Autism (symptom)
| Autism | |
|---|---|
| Synonym | Bleuler's autism |
 | |
| The picture above illustrates a case of schizophrenic autism. A patient in a world of his own, with fantasies about the transmitted ultrasound and hypnotic warfare. | |
| Classification and external resources | |
| Specialty | psychiatry |
| Patient UK | Autism |
 | This article is a rough translation from Russian. It may have been generated by a computer or by a translator without dual proficiency. |
Autism is a fundamental symptom of schizophrenia coined by Swiss psychiatrist Eugen Bleuler in 1911.[1] In his opinion, autistic thinking is a desire to avoid what they consider to be an unsatisfying reality and replace it with fantasies with ideas of persecution.[2] Autism is extreme introvertedness, characterized by a the subject's symbolic "inner life" and it is not readily accessible to other people.[1] Predominance of inner fantasies, loss of contact with external reality, and distance from others are the main aspects of autism in schizophrenia.[3] In more severe cases a schizophrenic patient withdraws into themselves and lives a dream. Autistic thinking is independent of logical rules and it is directed by emotional needs.[4] There are various levels of autism, that condition is more severe in people with schizophrenia and in the dream, mild level is then a person have schizoid personality and histrionic persons may have autistic thinking in the daydreams.[4] Autism is also mentioned as a symptom of schizophrenic psychoses in the 9th revision of the International Statistical Classification of Diseases (ICD-9), but from the next revision it was removed.[5]
Types of autism[edit]
Bleuler’s views on schizophrenia can be summarized by the 4 A's (4 fundamental symptoms): ambivalence, affectivity (inappropriate / incongruent), associations (weak), and autism.[6] It was the basic symptoms that gave schizophrenia its distinctive diagnostic features, in Bleuler's opinion. He wrote a lot of publications on autism and autistic thinking. Autist can use highly illogical material in his statements, and replace logic may clang associations and incidental connections of any ideas.[4] In their struggles, they commonly disregard logic and reality.[4]
Eugène Minkowski (1927) singled out "poor" (autisme pauvre) and "rich" autism (autisme riche).[7] "Poor autism" is characterized by affective deterioration, and "rich autism" is characterized by a richness of mental processes. He also noted that autism is the loss of vital contact with reality (French: »la perte du contact vital avec la réalité«).
Ernst Kretschmer distinguished hyperesthetic autism and anesthetic autism.[8] Hyperesthetic autism manifests itself with increased sensitivity in the form of withdrawal into oneself and life in dreams, and anesthetic – by the absence of emotional interest in the outside world, "simple soullessness".
L. Korzeniewski introduced the concepts of "simple" (initial) autism and "complex" (secondary) autism.[9] Simple autism characterize the simple-type schizophrenia and it's the impossibility of adaptation to the real world.[9] The impossibility of adaptation is based on the autistic motivation. Complex autism occurs in the delusional forms of schizophrenia and expresses "a patient's protest against the real world".[9]
The types of autism symptoms for schizophrenia can also be understood through an understanding of autism as a spectrum disorder due to the number of variations in terms of the type, symptoms, and severity experienced.[10] The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which was designed by the American Psychiatric Association outlined a broad category of the illness under the Autism Spectrum Disorder (ADS). The manual, which is, to date, the most accepted guide for autism identified five types of ADS and these include: autism, pervasive developmental disorder not otherwise specified (PDDNOS), Asperger syndrome, Rett syndrome, and childhood disintegrative disorder or Heller's syndrome.[11] According to some experts, the ICD-10 criteria for schizophrenia overlap with those in the autistic spectrum.[12]
Etymology and terminology[edit]
Bleuler derived the word "autism" from the Ancient Greek word αὐτός, meaning "self", and described it as psychopathological self-admiration, referring to "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance".[13] It is based on a struggle to understand the environment and how to organize perceptions in response to other people's expectations.[14]
Eugen Bleuler wanted to change term "atheistic thinking" to "dereistic thinking" (it derives from Latin: reor – ratio, ratus – res, sum – real), because the first term was misunderstood (even in Jasper's book German: "Psychopathologie"– "psychopathology"). By design, term "dereistic thiniking" is a thinking that disregards reality and might be more appropriate.
Autistic thinking[edit]
Autistic thinking is a term about way of thinking of schizophrenic patients which was for the first time described in the Eugen Bleuler's book "The autistic thinking" (German: Das autistische Denken). Autistic thinking is thought processes of people with schizophrenia, which means that, they start to ignore reality and live in a world full of fantasies. Then a person experience autistic thinking, he/she can concern with the fulfillment of all wishes. Schizophrenics with autism ignores the rules of logic, they can make the impossible possible, all their goals are attained. In the most severe cases people can live in completely dream world, and ignore the real world.
