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Paul Eugen Bleuler and the Birth of Schizophrenia (1908)

Authors:
  • King's College London (primary) and University of Pavia (secondary)
Am J Psychiatry 165:11, November 2008 1407
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Paul Eugen Bleuler and the Birth of Schizophrenia (1908)
The term “schizophrenia was coined 100 years ago, on April
24, 1908, when Paul Eugen Bleuler gave a lecture at a meeting of
the German Psychiatric Association in Berlin (1): “For the sake of
further discussion I wish to emphasize that in Kraepelin’s demen-
tia praecox it is neither a question of an essential dementia nor of
a necessary precociousness. For this reason, and because from
the expression dementia praecox one cannot form further adjec-
tives nor substantives, I am taking the liberty of employing the
word schizophrenia for revising the Kraepelinian concept. In my
opinion the breaking up or splitting of psychic functioning is an
excellent symptom of the whole group” (2).
Kraepelin’s use of “dementia” derived from the Latin word mens
and the prefix de-, expressing privation; it was a noun that implied a
static condition. While Kraepelin selected descriptions of the symp-
toms and studied their time course mostly from patients’ records,
Bleuler collected material directly from his p assionate clinical work.
By accommodating himself to the spatial and temporal environ-
ment of his patients, he realized that the condition was not a single
disease (he referred to a “whole group” of schizophrenias [3]), was
not invariably incurable, and did not always progress to full demen-
tia, nor did it always and only occur in young people. The main
symptoms of this disease were the loosening of associations, distur-
bances of affectivity, ambivalence, and autism (“the four As”) (4).
However, the splitting of different psychological functions, resulting
in a loss of unity of the personality, was the most important sign of
disease in Bleuler’s conception (4). Thus, he challenged the ac-
cepted wisdom of the time and advanced his purportedly less static
and stigmatizing concept by juxtaposing the Greek roots schizen
(σχι´ζειν, “to split) and phre¯n, phr en- (ϕρη´ν, ϕρεν-, orig inally de-
noting “diaphragm” but later changing, by metonymy, to “soul,
spirit, mind”).
After completing his studies in medicine (1881) and mental
and nervous diseases (1883), Bleuler visited Paris, London, and
Munich. He became director of a small psychiatric clinic situated
in an abandoned monastery on the Rhine (Rheinau, 1886–1898),
then he was appointed professor and director of the Burghölzli
Asylum in Zurich (1898–1927). Among his pupils there were such
outstanding personalities as Carl Gustav Jung, Karl Abraham, Eu-
gene Minkowski, Ludwig Biswanger, and Hermann Rorschach.
He published the work “Dementia praecox oder Gruppe der
Schizophrenien” in 1911 (3) and the book Lehrbuch der Psychiat-
rie in 1916 (5). He died in 1939 in Zollikon, Switzerland, where he
had been born in 1857.
References
1. Bleuler E: Die Prognose der Dementia praecox (Schizophre-
niegruppe). Allgemeine Zeitschrift für Psychiatrie und psych-
ischgerichtliche Medizin 1908; 65:436–464
2. Kuhn R (translated by Cahn CH): Eugen Bleuler’s concepts of
psychopathology. Hist Psychiatry 2004; 15:361–366
3. Bleuler E: Dementia Praecox or the Group of Schizophrenias
(1911). Translated by Zinkin J. New York, International Univer-
sities Press, 1950
4. Stotz-Ingenlath G: Epistemological aspects of Eugen Bleuler’s
conception of schizophrenia in 1911. Med Health Care Philos
2000; 3:153–159
5. Bleuler E: Lehrbuch der Psychiatrie. Berlin, Springer, 1916
PAO LO F USA R -PO L I , M. D.
PIERLUIGI POLITI, M.D., PH.D.
Address correspondence and reprint requests to Dr. Fusar-Poli, Department of Applied and Psychobehavioral Health Sciences, University of Pavia,
via Bassi 21, 27100 Pavia, Italy; p.fusar@libero.it (e-mail). Photograph reproduced by permission of Civic Library of Cremona, Italy. Image ac-
cepted for publication June 2008 (doi: 10.1176/appi.ajp.2008.08050714).
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Eugen Bleuler, in 1911, renamed the group of mental disorders with poor prognosis which Emil Kraepel in had called ``dementia praecox'' ``group of schizophrenias'',because for him the splitting of personality was the main symptom. Biographical, scientific and methodological influences on Bleuler's concept of schizophrenia are shown with special reference to Kraepelin and Freud. Bleuler was a passionate and very experienced clinician. He lived with his patients, taking care of them and writing down his observations. Methodologically he was an empiricist and an eclecticist with a wide reading knowledge. In an impaired association of ideas, in disordered affectivity, in marked ambivalence and autism Bleuler saw the main symptoms of schizophrenia. For him these so-called pathological phenomena actually seemed to be only exaggerations of normal psychic functions. So there were only a quantitative, not a qualitative difference between schizophrenia and normal psychic processes and studies on schizophrenic ``pathology'' –seen as a disturbance, not as a disease – might analogously illustrate normal psychic reactions and vice versa. In etiology as well as in therapy Bleuler took into account psychological and (neuro)physiological(somatic) mechanisms – thus combining organicism and dynamic psychiatry and coming very close to modern concepts, e.g. the one of stress and vulnerability. Bleuler's main merit is the stressing of an idiographic ``understanding'' of the patient and a plausible and subtle explanation of schizophrenia which helped to reduce the alienation of the affected persons.
Die Prognose der Dementia praecox (Schizophre-niegruppe) Allgemeine Zeitschrift für Psychiatrie und psych-ischgerichtliche
  • Bleuler
Bleuler E: Die Prognose der Dementia praecox (Schizophre-niegruppe). Allgemeine Zeitschrift für Psychiatrie und psych-ischgerichtliche Medizin 1908; 65:436–464
Fusar-Poli, Department of Applied and Psychobehavioral Health Sciences, University of Pavia, via Bassi 21, 27100 Pavia, Italy; p.fusar@libero.it (e-mail) Photograph reproduced by permission of Civic Library of Cremona, Italy. Image accepted for publication
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Address correspondence and reprint requests to Dr. Fusar-Poli, Department of Applied and Psychobehavioral Health Sciences, University of Pavia, via Bassi 21, 27100 Pavia, Italy; p.fusar@libero.it (e-mail). Photograph reproduced by permission of Civic Library of Cremona, Italy. Image accepted for publication June 2008 (doi: 10.1176/appi.ajp.2008.08050714).
Kuhn R (translated by Cahn CH): Eugen Bleuler's concepts of psychopathology
Kuhn R (translated by Cahn CH): Eugen Bleuler's concepts of psychopathology. Hist Psychiatry 2004; 15:361-366
Translated by Zinkin J
  • E Bleuler
Bleuler E: Dementia Praecox or the Group of Schizophrenias (1911). Translated by Zinkin J. New York, International Universities Press, 1950