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.

Asperger

Asperger (pronounced a-spuh-guh or a-spr-gr)

(1) In neo-paganism and modern witchcraft, a ceremonial bundle of herbs or a perforated object used to sprinkle water (in spells as “witches water”), usually at the commencement of a ritual.

(2) In neurology, as Asperger's syndrome (less commonly Asperger syndrome), an autism-related developmental disorder characterised by sustained impairment in social interaction and non-verbal communication and by repetitive behaviour as well as restricted interests and routines.  The condition was named after Austrian pediatrician Hans Asperger (1906–1980).

Pre-1300: The surname Asperger was of German origin and was toponymic (derived from a geographical location or feature).  The town of Asperg lies in what is now the district of Ludwigsburg, Baden-Württemberg, in south-west Germany and in German, appending the suffix “-er” can denote being “from a place”, Asperger thus deconstructs as “someone from Asperg” and in modern use would suggest ancestral ties to the town of Asperg or a similar-sounding locality.  Etymologically, Asperg may be derived from older Germanic or Latin roots, possibly meaning “rough hill” or “stony mountain” (the Latin asper meaning “rough” and the German berg meaning “mountain or hill”.  The term “Asperger’s syndrome” was in 1976 coined by English psychiatrist Lorna Wing (1928–2014), acknowledging the work of Austrian pediatrician Hans Asperger (1906–1980).  Dr Wing was instrumental in the creation of the National Autistic Society, a charity which has operated since 1962.  Asperger is a noun (capitalized if in any context used as a proper noun).  Aspergerian & Aspergic are nouns; the noun plural forms being Aspergers, Aspergerians & Aspergics.  In the literature, Aspergerian & Aspergic (of, related to, or having qualities similar to those of Asperger's syndrome (adjective) & (2) someone with Asperger's syndrome (noun)) appear both to have been used.  In general use “Asperger's” was the accepted ellipsis of Asperger's syndrome while the derogratory slang forms included Aspie, autie, aspie, sperg, sperglord & assburger, now all regarded as offensive in the same way “retard” is now proscribed.

The noun asperges described a sprinkling ritual of the Catholic Church, the name was applied also to an antiphon intoned or sung during the ceremony.  It was from the Late Latin asperges, noun use of second-person singular future indicative of aspergere (to scatter, strew upon, sprinkle), the construct being ad (to, towards, at) + spargere (to sprinkle).  The use in Church Latin was a learned borrowing from Latin aspergō (to scatter or strew something or someone; to splash over; to spot, stain, sully, asperse; besmirch; (figuratively) to bestow, bequeath something to, set apart for) the construct being ad- +‎ spargō (strew, scatter; sprinkle; moisten).  The origin lay in the phrase Asperges me, Domine, hyssopo et mundabor (Thou shalt sprinkle me, O Lord, with hyssop, and I shall be cleansed), from the 51^st Psalm (in the Vulgate), sung during the rite of sprinkling a congregation with holy water.  Hyssop (any of a number of aromatic bushy herbs) was from the Latin hȳsōpum, from the Ancient Greek ὕσσωπος (hússōpos), of Semitic origin and the idea was would be cleansed of one’s sins.  In the Old English the loan-translation of the Latin aspergere was onstregdan.

The three most recent popes demonstrate their aspergillum (also spelled aspergill) technique while performing the sprinkling rite.  In the more elaborate rituals, it's often used in conjunction with a container called an aspersorium (holy water bucket).  Benedict XVI (1927–2022; pope 2005-2013, pope emeritus 2013-2022, left), Francis (1936-2025; pope 2013-2025, centre) and Leo XIV (b 1955; pope since 2025, right).

In the Christian liturgy, an aspergillum was used to sprinkle holy water and the borrowing, adaptation and re-purposing of ceremonies, feasts days and such from paganism widely was practiced by the early Church.  In the Bible (notably chapter 14 in the Old Testament’s Book of Leviticus) there are descriptions of purification rituals involving the use of cedar wood, hyssop, and scarlet wool to create an instrument for sprinkling blood or water and historians sometimes cite this as “proto-aspergillum”.  While it seems the earliest known use on English of “aspergillum” dates from 1649, the documentary evidence is clear the practice in the Christian liturgy was ancient and common since at least the tenth century.  Exactly when the ritualistic practice began isn’t known but because water is so obviously something used “to cleanse”, it’s likely it has been a part of religious rituals for millennia before Christianity.

