Mentism in healthy people and in mental disorders

Introduction

Human thinking is a complex process, and its disturbances accompany virtually every psychiatric pathology to some degree. Among thought disorders, the phenomenon of mentism occupies a significant place. Patients exhibiting mentism report being overwhelmed by thoughts; they wish to free themselves from the stream of thinking, yet are unable to do so. The same phrases may repeat, memories or details of long-past events, or heard words may intrude. In this literature review, we will examine this phenomenon and related states in detail, propose our own typology of mentism, trace its connection to schizophrenic and affective spectrum disorders, and address unresolved questions in the sections below.

The literature reviewed is based on a search of Russian- and English-language articles in the databases ELibrary.ru, Web of Science, Scopus, Clinical Case, PubMed, and Cochrane Database of Systematic Reviews. The search used keywords such as “mentism”, “volitional thinking”, “automatism”, and “basic symptoms of schizophrenia”. The inclusion criteria were: full-text articles in Russian and English, original research, Cochrane reviews, and clinical observations, published between 1895 and 2025. The exclusion criteria were abstracts, theses, textbooks, and publications prior to 1895. A total of 126 publications were found, of which 28 met the inclusion/exclusion criteria.

Description of the phenomenon

Mentism is a type of formal thought disorder, a specific psychopathological phenomenon observed in both psychiatric patients and healthy individuals.

The first mentions of mentism in medical literature appeared in the late 19th century; Dumont de Monteux wrote in 1895: “They (the patients) cannot sit still, become agitated without a specific purpose, or this agitation is purely intellectual. It is then that one can observe the well-known phenomenon of mentism, a peculiar intellectual excitement”.¹

In 1938, Skvortsov, in his work On the Syndrome of Mentism (Flood of Thoughts), vividly described a patient’s experience: “Suddenly, in the middle of work or lessons, a whirlwind of thoughts, memories, and images bursts into my mind. It was difficult to drive these thoughts away and focus on work; these unwelcome thoughts surged again, pushing out the necessary ones... In school, it often happened that, as they say, I was miles away, carried away by my thoughts, not hearing the teachers’ explanations. Thoughts raced one after another. They did not stop, did not linger, changing in my mind like a film... Sometimes thoughts appear to me as rapidly running boys on roller skates. They run endlessly, chasing and overtaking each other, merging into a general pattern of flickering lines".²

Subjectively, mentism can be experienced as an acceleration of the thinking pace that is impossible to halt. Patients describe it as a “storm,” “hurricane,” or “whirlwind” of thoughts. Emil Kraepelin (1910) used the term “whirl of ideas”, attributing it to a disturbance of the will: “A whirl of ideas therefore occurs constantly where the ability to maintain prolonged and steady volitional tension is impaired, whether due to relaxation of the will or the discharge of volitional movements into individual changing impulses”.³

Mentism may involve an increase in associative connections – “piling up,” “swarm,” or “cluster” of ideas, accompanied by a sense of loss of control over the associative process. Examples of intrusive thinking or an inability to stop thoughts voluntarily can be found in Karl Jaspers’ General Psychopathology (1959): “Mademoiselle S. complains: ‘I cannot hold a single thought; one dances inside me after another... I cannot gather them together; therefore I have no will... Phew, how meaningless all this is... Through my mind runs a continuous stream of thoughts, like clockwork. One thought chases another, with the most bizarre associations; yet there seems to be some connection between the links. What representations swarm in my head, what funny associations of ideas arise!’”.⁴

Mentism can take ideational, imagistic, or combined forms. Tiganov (1999) linked imagistic mentism to asthenic states: “The essence of this phenomenon is that in states of extreme mental fatigue, patients experience a stream of vivid mental images”.⁵ He also classified ideational mentism among automatisms, along with thought broadcasting and audible thoughts. Krylov (2024) concluded that a transformation from ideational to imagistic mentism indicates a worsening condition [1].

