TR (2022) make any reference to the Rorschach test.

Zoanthropy

Zoanthropy (pronounced zoh-an-thruh-pee)

In clinical psychiatry, a mental disorder; a delusion in which the patient believes themselves transformed into one of the lower animals; historically treated as a form of insanity in which one imagines themselves to be another type of beast.

1845: From the French zoanthrope (one who suffers from zoanthropy) or directly from the Modern Latin zoanthropia, the construct being zo-, from the Ancient Greek ζῷο (zôion) (animal, beast), from the Proto-Hellenic ďṓyyon, from the Pre-Hellenic gwyōwyon, from the primitive Indo-European gwyeh₃w-y-om, from gwei (to live) + anthrōpos (man); the use in English can thus be analyzed as zo(o)- + -anthropy.  The Greek ζώο (the plural ζώα)) translated literally as “animal, beast, creature” but among citizens was used as an insult to label someone was “a brute; stupid”.  In modern zoological use, it’s used to refer to mammals.  Zoanthropy is a noun and zoanthropic is an adjective; the nous plural is zoanthropies.

The modern terms (covering all animal-delusions and apparently extending to alien life-forms) are Species Identity Disorder & Species Dysphoria, sub-sets of the category Dissociative Identity Disorder (DID) while the historic companion terms of Zoanthropy were Lycanthropy & Boanthropy.  Lycanthropy was from the Ancient Greek λυκανθρωπία (lukanthrōpía), from λυκάνθρωπος (lukánthrōpos) and in the mythology of Antiquity it described the state of being a lycanthrope (or werewolf), one who could shape-shift between being human and wolf, something often claimed to happen involuntarily during a full moon; werewolfdom has for centuries been a staple of writers of things supernatural.  In mythology, by extension, the word was used also to describe those able to shape-shift between the form of a human being and an animal, whether or not a wolf.  In modern psychiatry, it’s sometimes used to refer to the delusion in which one believes oneself to be a wolf or other wild animal.  Boanthropy is the delusion one is an ox or cow, the word derived from bovine, from the Late Latin bovīnus (relating to cattle), from the Classical Latin bōs (ox).  The terms Species Identity Disorder & Species Dysphoria are useful for clinicians who no longer have to deal with the proliferation of species-specific labels for the syndrome including Cynanthropy (dogs) & Ophidianthropy (snakes).  Presumably, while there might be behavioral variations between patients (one believing themselves to be a horse should move differently to one thinking they’re a frog), the treatment regimes will little differ so the names are really of more interest to word nerds than clinicians who have recorded, inter-alia, instances of delusional bees, cats, foxes & chickens.           

Reviews of the literature suggest Zoanthropy is a rare delusion.  There are countless folk who identify with animals and regard them as their spirit being (charismatic creatures like dolphins, eagles and the big cats being popular choices) but a zoanthrope actually believes themselves to be an animal, at least on occasions.  In the last two-hundred odd years, it seems there have been only a few dozen documented cases, three-quarters of whom also suffered some other mental disorders including schizophrenia, psychotic depression & bipolar disorder (the old manic-depression).  Patients suffered both permanent and transitory afflictions which could last only minutes or endure for decades.

Zoanthropic NFT: Lindsay Lohan's Furry canine (some suggested it was wolf-like) was rendered in dolichocephalic form.  The Lohanic fursona was first mentioned in September 2021 but not minted until October.

The fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5 (2013)) noted (1) it was an inherently psychotic delusion because human metamorphosis into an animal is not possible (as opposed to other delusions which may seem bizarre but which are physically possible) and it seemed overwhelmingly to be associated with instances of monomania (excessive interest or concentration on a singular object or subject; a pathological obsession with one person, thing or idea; an excessive interest with a single subject).  Monomania (the plural monomanias or monomaniæ) was from the French monomanie or the Modern Latin monomania, the construct being mono-, from the Ancient Greek μόνος (mónos) (alone, only, sole, single) +‎ mania.  The suffix –mania was from the Latin mania, from the Ancient Greek μανία (mania) (madness).  In modern use in psychiatry it is used to describe a state of abnormally elevated or irritable mood, arousal, and/or energy levels and as a suffix appended as required.  In general use, under the influence of the historic meaning (violent derangement of mind; madness; insanity), it’s applied to describe any “excessive or unreasonable desire; a passion or fanaticism” which can be used even of unthreatening behaviors such as “a mania for flower arranging, basket weaving et al”.  As a suffix, it’s often appended with the interfix -o- make pronunciation more natural.

