Psychosis (pronounced sahy-koh-sis)
In psychiatry, a severe mental
disorder (sometimes with physical damage to the brain), more serious than
neurosis, characterized by disorganized thought processes, disorientation in
time and space, hallucinations, delusions and a disconnection from
reality. Paranoia, manic depression,
megalomania, and schizophrenia are all psychoses.
1847: From the New Latin & Late
Greek psȳ́chōsis,
the construct being psycho- + -osis, the source being the Ancient Greek ψύχωσις
(psúkhōsis) (animation, principle of
life), psych from the Ancient Greek ψυχή (psukhḗ or psykhē) (mind, life, soul).
The suffix –osis is from the Ancient Greek -ωσις (-ōsis) (state,
abnormal condition or action), from -όω (-óō)
(stem verbs) + -σις (-sis); -oses was the plural form and
corresponding adjectives are formed using –otic,
thus respectively producing psychoses and psychotic. The Ancient Greek psykhosis meant "a giving of life; animation; principle of
life". In English, the original
1847 construction meant "mental affection or derangement" while the
adjective psychotic (of or pertaining to psychosis) dates from 1889, coined
from psychosis, on the model of neurotic/neurosis and ultimately from the
Ancient Greek psykhē (understanding,
the mind (as the seat of thought), faculty of reason).
In
clinical use there are many derived forms (with meanings more precise than is
often the case when such words migrate to general use) including antipsychotic,
micropsychotic, neuropsychotic, nonpsychotic, postpsychotic, prepsychotic,
propsychotic, protopsychotic, quasipsychotic, semipsychotic &
unpsychotic. The useful portmanteau word
sarchotic (the construct a blend of sarcastic +
psychotic) is used to describe a statement so distrubingly sarcastic it can't be
certain if the remark is intended to be humerous or the person making it
genuinely is psychotic and even then there are graduations for which the adverb is used, the comparative being "more psychotically" and the superlative "most psychotically". Psychosis &
psychoticism are nouns, psychotic is a noun & adjective and psychotically is
an adverb; the noun plural is psychoses.
Psychosis and the DSM
The word psychosis was a
mid-nineteenth century creation necessitated by early psychiatry’s separation
of psychiatric conditions from neurological disorders. Originally a generalized concept to refer to
psychiatric disorders, gradually it became one of the major classes of mental
illness, assumed to be the result of a disease process, and, more recently, to
a symptom present in many psychiatric disorders. During this evolution, the diagnostic
criteria shifted from the severity of the clinical manifestations and the
degree of impairment in social functioning to the presence of one or more
symptoms in a set of psychopathological symptoms. By the early twentieth century, the concept
of neurosis (which once embraced both the psychiatric and the neurological
disorders), became restricted to one major class of psychiatric disease whereas
psychosis (which once embraced all psychiatric disorders) became restricted to
the other.
The first consensus-based
classification with a description of diagnostic terms was in the first edition (DSM-I (1952)) of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) in which mental
disorders were divided into two classes of illness: (1) organic disorders, caused
by or associated with impairment of brain tissue function; and (2) disorders of
psychogenic origin without clearly defined physical cause or structural changes
in the brain. When DSM-II (1968) was released, the classifications were revised with mental disorders now classed as
(1) psychoses and (2) neuroses, personality disorders, and other non-psychotic
mental disorders. Psychosis was defined
as a mental disorder in which mental functioning is impaired to the degree that
it interferes with the patient's ability to meet the ordinary demands of life
and recognize reality.
Advances in both neurology and
psychiatry led to an extensive revision in DSM-III (1980). Radically, all traditional dichotomies
(organic versus functional, psychotic versus neurotic etc) were discarded
with psychiatric syndromes assigned to one of fifteen categories of
disease. At the labelling level, the
term psychotic was used to describe a patient at a given time, or a mental
disorder in which at some time during its course, all patients evaluate
incorrectly the accuracy of their perceptions and thoughts but the editors emphasized it should not be applied to patients suffering only minor
distortions of reality, regardless of how exactly they might fulfil the
clinical criteria. The revisions in
DSM-III-R (1987) extended only to slight changes in terminology.
Mirroring the changes in diagnostic
criteria published by the WHO, DSM-IV (1994) noted the diagnosis of psychosis
should no longer be based on the severity of the functional impairment but
rather on the presence of certain symptoms which included delusions,
hallucinations, disorganized speech and grossly disorganized or catatonic
behavior. This emphasis on psychoses
being spectrum conditions was continued in DSM-5 (2013) with schizoid
(personality) disorder and schizophrenia defining its mild and severe
ends. Additionally, a more precise
diagnostic framework was defined in which patients were assessed in terms both
of symptoms and duration of suffering.
Two examples of "schizophrenia art".
My
Eyes in the Time of Apparition (1913)
by August Natterer (1868-1938).
The life of German artist August Natterer began
innocuously enough, studying engineering, travelling extensively, marrying and
building a successful career as an electrician.
