Surname:

Bleuler

First name:

Paul Eugen

Era:

19th century
20th century

Field of expertise:

Neurology
Psychiatry

Place of birth:

Zollikon (CHE)

* 30.04.1857

† 15.07.1939

Eminent Swiss psychiatrist; coined the term “schizophrenia”.

Biography

Eugen Bleuler (1857-1939) was born in the Swiss town of Zollikon, near Zurich, as the second child of the silk merchant and farmer Hans Rudolf Bleuler and his wife Pauline. He grew up in a large family in the rural setting of the family homestead, together with his five-year-older sister, Anna Pauline (1852-1926). His sister was said to have been seriously mentally disturbed since early adulthood. Bleuler’s own experiences as a care-giving relative can be assumed to have had a crucial influence on his choice of career and may also have contributed to his later eugenic views as he feared to possess a hereditary disposition to the same condition (Bleuler 1881; cf. Apelt-Riel 2009: 14 f.). Following his graduation in medicine at the University of Zurich in 1881, he worked as a medical assistant to Rudolf Schärer at Waldau hospital in Bern where he also obtained his doctorate. He left this post in 1884 and spent one year on study trips to Jean-Martin Charcot in Paris and Bernhard von Gudden in Munich, among others.

Returning to Switzerland, he briefly worked as assistant to Auguste Forel at “Burghölzli”, the University of Zurich’s psychiatric clinic and was appointed director of the cantonal asylum in Rheinau in 1886. His experiences at this asylum and his longstanding interest in association psychology laid the groundwork for his later description of schizophrenia. His collaboration with Auguste Forel – whose hypnosis research heralded the psychoanalytic methods developed by Freud and Jung – contributed to integrating psychoanalysis into clinical psychiatry. In 1898, Bleuler was appointed successor to Forel at the “Burghölzli” in Zurich and became full professor of psychiatry at the University of Zurich. After his parents died the same year, he took care of his sister, Anna Pauline, first at the clinic and later at his residence (Letsch 2013: 250; Scharfetter 2006: 43 f.)

Bleuler served as Burghölzli’s director for 29 years, during which time he trained countless physicians, among them Carl Gustav Jung, who was one of his most important assistants between 1900 and 1909. Starting in 1907, a psychoanalytically oriented research group formed at the clinic. Aside from Jung, who had become Bleuler’s senior physician in 1905, this group comprised Karl Abraham, Frank Riklin, and Alphonse Maeder. Many of Bleuler’s students later became professors themselves, such as Jakob Kläsi, Hans Steck, and Max Müller. Social life in these circles was marked by extensive professional exchange but also by strict moral norms, such as a ban on drinking alcohol during off hours, both of which probably influenced Bleuler’s theoretical positions (Bernet 2013: 215 ff.). Bleuler himself indeed considered his contributions to the treatment of alhoholism as his most significant work. Under his leadership, Burghölzli developed into an institution of international repute. He also founded a clinic for child psychiatry in Zurich in 1921 and, between 1924 and 1926, served as rector of the local university. He became emeritus in 1927 but continued to work as a researcher and expert-consultant at his home in Zollikon.

Eugen Bleuler was married to writer Dr. phil. Hedwig Waser since 1901. The couple had five children. Their son Manfred Bleuler (1903-1994) also became a professor of psychiatry at the University of Zurich and director of the Burghölzli clinic.

Research on schizophrenia

Bleuler’s most prominent work Dementia praecox oder Gruppe der Schizophrenien was published in 1911 (Dementia praecox or the Group of Schizophrenias, 1950). The new coinage “schizophrenia” originated from the Greek terms “schizein” (to split) and “phrenes” (mind, diaphragm) – the latter because, in ancient Greece, the thoracic diaphragm was thought to house the mind. Bleuler’s first use of the term dates back to April 1908. In his lecture titled Die Prognose der Dementia praecox (The Prognosis of Dementia Praecox),held at the annual meeting of the German Psychiatric Association in Berlin, he claimed that the disorder, referred to by Kraepelin as “dementia praecox” (premature or precocious dementia), neither always implied a serious loss of intellectual functions nor necessarily a “premature” occurrence. According to Bleuler, the disorder instead involved very heterogeneous symptoms, was not restricted to young age, and actually represented a whole group of disorders. However, although this broadened conception indeed acknowledged the patients’ social roles, it also increased the number of people likely to be diagnosed with schizophrenia (cf. Bernet 2013: 207 ff.).