Catatonic patient with oneiroid syndrome, for example, may have such features, as a dream-like state as a background and intensive psychopathological experiences (depersonalisation/derealisation, catatonic behaviour (from stupor to increased psychomotor activity), complex hallucinatory symptoms). In some cases the reality, hallucinations and illusions are merged into one, and schizophrenic in a psychiatric hospital thinks that he's a captain of a starship, all other patients are the crew etc. Information about the real world is ignored.
There are experts who stressed that autistic individuals do not exist in solipsistic universe since their being - both conscious and bodily deportment - is still imbued in the social world despite the fact that their order might sometimes elude their understanding. For this reason, Majia Nadesan explained that autistic symptomatology should be interpreted as an expression of a lack of fit "between the autistic individual's embodiment and their world."[15]
Autistic-undisciplined thinking of physicians[edit]
In 1919, Eugen Bleuler wrote a book, "Autistic-undisciplined thinking in medicine and how to overcome it," in which he tried to justify that thought process of medical workers is for the most time illogical and autistic. It is similar to the autistic thinking of schizophrenic patients who disregards reality. Here's example of autistic thinking with purely affective argument instead of logical: a person rejecting hypnosis with the argument that it "weakens the will", it is autistic, because his advance this imaginary opinion only because the power of hypnosis over the intimate ego happens not to suit him. So, in other words, his argument is purely affective and "logic" is merely a means to an end.[16]
Bleuler said that in medicine the drive to help people is too uninhibited & quick, and question "where and how to help" is too slow and halting.[16] Physicians make a lot of mistakes and enthusiastically provide the medical treatment in cases with self-recovery of a patient when treatment was not really required, and also willingly in cases when a patient have an incurable disease.[16] As an example of autistic thinking of medics, shocks (shock treatment, insulin shock therapy) and lobotomy of people with mental disorders were used, and almost every psychiatrist thinking about this as an effective treatment.[16]
In the preface to the second edition, Bleuler reduced the criticism of "autistic undisciplined thinking" in medicine, expressing regret that he used the psychopathological term "autistic" to refer to the medical way of thinking.[17]
Theoretical and experimental use of autistic thinking[edit]
In Bleuler's "Autistic thinking" there is written that the most extensive experimental and theoretical use of the his autism concept is made by Gardner Murphy. According to results of Murphy and his collaborators, for a summary of their work they concluded about autism:
…movement of cognitive processes in the direction direction of need satisfaction…
Bleuler criticized the definition, because in that case all human thought subserves and behavior directed toward satisfaction, so he said "the distinctive character of autistic thinking is probably its short-circuit course toward satisfaction." Following Murphy's work, interest in the autistic thinking was high at that time, as indicated by the studies of Klein, McClelland, Bruner, Postman etc.
Autism and introversion[edit]
In 1912 Bleuler acknowledged that his term "autism" is much the same with the term "introversion" of a Swiss psychiatrist and psychoanalyst Carl Jung.[18] But Jung's term "introversion" is not a symptom or mental disorder, but a personality trait of a mentally healthy person. However, Jung's concept introversion and Bleuler's autism greatly overlap.[4] The introversion simple denoting the turning inward of libido.
Psychologically, the concepts introversion and autism both derive from Freud's hypothesis that withdrawal of libidinous energy is the necessary condition that psychological repression that cause rich fantasies.[4]
In 1912 Carl Jung published a psychological book „Wandlungen und Symbole der Libido“ (known in English as "Psychology of the Unconscious"). According to book "Autistic thinking", what Bleuler calls "logical" (logisches) or "realistic" (realistisches) Jung calls "directed thinking" (gerichtetes Denken). What Bleuler calls "autistic" (autistische) Jung calls "fantasying" (Phantasieren) or "dreaming" (Träumen).
Autism directed outward[edit]
Autistic strivings may be directed outside, for example, in a patient with schizophrenia with delusion of reformism who wants to globally reform society, or in those who animate objects, or create a god out of an abstract force or concept, or in the little girl in whose fantasy a piece of wood is a child.[4]
Сlinical example of a schizophrenic autist[edit]
"I am a Zähringer since 1886", a stereotypical phrase by a Carl Jung's paranoid patient from the book "Über die Psychologie der Dementia praecox" (in English "The Psychology of Dementia praecox"; Latin term "dementia praecox" meaning a "precocious madness"; now term replaced by "schizophrenia").[19] The symbolic significance of Zähringer is understandable. Patient is a Zähringer because she is zäh ('tough'). At the same Zähringer also means to her a nice apartment in the "Zäh ringer quarter" (German: „Zähringerquartier“). This sounds like a pun, but to her this sort of metonymy becomes reality. She also keeps saying that she is Switzerland.