However, in his thirties, he began to experience anxiety attacks and
delusions and in 1907 suffered a hallucination in which thousands of images
flashed before his eyes in little more than thirty minutes. So affected by the experience that he
attempted suicide, he was admitted to an asylum and would spend the remaining
quarter-century of his life in and out of institutes for the insane. In the literature, Natterer is
referred to as Neter, a pseudonym used by his psychiatrist to protect patient
and family from the social stigma then associated with mental illness. He described the 1907 hallucination as a
vision of the Last Judgment which he described as:
"...10,000 images flashed by in
half an hour. I saw a white spot in the
clouds absolutely close – all the clouds paused – then the white spot departed
and stood all the time like a board in the sky. On the same board or the screen
or stage now images as quick as a flash followed each other, about 10,000 in
half an hour… God himself occurred, the witch, who created the world – in
between worldly visions: images of war, continents, memorials, castles,
beautiful castles, just the glory of the world – but all of this to see in
supernal images. They were at least twenty meters big, clear to observe, almost
without color like photographs… The images were epiphanies of the Last
Judgment. Christ couldn't fulfil the salvation because he was crucified
early... God revealed them to me to accomplish the salvation."
After his suicide attempt and
committal to the first of what would be several mental asylums, Natterer
thereafter maintained that he was the illegitimate child of Emperor Napoleon I (Napoleon Bonaparte (1769–1821; leader of the French Republic 1799-1804 & Emperor of the French from 1804-1814 & 1815)) and "Redeemer of the World".
The vision inspired Natterer to a prolific production of drawings, all
documenting images and ideas seen in the vision, one especially interesting to
those studying psychosis and schizophrenia being My Eyes in the Time of Apparition (1913), two eyes bloodshot and
wide-open eyes staring from the page.
The irises of the eyes do not match.
The
Scream (1893), oil, tempera & paste on cardboard, by Edvard
Munch (1863-1944), National Gallery of Norway.
Norwegian Edvard Munch was one of a number of artists modern psychiatrists have written of as having
both genetic and environmental predispositions to mental illness, schizophrenia
in particular; one of Munch’s sisters had schizophrenia, his father suffered
from depression, his mother and another sister dying from tuberculosis when he
was young. Munch though was a realist,
once telling an interviewer, “I cannot
get rid of my illnesses, for there is a lot in my art that exists only because
of them.” The idea of affliction as a source or artistic inspiration appears often in the literature of art, music and such and in that it's something of a parallel with those who produce their finest work while living under political oppression; unpleasant as that can be, reform can see careers suffer, famous dissidents abruptly left as "rebels without a cause" after the fall of the Soviet Union (1922-1991) and a generation of the UK's activists found grist for their mills less prolific after the Tory Party had Margaret Thatcher (1925–2013; UK prime-minister 1979-1990) walk the political plank. Where one door closes however, another sometimes opens and in John Major (b 1943; UK prime-minister 1990-1997) the comedians found a rich vein of material.
His was a troubled life and in 1908,
following a psychotic break exacerbated by alcoholism, Munch was admitted to a
mental health clinic, later diagnosed with neurasthenia, a clinical condition now
known to be closely associated with hypochondria and hysteria. Adding to his problems, the Nazis labelled
Munch’s style “degenerate art” and in 1937 confiscated many of his works but
their disapprobation had less of an influence on his painting than his schizophrenia,
his output continuing to feature figures obviously tortured by anguish and
despair. The apparently frantic strokes of
the brush and his seemingly chaotic pallet of colors have long intrigued both
critics and clinicians seeing insight into his state of mind, the idea being
his paintings provide something of a visual representation of how schizophrenia
might lead individuals to see the world.
Lindsay Lohan, following Edvard Munch, rendered by Vovsoft in comicbook style. Endlessly
reproduced, the subject of numerous memes and the inspiration for many re-interpretations,
The Scream is Munch’s most famous
work and the most emblematic of what now casually is called “schizophrenic art”
(unfortunately often conflated with “art by schizophrenics”). For decades it has been the chosen artistic
representation for the angst-ridden modern human condition, the artist in 1890
noting in his diary a still vivid memory: “I was walking along the road with two friends—the sun went
down—I felt a gust of melancholy—suddenly the sky turned a bloody red... I felt
this big, infinite scream through nature.” That entry was written some years after the sight
and before painting The Scream in
1893 but the moment stayed with him because his vision of the sky caused him to
“tremble with pain and angst” and he
felt he heard his “…scream passing endlessly through the world.” For historians those fragment of memory
proved of interest and in his book Krakatoa:The Day the World Exploded (2003), detailing the 1883 eruption of the
Indonesian volcano Krakatoa, Simon Winchester (b 1944) connected the “blood red” Norwegian sky with the fiery
sunsets created by the ash from the explosion circulating the planet, high in
the atmosphere.

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