Eugen Bleuler

Eugen Bleuler
Eugen Bleuler around 1900
Born	Paul Eugen Bleuler 30 April 1857 (1857-04-30) Zollikon, Switzerland
Died	15 July 1939(1939-07-15) (aged 82) Zollikon, Switzerland
Nationality	Swiss
Alma mater	University of Zürich
Known for	Coining the terms schizophrenia, schizoid, autism
Spouse	Hedwig Bleuler–Waser
Children	5
Scientific career
Fields	Psychiatry
Institutions	Rheinau-Zürich clinic Burghölzli clinic University of Zürich
Doctoral advisors	Jean-Martin Charcot Bernhard von Gudden
Doctoral students	Manfred Bleuler Carl Jung
Other notable students	Medard Boss

Paul Eugen Bleuler (/ˈblɔɪlər/ BLOY-lər,^[1] Swiss Standard German: [ˈɔʏɡeːn ˈblɔʏlər, ˈɔʏɡn̩ -]; 30 April 1857 – 15 July 1939)^[2] was a Swiss psychiatrist and humanist^[3][4] most notable for his contributions to the understanding of mental illness. He coined several psychiatric terms including "schizophrenia",^[5][6] "schizoid",^[7] "autism",^[8] depth psychology and what Sigmund Freud called "Bleuler's happily chosen term ambivalence".^[9]

Bleuler was born in Zollikon, a town near Zürich in Switzerland, to Johann Rudolf Bleuler (1823–1898), a wealthy farmer, and Pauline Bleuler-Bleuler (1829–1898).^[10] He married Hedwig Bleuler–Waser, one of the first women to receive her doctorate from the University of Zurich.^[11]

Bleuler studied medicine in Zürich. He trained for his psychiatric residency at Waldau Hospital under Gottlieb Burckhardt, a Swiss psychiatrist, from 1881 to 1884.^[10] He left his job in 1884 and spent one year on medical study trips with Jean-Martin Charcot, a French neurologist in Paris, Bernhard von Gudden, a German psychiatrist in Munich, and to London.^[10] After these trips, he returned to Zürich to briefly work as assistant to Auguste Forel while completing his psychiatric residency at the Burghölzli, a university hospital.^[12]

Bleuler became the director of a psychiatric clinic in Rheinau,^[12] a hospital located in an old monastery on an island in the Rhine. At the time, the clinic was known for being functionally backward and largely ineffective. Because of this, Bleuler set about improving conditions for the patients residing there.^{[citation needed]}

In the year 1898, Bleuler returned to the Burghölzli and became a psychiatry professor at Burghölzli, the same university hospital at which he completed his residency. He was also appointed director of the mental asylum in Rheinau. He served as the director from the years 1898 to 1927. While working at this asylum, Bleuler cared for long-term psychiatric patients. He also implemented both psychoanalytic treatment and research, and was influenced by Sigmund Freud.

During his time as the director of psychiatry at Burghölzli, Bleuler made great contributions to the field of psychiatry and psychology that made him known today. Given these findings, Bleuler has been described as one of the most influential Swiss psychiatrists.

Following his interest in hypnotism, especially in its "introspective" variant,^[13] Bleuler became interested in Sigmund Freud's work. He favorably reviewed Josef Breuer and Freud's Studies on Hysteria.

Like Freud, Bleuler believed that complex mental processes could be unconscious. He encouraged his staff at the Burghölzli to study unconscious and psychotic mental phenomena. Influenced by Bleuler, Carl Jung and Franz Riklin used word association tests to integrate Freud's theory of repression with empirical psychological findings. As a series of letters demonstrates, Bleuler performed a self-analysis with Freud, beginning in 1905. Bleuler laid the foundation for a less fatalistic view of the course and outcome of psychotic disorders along with C. G. Jung, who further used Bleuler's theory of ambivalence and association experiments to diagnose neurotic illnesses.^[14]

Bleuler found Freud's movement to be overly dogmatic and resigned from the International Psychoanalytic Association in 1911, writing to Freud that "this 'all or nothing' is in my opinion necessary for religious communities and useful for political parties...but for science I consider it harmful".^[15] Bleuler remained interested in Freud's work, citing him favorably, for example, in his often reprinted Textbook of Psychiatry (1916). He also supported the nomination of Freud for the Nobel Prize in the late twenties.^[16]

Bleuler introduced the term "schizophrenia" in a Berlin lecture on 24 April 1908.^[17] However, he and his colleagues had been using the term in Zurich to replace Emil Kraepelin's term dementia praecox since 1907. He revised and expanded his schizophrenia concept in his seminal study of 1911, Dementia Praecox, oder Gruppe der Schizophrenien (Dementia Praecox, or Group of Schizophrenias). This was translated into English in 1950 (by Joseph Zinkin).^[18]

Bleuler distinguished between positive and negative symptoms of schizophrenia. Positive symptoms include symptoms not found in unaffected people, such as hallucinations or delusions. Negative symptoms describe the absence of typical experiences such as social withdrawal or lack of pleasure. Bleuler also distinguished between basic and accessory symptoms as well as primary and secondary symptoms. Basic symptoms are those that are present in every case of schizophrenia, whereas accessory symptoms vary depending on the patient. Bleuler defined primary symptoms as those that are directly related to neurobiological processes. He defined secondary symptoms as behavioral reactions to primary symptoms. Differentiating these symptoms contributed to an increased understanding of schizophrenia in general.

