Eugen Bleuler: biography of this Swiss psychiatrist

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 spoke of the symptoms of schizophrenia, and differentiated them into two groups: the basics and the accessories. 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.

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Eugen Bleuler: beginnings

Paul Eugen Bleuler (1857-1939) was a Swiss psychiatrist who was born in 1857 in a city near Zurich, Zollikon, and who died in the same city 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 served as a professor of psychiatry.

In 1881 graduated as a physician and began working as an assistant physician at the Waldau Psychiatric Clinic of Bern, Swiss city. There he worked for Gottlieb Burckhardt, another leading Swiss psychiatrist. Three years later, in 1884, Bleuler left that clinic and began traveling to continue training as doctor, with figures like Jean-Martin Charcot, in Paris, Bernhard von Gudden, in Munich, and in London.

After these trips he returned to his native country, specifically to Zurich, and worked as an intern psychiatrist at the University Hospital of Burghölzli (Zurich). Subsequently, in 1886, Eugen Bleuler assumed the position of director of a Psychiatric Clinic in Rheinau.

Bleuler's work there was very important, since he improved the conditions of 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 global clinical status of the patient, that is, he observed all the symptoms that the person presented at a specific moment, and made a global assessment.

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Influence of Freud

Eugen Bleuler closely followed in the footsteps of Sigmund Freud, being influenced by his work and his contributions to the field of psychology and mental health. What's more, he was especially interested in hypnosis.

Bleuler believed that complex mental processes could be unconscious, as argued by Freud's psychoanalysis. That is why Bleuler was interested in allowing his employees at Burghölzli Hospital to study this type of process, from a psychoanalytic perspective.

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

Contributions to mental health research

Some of the most relevant works of Eugen Bleuler were: Precocious dementia. The group of Schizophrenias (1993) and Treatise on Psychiatry (1924) (1st Spanish edition). As for his contributions, Bleuler He is especially known for coining the terms "schizoid", "schizophrenia" and "autism".

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

Term of "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 that he drew up, based on the study of 647 patients he had cared for.

The term "schizophrenia", for Bleuler, alluded to a dissociation of normal brain functions that appeared in this type of patients. The word comes from the Greek, and means "division" or "split" (schizo) 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 unrelated, separated or disaggregated.

Schizophrenia group

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

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

Simple schizophrenia

Bleuler, in addition, also he considered the subtypes of schizophrenia: paranoid, catatonic and hebephrenic, which had already been introduced by E. Kraepelin. These subtypes no longer appear in DSM-5, but they do appear in DSM-IV-TR. As an important contribution, Eugen Bleuler added a new one to these subtypes: simple schizophrenia.

Simple schizophrenia is characterized by the fact that the patient has never presented positive symptoms (psychotic), but nevertheless, he does manifest negative symptoms such as apathy, 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 to DSM-IV-TR (Diagnostic Manual of Disorders Mental). In DSM-5, however, it is no longer mentioned.

The 4 Aes of Bleuler

Another very interesting contribution that Eugen Bleuler made was that of the “4 A's” of schizophrenia. These 4 Aes 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 of them); that is, according to him, manifesting one of them was already indicative of suffering from the disorder. Accessory symptoms, however, do not have to appear all the time.

The 4 Aes (basic symptoms), indicate the letter (A) with 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, it is an alteration in thinking that is translated into language through inconsistencies, illogicality, 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 appears "as if he does not feel anything."

3. Ambivalence

Ambivalence manifests itself in the patient's behavior, which is somewhat incoherent, disorganized, "From one side to another", and so on. Today we would translate it as disorganized behavior, a typical positive symptom of schizophrenia.

4. Autism

Finally, the 4th A proposed by Eugen Bleuler is Autism; thus, the patient is distant, as if “locked in his world”, isolated, with very restricted interests, etc.

Accessory symptoms

The accessory symptoms that Bleuler proposed were: delusions, hallucinations, negativism, alterations in language, somatic symptoms and catatonia. Namely, only positive symptoms, according to the classification of symptoms of schizophrenia.

Eugenics

An important fact about Eugen Bleuler that is also worth commenting is that he advocated forced eugenic sterilization in people with a diagnosis of schizophrenia (or with predisposition to suffer it).

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 defends the "improvement" of the human species through the application of the biological laws of inheritance.

Bleuler believed that this would prevent the perpetuation of the disorder, thus avoiding the "racial deterioration" of the human species. These ideas were reflected in his work "Treatise on psychiatry", which is dated 1924 (1st Spanish edition).

Bibliographic references:

• Bleuler E. (1993). Precocious dementia. The group of Schizophrenias. 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). As cards on classics of Psychiatry: Eugen Bleuler. Lmentala.net, 35: 1-5.