Jung's analysis:
Long since I affirmed Switzerland as double—I do not belong here confined—I came here free—he who is free from death and error retains a child’s pure soul—I am also a crane—one cannot confine Switzerland. It is not difficult to see how patient is Switzerland: Switzerland is free patient "came here free," hence she should not be confined. The tertium comparationis "free" leads to a "contamination" with Switzerland.[20]
Original quote: Ich habe als Doppel die Schweiz schon lange festgestellt — ich gehöre nicht hier eingesperrt — ich bin frei hier eingetreten — Wer frei von Schuld und Fehle, bewahrt die kindlich reine Seele — ich bin auch eine Kranich — die Schweiz kann man doch nicht einsperren. Wieso Pat. eine Schweiz ist, ist unschwer einzusehen: die Schweiz ist frei — Pat. ist „frei“ hier „eingetreten“ also darf man sie nicht eingesperrt halten. Das tertium comparationis „frei“ gibt ohne weiteres den Anlaß zur Kontamination mit Schweiz.
— „Über die Psychologie der Dementia praecox“. 1907.[19]
Similar but more grotesque is the neologism "l am a crane.", "she who is free from debt,” etc., is the familiar quotation from the "Cranes of Ibykus (written in 1797 ballad by Johann Christoph Friedrich von Schiller)." Patient therefore identifies or "condenses" herself very rapidly with "crane." The analysis thus far given concerns only symbols, of the extraordinary, health, power, and virtue of patient.
We can also understand that her fantasies are the cause of many wishes, such as recognition by society and financial provision. Before schizophrenia she was very pour and belonged to a family of low station, also her sister being a prostitute.
Beyond the simplest functions, like sleeping and eating and, such patients live only in the world of their fantasies, and only this makes them quite happy.
In the book "Autistic thinking" (1912) Bleuler quoted text about this patient, because it's excellent example of the autistic thinking.[4]
Schizophrenia is in this clinical case has destroyed the function of the clearest purposive associations, also she thinks that her dreams and fantasies are real/objective.
In addition about her, typical facts about autism could be added: she thinks away obstacles, feel the fulfillment of the wishes and strivings, and consider of goals as already attained.
Term redefining[edit]
Bleuler's concept of autism influenced other psychiatrist including Leo Kanner and Hans Asperger. The term autism was later redefined by Leo Kanner for a developmental disorder (a type of pervasive developmental disorder known as childhood autism, infantile autism, autistic disorder, Kanner's autism).[21]
Further reading[edit]
- Bleuler E. (1912). "Das autistische Denken" [The autistic thinking]. Jahrbuch für psychoanalytische und psychopathologische Forschungen (in German). Leipzig und Wien: Deuticke. 4: 1–39.CS1 maint: Unrecognized language (link)
- Inoue, Y.; Mizuta, I. (1998). "[Psychopathological study on schizophrenic autism through the paintings of a case of simple schizophrenia]" [一単純型分裂病症例の描画にみる分裂病性自閉の精神病理学的研究]. 精神神経学雑誌 = Seishin Shinkeigaku Zasshi (in Japanese). 100 (6): 398–411. ISSN 0033-2658. PMID 9745354.CS1 maint: Unrecognized language (link)
- Gündel H., Rudolf G. A. (1993). "Schizophrenic autism. 1. Historical evolution and perspectives". Psychopathology. 26 (5–6): 294–303. PMID 8190851.
- Gündel H., Rudolf G. A. (1993). "Schizophrenic autism. 2. Proposal for a nomothetic definition". Psychopathology. 26 (5–6): 304–312. PMID 8190852.
- Parnas J., Bovet P. (1991). "Autism in schizophrenia revisited". Comprehensive Psychiatry. 32 (1): 7–21. PMID 2001623.
References[edit]
- ↑ 1.0 1.1 Bleuler E. Dementia praecox oder Gruppe der Schizophrenien // Handbuch der Psychiatrie. — Leipzig, 1911. — 420 s.
