Eugen Bleuler (1859–1939), Swiss psychiatrist, was born in Zollikon, which today is a suburb of Zurich. After a short period of study at the Waldau Clinic in Bern and a brief stay at Burghölzli, he was appointed director of the Rheinau Psychiatric Hospital at the early age of 29. Twelve years later he was appointed full professor of psychiatry at the University of Zurich—against the wishes of the Zurich faculty of medicine. He occupied that chair until 1927.
Outwardly Bleuler’s career was uneventful; his brilliant achievements are all the more startling by contrast. In 1911 the publication of his monograph Dementia Praecox: Or the Group of Schizophrenias made Bleuler famous. He took over where Emil Kraepelin, with his clinical definition of dementia praecox, had left off. Bleuler added new symptoms to the description of this disease and, by his subtle analyses, so enriched our appreciation of these symptoms that in the world of psychiatry, schizophrenia became the standard name of the syndrome. Of late it has even become fashionable to call many social and political crises schizophrenic—which is a misuse of a medical concept.
Schizophrenia was a term first proposed by Bleuler in his paper “Die Prognose der Dementia Praecox (Schizophreniegruppe)” (1908), which was read at a conference of German psychiatrists in Berlin in 1908. Bleuler, who was then 50, emerged as a brilliant, accurate clinical researcher. He based his findings on 647 cases treated at Burghölzli over a period of eight years. This is a classic paper in the best sense of the term. It contains a number of important statements. Bleuler observed, for example: “Acuteness (of illness) is apparently of great significance in determining the outcome. Of the cases whose onset was acute, 73 per cent were discharged as capable of outside employment, 11 per cent deteriorated severely, and the remaining 16 per cent represented cases between these two extremes. Of the cases whose onset was chronic, 30 per cent remained severely deteriorated, and only 50 per cent were able to work independently outside the mental hospital” (1908, p. 437). He noted that abnormal personalities “tend more to severe illness and less to mild illness than do normal or nervous cases” (1908, p. 439) and that “it is rare to find patients with … remission (of symptoms) deteriorating so severely as to require permanent institutionalization” (1908, p. 441). His statement, “The schizophrenic is not simply demented, but merely demented with respect to certain questions, at certain times, and in response to certain complexes” (1908, pp. 452–453), has not been outdated. And he was the first to note a fundamental problem that still concerns us: “Above all, we must endeavor to distinguish between the primary symptoms, which are part of the disease process, and the secondary symptoms, which develop only as a reaction of the afflicted psyche to the influences of its surroundings and to its own efforts” (1908, p. 454).
Of the numerous other papers by Bleuler, particular mention should be made of those based on psychoanalytical thinking and of his polemics against alcohol. Even today psychiatrists are willing to learn from Bleuler about the general problems of psychopathology and psychology, of schizophrenia and paranoia, and of reason and unreason in science and practice. Today as then, however, his writings on natural philosophy have less appeal. Bleuler, as a child of his time—very much like his contemporary Kraepelin—was too much impressed by a materialism that now seems naive. He was, however, sufficiently flexible to have been receptive to the existential analysis of his pupil Ludwig Binswanger, 1922–1957, and he certainly would have liked Die Person des Schizophrenen (“The Schizophrenic Personality”), a study by his pupil Jacob Wyrsch (1949). Indeed, in his clinical writings Bleuler had elaborated a psychopathology of the schizophrenic personality in existentialist terms. Long before World War i, before Karl Jaspers and the later epigoni of Heidegger, Bleuler sought to make the world of the schizophrenic more familiar and real. For Bleuler, the scientifically trained nosologist, human beings suffering from psychoses were, of course, sick, but they also represented instances of humanity whose existence under extraordinary conditions he explored, most often through psychoanalysis. He was fascinated by psychoanalysis and was among the first to grant it respectability in psychiatry.
