The history of psychopathology is full of important figures who made numerous 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”, which included a group of heterogeneous disorders.

Bleuler also talked about the symptoms of schizophrenia, differentiating them into two groups: the basic ones and the accessory ones. In this article you will find a brief biography of Eugen Bleuler, covering his educational and professional career , and knowing the contributions he made, especially in relation to schizophrenia.

Eugen Bleuler: beginnings

Paul Eugen Bleuler (1857-1939) was a Swiss psychiatrist who was born in 1857 in a town near Zurich, Zollikon, and who died in the same town in 1939, at the age of 82. The 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 he graduated as a doctor and started working as an assistant doctor at the Waldau Psychiatric Clinic in Bern, Switzerland. There he worked for Gottlieb Burckhardt, another leading Swiss psychiatrist. Three years later, in 1884, Bleuler left that clinic and began to travel in order to continue training as a doctor, with figures such as Jean-Martin Charcot in Paris, Bernhard von Gudden in Munich, and in London.

After these trips he returned to his native country, Zurich, and worked as an in-house psychiatrist at Burghölzli University Hospital (Zurich). Then, in 1886, Eugen Bleuler became the director of a psychiatric clinic in Rheinau.

Bleuler’s work there was very important, as it improved the conditions of the institutionalized patients. Finally, twelve years later, Bleuler was appointed director at the previous hospital where he had worked, the Burghölzli University Hospital . Eugen Bleuler paid special attention to the overall clinical state of the patient, that is, he observed all the symptoms that the person presented at a specific time, and made an overall assessment.

Freud’s influence

Eugen Bleuler followed closely in the footsteps of Sigmund Freud, influenced by his work and his contributions to the field of psychology and mental health. In addition, he was particularly interested in hypnosis .

Bleuler was of the opinion that complex mental processes can be unconscious, as Freud’s psychoanalysis advocates. That is why Bleuler was interested in having his employees at the Burghölzli Hospital study these types of processes from a psychoanalytic perspective.

However, although Eugen Bleuler allowed himself to be nourished by psychoanalysis , and followed this theoretical orientation for a large part of his academic and professional career, he ended up distancing himself from it, because he did not share its principles with as much determination as Freud. Bleuler considered this psychological current to be excessively dogmatic.

Contributions to mental health research

Some of Eugen Bleuler’s most relevant works were: Early Dementia. The Schizophrenia Group (1993) and Treatise on Psychiatry (1924) (1st Spanish edition). As for his contributions, Bleuler is especially known for coining the terms “schizoid”, “schizophrenia” and “autism” .

To arrive at the term schizophrenia, he started from the early dementia proposed by Emil Kraepelin, a German psychiatrist and the first to define what would later be called schizophrenia.

Term for “schizophrenia”

Specifically, Eugen Bleuler introduced the concept of “schizophrenia” worldwide, and coined the term, at a conference in Berlin on April 24, 1908. He did so through a treatise he drew up, which was based on the study of 647 patients he had treated.

The term “schizophrenia”, for Bleuler, referred to a dissociation of normal brain functions that appeared in this type of patients . The word comes from Greek, and means “division” or “cleavage” (schizophrenia) and “mind” or “reasoning” (frenia).

According to the author, in people with schizophrenia, there was a separation or fissure between ideas (thought) and feelings ; thus, he defended that these two elements were detached, separated or disintegrated.

Schizophrenia group

For Eugen Bleuler, the concept of “schizophrenia” encompassed the forms of early dementia already proposed by Kraepelin, along with juvenile dementia, acquired idiocy, catatonia and hebephrenia. Thus, Bleuler’s term “schizophrenia” replaced Kraepelin’s “dementia praecox”, and included a group of disorders and not just one, as Kraepelin advocated .

Bleuler was very insistent on the heterogeneity of the concept of schizophrenia, since his “schizophrenia group” included disorders that were very heterogeneous from one patient to another.

Simple schizophrenia

Bleuler also considered the subtypes of schizophrenia: paranoid, catatonic and hebephrenic , which had already been introduced by E. Kraepelin. These subtypes no longer appear in the DSM-5, but in the 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 has never presented positive (psychotic) symptoms, but nevertheless, it does manifest negative symptoms such as abulia, emotional flattening or apathy.

Currently, this subtype of schizophrenia can be found as an official diagnosis in the ICD-10 (International Classification of Diseases) and in the annex of the DSM-IV-TR (Diagnostic Manual of Mental Disorders). In DSM-5, however, it is no longer mentioned.

The 4 A’s of Bleuler

Another very interesting contribution made by Eugen Bleuler was that of the “4 A’s” of schizophrenia. These 4 A’s referred to the basic symptoms of the disorder, and the accessory symptoms .

For Bleuler, the basic symptoms were those that are always present in schizophrenia (they don’t have to be all there); that is, according to him, manifesting one of them was already indicative of suffering the disorder. Accessory symptoms, however, don’t always have to be present.

The 4 A’s (basic symptoms), indicate the letter (A) by which the four symptoms begin, which were the following:

1. Lack of Association

It is the lack of association between the ideas expressed by the patient ; that is to say, it is an alteration in thought that is translated into language through incoherence, illogicity, etc.

2. Flattened affect

It is a negative symptom consisting of the absence of any emotional or affective expression (or the practical absence). The patient seems to “feel nothing”.

3. Ambivalence

The ambivalence is manifested in the patient’s behaviour, which is somewhat incoherent, disorganised , “from one side to the other”, etc. Today we would translate it as disorganized behavior, a positive symptom typical of schizophrenia.

4. Autism

Finally, the 4th A proposed by Eugen Bleuler is that of Autism; in this way, the patient shows himself to be distant, as if “closed in his world”, isolated , with very restricted interests, etc.

Accessory symptoms

The accessory symptoms proposed by Bleuler were: delusions, hallucinations, negativism, language disorders, somatic symptoms and catatonia. That is, only positive symptoms , according to the classification of symptoms of schizophrenia.

Eugenics

An important fact about Eugen Bleuler that is also worth commenting on is that he defended forced eugenic sterilization in people diagnosed with (or predisposed to) schizophrenia .

This involved sterilizing these people without their consent, and without prior medical or clinical justification. Eugenics, for its part, is a current, or a philosophy, that advocates the “perfecting” of the human species through the application of the biological laws of inheritance.

Bleuler was of the opinion that this would prevent the perpetuation of the disorder , thus avoiding the “racial deterioration” of the human species. He expressed these ideas in his work “Treatise on Psychiatry”, dated 1924 (1st Spanish edition).

Bibliographic references:

  • Bleuler E. (1993). Early Dementia. The Schizophrenia group. 2nd ed. Trad. D. Ricardo Wagner. Ed. Lumen. Buenos Aires. Argentina.
  • Moskowitz A, Heim G. Eugen Bleuler’s Dementia Praecox or the Group of Schizophrenias (1911): A Centenary Appreciation and Reconsideration. Schizophrenia Bulletin 2011; 37, 3:471-479.
  • Pacheco, L. (2015). By way of cards on classics of Psychiatry: Eugen Bleuler. Lmentala.net, 35: 1-5.