Bizarre delusions have traditionally been associated with conditions such as Schizophrenia but the DSM-5 cast a wider net, noting with interest the frequency with which the metaphorical and symbolic language of biblical and other religious texts were mentioned by patients, especially in the specific type of zoanthropy known as boanthropy, the delusion which causes a patient to believe themselves to be a bovine, the fate of Nebuchadnezzar II of Babylon.  According to the Biblical prophet Daniel, Nebuchadnezzar was punished by God and lost his sanity for a period of 7 years:

“Immediately the word concerning Nebuchadnezzar was fulfilled; and he was driven away from mankind and began eating grass like cattle, and his body was drenched with the dew of heaven until his hair had grown like eagles’ feathers and his nails like birds’ claws.” (Daniel 4:33)

There has had been speculation Nebuchadnezzar’s behavior may have been a manifestation of clinical Lycanthropy (the delusion of being a wolf) and the Bible makes 13 references to wolves, usually as metaphors for greed and destructiveness although what’s in scripture appears to be more consistent with Boanthropy and that would more align with the agricultural and historical contexts, cattle more common than wolves in the religious motifs and presumably also more numerous in ancient Babylon.

There are variations on the syndrome.  One man in Japan spent a reputed ¥2 million (US$13,500) on a bespoke dog costume to fulfill his desire to “become an animal”.  Known only as Toco, he has a YouTube channel (with some 56,000 subscribers and 3 million views) with footage of him being taken for a walk in a park, rolling on the ground, playing fetch and sniffing other dogs.  He also does a little twerking which will probably disturb as many as it delights.  Toco said he felt some nervousness before his first venture outside but that he’d since become more confident because of the warmth shown to him by people and, interestingly, (some) other dogs.  He added that he enjoys “doing things that only dogs do” without expanding on the comment.  There are practical difficulties Toco has faced including care of the costume which the specialist supplier Zeppet (best-known among film directors for creating sculptures and models for film, television commercials) took some weeks to fabricate before delivery in 2022.  Styled to look like a collie because that was his favorite breed, when outside he wears sandals to protect the feet from wear and stop the “fur” from getting too dirty.  Better to render his experience as a canine more “dog-like”, in February 2023, he acquired a cage and rather than wandering the house at night, Toco is locked in the cage although apparently not on a leash.  Had a leash been used however, that probably wouldn't have been thought an aspect of another syndrome because it was being used only in the context of "dogginess" rather than anything BDSM related.

Dog san: Part of an “interview” by German TV station RTL, 2022.

Predictably, his lifestyle choice has attracted both supporters and detractors but it appears not to be a case of zooanthropy (specifically Cynanthropy) because Toco describes his behavior as “play-acting like a collie”.  He those doesn’t believe himself to be a dog; he just enjoys appearing as one and interacting with others (people and dogs) on that basis, adding it was his “hobby”, one which “makes me happy and other people happy, too.” And what he does is notably less invasive than those who have undergone plastic surgery to give them the characteristic features of various creatures.  In an interview, Toco revealed he had been “dreaming of transforming into a dog since he was a child” so the interesting question is whether he should be considered a harmless eccentric or someone with some form of Dissociative Identity Disorder though clearly not classical zoanthropy.

Non-zoanthropic role-playing.  One astronaut took a gorilla-suit to the ISS (International Space Station).

Autophagia

Autophagia (pronounced aw-tuh-fey-juh or aw-tuh-fey-jee-uh)

(1) In cytology, the process of self-digestion by a cell through the action of enzymes originating within the same cell (the controlled digestion of damaged organelles within a cell which is often a defensive and/or self-preservation measure and associated with the maintenance of bodily nutrition by the metabolic breakdown of some bodily tissues).

(2) In cytology, a type of programmed cell death accomplished through self-digestion (known also as apoptosis and associated with the maintenance of bodily nutrition by the metabolic breakdown of some bodily tissues).

(3) In psychiatry, self-consumption; the act of eating oneself.