- ↑ Evans B. (2013). "How autism became autism: The radical transformation of a central concept of child development in Britain". Hist Human Sci. 26 (3): 3–31. doi:10.1177/0952695113484320. PMC 3757918. PMID 24014081.
- ↑ Ballerini A. (2012). "Understanding autism in schizophrenia". ScientificWorldJournal. 2012. doi:10.1100/2012/254091. PMC 3353288. PMID 22645417.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Bleuler E. (1912). "Das autistische Denken" [The autistic thinking]. Jahrbuch für psychoanalytische und psychopathologische Forschungen (in German). Leipzig und Wien: 39.CS1 maint: Unrecognized language (link)
- ↑ World Health Organisation (1977). "Other psychoses (295–299): 295 Schizophrenic psychoses". Manual of the international statistical classification of diseases, injuries, and causes of death (PDF). Vol. 1. Jeneva. p. 183.
Search this book on"Schizophrenic psychoses – a group of psychoses in which there is a fundamental disturbance of personality, a characteristic distortion of thinking, often a sense of being controlled by alien forces, delusions which may be bizarre, disturbed perception, abnormal affect out of keeping with the real situation, and autism."
- ↑ Peralta V., Cuesta M. J. (2011). "Eugen Bleuler and the schizophrenias: 100 years after". Schizophrenia Bulletin. 37 (6): 1118–1120. doi:10.1093/schbul/sbr126. PMC 3196952. PMID 22013084.
- ↑ Adam Feinstein (2011). A History of Autism: Conversations with the Pioneers. John Wiley & Sons. p. 6. ISBN 978-1-4443-5167-5. Search this book on
- ↑ Theodore Millon; Carrie M. Millon; Sarah E. Meagher; et al. (2012). Personality Disorders in Modern Life. John Wiley & Sons. p. 369. ISBN 978-1-118-42881-8. Search this book on
- ↑ 9.0 9.1 9.2 Korzenowsky L. Sur l’autisme // Annales Médico-Psychologiques. — 1967. — Vol. 1, № 2. — P. 229
- ↑ "NIMH » Autism Spectrum Disorder". www.nimh.nih.gov. Retrieved 2018-06-05.
- ↑ Willis, Clarissa (2009). Creating Inclusive Learning Environments for Young Children: What to Do on Monday Morning. Thousand Oaks: Corwin Press. p. 99. ISBN 9781412957182. Search this book on
- ↑ Hirsch, Steven; Weinberger, Daniel (2008). Schizophrenia. London: Blackwell Publishing. p. 7. ISBN 0632063882. Search this book on
- ↑ Kuhn R. (2004). "Eugen Bleuler's concepts of psychopathology". Hist Psychiatry. 15 (3): 361–366. doi:10.1177/0957154X04044603. PMID 15386868.
- ↑ Nadesan, Majia (2013). Constructing Autism: Unravelling the 'Truth' and Understanding the Social. London: Routledge. p. 174. ISBN 0415321808. Search this book on
- ↑ Nadesan, p. 174.
- ↑ 16.0 16.1 16.2 16.3 Bleuler E. (1921). Das autistisch-undisziplinierte Denken in der Medizin und seine Überwindung [Autistic undisciplined thinking in medicine and how to overcome it] (in German) (2nd, improved ed.). Berlin: Verlag von Julius Springer.CS1 maint: Unrecognized language (link) Search this book on
- ↑ Garrabé J. (1992). "Chapitre VI (Chapter VI)". Histoire de la schizophrénie (in French). Paris: Seghers. ISBN 978-2-232-10389-6.CS1 maint: Unrecognized language (link) Search this book on
- ↑ Dirk Marcel Dhossche (2006). Catatonia in Autism Spectrum Disorders. Elsevier. p. 11. ISBN 978-0-08-046338-4. Search this book on
- ↑ 19.0 19.1 Jung, C. C. (1907). Über die Psychologie der Dementia praecox [The Psychology of Dementia praecox] (in German). Halle a S.: Verlagsbuchhandlung Carl Marlhold. pp. 145–146.CS1 maint: Unrecognized language (link) Search this book on
- ↑ Jung, C. C. (1909). The Psychology of Dementia Præcox. Translated by Frederick, W. P.; Brill, A. A. New York: The Journal of Nervous and Mental Disease. pp. 124–125. Search this book on
- ↑ Kanner L. (1943). "Autistic disturbances of affective contact". The Nervous Child. 2: 217–50. Second: "Autistic disturbances of affective contact". Acta paedopsychiatrica. 35 (4): 100–36. 1968. PMID 4880460.
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