Eugen Bleuler

Eugen Bleuler (1857–1939) was a Swiss psychiatrist who directed the Burghölzli asylum in Zurich from 1898 to 1927 and in 1911 published Dementia Praecox or the Group of Schizophrenias, the work in which he renamed Kraepelin’s diagnostic category and gave psychiatry the word “schizophrenia.” Bleuler replaced Kraepelin’s fatalistic prognosis — that early cognitive deterioration was inevitable — with a framework organized around four core features: impaired associations, affective disturbance, autism, and ambivalence. He was a significant early ally of Freud’s, whose association experiments at the Burghölzli had helped give psychoanalysis its first experimental validation, but he ultimately refused to join the International Psychoanalytical Association on the grounds that its demand for theoretical orthodoxy was incompatible with scientific inquiry.

Formation and the Burghölzli

The institutional context that shaped Bleuler was the Burghölzli, the cantonal asylum in Zurich, which had gone through three largely ineffective directors before Auguste Forel transformed it from 1879 onward into a leading center for psychiatric research and teaching (Makari, George, 2008). Forel’s engagement with French research on hypnotism gave the Burghölzli an openness to psychological as well as biological explanations of mental illness — a disposition unusual in German-speaking academic psychiatry, which was dominated by Wilhelm Griesinger’s dictum that mental illnesses are brain diseases.

Before taking over the Burghölzli from Forel in 1898, Bleuler spent twelve years directing the smaller asylum at Rheinau, living alongside his patients in close daily proximity. It was at Rheinau that he began to question the reigning model. In 1896, Kraepelin had consolidated earlier descriptions of catatonia, hebephrenia, and dementia paranoides into his concept of dementia praecox — a psychosis that led to early and permanent cognitive deterioration (Makari, George, 2008). Porter’s account describes this synthesis more specifically: Kraepelin combined descriptions by Kahlbaum, Morel, and Hecker into dementia praecox, “the forerunner of schizophrenia.”(Porter, 1997) Bleuler’s observation at Rheinau was that many psychotic patients were not demented: they showed psychological reactivity rather than the inexorable cognitive decline that Kraepelin’s model predicted (Makari, George, 2008). The reigning pessimism about insanity, he concluded, was simply wrong.

The Intellectual Encounter with Freud

During these years, Eugen Bleuler began to formulate his theory of psychosis (Makari, George, 2008). He distinguished primary signs directly related to biological pathology from secondary signs that were psychological reactions to both the disease and the environment (Makari, George, 2008). This psychobiological model created intellectual common ground with Freud (Makari, George, 2008).

Bleuler criticized Wilhelm Wundt’s association psychology for making unconscious processes theoretically inconceivable, attributing Germany’s neglect of dissociated mental states to Wundt’s founding assumption that all associations are by definition conscious (Makari, George, 2008). Wundt had trained virtually all German practitioners of empirical psychology, imparting that presumption (Makari, George, 2008). Jung and Riklin claimed that unconscious complexes existed throughout a normal population, which appeared to confirm Freud’s theory of ubiquitous repression (Makari, George, 2008).

His first letter to Freud (June 1905) was characteristic: Bleuler praised Freud’s theory of jokes while expressing pointed skepticism about the Three Essays on the Theory of Sexuality, objecting that data from adult neurotics could not verify theories regarding normal children (Makari, George, 2008). In the same letter, he enclosed four dreams for Freud’s interpretation, initiating what Makari describes as a long-distance epistolary self-analysis, and simultaneously expressed reservations about Freud’s sexual theory (Makari, George, 2008). Freud interpreted these reservations as an inability to rationally consider that theory (Makari, George, 2008).

By 1907, the Freudian movement had two distinct centers with different social bases: Vienna relied on private clinicians and sexual reformers, while Zurich was embedded in academic psychiatry and committed to scientific study of psychopathology (Makari, George, 2008). Makari’s analysis characterizes Bleuler’s position as one wing of the Freudians: he “would keep the psychic and minimize the sexual” (Makari, George, 2008).

Schizophrenia and Its Concepts

The clinical reality at the Burghölzli was starkly different from Freud’s private office (Makari, George, 2008). In 1900, the asylum admitted 203 patients; only one was classified as hysteric, and none as obsessional neurotic (Makari, George, 2008).

His central theoretical innovation was the concept of ambivalence (Makari, George, 2008). Generalizing from psychotic negativism, he theorized a universal principle by which all mental phenomena are subject to simultaneous positive and negative charges (Makari, George, 2008). He wrote to Freud: “our entire life is regulated by an interplay of contrasting forces. We find this in the chemical, as well as the nervous and psychic areas” (Makari, George, 2008). This principle, extended from psychotic negativism, formed the basis of a broader theory of psychological opposition (Makari, George, 2008).

