The Acute Illness

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The onset may be rapid, or slow and insidious. In the latter situation in particular, there may be a prolonged period of undiagnosed illness in which the affected person slowly becomes more withdrawn and introverted. They may develop unusual interests, particularly of a religious or philosophical kind, and drift away from family and friends. They may also begin to fail in their occupation or schoolwork. This process can take weeks to years but eventually, often with a seemingly precipitating event, the symptoms of florid illness appear.

The acute symptoms are variable but usually include delusions, hallucinations, abnormal thought processes and passivity experiences (Figures 1.11-1.16). In addition, there may be formal thought disorder, and flat or inappropriate affect. Abnormal motor signs, sometimes termed catatonic, used to be common but now are much less so in Western countries. At this stage of the illness, positive symptoms tend to dominate the clinical picture.

Figure 1.11 Castle of Bad Dreams, by Phyllis Jones, 1936. This picture "Served a double purpose, firstly to illustrate one of Grimm's fairytales of 'The foolish old woman' and her wishes, and secondly to symbolize her own life". It is tempting to speculate that it indicates a depressive component to her symptoms. Reproduced with kind permission of the Bethlem Royal Hospital Archives and Museum, Beckenham, Kent, UK

Figure 1.11 Castle of Bad Dreams, by Phyllis Jones, 1936. This picture "Served a double purpose, firstly to illustrate one of Grimm's fairytales of 'The foolish old woman' and her wishes, and secondly to symbolize her own life". It is tempting to speculate that it indicates a depressive component to her symptoms. Reproduced with kind permission of the Bethlem Royal Hospital Archives and Museum, Beckenham, Kent, UK

Figure 1.12 Grey self-portrait, by Bryan Charnley. This painting illustrates aspects of Charnley's psychotic symptoms, including that of hearing voices. Reproduced with kind permission of the Bethlem Royal Hospital Archives and Museum, Beckenham, Kent, UK

Figure 1.13 Puppeteers, by Phyllis Jones, 1936. This patient was a talented artist, who was admitted to a psychiatric hospital at the age of 22 years complaining of hearing voices, and convinced her food was being poisoned. The clinical description suggests a florid psychotic illness, of acute onset, accompanied by severe affective disturbance. Reproduced with kind permission of the Bethlem Royal Hospital Archives and Museum, Beckenham, Kent, UK

Figure 1.13 Puppeteers, by Phyllis Jones, 1936. This patient was a talented artist, who was admitted to a psychiatric hospital at the age of 22 years complaining of hearing voices, and convinced her food was being poisoned. The clinical description suggests a florid psychotic illness, of acute onset, accompanied by severe affective disturbance. Reproduced with kind permission of the Bethlem Royal Hospital Archives and Museum, Beckenham, Kent, UK

Figure 1.14 Cordron, by Gilbert Price. This patient was admitted at the age of 22 years. His extreme shyness and eccentric behavior culminated in his arrest for 'suspicious' conduct. Neologisms, elaborated into complex descriptive systems of pictures, chimneys and other objects, dominated his psychopathology. Reproduced with kind permission of the Bethlem Royal Hospital Archives and Museum, Beckenham, Kent, UK

Figure 1.14 Cordron, by Gilbert Price. This patient was admitted at the age of 22 years. His extreme shyness and eccentric behavior culminated in his arrest for 'suspicious' conduct. Neologisms, elaborated into complex descriptive systems of pictures, chimneys and other objects, dominated his psychopathology. Reproduced with kind permission of the Bethlem Royal Hospital Archives and Museum, Beckenham, Kent, UK

Drawings Schizophrenic Patients

Figure 1.15 Cats, by Louis Wain (1860-1939). Wain was a British artist who became famous for his drawings of cats. He was a patient at the Bethlem Hospital in the 1920s. Paintings such as these, which are suggestive of disorganization, visual perceptual disturbances and abnormalities of affect, have been taken as illustrative of his psychological decline, although more recent scholarship suggests that they were not out of keeping with contemporary design practice. Reproduced with kind permission of the Bethlem Royal Hospital Archives and Museum, Beckenham, Kent, UK

Figure 1.15 Cats, by Louis Wain (1860-1939). Wain was a British artist who became famous for his drawings of cats. He was a patient at the Bethlem Hospital in the 1920s. Paintings such as these, which are suggestive of disorganization, visual perceptual disturbances and abnormalities of affect, have been taken as illustrative of his psychological decline, although more recent scholarship suggests that they were not out of keeping with contemporary design practice. Reproduced with kind permission of the Bethlem Royal Hospital Archives and Museum, Beckenham, Kent, UK

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