These brief statements may cover Bleuler’s major achievements. We gratefully remember, however, that it was Bleuler who added such pregnant concepts as autism, ambivalence, and Verhältnisblödsinn (a deficient sense of proportion) to our store of psychopathological terminology. These concepts are explained in Bleuler’s Textbook of Psychiatry (1916). On autism he wrote: “Schizophrenics lose contact with reality, the mild cases inconspicuously in one respect or another, the severe ones completely” ( 1951, p. 384). As for ambivalence, he commented that “schizophrenic splitting of function makes it possible for contradictions that are otherwise mutually exclusive to exist side by side within the psyche” ( 1951, p. 382). And concerning Verhältnisblödsinn, he noted:
Without any sharp line of demarcation, schizophrenia shades into Verhältnisblödsinn. Here too, there is sometimes confusion of thought. The essential factor, however, is a disproportion between aim and ability. Persons with Verhältnisblödsinn have sufficient intelligence for an ordinary position in life, sometimes even for one of somewhat more than average difficulty, but they are excessively active, always trying to do more than they can really handle, so that they make many mistakes and fail in life. ( 1951, p. 617)
All these noteworthy scientific achievements should not obscure Bleuler’s accomplishments as a practicing psychiatrist. Like his predecessor Auguste Forel, Bleuler cultivated the spirit of freedom in the institutionalization and treatment of patients that had been introduced into Germany from England by Ludwig Meyer. In contrast to his predecessors, who resigned their posts prematurely exhausted, Bleuler’s personality enabled him to overcome all obstacles, and his work, both as researcher and physician, raised Burghölzli to the summit of its influence in the world of medicine. To many outstanding psychiatrists throughout the world Kraepelin and Bleuler were centers of attraction from whom psychiatry constantly received new stimulation. Bleuler, with Freud and Kraepelin, had a lasting influence on Henry Maudsley and Adolf Meyer, the English-speaking reformers of psychiatry.
A lively picture of an unusual personality emerges in the obituaries of Bleuler written by his students the Minkowski brothers, Robert Gaupp, and Ludwig Binswanger, and in the biography by Jacob Klasi. The short, delicately built man with his expressive features was intellectually active to the last. The singleness of purpose and constancy of his character, governed by “practical reason,” as Binswanger put it, never hindered him from displaying broad tolerance, though he was not without traces of fanaticism. Eugen Bleuler knew of only two tasks, to which he devoted himself with the entire strength of his unique personality: to be a rational psychiatrist and a genuine human being.
[For the historical context of Bleuler’s work, see the biography ofKraepelin. For discussion of the subsequent development of his ideas, seePsychiatry; Schizophrenia; Psychoanalysis; and the biography ofMeyer.]
1908 Die Prognose der Dementia Praecox (Schizophreniegruppe). Allgemeine Zeitschrift für Psychiatrie und Physisch–gerichtliche Medizin 65:436–464. → Translation of extracts in text provided by the editors.
(1911) 1950 Dementia Praecox: Or the Group of Schizophrenias. New York: International Universities Press. → First published in German.
(1916) 1951 Textbook of Psychiatry. Authorized English edition by A. A. Brill, with a biographical sketch by Jacob Shatsky. New York: Dover. → First published as Lehrbuch der Psychiatrie.
(1919) 1921 Das autistisch–undisziplinierte Denken in der Medizin und seine Überwindung. 2d ed. Berlin: Springer.
Binswanger, Ludwig (1922–1957) 1963 Being-in-the-world: Selected Papers. New York: Basic Books. → Translated from the German by Jacob Needleman. Contains a critical introduction to Binswanger’s existential psychoanalysis.
Binswanger, Ludwig 1940 Bleulers geistige Gestalt. Schweizer Archiv für Neurologie und Psychiatrie 46:24–29.
Gaupp, Robert 1940 Eugen Bleuler: Die Personlichkeit und ihr Werk. Zeitschrift für die gesamte Neurologie und Psychiatrie 168:1–35.