Asperger ceremonial herb bundle.

The use of the “asperger” in neo-paganism & witchcraft was a continuation of the concept and well documented in the remarkably prolific literature (some book shops have dedicated sections) devoted to modern witchcraft and the construction of the objects (a bundle of fresh herbs or a perforated object for sprinkling water) is a lineal descendent of the aspergillum of the Medieval church and that makes sense, both institutions devoted to the process of cleansing although the targets may have differed.  According to Ancient Pathways Witchcraft (which sounds an authoritative source), although it’s the fluid which does the cleansing, the asperger is significant because it symbolizes “the transformative and cleansing properties of water…”, rinsing away “…spiritual debris that might interfere with the sanctity of rituals.”  In both neo-paganism and witchcraft, the herbs used may vary and while, pragmatically, sometimes this was dictated by seasonal or geographical availability, priests and witches would also choose the composition based on some “unique essences” being better suited to “enhance the sacred water's effectiveness”.  Nor were herbs always used for, as in the rituals of the church, “an asperger might be a metal or wooden rod designed with perforations or an attached mesh”, something like a “small brush or a dedicated holy water sprinkler akin to those seen in Christian liturgy.”  Again, it was the sprinkling of the water which was the critical element in the process, the devices really delivery systems which, regardless of form, existed to transform simple water into “a divine medium of purity and transformation.”  That said, their history of use did vest them with tradition, especially when certain herbs were central to a spell.

Dr Hans Asperger at work, Children's Clinic, University of Vienna, circa 1935.

The term “Asperger’s syndrome” first appeared in a paper by English psychiatrist Lorna Wing (1928–2014) although use seems not to have entered the medical mainstream until 1981.  Dr Wing (who in 1962 was one of the founders of the charitable organization the National Autistic Society) named it after Austrian pediatrician Hans Asperger (1906–1980) who first described the condition in 1944, calling it autistischen psychopathen (autistic psychopathy).  Dr Wing was instrumental in the creation of the National Autistic Society, a charity which has operated since 1962.  The German autistischen was an inflection of autistisch (autistic), the construct being Autist (autistic) +‎ -isch (an adjectival suffix).

Dementia Praecox, oder Gruppe der Schizophrenien (1911) by Eugen Bleuler.

The English word autism was from the German Autismus, used in 1913 by Swiss psychiatrist and eugenicist Eugen Bleuler (1857-1939), the first known instance dating from 1907 and attributed by Swiss psychiatrist & psychotherapist Carl Jung (1875-1961) as an alternative to his earlier “auto-erotism” although in his book Dementia Praecox, oder Gruppe der Schizophrenien (Precocious Dementia, or Group of Schizophrenias, 1911) Bleuler differentiated the terms.  The construct of the word was the Ancient Greek αὐτός (autos) (self) + -ισμός (-ismós) (a suffix used to form abstract nouns of action, state or condition equivalent to “-ism”).  Being a time of rapid advances in the relatively new discipline of psychiatry, it was a time also of linguistic innovation, Dr Bleuler in a Berlin lecture in 1908 using the term “schizophrenia”, something he’d been using in Switzerland for a year to replace “dementia praecox”, coined by German psychiatrist Emil Kraepelin's (1856-1926).  What Dr Bleuler in 1913 meant by “autistic” was very different from the modern understanding in that to him it was a symptom of schizophrenia, not an identifiably separate condition.  In the UK, the profession picked this up and it was used to describe “a tendency to turn inward and become absorbed in one's own mental and emotional life, often at the expense of connection to the external world” while “autistic thinking” referred to those who were “self-absorbed, fantasy-driven, and detached from reality; thinking patterns, commonly seen in those suffering schizophrenia.”

