The history of psychopathology is replete with important figures who have made many contributions to the field of psychology and mental health. One of them is Eugen Bleuler (1857-1939), the Swiss psychiatrist who coined the term “schizophrenia”, and who included a group of heterogeneous disorders.
Bleuler also spoke about the symptoms of schizophrenia and differentiated them into two groups: the bases and the accessories. In this article you will find a brief biography of Eugen Bleuler, covering his training and professional career, And knowing the contributions he has made, especially with regard to schizophrenia.
Eugen Bleuler: beginnings
Paul Eugen Bleuler (1857-1939) was a Swiss psychiatrist born in 1857 in a town near Zurich, Zollikon, and died in the same town in 1939, at the age of 82. Son of Johann Rudolf Bleuler and Pauline Bleuler-Bleuler, he studied medicine at the University of Zurich. There, years later, he worked as a professor of psychiatry.
in 1881 graduated as a doctor and started working as an assistant doctor at the psychiatric clinic in Waldau of Bern, Swiss city. Here he worked for Gottlieb Burckhardt, another prominent Swiss psychiatrist. Three years later, in 1884, Bleuler left this clinic and began to travel to continue his training as a doctor, with such figures as Jean-Martin Charcot in Paris, Bernhard von Gudden, Munich and London.
After these trips, he returned to his native country, more precisely to Zurich, and worked as a hospital psychiatrist at the Burghölzli University Hospital (Zurich). Then, in 1886, Eugen Bleuler assumed the post of director in a psychiatric clinic in Rheinau.
Bleuler’s work here was very important, as it improved the conditions of institutionalized patients. Finally, twelve years later, Bleuler he was appointed director of the old hospital where he worked, Burghölzli University Hospital. Eugen Bleuler paid particular attention to the general clinical condition of the patient, that is, he observed all the symptoms that the person had at a specific time, and made an overall assessment.
Eugen Bleuler followed in Sigmund Freud’s footsteps, influencing his work and contributions to the field of psychology and mental health. Outraged, he was particularly interested in hypnosis.
Bleuler believed that complex mental processes could be unconscious, as Freud’s psychoanalysis advocates. This is why Bleuler was interested in allowing his employees at the Burghölzli hospital to study such processes, from a psychoanalytic perspective.
However, although Eugen Bleuler he fed on psychoanalysisAnd followed this theoretical orientation for much of his academic and professional career, he ended up moving away from it, not to share his principles with as much determination as Freud. Bleuler considered this psychological current to be too dogmatic.
Contributions to mental health research
Some of Eugen Bleuler’s most important works were: Early Dementia. Le groupe de schizophrenias (1993) and Traite de psychiatrie (1924) (1st Spanish edition). As for his contributions, Bleuler is best known for coining the terms “schizoid”, “schizophrenia” and “autism”.
To arrive at the term schizophrenia, he starts from precocious dementia proposed by Emil Kraepelin, German psychiatrist and the first to define what will later be called schizophrenia.
Term for “schizophrenia”
Specifically, Eugen Bleuler introduced the concept of “schizophrenia” around the world, and coined the term, at a conference in Berlin on April 24, 1908. He did so through a treaty that ‘he wrote, and which is based on the study of 647 patients he had treated.
The term “schizophrenia”, by Bleuler, alludes to a dissociation of normal brain functions that occurred in these patients. The word comes from the Greek and means “division” or “scission” (schizo) and “spirit” or “reasoning” (frenia).
According to the author, in people with schizophrenia, there was a separation or rift between ideas (thinking) and feelings; thus, he maintained that these two elements were detached, separated or disintegrated.
For Eugen Bleuler, the concept of “schizophrenia” encompasses the forms of precocious dementia already proposed by Kraepelin, alongside juvenile dementia, acquired idiocy, catatonia and hebephrenia. For example, Bleuler’s term “schizophrenia” replaced Kraepelin’s “praecox dementia”, and it included a group of troubles and not just one, as Kraepelin argued.
Bleuler emphasized the heterogeneity of the concept of schizophrenia, as his “schizophrenia cluster” included very heterogeneous disorders from patient to patient.
Blue too considered the schizophrenia subtypes: paranoid, catatonic and hebephrenic, Which had already been introduced by E. Kraepelin. These subtypes no longer appear in DSM-5, but in DSM-IV-TR. As an important contribution to these subtypes Eugen Bleuler added a new one: simple schizophrenia.
Simple schizophrenia is characterized by the fact that the patient does not have positive (psychotic) symptoms, but nevertheless manifests negative symptoms such as abulia, emotional flattening or apathy.
Currently, this schizophrenia subtype can be found as an official diagnosis in ICD-10 (International Classification of Diseases) and in the appendix to DSM-IV-TR (Diagnostic Manual of Mental Disorders). In the DSM-5, however, it isn’t even mentioned anymore.
The 4 Aes of Bleuler
Another very interesting contribution from Eugen Bleuler was the “4 Aes” of schizophrenia. they referred to the basic symptoms of the disorder and the ancillary symptoms.
For Bleuler, the basic symptoms were those that are always present in schizophrenia (they don’t have to be everywhere); that is to say that, according to him, manifesting one of them was already a sign of suffering from the disorder. However, auxiliary symptoms do not always have to appear.
The 4 Aes (basic symptoms) indicate the letter (A) with which the four symptoms begin, which were as follows:
1. Lack of association
is the lack of association between the ideas expressed by the patient; that is to say, it is an alteration of thought which is reflected in the language by inconsistencies, illogicity, etc.
2. Flattened effect
It is a negative symptom consisting of the absence of any emotional or affective expression (Or the practical absence). The patient appears “as if he had heard nothing”.
Ambivalence manifests itself in the behavior of the patient, who it’s somewhat incoherent, disorganized, “Side to side”, & c. Today we would translate it into disorganized behavior, a typical positive symptom of schizophrenia.
Finally, the 4th A proposed by Eugen Bleuler is that of autism; This way, we show that the patient is distant, as if “locked in his world”, isolated, With very limited interests, etc.
The ancillary symptoms proposed by Bleuler were: delusions, hallucinations, negativity, language alterations, somatic symptoms and catatonia. In other words, that is to say only positive symptoms, According to the classification of symptoms of schizophrenia.
An important fact of Eugen Bleuler and which also deserves to be commented on is that advocated forced eugenic sterilization in people with schizophrenia (Or with a predisposition to suffer from it).
This involved sterilizing these people without their consent and without prior medical or clinical justification. Eugenics, on the other hand, is a current, or a philosophy, which advocates the “perfection” of the human species by the application of the biological laws of inheritance.
Bleuler believed that this would prevent the perpetuation of the disorder, To avoid hence the “racial deterioration” of the human species. These ideas were embodied in his work “Treatise on Psychiatry”, which dates from 1924 (1st Spanish edition).
- Bleuler E. (1993). Premature dementia. Group of schizophrenia. 2nd ed. Trad. D. Ricardo Wagner. Ed. Lumen. Buenos Aires. Argentina.
- Moskowitz A, Praecox Dementia by Heim G. Schizophrenia Bulletin 2011; 37, 3: 471-479.
- Pacheco, L. (2015). As tabs of the classics of psychiatry: Eugen Bleuler. Lmentala.net, 35: 1-5.