Like Kraepelin, Bleuler argued that dementia praecox, or "the schizophrenias", was a physical disease process characterized by exacerbations and remissions. He argued that no one was ever completely "cured" of schizophrenia; there was always some sort of lasting cognitive weakness or defect that was manifest in behavior. Unlike Kraepelin, Bleuler believed that the overall prognosis was not uniformly grim. He believed "dementia" was a secondary symptom not directly caused by the underlying biological process. There were three other "fundamental symptoms" that included deficits in associations, affectivity, and ambivalence. He believed the biological disease was much more prevalent in the population due to its "simple" and "latent" forms.^[19]

Bleuler's changes to Kraepelin's dementia praecox were accepted by countries such as Switzerland and Britain. However, some countries, such as Germany, did not accept these changes at first. Bleuler's concept of schizophrenia was pushed aside due to its similarities to Kraepelin's dementia praecox. It was only widely accepted after Kraepelin's disease classification did not have direct evidence nor was it directly expressed in his patients.

In 1911, Bleuler wrote, "When the disease process flares up, it is more correct, in my view, to talk in terms of deteriorating attacks, rather than its recurrence. Of course the term recurrence is more comforting to a patient and his relatives than the notion of progressively deteriorating attacks".^[20] The eugenic sterilization of persons diagnosed with (and viewed as predisposed to) schizophrenia was advocated by Bleuler.^[3] He argued that racial deterioration would result from the propagation of "mental and physical cripples" In his Textbook of Psychiatry, Bleuler states,^[4]

The more severely burdened should not propagate themselves...If we do nothing but make mental and physical cripples capable of propagating themselves, and the healthy stocks have to limit the number of their children because so much has to be done for the maintenance of others, if natural selection is generally suppressed, then unless we will get new measures our race must rapidly deteriorate.

In 1917, Bleuler discussed the heredity involved in schizophrenia after psychiatrist Ernst Rudin published his findings.^{[full citation needed]} Bleuler agreed with Rudin that having a family member with schizophrenia increases an individual's chance of also having the disease. However, Bleuler found that Rudin's study did not use sufficient sampling methods, threatening the integrity of the study. While researching further, Bleuler made several conclusions that differed from Rudin's. First, that the schizophrenic gene was not a dominant trait. Second, the disease involves a dihybrid, complex gene and does not include a monohybrid gene. Bleuler also said that there may be a polymorphic aspect to schizophrenia, meaning it presents itself in different forms.

Bleuler found that in order for schizophrenia to present itself in patients, several elements must come together. He found that there are a wide variety of symptoms associated with schizophrenia that can lead to a potential diagnosis. Bleuler concluded that several aspects of the disease are not genetically inherited. These tend to be behavioral aspects and positive symptoms, including hallucinations, delusions, and strange ideas.

He believed the disease's central characteristics were the product of splitting between the emotional and the intellectual functions of the personality.^[21] He favored early discharge from hospital into a community environment to avoid institutionalization.^[22]

Bleuler also explored the concept of moral idiocy,^[23] and the relationship between neurosis and alcoholism.^[24] He followed Freud's perspective of seeing sexuality as a potent influence upon anxiety,^[25] pondered on the origins of the sense of guilt, and studied the process of what he defined as switching (the affective shift from love to hate, for example).^[26]

Bleuler was known for his clinical observation and willingness to let symptoms speak for themselves. He was also known for his skillful expository writings. Bleuler has never been credited with healing his patients. Like Sigmund Freud he experimented on patients in his care; many were sterilised and many committed suicide.^[27]

Later in his life, Bleuler studied and published works on psychoids. He defined the psychoid as the capacity to respond and adapt to stimuli, creating permanent changes in the brain and shaping future reactions. Bleuler believed the psychoid to be a cause of psychic development.^[28] He also proposed that social, mental, and physical aspects of life are not separate from each other but instead are seen as aspects of a sole life principle. These ideas were not particularly popular among the scientific community and did not receive a great deal of attention.

• Bleuler's psycho syndrome
• Emil Kraepelin
• Hermann Rorschach
• Pierre Janet
• Wilhelm Wundt