Looking Up was the monthly newsletter of the International Autism Association and in Volume 4, Number 4 (2006), it was reported Lindsay Lohan’s car had blocked the drop-off point for Smashbox Cares, a charity devoted to teaching surfing to autistic youngsters.  Arriving at the designated spot at Malibu’s Carbon Beach, the volunteers were delayed in their attempt to disembark their charges, something of significance because routine and predictability is important to autistic people.  To make up for it, Ms Lohan staged an impromptu three hour beach party for the children, appearing as a bikini-clad DJ.  Apparently, it was enjoyed by all.

Autistic Disturbances of Affective Contact (1943) by Leo Kanner.

The modern sense of “autistic” began to emerge in the 1940s, among the first to contribute the Austrian-American psychiatrist Leo Kanner (1894–1981) who in 1943 published a paper using the phrase “early infantile autism” to describe a distinct syndrome (which now would be understood as autism spectrum disorder).  The following year, in Vienna, Dr Asperger wrote (seemingly influenced by earlier work in Russia) of his observational studies of children, listing the behaviors he associated with the disorder and unlike some working in the field during the 1940s, Dr Asperger wasn’t wholly pessimistic about his young patients, writing in Autistic Psychopathy in Childhood (1944): “The example of autism shows particularly well how even abnormal personalities can be capable of development and adjustment. Possibilities of social integration which one would never have dreamt of may arise in the course of development.”  Many of the documents associated with Dr Asperger’s work were lost (or possibly taken to the Soviet Union) in the chaotic last weeks of World War II (1939-1945) and it wasn’t until Dr Wing in the 1970s reviewed some material from the archives that his contributions began to be appreciated although not until 1992 did “Asperger’s Syndrome” became a standard diagnosis.

DSM IV (1994).  Not all in the profession approved of the reclassification of Asperger’s syndrome under the broader Autism Spectrum Disorder, believing it reduced the depth of diagnostic evaluation, flattened complexity and was disconnected from clinical reality.  There was also regret about structural changes, DSM-5 eliminating the multiaxial system (Axes I–V), which some clinicians found useful for organizing information about the patient, especially Axis II (personality disorders) and Axis V (Global Assessment of Functioning).

Asperger’s Syndrome first appeared in the American Psychiatric Association's (APA) classification system when it was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994) and the utility for clinicians was it created a sub-group of patients with autism but without a learning disability (ie characterized by deficits in social interaction and restricted interests, in the absence of significant language delay or cognitive impairment), something with obvious implications for treatment.  In the DSM-5 (2013), Autism Spectrum Disorder (ASD) was re-defined as a broader category which combined Asperger syndrome, Autistic Disorder & PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified) into a single ASD diagnosis, the editors explaining the change as a reflection of an enhanced understanding of the condition, the emphasis now on it being something with varying degrees of severity and presentation rather than distinct types.  The eleventh release of the World Health Organization’s (WHO) International Classification of Diseases (ICD) (ICD-11) aligned with the DSM-5 and regards what once would have been diagnosed as Asperger’s Syndrome to be deemed a relatively mild manifestation of ASD.  The diagnostic criteria for ASD focus on deficits in social communication and interaction, as well as repetitive behaviors and interests.  Although no longer current, the DSM IV’s criteria for Asperger's Disorder remain of interest because although the label is no longer used, clinicians need still to distinguish those in the spectrum suffering some degree of learning disability and those not so affected:

DSM-IV diagnostic criteria for Asperger’s Disorder (299.80).

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.

(2) failure to develop peer relationships appropriate to developmental level.

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (eg by a lack of showing, bringing, or pointing out objects of interest to other people).

(4) lack of social or emotional reciprocity.

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.

(2) apparently inflexible adherence to specific, non-functional routines or rituals.

(3) stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting, or complex whole-body movements).

(4) persistent preoccupation with parts of objects.

