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Paul Eugen Bleuler and the Birth of Schizophrenia (1908)

  • King's College London (primary) and University of Pavia (secondary)
Am J Psychiatry 165:11, November 2008 1407
Images in Psychiatry
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.
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
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; (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).
... Kanner adopted the concept of autism from Eugene Bleuler's "four As" that characterized schizophrenia: autism, (loosened) association, (restricted) affect, and ambivalence [28]. In this sense, autism reflects the absorption of individuals with psychosis in their inner world, detached from external reality. ...
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The disease burden of autism spectrum disorder (ASD) is a definitive public health challenge. The quality of life of children with ASD depends on how the cultural environment fits their special needs, including religious and spiritual factors. Does ASD predict low religiosity, and if not, what is the significance for clinical care? To answer this question, we reviewed the literature on the cognitive models of ASD and religious beliefs. We found that the cognitive models of ASD and religious beliefs substantially overlap, which is particularly important from a developmental psychological perspective. These models include Theory of Mind and intentionality, the “broken mirror” hypothesis, central coherence, and the intense world theory. We dispute the assumption that individuals with ASD are inherently less religious and spiritual than the neurotypical population. Religiosity is possibly expressed differently in ASD with unique spiritual experiences and beliefs (“gifted, visionary, and truth-seeker”). In some circumstances, a religious background can be helpful for both children with ASD and their caregivers. These circumstances should not be neglected, and clinicians are encouraged to consider patients’ religious context, resources, and needs.
... Dans la huitième et dernière édition de sa nosographie (1909-1915), Kraepelin identifie jusqu'à neuf formes différentes de démence précoce (Lavretsky, 2008) révélant toute la difficulté d'appréhension de ce trouble. Contrairement à Kraepelin, Eugen Bleuler (psychiatre suisse, 1857-1939 constate que certains patients présentent un bon pronostic, ne montrent pas de dégénérescence psychique et déclarent le trouble à un âge plus tardif (Paolo Fusar-Poli & Politi, 2008). En désaccord avec la vision de Kraepelin, Bleuler renomme donc la démence précoce en « schizophrénie » lors d'une conférence à Berlin en avril 1908 (Crocq, 2012). ...
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... Soon after defining the diagnostic category of dementia praecox (Kraepelin, 1896) and schizophrenia (Bleuler, 1908), researchers and physicians tried to identify possible cures for these psychiatric diseases (Fusar-Poli and Politi, 2008;Ashok et al., 2012). Trials in this area ranged from injecting patients with animal blood (Klebelsberg, 1922) or castor oil (Ingham, 1930) to insulin therapy (Brody and Hayman, 1937;Bolles et al., 1938;Halpern, 1940;Mayer-Gross, 1951), sleep therapy (Kläsi, 1922), or even psychosurgery (Peyton et al., 1948;Feld, 1950). ...
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... A c c e p t e d M a n u s c r i p t 5 of unity of the personality, was the most important sign. Thus, he proposed the less static and stigmatizing neologism, by juxtaposing the Greek roots schizen ("σχίζειν", -to split‖) and phren-("φρήν", originally denoting -diaphragm‖ but later changing by metonymy, to -soul, spirit, mind‖) 13 . ...
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Eighty years ago, schizophrenia was the first indication for electroconulsive therapy (ECT), and likewise ECT was one of the first treatments used for schizophrenia. This paper presents the history of ECT in the treatment of schizophrenia and its evolution, from it’s discovery in the 20 th century, which is an example of empiricism with a sequence of “shock” therapies. Following this discovery, the use ECT in schizophrenia has been in expansion during several decades, in a context of lack of efficacy of the treatment in schizophrenia. Then, after World War II and the derivative use of ECT in Germany, the use of ECT has decline during several decades. However, in the last decades, the use of ECT in schizophrenia has reemerged. Indeed, among patients in schizophrenia, rates of resistance to tratment have always been and still are high. In 2017, the concept of “ultra-treatment resistant schizophrenia” was defined when clozapine was tried and failed; and ECT, that had been long since abandoned in the treatment of schizophrenia until recent renewed interest, has emerged especially concerning the add-on of ECT to clozapine. However, ECT remains highly stigmatized and underutilized. This article looks at the history of the practice of ECT in schizophrenia with a historical and clinical approach and makes connections between the history of the treatment and its influence on its current reccomandation and practice.
... Samotný pojem autizmus prvýkrát použil švajčiarsky psychiater Paul Eugen Bleuler (1857Bleuler ( -1939, a to 24. apríla 1908 vo svojej prednáške na výročnom zhromaždení Nemeckej psychiatrickej asociácie v Berlíne. Bleuler tu prvýkrát predstavil aj pojem schizofrénia, autizmus bol len jeden zo štyroch typických príznakov schizofrénie, ktoré sú označované ako "štyri A": nekontrolované asociácie, poruchy afektivity, ambivalencia a autizmus (Fusar-Poli & Politi, 2008). V roku 1911 uviedol termín autizmus aj vo svojom diele Dementia praecox alebo skupina schizofrénií na vyjadrenie jedného z prejavov schizofrénie. ...
