Eugen Bleuler

Swiss psychiatrist

• Born: April 30, 1857
• Birthplace: Zollikon, Switzerland
• Died: July 15, 1939
• Place of death: Zollikon, Switzerland

Bleuler’s major achievements were in the study and treatment of schizophrenia, a term he coined in 1908 to denote the splitting of psychological functions that he observed in many of his patients. He also introduced the related terms “autism” and “ambivalence” into psychiatry. He has been admired as much for his tireless and uncompromising devotion to his psychiatric patients as for his important contributions to psychiatric theory.

Early Life

Eugen Bleuler (OY-gehn BLOY-lehr) was born in Zollikon, which was then a farming village and is now a suburb of the city of Zurich, Switzerland. His father was a merchant and local educational administrator, but his ancestral roots reached deeply into the Swiss farming tradition. It is quite significant for Bleuler’s personal and professional development that during the 1700’s the farmers and their families living in the countryside around Zurich were governed by the aristocrats living in the city. These city authorities restricted the access of the country people to educational opportunities and to certain professions, a state of affairs that caused great resentment among the peasants. Thus, in 1831, they overthrew the aristocracy and established a democratic form of government. The Bleuler family participated in this social and political movement, one of the primary goals of which was to create a university open equally to all citizens. The University of Zurich was founded in 1833 in the hope that the children of the farm families could gain the advanced training necessary to serve the legal, educational, religious, and medical needs of the population, and to do a better job of it than had been done by the officials appointed for this purpose by the aristocracy.

Bleuler was a beneficiary of this democratic revolution in nineteenth century Zurich. One problem with the new educational system, however, was that, since Zurich did not have a strong academic tradition, many of the teaching posts had to be filled by Germans, who did not speak the Swiss dialect. Bleuler was well aware of the long-standing social and interpersonal difficulties brought on by this language gap. During his college years, a young village girl was taken to the university psychiatric clinic with a serious psychological disorder, and the girl’s relatives were frustrated by the communication difficulties they encountered with the clinic’s German director. The belief among the peasants was that psychiatrists who were attentive to the needs and conversant in the dialect of the Swiss people would be able to provide much more effective treatment. Sentiments such as these influenced Bleuler’s decision to devote his life to the practice of psychiatry among his native people. After obtaining his M.D. from the University of Zurich, he served as a resident at Waldau Mental Hospital near Bern and later went to Paris to study briefly with the great French neurologistJean-Martin Charcot at the Salpětrière clinic. He also traveled to London and Munich and then returned to Switzerland to begin in earnest his professional psychiatric career.

Life’s Work

In 1886, Bleuler, at age twenty-nine, became medical director of the mental hospital in Rheinau, a secluded town on the Rhine River. This large institution housed 850 patients and was badly in need of rehabilitation and administrative reorganization. Bleuler threw himself into this task and, being a bachelor, lived in the hospital and devoted countless hours to his patients. He participated in all aspects of their treatment and organized a system of occupational or work therapy, which was designed not only to encourage the patients to engage in productive and creative activity but also to provide regular occasions for the patients and the staff to come into close personal contact. It is significant that Bleuler considered work therapy the most essential aspect of psychiatric treatment, for it reveals his firm conviction that, though his mental patients were torn and troubled, they nevertheless remained human beings with hopes, fears, needs, and possibilities. During his years at Rheinau, Bleuler became convinced that, while the neurological aspects of psychiatric disorders and treatment were of great importance, the practice of communicating with patients in a caring and familiar manner in an effort to understand the real meaning of their expressions, symptoms, and behavior was of even greater therapeutic significance. Bleuler thus replaced the microscope, which he had learned to use so well during his medical training and which was still the primary instrument of psychiatric research among his contemporaries, with the human ear and human voice as the most essential tools of such research. In addition to being a faithful friend to his patients, Bleuler was also a sympathetic father figure to his staff. He worked alongside them, ate meals with them, arranged for and participated in their social gatherings, and sometimes assisted them in financial matters. The structure and sensitive style of therapy, as well as the democratic manner of dealing with coworkers, that Bleuler developed at Rheinau would characterize all of his subsequent psychiatric work.

In 1898, the Zurich government honored Bleuler by offering him the opportunity of succeeding Auguste Forel as head of the Burghölzli Mental Hospital and professor of psychiatry at the University of Zurich. He accepted the offer, in part to be closer to his aging parents and to his boyhood home, and thus became the first professor of psychiatry in Zurich who spoke the local Swiss dialect. He accepted the teaching aspect of the position with some reluctance, knowing that he would no longer be able to devote his time and attention exclusively to his patients. He came, nevertheless, to view his professional responsibilities as an important opportunity for conveying to his students the insights he had drawn from his wealth of clinical experience.

Bleuler’s lectures eventually grew to form the core of his influential book entitled Dementia praecox: Oder, Gruppe der Schizophrenien (1911; Dementia Praecox: Or, The Group of Schizophrenias , 1950). He first presented the term “schizophrenia” in a 1908 article in which he said that “dementia praecox,” the older and widely accepted term promoted by Emil Kraepelin and meaning “premature dementia,” was not accurate, because simple dementia was not universally observed in these patients and because the disorder did not always appear at an early age. Bleuler suggested that “schizophrenia,” a coinage derived from Greek words meaning “split mind,” was a better term, because he had discovered through extensive clinical observations that the most common characteristic of his schizophrenic patients was the dissociation of different aspects of their personalities of thoughts from emotions, or of words and intentions from behavior. He distinguished between primary symptoms, those arising directly from the unknown organic process, and secondary symptoms, those involving psychological reactions to the primary symptoms. Bleuler thought that the lack of integration in his patients’ personalities caused them to lose contact with reality, a state for which he invented the term “autism.” He also noticed that many patients experienced the simultaneous presence of opposite or conflicting thoughts or emotions concerning a particular object, idea, or person, and he described this condition as “ambivalence.”