Bleuler wrote that a schizophrenic’s mental functions “no longer form a conglomerate of strivings with consistent results, as is the case in healthy subjects, but that one complex temporarily dominates the personality, while other groups of imaginations or strivings are ‘split off’ and thus wholly or partially ineffective” (translated from Bleuler 1911: 6). He did not find any distortion of perception, memory, and orientation, but instead observed anomalies in associative processes (incoherence) and an inhibition of emotional expression (autism). The key symptom (“Grundsymptome”), according to Bleuler, is the association disorder, which is then accompanied by unspecific, yet often conspicuous “accessory” symptoms, such as delusions or hallucinations. He differentiated four sub-types: the “paranoid type”, characterized by delusions; the “catatonic type”, characterized by motor disorders; the “hebephrenic type” with mild accessory symptoms; and “simple schizophrenia” in which only the key symptoms can be observed.

This classification is still reflected in the World Health Organization’s current issue of the International Statistical Classification of Diseases (ICD). Furthermore, differentiating between primary or key symptoms and secondary or accessory symptoms had a profound impact on the distinction between underlying disorder and symptoms, a distinct feature of 20th century psychopathology. Quite similar to Karl Jaspers, Bleuler (1930: 644) saw a dichotomy between “somatic processes” (underlying disorder) and the “psychological superstructure” (symptoms). And just like Emil Kraepelin, he sought to explain the disorder using the highly speculative degeneration theory. He was therefore convinced that schizophrenia cannot be cured and that “training” the patients is the only way to achieve at least a “social healing”.

Bleuler and psychoanalysis

Bleuler was the first clinic director in Europe to give attention to psychoanalysis and thus paved the way for its academic recognition. This approach was rather unusual given the different clientele of clinical psychiatry and psychoanalysis. Furthermore, Freud himself was very skeptical about the psychotherapeutic treatment of psychosis. Kraepelin dismissed Freud’s theories in a sometimes-polemic manner, while Bleuler tried to mediate in this controversy (Tölle 2008). Even though he managed to integrate psychoanalytical concepts into his understanding of pathoplasticity, he would never accept Freud’s theoretical explanations on the causes of mental disorders and always remained a staunch advocate of a biological etiology (cf. Bleuler 1930). Despite these differences, Bleuler and Freud engaged in professional exchange (Schröter 2012). Between 1909 and 1913, they jointly edited six volumes of the Jahrbuch für psychoanalytische und psychopathologische Forschung (Yearbook for Psychoanalytical and Psychopathological Research). Between 1904 and 1937, they engaged in lively correspondence, and, in his 1910 article Die Psychoanalyse Freuds (Freud’s psychoanalysis), Bleuler was the first to use the term “Tiefenpsychologie” (depth psychology).

Bleuler and eugenics in Switzerland

Meanwhile, Bleuler’s position on psychiatric eugenics has been critically reappraised. Eugenically motivated attempts at restricting patients’ and disabled persons’ right to parenthood, the promotion of (forced) sterilizations and even patient killings – such as in the radical “racial hygiene” policies of Nazi Germany – were widespread throughout the world in the early the 20th century (for instance, in the US or in Scandinavia ). Forel was among the early advocates of eugenic policies. The first four sterilizations in Europe were performed at the Swiss asylum in Will in1907. From 1909 onwards, the Burghölzli clinic, under Eugen Bleuler’s direction, produced expert reports supporting surgical interventions on eugenic grounds (Küchenhoff 2003). Sterilizations were still carried out when his son Manfred was director of the clinic. The Swiss canton of Vaud introduced Europe’s first law on forced sterilization in 1928. In his 1936 article Die naturwissenschaftlichen Grundlagen der Ethik (The scientific foundations of ethics), Bleuler argued that “mad-doctors” had long since considered the “procreation of mentally defective and inferior persons” to be “utterly wrong.” He recommended as a “legitimate duty” that “serious cases” be subject to joint expert assessment to determine whether they should be killed. Sterilizations on eugenic grounds were performed in Switzerland up until the 1970s.

Awards

1928: Honorary member of the German Psychiatric Association

1932: Member of the Leopoldina Academy of Sciences

Literature

Apelt-Riel, S. (2009): Der Briefwechsel zwischen Ludwig Binswanger und Eugen Bleuler von 1907 – 1939 im Spannungsfeld von Psychoanalyse und Psychiatrie in der ersten Hälfte des 20. Jahrhunderts. Inaugural-Dissertation zur Erlangung des Doktorgrades der Medizin der Medizinischen Fakultät der Eberhard-Karls-Universität zu Tübingen.

Bernet, B. (2013): Schizophrenie. Entstehung und Entwicklung eines psychiatrischen Krankheitsbilds um 1900. Zurich: Chronos.

Berrios, G. E. (2011): Bleuler’s place in the history of psychiatry. In: Schizophrenia Bulletin 37, (6), pp. 1096–1098.

Bleuler, E., K. H. Lehmann (1881): Zwangsmässige Lichtempfindungen durch Schall und verwandte Erscheinungen auf dem Gebiete der andern Sinnesempfindungen. Leipzig: Fues.

