Autism (symptom)

Autism is a fundamental symptom of schizophrenia coined by Swiss psychiatrist Eugen Bleuler in 1911. In his opinion, autistic thinking was characterized by desire to avoid unsatisfying reality and then replace it with fantasies with IDeaS of persecution. Autism is extreme introvertedness, it's the subject's symbolic "inner life" and it is not readily accessible to other people. Predominance of inner fantasies, loss contact with the external reality, distance from others are the main aspects of autism in schizophrenia. In more severe cases a schizophrenic patient withdrew into himself and live a dream. Autistic thinking is independent of logical rules and it is directed by emotional needs. 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. 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.

Types of autism

Bleuler’s views on schizophrenia can be summarized by the 4 A's (4 fundamental symptoms): ambivalence, affectivity (inappropriate / incongruent), associations (weak), and autism. 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. In their struggles, they commonly disregard logic and reality.

Eugène Minkowski (1927) singled out "poor" (autisme pauvre) and "rich" autism (autisme riche). "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 ().

Ernst Kretschmer distinguished hyperesthetic autism and anesthetic autism. 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. Simple autism characterize the simple-type schizophrenia and it's the impossibility of adaptation to the real world. 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".

Etymology and terminology

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".

Eugen Bleuler wanted to change term "atheistic thinking" to "dereistic thinking" (it derives from – ratio, ratus – res, sum – real), because the first term was misunderstood (even in Jasper's book – "psychopathology"). By design, term "dereistic thiniking" is a thinking that disregards reality and might be more appropriate.

Autistic thinking

Autistic thinking is a term about way of thinking of schizophrenic patients which is described in detail in the Eugen Bleuler's book "The autistic thinking" (). Autistic thinking occurs in the thought processes of people with schizophrenia, after 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.

Autistic-undisciplined thinking of physicians

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.

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. 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. 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.

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.

Theoretical and experimental use of autistic thinking

In Bleuler's "Autistic thinking" there is written that the most extensive experimental & 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:

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

In 1912 Bleuler acknowledged that his term "autism" is much the same with the term "introversion" of a Swiss psychiatrist and psychoanalyst Carl Jung. But Jung's term "introversion" isn't a symptom or mental disorder, but a personality trait of a mentally healthy person.

The Jung's concept introversion and Bleuler's autism greatly overlap. 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.

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

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.

Сlinical example of an schizophrenic autist

"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"). 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 appartment 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:

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.

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

Bleuler's concept of autism influenced other psychiatrist including Leo Kanner, Hans Asperger. The term autism was later redefined by Leo Kanner for a developmental disorder (a type of pervasive developmental disorder that known as childhood autism, infantile autism, autistic disorder, Kanner's autism).