Eugen Bleuler

Paul Eugen Bleuler (German: [ˈɔɪɡeːn ˈblɔɪlər]; 30 April 1857 – 15 July 1939) was a Swiss psychiatrist and eugenicist most notable for his contributions to the understanding of mental illness and for coining the terms "schizophrenia", "schizoid", "autism", and what Sigmund Freud called "Bleuler's happily chosen term ambivalence".

Bleuler was born in Zollikon, a town near Zürich in Switzerland, to Johann Rudolf Bleuler, a wealthy farmer, and Pauline Bleuler-Bleuler. He studied medicine in Zürich and following his graduation in 1881 he worked as a medical assistant to Gottlieb Burckhardt at the Waldau Psychiatric Clinic in Bern. Leaving this post in 1884 he spent one year on medical study trips to Jean-Martin Charcot in Paris, to Bernhard von Gudden in Munich and to London. Thereafter he returned to Zürich to take a post as an intern at the Burghölzli, a university hospital.

In 1886 Bleuler became the director of a psychiatric clinic at Rheinau, a hospital located in an old monastery on an island in the Rhine. It was noted at the time for being backward, and Bleuler set about improving conditions for the patients resident there.

Bleuler returned to the Burghölzli in 1898 where he was appointed director.

Following his interest in hypnotism, especially in its "introspective" variant, Bleuler became interested in Sigmund Freud's work. He favorably reviewed Josef Breuer and Sigmund 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 (published in English in 2003), Bleuler performed a self-analysis with Freud, beginning in 1905.

He found Freud's movement to be over-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".

Bleuler remained interested in Freud's work, citing him favourably, 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.

Bleuler introduced the term "schizophrenia" to the world in a lecture in Berlin on 24 April 1908. However, perhaps as early as 1907 he and his colleagues had been using the term in Zurich to replace Emil Kraepelin's term dementia praecox. 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), which was only translated into English in 1950 (by Joseph Zinkin). Like Kraepelin, Bleuler argued that dementia praecox, or "the schizophrenias," was fundamentally a physical disease process characterized by exacerbations and remissions. 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, he believed that the overall prognosis was not uniformly grim, the "dementia" was a secondary symptom not directly caused by the underlying biological process (three other "fundamental symtpoms," deficits in associations, affectivity and ambivalence, were), and that the biological disease was much more prevalent in the population due to its "simple" and especially "latent" forms. Bleuler wrote in 1911: "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." (See Noll, American Madness, pages 236-242). The eugenic sterilization of persons diagnosed with (and viewed as predisposed to) schizophrenia was advocated by Bleuler. He believed racial deterioration would result from the propagation of mental and physical cripples in his Textbook of Psychiatry:

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.

He believed the disease's central characteristics to be the product of a process of splitting between the emotional and the intellectual functions of the personality. He favoured early discharge from hospital into a community environment to avoid institutionalisation.

Bleuler also explored the concept of moral idiocy, and the relationship between neurosis and alcoholism. He followed Freud in seeing sexuality as a potent influence upon anxiety, pondered on the origins of the sense of guilt, and studied the process of what he termed switching (the affective shift from love to hate, for example).

Bleuler was known for his clinical observation and willingness to let symptoms speak for themselves, as well as for his skillful expository writings.