The construct was auto- + -phagia.  The auto-prefix was a learned borrowing from Ancient Greek αὐτο- (auto-) (self-) (reflexive, regarding or to oneself (and most familiar in forms like autobiography)), from αὐτός (autós) (himself/herself/oneself), from either a construct of (1) the primitive Indo-European hew (again) + to- (that) or (2) the Ancient Greek reflexes of those words, αὖ (aû) (back, again, other) +‎ τόν (tón) (the) and related to Phrygian αυτος (autos), the existence of alternatives suggesting there may have been a common innovation.  Phagia was from the Ancient Greek -φαγία (-phagía) (and related to -φαγος (-phagos) (eater)), the suffix corresponding to φαγεῖν (phageîn) (to eat), the infinitive of ἔφαγον (éphagon) (I eat), which serves as aorist (A verb paradigm found in certain languages, usually an unmarked form or one that expresses the perfective or aorist aspect) for the defective verb ἐσθίω (esthíō) (I eat).  The alternative spelling is autophagal and the synonyms (sometimes used in non-specialist contexts) are self-consumption & auto-cannibalism.  Autophagia, autophagophore, autophagosome & autophagy are nouns, autophagically is an adverb, autophagocytotic is an adjective and autophagic is an adjective (and a non-standard noun); the noun plural is autophagies.

In cytology (in biology, the study of cells), autophagy is one aspect of evolutionary development, a self-preservation and life-extending mechanism in which damaged or dysfunctional parts of a cell are removed and used for cellular repair.  Internally, it’s thus beneficial, the removal or recycling of debris both efficient and (by this stage of evolutionary development) essential, most obviously because it removes toxins and “effectively “creates” younger cells from the old; it can thus be thought an anti-aging mechanism.  It something which has also interested cancer researchers because all cancers (as the word and the parameters of the disease(s) are defined) start from some sort of cell-defect and the speculation is it might be possible to in some way adapt the autophagic process, re-purposing it to identify and remove suspect cells.

In psychiatry, autophagia refers to the act of eating oneself which is sometimes described as self-consumption or the even more evocative auto-cannibalism.  Perhaps surprisingly, the behavior is not explicitly mentioned in the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) which of course means there are no published diagnostic criteria nor recommendations for treatments.  The DSM’s editors note there are a number of reasons why a specific behavior may not be included in the manual notably (1) the lack of substantial empirical evidence or research, (2) the rarity of cases and (3) the material to hand being unsuitable (in terms of volume or quality) for the development of practical tools for clinicians to diagnose and treat a disorders.

It would be flippant to suggest autophagia might have been included when the revisions in the fifth edition of the DSM (DSM-5 (2013)) included a more systematic approach taken to eating disorders and as well as variable definitional criteria being defined for the range of behaviours within that general rubric, just about every other form of “unusual” consumption was listed including sharp objects (acuphagia), purified starch (amylophagia), burnt matches (cautopyreiophagia), dust (coniophagia), feces (coprophagia), sick (emetophagia), raw potatoes (geomelophagia), soil, clay or chalk (geophagia), glass (hyalophagia), stones (lithophagia), metal (metallophagia), musus (mucophagia), ice (pagophagia), lead (plumbophagia), hair, wool, and other fibres (trichophagia), urine (urophagia), blood (hematophagia (sometimes called vampirism)) and wood or derivates such as paper & cardboard (xylophagia).  The DSM-5 also codified the criteria for behaviour to be classified pica (a disorder characterized by craving and appetite for non-edible substances, such as ice, clay, chalk, dirt, or sand and named for the jay or magpie (pīca in Latin), based on the idea the birds will eat almost anything): they must (1) last beyond one (1) month beyond an age in infancy when eating such objects is not unusual, (2) not be culturally sanctioned practice and (3), in quantity or consequence, be of sufficient severity to demand clinical intervention.  However, pica encompassed only “non-nutritive substances” which of course one’s own body parts are not.

Finger food: Severed fingers are a popular menu item for Halloween parties; kids think they're great.  For those who like detail, those emulating nail polish seem to be following Dior shades 742 (top right) and 999 (bottom right). 