KlÄsi, Jacob 1923 Beitrag zur Frage der Behandlung von Magenneurosen. Zeitschrift für die gesamte Neurologie und Psychiatrie 82:122–130.
Maier, Hans W. 1923 Eugen Bleuler zur Feier seiner 25 jährigen Tätigkeit als Ordinarius der Psychiatrie und Direktor der Psychiatrischen Klinik in Zürich, April 1923. Zeitschrift für die gesamte Neurologic und Psychiatrie 82:1–9. → Contains a bibliography of Bleuler’s works.
Minkowski, E. 1939 Hommage à la mémoire du Professeur Bleuler. Annales médico-psychologiques 97: 420–423.
Wyrsch, Jacob 1949 Die Person des Schizophrenen: Studien zur Klinik, Psychologie, Daseinsiveise. Bern (Switzerland): Haupt.
The Swiss psychiatrist Eugen Bleuler (1857-1939), noted primarily for his work on schizophrenia, was a renowned dissenter from the orthodox Freudian psychoanalytic approach to psychopathology.
Eugen Bleuler was born in Zurich on April 30, 1857. After taking his medical degree at the University of Zurich, he spent his professional life as director of the Burghölzi hospital, a neurological clinic near Zurich, and as professor of psychiatry at the University of Zurich. Bleuler's approach to mental illness included an appreciation of the importance of motivational factors in abnormal behavior, as well as an understanding that some of these motivational factors may be "unconscious," that is, not recognized by the patient himself. Consequently, he was attracted to certain aspects of Sigmund Freud's psychoanalytical theory. Bleuler began an early correspondence with Freud, and he appointed as his chief assistant at the Burghölzi one of Freud's followers, Carl Jung. Also on the staff of the Burghölzi was another Freudian psychiatrist, Karl Abraham.
Bleuler was present at the first International Psycho-Analytic Congress in Salzburg in April 1908. The first periodical devoted exclusively to psychoanalysis, Jahrbuch für psychoanalytische und psychopathologische Forschungen, was directed by Freud and Bleuler and edited by Jung. Disagreements, both professional and personal, arose between Jung and Bleuler and, eventually, between Freud and Bleuler. Jung finally resigned his position at the Burghölzi, and Bleuler resigned from both the Swiss and the International psychoanalytic associations.
Bleuler's contributions to psychiatry were in the field of psychosis. At the time he began his work, psychiatrists tended to think of dementia praecox (early insanity) as a single disorder. Bleuler argued that it was in fact a group of disorders which shared certain symptoms, such as a lack of contact with reality. He coined the term "schizophrenia" (splitting of the mind) as a general classification for these abnormalities. His choice of the term was dictated by his belief that the most characteristic aspect of the disorder was a splitting or dissociation of the patient's total personality. In this regard, Bleuler also introduced the term "ambivalence," which refers to the often conflicting feelings and emotions, both positive and negative, that schizophrenics, and indeed even normal individuals, feel toward the same person, idea, or object. It has been suggested that Bleuler's own conflict with orthodox Freudian psychoanalysis may have been motivated in part by his puritanical feelings about sex and alcohol and may provide an example of his own concept of ambivalence.
Another aspect of schizophrenic behavior studied by Bleuler was the tendency of some patients to withdraw from contact with the reality of the outside world and to live in an "inner world" of their own making. He termed this escape from outer to inner life "autism." Bleuler died in Zurich on July 15, 1939.
There is no full-length biography of Bleuler. Bleuler's Textbook of Psychiatry, edited by A. A. Brill (1951), contains a biographical sketch by Jacob Shatzky. Bleuler's life and work are often discussed in works on Freud. Ernest Jones's comprehensive The Life and Work of Sigmund Freud (3 vols., 1955) contains numerous references to Bleuler, especially vol. 2: Years of Maturity. Vincent Brome, Freud and His Early Circle: The Struggles of Psycho-Analysis (1968), deals with the pioneers in the field, including Bleuler. See also H. F. Ellenberger, Discovery of the Unconscious (1970). □