Bleuler’s new theory of schizophrenia not only was a terminological and descriptive innovation but also implied new forms of treatment. While most psychiatrists of his day were convinced that hope for those with mental disorders would have to await the discovery of effective physiological treatments, Bleuler was the foremost proponent of the optimistic idea that the symptoms of schizophrenia could be alleviated through psychological forms of therapy. At the Burghölzli Mental Hospital, he continued the therapeutic measures instituted at Rheinau but supplemented them with psychoanalytic techniques being developed by Sigmund Freud and Carl Jung. Bleuler had become acquainted with Freud through discussions of the latter’s early neurological research on aphasia, and this relationship formed the basis for years of productive interaction between Freud and several of the Zurich psychiatrists. Jung became a resident at the Burghölzli Mental Hospital in 1900, and he and Bleuler were the first to employ word-association tests in modern psychiatric research.

The first decade of the twentieth century was a critical period in the development of the emerging discipline of psychoanalysis, and Bleuler collaborated with Freud and Jung, along with other Swiss and Austrian psychiatrists, in various intellectual and organizational endeavors during these early years. They were all present in Salzburg in 1908 for the first international meeting of psychoanalysts, and the first psychoanalytic journal appeared in the same year as a joint venture of the three. By the time of the second congress of the International Psychoanalytic Association in 1910, however, disagreements concerning the structure and purpose of the association had arisen between Bleuler and Freud, and Bleuler decided to resign. Because Bleuler was the most prominent representative of academic psychiatry, his resignation served to weaken the link between psychoanalysis and the larger field of psychiatry. Bleuler continued the teaching and practice of psychiatry at the university and hospital in Zurich for many years and died there in 1939.

Significance

Bleuler’s passion was to understand and to heal the victims of severe mental disorders, particularly schizophrenia. His new theory of schizophrenia recognized the importance of underlying organic factors but is significant in that it was not a purely organic theory but was instead the most successful early twentieth century attempt to recognize and to deal with psychological factors as well. In his efforts to introduce psychological understanding and treatments into the care of psychiatric patients, Bleuler initiated a way of thinking and style of therapy that has come to be known as the existential approach, which emphasizes the importance of finding meaning in life. It is not surprising that Ludwig Binswanger, a major twentieth century exponent of this approach, was a student of Bleuler in Zurich.

Bleuler’s selfless and uncompromising search for psychiatric truths motivated every aspect of his professional life. It led him to criticize many of his colleagues for engaging in what he called “the autistic-undisciplined thinking in medicine” a form of thinking in which the physician or psychiatrist is entrenched in his or her own conceptual system and, therefore, does not make full contact with the reality of the patient. A similar criticism was the basis of Bleuler’s disagreements with Freud, for Bleuler believed that both Freud and the International Psychoanalytic Association were becoming overly intent on the simple advancement of psychoanalysis and were sacrificing open-minded evaluation of the theory in the service of this sectarian cause. He also disliked the rigid hierarchical structure the association was assuming and would have preferred a more flexible, democratic organization. Bleuler, it seems, retained the spirit of his Swiss peasant heritage throughout his life and could not rest easy in the face of splits in humanity, neither those between human beings nor those within.

Bibliography

Alexander, Franz G., and Sheldon T. Selesnick. The History of Psychiatry. New York: Harper & Row, 1966. A study of psychiatric theories and therapies from ancient through modern times. Contains several chapters on the emergence and development of psychoanalysis and on the relationship and friction between Bleuler and Freud. Includes references to the Freud-Bleuler correspondence, selections from which have been edited and published by the authors.

Bleuler, Eugen. Dementia Praecox: Or, The Group of Schizophrenias. New York: International Universities Press, 1950. Discusses the history of research on schizophrenia and numerous theoretical and therapeutic issues concerning the mental disorder.

‗‗‗‗‗‗‗. Textbook of Psychiatry. Translated by A. A. Brill. New York: Dover, 1951. Reprint. Birmingham, Ala.: Classics of Psychiatry & Behavioral Sciences Library, 1988. Contains a biographical sketch of Bleuler by Jacob Shatzky as well as a bibliography of Bleuler’s writings.

Bleuler, Manfred. “Some Aspects of the History of Swiss Psychiatry.” American Journal of Psychiatry 130 (September, 1973): 991-994. This article, written by Bleuler’s son (who was also to become a professor of psychiatry at Zurich and director of the Burghölzli Mental Hospital) outlines some of the historical and cultural factors that, in the author’s view, have shaped the contributions of Swiss psychiatrists.

Brome, Vincent. Freud and His Early Circle. New York: William Morrow, 1968. Discusses the formative years of the psychoanalytic movement and deals with the relationships between the major centers and pioneers, including Bleuler.

Ellenberger, Henri F. The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York: Basic Books, 1970. A substantial and detailed study of the development of dynamic psychiatry. Deals with Bleuler’s life and influence in a number of instances and contains many illustrations of the players in this drama.

Kuhn, Roland. “Eugen Bleuler’s Concepts of Psychopathology.” History of Psychiatry 15, no. 3 (September, 2004): 361-366. Discusses Bleuler’s concepts of schizophrenia and other forms of psychopathology.

Zilboorg, Gregory. “Eugen Bleuler and Present-Day Psychiatry.” American Journal of Psychiatry 114 (October, 1957): 289-298. This article, originally an address delivered to the American Psychiatric Association on the centenary of Bleuler’s birth, is an appreciative survey of his personal convictions and professional achievements, along with an appraisal of their enduring relevance.