In the profession, autophagia seems to be regarded not as a progression from those who eat their fingernails or hair but something with more in common with the cutters.  Cutters are the best known example of self-harmers, the diagnosis of which is described in DSM as non-suicidal self-injury (NSSI).  NSSI is defined as the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned; it includes behaviors such as cutting, burning, biting and scratching skin.  Behaviorally, it’s highly clustered with instances especially prevalent during adolescence and the majority of cases being female although there is some evidence the instances among males may be under-reported.  It’s a behavior which has long interested and perplexed the profession because as something which involves deliberate and intentional injury to body tissue in the absence of suicidal intent (1) it runs counter to the fundamental human instinct to avoid injury and (2) as defined the injuries are never sufficiently serious to risk death, a well-understood reason for self-harm.  Historically, such behaviors tended to be viewed as self-mutilation and were thought a form of attenuated suicide but in recent decades more attention has been devoted to the syndrome, beginning in the 1980s at a time when self-harm was regarded as a symptom of borderline personality disorder (BPD) (personality disorders first entered DSM when DSM-III was published in 1980), distinguished by suicidal behavior, gestures, threats or acts of self-mutilation.  Clinicians however advanced the argument the condition should be thought a separate syndrome (deliberate self-harm syndrome (DSHS)), based on case studies which identified (1) a patient’s inability to resist the impulse to injure themselves, (2) a raised sense of tension prior to the act and (3) an experience of release or at least partial relief after the act.  That a small number of patients were noted as repeatedly self-harming was noted and it was suggested that a diagnosis called repetitive self-mutilation syndrome (RSMS) should be added to the DSM.  Important points associated with RSMS were (1) an absence of conscious suicidal intent, (2) the patient’s perpetually negative affective/cognitive which was (temporarily) relieved only after an act of self-harm and (3) a preoccupation with and repetitiveness of the behavior.  Accordingly, NSSI Disorder was added to the DSM-5 (2013) and noted as a condition in need of further study.

However, although there would seem some relationship to cutting, it’s obviously a different behavior to eat one’s body parts and the feeling seems to be that autophagia involves a quest for pain and that suggests some overlap with other conditions and it certainly belongs in the sub category of self-injurious behavior (SIB).  The literature is said to be sparse and the analysis seems not to have been extensive but the behavior has been noted in those diagnosed with a variety of conditions including personality disorders, anxiety disorders, obsessive compulsive disorder, schizophrenia and bipolar disorder.  The last two have been of particular interest because the act of biting off and eating some body part (most typically fingers) has been associated with the experience of hallucinations and patients have been recorded as saying the pain of the injury “makes the voices stop”.  Importantly, autophagia has a threshold and while in some senses can be thought a spectrum condition (in terms of frequency & severity), behaviors such as biting (and even consuming) the loose skin on the lips (morsicatio buccarum) or the ragged edges of skin which manifest after nail biting (onychophagia) are common and few proceed to autophagia and clinicians note neurological reasons may also be involved.    

Lindsay Lohan with bread on the syndicated Rachael Ray Show, April 2019.

Autophagia and related words should not be confused with the adjective artophagous (bread-eating).  The construct was the Artos +‎ -phagous.  Artos was from the Ancient Greek ἄρτος (ártos) (bread), of pre-Greek origin.  Phagous was from the Latin -phagus, from the Ancient Greek -φάγος (-phágos) (eating) from φαγεῖν (phageîn) (to eat).  Apparently, in the writings of the more self-consciously erudite, the word artophagous, which enjoyed some currency in the nineteenth century, was still in occasional use as late as the 1920s but most lexicographers now either ignore it or list it as archaic or obsolete.  It’s an example of a word which has effectively been driven extinct even though the practice it describes (the eating of bread) remains as widespread and popular as ever.  Linguistically, this is not uncommon in English and is analogous with the famous remark by Sheikh Ahmed Zaki Yamani (1930–2021; Saudi Arabian Minister of Petroleum and Mineral Resources 1962-1986): “The Stone Age came to an end not for a lack of stones, and the Oil Age will end, but not for a lack of oil” (the first part of that paraphrased usually as the punchier “the Stone Age did not end because the world ran out of rocks”).

Mania

Mania (pronounced mey-nee-uh or meyn-yuh)

(1) Excessive excitement or enthusiasm; craze; excessive or unreasonable desire; insane passion affecting one or many people; fanaticism.

(2) In psychiatry, the condition manic disorder; a combining form of mania (megalomania); extended to mean “enthusiasm, often of an extreme and transient nature,” for that specified by the initial element; characterized by great excitement and occasionally violent behavior; violent derangement of mind; madness; insanity.