A distinct type is hypnagogic mentism, occurring at the onset of sleep. It may also be ideational or imagistic: “Frames flash by, one after another. Faces, heads, body parts, monsters, cats, fish, elephants, flowers, flies in webs, dust whirls, spots, streets, circles, too much to recount. Everything resembles a kaleidoscope; images change so quickly. Just as I grasp one image, it disappears and something else appears. It happens by itself; I can only observe the flashing frames”. Zhmurov (1994) noted that hypnagogic mentism occurred in stage 1 of slow-wave sleep. Patients typically distinguish hypnagogic mentism, hypnagogic hallucinations, and dreams. Despite its variety, mentism is nonspecific to any particular psychopathology, dynamic, and acquires characteristics depending on the disorder present.⁶

Disorders and states in which mentism occurs

Healthy individuals may experience mentism during fatigue or under the influence of alcohol and other psychoactive substances. Kraepelin (1910) noted: “Under fatigue, we often encounter mild degrees of such disturbance. Here, to some extent, we lose control over our thinking. We cannot adhere firmly to our goal, deviate from it, and must exert effort to return to our initial train of thought”.³

Mentism is characteristic of manic and hypomanic states. Thought associations accelerate, with abundant spontaneous ideas and representations, superficial judgments, distractibility, and hypermnesia (Zhmurov, 1994).⁶ Thought content corresponds to mood. Bleuler (1983) observed that as mania intensifies, thinking loses relative orderliness, transforming into true flight of ideas.⁷

Kraepelin (1921) separately described depression with flight of ideas, suggesting that in depression, this phenomenon (what we would now call mentism) is hidden beneath the patient’s distress: “In the usual picture of depression, slowed thinking may be replaced by flight of ideas. Delusions drive patients toward vivid associations; they read extensively, show interest in and understanding of their surroundings, and sometimes exhibit overt curiosity, though almost mute, rigid, and in a depressed, hopeless mood. When they speak again about their state, we hear that they cannot hold their thoughts, constantly encountering ideas they had never considered. Considering other experiences alongside pathological symptoms, it is easy to recognize this as the appearance of flight of ideas, not always detected due to inhibition of speech and outward movements” [2].

Painful acceleration of thinking also occurs in anxiety disorders. Alexandrovsky (2004) stated that anxiety, a natural human reaction to danger, accelerates thinking.⁸ Patients mentally review potential threats and ways to avoid them. Kraepelin (1921) described depressive or anxious mania: “They (patients) complain of having to think so much that thoughts arise spontaneously, they want to share them, but easily lose the thread, can be distracted by any question, and suddenly switch to entirely different thoughts” [2]. Within the framework of modern classification, these states are considered mixed.

In progressive paralysis, mentism may persist for weeks, consisting of a dialogue with a single close person, spoken aloud as questions and answers, often accompanied by writing (graphorrhea). Clérambault (1934) considered diffuse positive phenomena (mentism) to signal an impending dementing process in young people recently recovered from infection.⁹ Similar phenomena may occur post-encephalitis. Jaspers (2020) quotes a patient: “I cannot sit still for even five minutes without thinking. The speed of my thoughts exceeds my ability to speak them aloud; I know the answers long before I can say them. This continues as if a film runs in my mind. Everything is lightning-fast. I retain all details, even the smallest... When I do not answer immediately, it seems I didn’t understand, and it repeats. But I cannot answer immediately. Thinking continues all day; the same ideas return, again and again”.⁴

States similar to mentism

A state similar to mentism can occur with obsessive thoughts. They arise involuntarily, and their content does not carry adequate information, which the patient correctly understands and critically evaluates while maintaining control over their behavior.¹⁰ Obsessions are characterized by protective behaviors aimed at preventing or counteracting them.¹¹ In phobias, thoughts are limited to known objects; obsessions are localized (Skvortsov, 1938).² Emotionally neutral obsessions can manifest as abstract reasoning, endless internal dialogues, fruitless debates, and argumentation. They may take the form of a flood of question-thoughts: “Why does the Earth rotate in this direction?” (Krylov, 2016).

Both mentism and obsessive thoughts share involuntary occurrence and potential acceleration. The distinction lies in that in mentism, thoughts carry no subjective meaning for the patient, and protective rituals characteristic of obsessions do not appear. Thoughts are not restricted to specific topics; it is the process of thinking, not its content, that is disrupted. Structural disturbance of thought is the main difference between obsessions and mentism.

Possible typology of mentism

Analysis of the literature and our clinical experience allowed identifying three forms of accelerated thought activity (Table 1): 1. Thought acceleration; 2. Mentism; 3. Mentism-automatism.