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Abstrakt: História autizmu, jeho vývoj od opisu prvých individuálnych prípadov cez konšti-tuovanie terminológie, skúmanie jeho príčin až po hľadanie najúčinnejších terapeutických metód, nie je tak jasná a priamočiara. Mená ako Hans Asperger a Leo Kanner, ktorí sú dnes považovaní za pionierov pri formovaní autizmu ako samostatnej diagnostickej jednotky, nie sú pravdepodobne najvýznamnejšie. V tomto príspevku obraciame pozornosť na tých menej známych odborníkov, ktorí pripravili pôdu týmto osobnostiam. V raných dejinách autizmu môžeme vidieť niekoľko vý-vojových etáp. V prvých dvoch dekádach 20. storočia vidíme silný vplyv psychiatrov na konštituo-vanie samotnej diagnózy. Autizmus je vnímaný predovšetkým ako symptóm schizofrénie. Ďal-šie dve dekády prinášajú podrobný opis kazuistík detí s autizmom. Tomuto obdobiu zodpovedajú i používané termíny-schizoidná psychopatia (Suchareva), autistická psychopatia (Asperger) a až neskôr autistická porucha (Kanner). V príspevku poukazujeme práve na tie osobnosti, ktoré sú v dejinách autizmu menej spomínané alebo spomínané okrajovo, a sú nimi predovšetkým psychiatri ako Grunya Suchareva, George Frankl, Lauretta Benderová a i. Cieľom príspevku je poukázať na zložité a nie úplne jednoznačné obdobia, ktoré boli spôsobené predovšetkým nacistickou ideológiou, druhou svetovou vojnou a povojnovým vývojom. Abstract: Th e history of autism, its development from the description of the fi rst individual cases, through the constitution of terminology and the exploration of its causes to the search for the most eff ective therapeutic methods, is not so clear or straightforward. Names such as Hans Asperger and Leo Kanner, who are nowadays considered to be pioneers in forming autism as a separate diagnostic unit, are probably not the most signifi cant. In this article, we draw attention to those lesser-known specialists who prepared the ground for these personalities. In the early history of autism, we can see several stages of development. In the fi rst two decades of the 20th century, we perceive a strong infl uence of psychiatrists on the constitution of the diagnosis. Autism is particularly viewed as a symptom of schizophrenia. Th e following two decades provide a detailed exposition of case studies of children with autism. Th e terms used were in accordance with this period-schizoid psychopathy (Suchareva), autistic psychopathy (Asperger), and later autistic disorder (Kanner). In this article,
... The term "schizophrenia," literally meaning "split-mind," was initially introduced by Eugene Bleuler in the early 20th century (Fusar-Poli and Politi, 2008). While our understanding of the neurobiological basis of this illness and approaches to treatment have dramatically evolved (Tandon et al., 2009), the term "schizophrenia" has persisted in our diagnostic nomenclature. ...
About one in 100 people worldwide are diagnosed with schizophrenia. Many people advocate for a name change for the condition, pointing to the stigma and discrimination associated with the term "schizophrenia", as well as to how the name poorly characterizes features of the illness. The purpose of this project was to collect opinions from a broad, diverse sample of stakeholders about possible name changes for schizophrenia. The project represented a partnership between researchers, clinicians, and those with lived experience with psychosis. The group developed a survey to assess opinions about the need for change in the name schizophrenia as well as potential alternate names. We accumulated 1190 responses from a broad array of community stakeholders, including those with lived experience of mental illness, family members, clinicians, researchers, government officials, and the general public. Findings indicated that the majority of respondents (74.1%) favored a name change for schizophrenia. Most (71.4%) found the name stigmatizing. Of the proposed alternate names, those with the most support included "Altered Perception Syndrome", "Psychosis Spectrum Syndrome", and "Neuro-Emotional Integration Disorder". Survey findings provide strong support for renaming schizophrenia. Most expressed hope that a name change will reduce stigma and discrimination.
Mental illnesses including anxiety disorders, autism spectrum disorder, post-traumatic stress disorder, schizophrenia, depression, and others exact an immense toll on the healthcare system and society at large. Depression alone impacts 21 million adults and costs over $200 billion annually in the United States. However, pharmaceutical strategies to treat mental illnesses are lagging behind drug development in many other disease areas. Because many of the shortcomings of therapeutics for mental illness relate to delivery problems, drug delivery technologies have the potential to radically improve the effectiveness of therapeutics for these diseases. This review describes the current pharmacotherapeutic approaches to treating mental illnesses as well as drug delivery approaches that have improved existing therapies. Approaches to improve drug bioavailability, provide controlled release of therapeutics, and enable drug targeting to the central nervous system (CNS) will be highlighted. Moreover, next-generation delivery approaches such as environmentally-controlled release and interval/sequential drug release will be addressed. Based on the evolving landscape of the treatment of mental illnesses, the nascent field of drug delivery in mental health has tremendous potential for growth in terms of both economic and patient impact.
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Psychosis is the most ineffable experience of mental disorder. We provide here the first co‐written bottom‐up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically‐informed perspectives. First‐person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud‐based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self‐referentiality and permeated self‐world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re‐establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.
During the first half of the twentieth century, advances were accelerated and the field expanded dramatically, making very difficult the narration of events and developments in a simultaneous temporal and cause-and-effect relationship. The twentieth century begun with the publication of the ‘Interpretation of Dreams’ by Sigmund Freud and the first half concluded with the development of the ECT and psychosurgery.
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; (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; (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