(3) In mythology, the consort of Mantus, Etruscan god of the dead and ruler of the underworld.  Perhaps identified with the tenebrous Mater Larum, she should not be confused with the Greek Maniae, goddess of the dead; In Greek mythology Mania was the personification of insanity.

(4) In popular use, any behavior, practice, cultural phenomenon, product etc enjoying a sudden popularity.

1350–1400: From the Middle English mania (madness), from the Latin mania (insanity, madness), from the Ancient Greek μανία (manía) (madness, frenzy; enthusiasm, inspired frenzy; mad passion, fury), from μαίνομαι (maínomai) (I am mad) +‎ -ῐ́ᾱ (-íā).  The –ia suffix was from the Latin -ia and the Ancient Greek -ία (-ía) & -εια (-eia), which form abstract nouns of feminine gender.  It was used when names of countries, diseases, species etc and occasionally collections of stuff.  The Ancient Greek mainesthai (to rage, go mad), mantis (seer) and menos (passion, spirit), were all of uncertain origin but probably related to the primitive Indo-European mnyo-, a suffixed form of the root men- (to think)," with derivatives referring to qualities and states of maenad (mind) or thought.

The sense of a "fad, craze, enthusiasm resembling mania, eager or uncontrollable desire" dates from the 1680s, the use in English in this sense borrowed from the French manie.  In Middle English, mania had sometimes been nativized as manye. The familiar modern use as the second element in compounds expressing particular types of madness emerged in the 1500s (bibliomania 1734, nymphomania, 1775; kleptomania, 1830; narcomania 1887, megalomania, 1890), the origin of this being Medical Latin, in imitation of the Greek, which had a few such compounds (although, despite popular opinion, most were actually post-classical: gynaikomania (women), hippomania (horses) etc).

The adjective maniac was from circa 1600 in the sense of "affected with mania, raving with madness" and was from the fourteenth century French maniaque, from the Late Latin maniacus, from the Ancient Greek maniakos, the Adoption in English another borrowing from French use; from 1727 it came also to mean "pertaining to mania." The noun, "one who is affected with mania, a madman" was noted from 1763, derived from the adjective.  The adjective manic (pertaining to or affected with mania), dates from 1902, the same year the clinical term “manic depressive” appeared in the literature although, perhaps strangely, the condition “manic depression” wasn’t describe until the following year although the symptoms had as early as 1857 been noted as defined as “circular insanity”, from the from French folie circulaire (1854).  It’s now known as bi-polar disorder.  The constructions hypermania & submania are both from the mid-twentieth century.  The adjective maniacal was from the 1670s, firstly in the sense of "affected with mania" and by 1701 "pertaining to or characteristic of a maniac; the form maniacally emerged during the same era.  Mania is quite specific but craving, craze, craziness, enthusiasm, fad, fascination, frenzy, infatuation, lunacy, obsession, passion, rage, aberration, bee, bug, compulsion, delirium, derangement, desire & disorder peacefully co-exist.

Noted manias

Anglomania: An excessive or undue enthusiasm for England and all things English; rarely noted in the Quai D'Orsay.

Anthomania: An extravagant passion for flowers; although it really can’t be proved, the most extreme of these are probably the orchid fanciers.  Those with an extravagant passion for weed are a different sub-set of humanity and are really narcomanics (qv) although there may be some overlap. 

Apimania: A passionate obsession with bees; beekeepers tend to be devoted to their little creatures so among the manias, this one may more than most be a spectrum condition.

Arithmomania: A compulsive desire to count objects and make calculations; noted since 1884, it’s now usually regarded as being within the rubric of obsessive-compulsive disorder (OCD).

Bibliomania: A rage for collecting rare or unusual books.  This has led to crime and there have been famous cases.

Cacodaemomania: The obsessive fixation on the idea that one is inhabited by evil spirits.  To the point where it becomes troublesome it’s apparently rare but there are dramatic cases in the literature, one of the most notorious being Anneliese Michel (1952–1976) who was subject to the rites of exorcism by Roman Catholic priests in the months before she died.  The priests and her parents (who after conventional medical interventions failed, also become convinced the cause of her problems was demonic possession) were convicted of various offences related to her death.  Films based on the events leading up to death have been released including The Exorcism of Emily Rose (2005), Requiem (2006) and Anneliese: The Exorcist Tapes (2011).

