Uncritical thinking dominated by fantasies that have little or no relation to reality, the gratification of wishes and desires in imagination.Reverie, flights of fancy, and daydreams are normal forms of autistic thinking and may have positive value in arousing ambition and in enabling us to release emotions and temporarily escape everyday pressures. The boy who imagines himself a hero and the girl who sees herself as the belle of the ball are common examples. Drowsiness, sleep, fatigue, or monotonous tasks invite autistic thinking, particularly among those who have a store of unfulfilled wishes or frustrations within them.In psychiatry, autism generally means loss of contact with reality and retreat into a private world of delusions, hallucinations, or disjointed ideas (PLATE 8). This kind of thinking appears in a variety of disorders, including senile psychoses, some forms of depression, and Kanner’s syndrome (early infantile autism). It manifests itself most frequently in schizophrenic reactions and was at one time considered to be the major characteristic of this psychosis. A distinction is sometimes made between an agitated autistic state in which the psychotic patient experiences terror, religious ecstasy, martyrdom, or messianic delusions; and a calm autistic state in which he believes he is receiving thoughts from another planet or from a divine being. Yet, as Maslow and Mittelmann (1951) point out, even in an outwardly calm condition, such as a state of stupor, a patient’s fantasies may be “very vivid and often on a cosmic scale.” They cite the case of a patient who “stated that a gigantic struggle was going on in the universe between good and evil and that he was the battleground. The forces of good and evil were so equally balanced that any movement on his part might have decided the struggle one way or another. He was afraid to make the wrong move, hence he lay still.” Illustrative Case: autism A young engineer, who had graduated creditably from an engineering school and landed a good job for himself, showed a gradual decline in his ability to do his work until he finally lost his job. At home he spent his days lying around the house; he had no complaints. After admission to a psychiatric clinic he said frankly that there was nothing anyone in the world could offer him as valuable as his daydreams. This patient said that as a child he had always had an imaginary boy playmate who meant a great deal to him. In adolescence the imaginary playmate became a girl with whom he fell in love. He made strong attempts in college to get away from this autistic affair and managed to fall in love with a married woman who appears, from all the evidence available, to have considered him as no more than a good friend. He did well in his studies and went aggressively and successfully after a job, as we have said. But here the difficulties involved in getting started in a competitive field, where rewards were only in a vague and distant future, proved too much for him. It was the imaginary playmate of his daydreams who rescued him from this situation. In his fantasy he courted and married her; and they lived a complete life together as man and wife in the autistic community of his own imagining. Thus, the satisfactions he had learned to find by this technique, throughout childhood and adolescence, now culminated fittingly in the perfect autistic union. To leave this fan- tasied world for the drab loneliness of the shared social community was to give up everything he valued in return for nothing. He said, “I know where this is leading me, but it doesn’t matter.” (Cameron, 1947) AUTISTIC CHILD. A child who has lost or never achieved contact with other people and is totally preoccupied with his own fantasies, thoughts, and stereotyped behavior. Autistic children are so withdrawn that they are often thought to be mentally retarded, although actually they are immature and emotionally disturbed. The term autism is somewhat loosely used to cover both early infantile autism and childhood schizophrenia. A delusion or other false idea which the individual feels is thrust upon him, even though it actually stems from his own unconscious. The word autochthonous means, literally, “sprung from the soil” and is synonymous with native or indigenous. An autochthonous idea is therefore one that springs from within the region of the mind, just as certain plants or animals are indigenous to a given region of the earth. The reason the patient feels this idea comes from outside himself is that it appears so strange and foreign. He may therefore conclude that he is possessed by a demon or that his enemies are injecting thoughts into his mind. Delusions of this kind are characteristic of paranoia or the paranoid type of schizophrenia. Less extreme autochthonous ideas are found in some obsessive-compulsive individuals. Such patients are at the mercy of repetitious thoughts which appear to be forced upon them. Even though they consider these ideas irrational, they cannot get them out of their minds.