Bleuler, E. (1906): Affektivität, Suggestibilität, Paranoia. Zürich, Halle: Marhold.

Bleuler, E. (1908): Die Prognose der Dementia praecox (Schizophreniegruppe). In: Allgemeine Zeitschrift für Psychiatrie und psychisch-gerichtliche Medizin 65, pp. 436–464.

Bleuler, E. (1910): Die Psychoanalyse Freuds. Verteidigung und kritische Bemerkungen. In: Jahrbuch für Psychoanalyse 2, pp. 623–730.

Bleuler, E. (1911): Dementia praecox oder Gruppe der Schizophrenien. [In: G. Aschaffenburg (ed.), Handbuch der Psychiatrie, Spez. Teil, 4. Abt., 1. Hälfte]. Leipzig and Vienna: Deuticke.

Bleuler, E. (1916): Lehrbuch der Psychiatrie. Berlin: Springer.

Bleuler, E. (1921): Naturgeschichte der Seele und ihres Bewusstwerdens; eine Elementarpsychologie. Berlin: Springer.

Bleuler, E. (1930): Primäre und sekundäre Symptome der Schizophrenie. In: Zeitschrift für die gesamte Neurologie und Psychiatrie 124, (1), pp. 607–646.

Bleuler, E. (1936): Die naturwissenschaftlichen Grundlagen der Ethik. In: Schweizer Archiv für Neurologie und Psychiatrie 3, (2), pp. 177–206.

Dalzell, T. (2010): The reception of Eugen Bleuler in British psychiatry, 1892 – 1954. In: History of Psychiatry 21, (3), pp. 325–339.

Dalzell, T. G. (2015): Bleuler, Eugen (1857-1939). In: R. Cautin, S. Lilienfield (Hg.): Encyclopedia of Clinical Psychology, Bd. 1. Hoboken: Wiley-Blackwell, S. 404-407.

Heckers, S. (2011): Bleuler and the neurobiology of schizophrenia. In: Schizophrenia Bulletin 37, (6), pp. 1131–1135.

Hell, D. (2012): Herkunft, Kindheit und Jugend. In: R. Mösli (ed.): Eugen Bleuler – Pionier der Psychiatrie. Zurich: Römerhof, pp. 15–28.

Hell, D., C. Scharfetter, A. Möller (eds.) (2001): Eugen Bleuler – Leben und Werk. Bern: Hans Huber.

Hoff, P. (2015): Bleuler, Eugen (1857-1939). In: J. D. Wright (Hg.): International Encyclopedia of the Social & Behavioral Sciences (Second Edition). Amsterdam: Elsevier, S. 700-702.

Huonker, T. (2003): Diagnose “moralisch defekt”. Kastration, Sterilisation und Rassenhygiene im Dienst der Schweizer Sozialpolitik und Psychiatrie 1890 – 1970. Zurich: Orell Füssli.

Küchenhoff, B. (2003): Eugenisch motiviertes Denken und Handeln im “Burghölzli” am Anfang des 20. Jahrhunderts. In: Schweizer Archiv für Neurologie und Psychiatrie 154, (1), pp. 11–19.

Letsch, W. (2013): Eugen Bleulers Herkunft und Jugendzeit. In: Schweizer Archiv für Neurologie und Psychiatrie 164, (7), pp. 236–251.

Maatz, A., P. Hoff (2014): The birth of schizophrenia or a very modern Bleuler: a close reading of Eugen Bleuler’s ‘Die Prognose der Dementia praecox’ and a re-consideration of his contribution to psychiatry. In: History of Psychiatry 25, (4), S. 431-440.

Möller, A., D. Hell (2003): Das Gesellschaftsbild von Eugen Bleuler - Anschauungen jenseits der psychiatrischen Klinik. In: Fortschritte der Neurologie und Psychiatrie71, (12), pp. 661–666.

Mösli, R. (ed.) (2012): Eugen Bleuler – Pionier der Psychiatrie. Zurich: Römerhof Verlag.

Scharfetter, C. (2006): Eugen Bleuler 1857 – 1939. Polyphrenie und Schizophrenie. Zürich: vdf Hochschulverlag.

Schröter, M. (ed.) (2012): Sigmund Freud – Eugen Bleuler: „Ich bin zuversichtlich, wir erobern bald die Psychiatrie“. Briefwechsel 1904 – 1937. Basel: Schwabe.

Tölle, R. (2008): Eugen Bleuler (1857-1939) und die deutsche Psychiatrie. In: Der Nervenarzt 79, (1), pp. 90–98.

Burkhart Brückner, Ansgar Fabri

Photo: author of photograph unknown / Source: Wikimedia / [public domain].