Callomania: The obsessive belief in one’s own beauty, even when to all others this is obviously delusional.

Dipsomania: The morbid craving for alcohol; in pre-modern medicine, it was used also to describe the “temporary madness caused by excessive drinking”, the origin of this being Italian (1829) and German (1830) medical literature.

Egomania: An obsessive self-centeredness; it was known since 1825 but use didn’t spike until Freud (and others) made it widely discussed after the 1890s and few terms from the early days of psycho-analysis are better remembered.

Erotomania: Desperate love, a sentimentalism producing morbid feelings.

Flagellomania: An obsessive interest in flogging and/or being flogged, often as one’s single form of sexual expression and thus a manifestation of monomania (qv).  The English Liberal Party politician Robert Bernays (1902-1945), the son of a Church of England vicar, was a flagellomanic whose proclivities were, in the manner of English society at the time, both much discussed and kept secret.  He was also an illustration of the way such fetishes transcend other sexual categories.

Gallomania: An excessive or undue enthusiasm for France and all things French; rarely noted in the British Foreign Office.

Graphomania: A morbid desire to write.  Niccolò Machiavelli (1469-1527; Italian diplomat, philosopher and political advisor of the Renaissance) attributed many of the problems he suffered to his graphomania and he was right, his sufferings because of what he wrote, when it was written and about whom.

Hippomania: An excessive fondness for horses; an affliction which often manifests as the intense and passionate interest in horses developed by some girls who join pony clubs and fall in love.

Hypermania: There’s a definitional dualism to hypermania; it can mean either an extreme example of any mania or, as used by clinicians, specifically (and characterized usually by a mental state with high intensity disorientation and often violent behavior), a severe case of bipolar disorder (the old manic-depression).  The earlier term was hypomania (A manic elation accompanied by quickened perception), one of the earliest (1882) clinical terms from early-modern psychiatry.

Kleptomania: The obsessive desire to steal; in early (1830s) use, the alternative form was cleptomania.  The klepto element was from the Ancient Greek kleptes (thief, a cheater), from kleptein (to steal, act secretly), from the primitive Indo-European klep- (to steal), from the root kel- (to cover, conceal, save) and was cognate with the Latin clepere (to steal, listen secretly to), the Old Prussian au-klipts (hidden), the Old Church Slavonic poklopu (cover, wrapping) and the Gothic hlifan (to steal) & hliftus (thief).  The history of the word kleptomania is of interest also to sociologists in that as early as the mid-nineteenth century, there was controversy about the use by those with the capacity to buy the services of doctors and lawyers were able to minimize or escape the consequences of criminal misbehavior by claiming a psychological motive.  The argument was that the “respectable” classes were afforded the benefit of this defense while the working class were presumed to be inherently criminal and judged accordingly.  The same debate, now also along racial divides, continues today.

Logomania: An obsession with words.  It differs from graphomania (qv) which is an obsession to write; logomania instead is a fascination with words, their meanings and etymologies.

Megalomania: Delusions of greatness; a form of insanity in which the subjects imagine themselves to be great, exalted, or powerful personages.  It was first used in the medical literature in 1866 (from the French mégalomanie) and came to be widely applied to many politicians and potentates the twentieth century.

Micromania:  "A form of mania in which the patient thinks himself, or some part of himself, to be reduced in size", noted first in 1879 and twenty years later used also in reference to insane self-belittling.  In the twentieth century and beyond, micromania was widely used, sometimes humorously, to refer to things as varied as the sudden consumer in interest in small cars to the shrinking size of electronic components.   

Monomania: An insane obsession in regard to a single subject or class of subjects; applied most often in academic, scientific or political matters but can be used about anything where the overriding mental impulses are perverted to a specific delusion or the pursuit of a particular thing.

Morphinomania: A craving for morphine; one of the earliest of the words which noted specific addictions, it dates from 1885 but earlier still there had been morphiomania (1876) and morphinism (1875) from the German Morphiumsucht.  In the medical literature, morphinomaniac & morphiomaniac rapidly became common.

Narcomania: The uncontrollable craving for narcotic drugs and a term which is so nineteenth century, the preferred modern form being variations of "addiction".