Mentism as a basic symptom of schizophrenia

The schizotypal nature of mentism is supported by Bleuler and Kurt Schneider. Bleuler identified two thought disturbances specific to schizophrenia: “flood of thoughts” and Sperrung.¹² Schneider incorporated mentism-automatism as thought insertion into first-rank schizophrenia symptoms.¹³ Skvortsov (1938) considered mentism an initial stage of automatism and thought alienation.² Mentism may acquire a sense of artificiality, external influence: “thought flows by itself,” “as if against will,” “something is making me think,” “impossible to stop thought; everything is thought unconsciously; self-control is lost”; “like a wheel in the head, something spins, the brain never rests,” “storm of thoughts” (Grigoryeva, Khokhlov, Dyakonov, 2007).¹⁴ At this stage, it is easy for an interpretation to arise, along with the perception of a “person” influencing the thoughts. Kandinsky (1952) describes this as follows: “Patients speak of ‘mental suggestion,’ complaining that other people ‘implant thoughts in their heads,’ that thoughts are ‘forced into their minds from outside’ – cases in which they attribute their intrusive ideas to persecutors or consider these subjective experiences a divine revelation”.¹⁵ The possibility of delusions arising from mentism-automatism was outlined by Berze (1929): “Many patients report that only through the greatest concentration of attention, the utmost focus on a single thought, is it possible to resist the ‘implanted’ thoughts. Many express concern that they will not be able to maintain such tension for long and will then fall entirely under external influence. Others have already abandoned the struggle, having come to accept this phenomenon. Although the patient’s internal state changes afterward, these implanted thoughts, feelings, and so on retain their alien character, apparently due to the continued effect of a certain all-powerful explanatory thought”.¹⁶ Some authors suggest that the further development of mentism-automatism may progress toward the acute Kandinsky-Clérambault syndrome (Tiganov, 1999) and oneiroid states (Papadopoulos, 1975).¹⁷

In contemporary literature, the concept of mentism appears in terms such as a surge of thoughts, accelerated thinking, “chaos” of thoughts, or confusion of thoughts. The boundaries are shifting toward a more schizophrenic interpretation of mentism (mentism-automatism). Mentisms are included in the ICD-10 as a criterion for schizophrenia (thought insertion, item 1)¹⁸, and are part of the SAPS scale as a positive symptom (thought insertion)^{19, 20}. Mentisms are also mentioned among the basic symptoms of schizophrenia in Gerd Huber’s concept [3]. Huber considered basic symptoms as the earliest manifestations of impaired information processing, reflecting neurobiological disturbances. Basic symptoms were regarded as an obligatory part of a future psychosis. The symptoms themselves are not specific indicators of psychosis and may appear in other mental disorders, such as affective disorders. Huber described two types of pre-psychotic syndromes (Huber & Gross, 1989) [4]: “outpost syndromes” and the continuous prodrome. The former precedes the first psychotic episode by an average of 10 years and may disappear entirely without progressing to psychosis. The latter represents a progressive “prodrome” which develops into psychosis without a symptom-free period, on average over 3.2 years (Bota, 2008) [5]. By definition, basic symptoms differ from what is considered a “normal” mental state. Being subjective, they remain apparent only to the patient and are rarely noticeable to others, although the coping strategies that the patient employs independently in response to them may be observable. Basic symptoms also differ from overt psychotic symptoms, which the patient experiences as real. Unlike psychotic symptoms, basic symptoms are recognized by the patient as disruptions of their own (mental) processes. Awareness that something is wrong with their thinking is present, but some experiences may be so novel and strange that they remain almost inexplicable. Rarely, highly introspective individuals can articulate what is happening, but detailed descriptions of these experiences usually require guided questioning (Schultze-Lutter, 2009) [6].

Building on the concept of basic symptoms, high-risk criteria for psychosis were developed: the cognitive-perceptive group, “COPER” (Table 2), and the cognitive disturbances group, “COGDIS” (Table 3) [7][8]. Mentisms are noted in both groups and serve as reliable indicators of elevated psychosis risk.

Thus, within the concept of basic symptoms, mentism is a significant marker for early psychosis diagnosis and can inform therapeutic strategy.

Unresolved Questions

Mentism is a common yet underappreciated phenomenon in psychiatric diagnosis. It is nonspecific, occurs at multiple levels (possibly stages), and mild forms (flood of thoughts) may occur in healthy individuals. There appears to be a stronger “attachment” of mentism to affective disorders (classic mentism) and schizophrenia (mentism-automatism). Further research (planned at RostSMU by the review authors) is necessary to answer questions such as:

1. How frequently do different forms of mentism occur in patients and healthy individuals?
2. Are there patterns of transition from one form to another?
3. Is mentism more associated with schizophrenia-spectrum disorders or affective/organic pathology?
4. How does affect influence the subjective perception and distress of mentism?

Resolving these questions could improve the quality of diagnostic and therapeutic interventions in psychiatry.