• Tölle R (January 2008). "Eugen Bleuler (1857–1939) und die deutsche Psychiatrie" [Eugen Bleuler (1857–1939) and German psychiatry]. Der Nervenarzt (in German). 79 (1): 90–6, 98. doi:10.1007/s00115-007-2379-9. PMID 18058081. S2CID 25027109.
• Falzeder E (June 2007). "The story of an ambivalent relationship: Sigmund Freud and Eugen Bleuler". The Journal of Analytical Psychology. 52 (3): 343–368. doi:10.1111/j.1468-5922.2007.00666.x. PMID 17537145.
• Bernet B (2006). "Associative disorder. On the relationship between the interpretation of disorder and society in the early writings of Eugen Bleuler" [Associative disorder. On the relationship between the interpretation of disorder and society in the early writings of Eugen Bleuler]. Medizin, Gesellschaft, und Geschichte (in German). 26: 169–93. PMID 17144374.
• Möller A, Hell D (December 2003). "Das Gesellschaftsbild von Eugen Bleuler - Anschauungen jenseits der psychiatrischen Klinik" [The social understanding of Eugen Bleuler - his viewpoint outside of the psychiatric clinic]. Fortschritte der Neurologie · Psychiatrie (in German). 71 (12): 661–6. doi:10.1055/s-2003-45344. PMID 14661160. S2CID 260135455.
• Möller A, Scharfetter C, Hell D (December 2002). "Development and termination of the working relationship of C. G. Jung and Eugen Bleuler 1900-1909". History of Psychiatry. 13 (52 Pt 4): 445–53. doi:10.1177/0957154X0201305206. PMID 12645573. S2CID 39653638.
• Möller A, Hell D (2002). "Eugen Bleuler and forensic psychiatry". International Journal of Law and Psychiatry. 25 (4): 351–60. doi:10.1016/S0160-2527(02)00127-9. PMID 12613049.
• Möller A, Scharfetter C, Hell D (January 2003). "Das "psychopathologische Laboratorium" am "Burghölzli"" [The "Psychopathologic laboratory" at Burghölzli.]. Der Nervenarzt (in German). 74 (1): 85–90. doi:10.1007/s00115-002-1282-7. PMID 12596032. S2CID 25486950.
• Möller A, Hell D (September 2000). "Prinzipien einer naturwissenschaftlich begründeten Ethik im Werk Eugen Bleulers" [Fundamentals of scientifically based ethics in the works of Eugen Bleuler]. Der Nervenarzt (in German). 71 (9): 751–7. doi:10.1007/s001150050660. PMID 11042871. S2CID 40174958.
• Möller A, Hell D (July 1999). "Scientific psychology in the works of Eugen Bleuler". Psychiatrische Praxis (in German). 26 (4): 157–62. PMID 10457965.
• Scharfetter C (April 1999). "Recht- und Andersgläubige" [Orthodoxy against heretics. Correspondence of Gaupp and Kretschmer to Eugen Bleuler]. Fortschritte der Neurologie · Psychiatrie (in German). 67 (4): 143–6. doi:10.1055/s-2007-993991. PMID 10327309. S2CID 147903693.
• Möller A, Hell D (November 1997). "Zur Entwicklung kriminalpsychologischer Grundanschauungen im Werk Eugen Bleulers" [The development of criminal psychology in the work of Eugen Bleuler]. Fortschritte der Neurologie · Psychiatrie (in German). 65 (11): 504–8. doi:10.1055/s-2007-996356. PMID 9480292. S2CID 260138939.
• Kruse G (September 1996). "Autistic-undisciplined thinking in medicine and overcoming it by Eugen Bleuler". Psychiatrische Praxis (in German). 23 (5): 255–6. PMID 8992526.
• Wilhelm HR (1996). "Eugen Bleuler und Carl Gustav Jungs habilitation" [Eugen Bleuler and Carl Gustav Jung's habilitation]. Sudhoffs Archiv (in German). 80 (1): 99–108. JSTOR 20777526. PMID 8928214.
• De Ridder H, Corveleyn J (1992). "Eugen Bleuler (1857–1939) and psychoanalysis". Zeitschrift für Klinische Psychologie, Psychopathologie und Psychotherapie (in German). 40 (3): 246–62. PMID 1519383.
• Bleuler M, Bleuler R (November 1986). "Dementia praecox oder die Gruppe der Schizophrenien: Eugen Bleuler". The British Journal of Psychiatry. 149 (5): 661–2. doi:10.1192/bjp.149.5.661. PMID 3545358. S2CID 5881202.
• Bleuler M (March 1984). "Eugen Bleuler and schizophrenia". The British Journal of Psychiatry. 144: 327–8. PMID 6367878.
• Menuck M (March 1979). "What did Eugen Bleuler really say?". Canadian Journal of Psychiatry. 24 (2): 161–6. doi:10.1177/070674377902400209. PMID 371780. S2CID 33934452.
• Gärtner JK (February 1965). "Significance of Eugen Bleuler in the development of general medical practice". Der Landarzt (in German). 41 (5): 187–91. PMID 5320265.
• Klaesi, Jakob (December 1957). "Zum hundertsten Geburtstag Eugen Bleulers" [On the hundredth birthday of Eugen Bleuler]. Psychiatria et Neurologia. 134 (6): 353–61. doi:10.1159/000138783. PMID 13505951.

Wikimedia Commons has media related to Eugen Bleuler.

• Eugen Bleuler Affectivity, suggestibility, paranoia 1912 translation
• Eugen Bleuler The theory of schizophrenic negativism 1912 translation
• Paul Eugen Bleuler and the Birth of Schizophrenia (1908)
• Burkhart Brückner, Ansgar Fabri: Biography of Eugen Bleuler in: Biographical Archive of Psychiatry (BIAPSY).
• "Eugen Bleuler". Encyclopædia Britannica. 23 April 2018.