Necromania: An obsession to have sexual relations with the bodies of the dead although, perhaps surprisingly, practitioners (those who treat rather than practice the condition) classify many different behaviors which they list under the rubric of necromania, some of the less confronting being a morbid interest in funeral rituals,  morgues, autopsies, and cemeteries.   Those whose hobbies include the study of the architecture of crypts and tombs or the coachwork of funeral hearses might be shocked to find there are psychiatrists who classify them in the same chapters as those who enjoy intimacy with corpses.

Nymphomania: The morbid and uncontrollable sexual desire in women.  Perhaps the most celebrated (and often sought) of the manias, it dates from 1775, in the English translation of Nymphomania, or a Dissertation Concerning the Furor Uterinus (1771) by French doctor Jean Baptiste Louis de Thesacq de Bienville (1726-1813), the construct being the Ancient Greek nymphē (bride, young wife; young lady) + mania.  The actual condition is presumed to have long pre-dated the term.

Onomatomania: One obsessively compelled to respond with a rhyming word to the last word spoken by another (something possible even with orange and silver).  It’s thought to co-exist with other conditions, especially schizophrenia.

Phonomania: An uncontrollable urge to murder; those who suffer this now usually described as the more accessible “homicidal maniac”.  When applied especially to serial killers, the companion condition (just further along the spectrum) is androphonomania which, if properly argued, could be a defense against a charge of mass-murder but counsel would need to be most assiduous in jury selection.

Plutomania: The obsessive pursuit of wealth (and used sometimes in a clinical setting to describe an "imaginary possession of wealth").

Pyromania: A form of insanity marked by a mania for destroying things by fire.  It was used in German in the 1830s and seemed to have captured the imagination of Richard Wagner (1813–1883); the older word for the condition was incendiarism.

Rhinotillexomania: Nose picking. Gross, but a thing which apparently often manifests when young but fades, usually of its own volition or in reaction to the disapprobation of others.

Trichotillomania: The compulsion to pull-out one’s hair.  The companion condition is trichtillophagia which is the compulsive eating of one’s own hair, one of a remarkable number of eating disorders.

Definitional variations in the criteria for mania, DSM-IV & DSM-5

The study and classification of idea of manias had been part of psychiatry almost from its origin as a modern discipline although the wealth of details and fragmentation of nomenclature would come later, the condition first noted “increased busyness”, the manic episodes characterized by Emil Kraepelin (1856-1926; a founding father of psychiatric phenomenology) as those of someone who was “…a stranger to fatigue, his activity goes on day and night; work becomes very easy to him; ideas flow to him.” 

Whatever the advances (and otherwise) in treatment regimes, little has changed in some aspects of the condition.  In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013), the primary criterion of mania remains “a distinct period of abnormally and persistently elevated, expansive, or irritable mood” and “abnormally and persistently increased goal-directed activity or energy” but did extend duration of the event to qualify for a diagnosis.  In the DSM-IV (1994), the criterion for a manic episode only required “a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week” whereas DSM-5 now requires in addition the presence of “abnormally and persistently increased goal-directed activity or energy”; moreover, these symptoms must not only last at least one week, they must also be “present most of the day, nearly every day.”

The changes certainly affected the practice of the clinician, DSM-5 substantially increasing the complexity associated with the diagnosis and treatment of bipolar disorder, no longer requiring that clinically significant symptoms which may be present should be ignored.  All those years ago, Kraepelin conceptualized manic-depression as a single illness with a continuum of episodic presentations including admixtures of symptoms which have long since been considered opposing polarity.  DSM-5 thus represents an advance with the possibility of improved treatment outcomes because it enables clinicians to diagnose mood episodes and specify the presence of symptoms inconsistent with pure episodes; a major depressive episode with or without mixed features and manic/hypomanic episodes with or without mixed features.

The revisions in DSM-5 also reflect the efforts of the editors over several decades to simplify diagnostic criteria while developing more precise categories of classification.  In the DSM-IV, both bipolar disorder and major depressive disorder were included in one chapter of mood disorders and a “mixed state” was a subtype of bipolar I mania, a diagnosis of a mixed state requiring that criteria for both a manic episode (at least three or four of seven manic symptoms) and a depressive episode (at least five of nine depressive symptoms) were met for at least one week.  In DSM-5, bipolar disorder and depressive disorders have their own chapters, and “mixed state” was removed and replaced with “manic episode with mixed features” and “major depressive disorder with mixed features.”