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning

D. There is no clinically significant general delay in language (eg single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

The term in the twenty-first century became controversial after revelations of some of Dr Asperger's activities during the Third Reich (Austria annexed by Germany in 1938) which included his clinic in Vienna sending selected children to be victims of Aktion T4 (a mass-murder programme of involuntary euthanasia targeting those with disabilities), an operation which ran at times in parallel with the programmes designed to exterminate the Jews, Gypsies, homosexuals and others.  While there is no surviving documentary evidence directly linking Dr Asperger to the selection process which decided which children were to be killed, researchers have concluded the records suggest his construction of what came later to be called “Asperger’s syndrome” was actually that very process with an academic gloss.  Because those Dr Asperger so categorized were the autistic children without learning difficulties, they were thus deemed capable of being “cured” and thus spared from the T4’s lists, unlike the “uneducable” who would never be able to be made into useful German citizens.  While the surviving material makes clear Dr Asperger was at least a “fellow traveller” with the Nazi regime, in professional, artistic and academic circles there was nothing unusual or even necessarily sinister about that because in a totalitarian state, people have few other choices if they wish to avoid unpleasantness.  However, it does appear Dr Asperger may have been unusually co-operative with the regime and his pre-1945 publication record suggests sympathy with at least some aspects of the Nazis’ racial theories and eugenics.

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.

The Rorschach cards.

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 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 famous astrophotograph of The Pillars of Creation in the Eagle Nebula of the Serpens constellation (taken by the Hubble Space Telescope on 1 April 1995) imagined as four Rorschach ink-blot cards.  The original is at the top, below is a rendering in greyscale and the lower two have different filters applied.

In 2022, the JWST (James Webb Space Telescope) was used to obtain a more detailed image of what was happening there some 7000 years ago and while the consensus among cosmologists was comething like “not much has appears to have changed in 27 years”, because the JWST captures in infrared, it was able to penetrate the dense dust, revealing embedded stars and internal structures Hubble (which captured only visible light) couldn’t see.  So much more detailed was the later image that the sharper edges of the clouds could be studied, providing insights into the interplay between the gas and stellar winds.

There is significance in some Rorschach inkblot plates including color while others are black-and-white and the use of color was a deliberate design choice by Hermann Rorschach as part of the “interpretative tool-set” used to assess a subject's responses.  Of the ten plate, cards 1, 4, 5, 6 & 7 are black & white, cards 2 & 3 include red & black while cards 8, 9 & 10 feature multiple colors, including pastels.  The notion was that color introduces emotional and affective complexity and it must be remembered that in this context, “black” & “white” also are “colors”.  According to Dr Rorschach, (1) black & white blots tend to elicit more structured, form-based, and cognitive responses, (2) red is often interpreted as a prompt for more emotional, aggressive, or stimulus-bound reactions and (3) the multi-colored blots test the subject's ability to integrate complex stimuli, including emotional nuance, conflict, or ambiguity.  The theory thus was color could be used to help assess (1) emotional responses, (2) impulsivity, (3) affective regulation and (4) cognitive integration.  What all that of course implied is that were the plates to be rendered in black (and thus rely on shape alone), outcomes and the validity of the test would be affected, most obviously because of the removal of stimuli which would make responses more form-focused, diminishing the utility of the test in differentiating certain traits, notably the interpretation of ambiguous affective signals.  This has been tested and researchers reported results became less rich and less diagnostic when color was removed.

PapaLeoArts take on the Rorschach in water colors.  This array should probably be thought a montage but there might be critics who would find definitional reasons why it's a collage.

In the ink-blots, Dr Rorschach used color selectively with some plates wholly black shapes on a white background, the allocation as critical to the integrity of the process as the shapes but once the test became well known, the ink-blots became pop-culture artefacts, reproduced on posters, T-Shirts, coffee mugs and anything else which might be packaged for sale.  Sometimes the color mix was retained in the original while others applied just about everything from the motifs of psychedelia to polka-dots.     

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.  The defendant in the front row at the far right of the photograph was Horace Greeley Hjalmar Schacht (1877–1970; president of the Reichsbank 1923-1930 & 1933-1939, general plenipotentiary for war economy 1935–1937 and Reichsminister without portfolio 1937-1943) and he secured an acquittal, which might seem surprising given the extent of his complicity in the Nazi re-armament programme but it did reflect the historic difficulties in securing the convictions of enablers of crime (accountants, lawyers, financiers etc) who are a step or more removed from the act(s) being prosecuted, a phenomenon which manifests still in many jurisdictions.  Of the accused, Dr Schacht was the only confessed Freemason but there's never been anything to suggest any of the IMT's eight judges had any connection with the cult.

The notion  “…the Nazis were not psychologically normal or healthy individuals” 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.