Bleuler renamed Kraepelin’s dementia praecox “schizophrenia” (“split minds”) to describe a condition in which positive and negative affective charges had split apart, rather than one characterized by inevitable cognitive deterioration (Makari, George, 2008). This renaming removed the deterministic prognosis embedded in the term “dementia,” opening the nosological space for the possibility of recovery (German E. Berrios & Roy Porter (eds.), 1995).

In 1906, before the monograph, Bleuler had published “Freudian Mechanisms in the Symptomatology of Psychoses,” proposing that paranoid delusions and hallucinations were disguised wishful dreams — an extension of Freud’s dream analysis to psychosis — though Freud himself dissented from this application (Makari, George, 2008). Around the same time, Bleuler developed an alternative to Freud’s transference-based account of suggestibility: proposing that negative emotional states could be primary rather than reactive, driven by a fundamental split between love and hate rather than repressed sexual drives.(Makari, George, 2008)

The 1911 Monograph

Dementia Praecox or the Group of Schizophrenias, published in the fall of 1911, was quickly recognized as a major achievement. The book characterized schizophrenia by four core psychopathological features: impaired associations, affective disturbance, autism, and ambivalence — the “four As” of the clinical teaching tradition (German E. Berrios & Roy Porter (eds.), 1995).

“Autism” was Bleuler’s term for the psychotic’s inward isolation, his desexualized version of Freud’s “autoerotism.” Where Freud had described autoerotism as sexual pleasure taken from one’s own body, Bleuler stripped the sexual valence and described the schizophrenic withdrawal from external reality as a structural feature of the illness (Makari, George, 2008). “Ambivalence” was drawn from his debates with Freud, now formalized as the theory of contrary but simultaneous feelings (Makari, George, 2008).

The monograph also demonstrated Bleuler’s independence from Freud. He concluded that some brain disease was most likely at work in schizophrenia — a rationale that made it reasonable to omit psychoanalysis from his section on therapeutics entirely (Makari, George, 2008). The Freudian mechanisms he had identified in psychosis were real, he maintained, but they did not mean that psychoanalysis was the appropriate treatment for a condition with an organic substrate.

The Dispute with the IPA

The founding of the International Psychoanalytical Association (IPA) at Nuremberg in 1910 brought Bleuler’s ambivalence toward the Freudian movement to a head. On October 18–19, 1910, he wrote Freud a long eight-page letter withholding nothing. The IPA’s exclusivity — accepting members “solely depending on whether they have adopted your theories or not” — was incompatible with scientific community norms. Freud, Bleuler told him, was an intellectual giant, “a Copernicus or Darwin for psychology,” but “your truth is still one among many.” He ended by accusing Freud of having turned from the pursuit of science to the politics of getting his theory accepted (Makari, George, 2008).

Specific incidents hardened his position. Jung had invited Kraepelin’s associate Max Isserlin to the Nuremberg Congress as a hoax; when Isserlin accepted, Freud excluded him from attending on the basis of Jung’s description of him as a “bastard.” Kraepelin subsequently visited Zurich and berated Bleuler for this treatment of his associate. Bleuler told Freud he could understand not inviting Isserlin, but once the man had been invited, refusing him was “exceedingly rude” (Makari, George, 2008).

Bleuler resigned permanently from the IPA in November 1911. His final letter articulated the principled objection clearly: “The ‘who is not for us is against us’ and ‘everything or nothing’ is in my opinion necessary for religious groups and useful for political parties. Thus I can understand the principle as such, but I deem it noxious to science.” He invoked the anti-psychiatry critic Hoche: the “malicious term of calling it a sect, which at the time was inappropriate, has been turned into truth by the psychoanalysts themselves” (Makari, George, 2008).

Institutional Significance

During the years before his break with the IPA, Bleuler’s Burghölzli had served as the primary training ground for the international spread of Freudian ideas — precisely because Freud himself could offer no ward of patients, no laboratory, and no lecture series. In August 1907, Jung informed Freud that the Burghölzli had hosted six Americans, a Russian, a Hungarian, and an Italian in just three weeks (Makari, George, 2008). Doctors who trained there returned to London, New York, Budapest, Jena, Geneva, and Munich carrying what Freud jokingly called “a focus of infection” (Makari, George, 2008).

Bleuler had also been strategically valuable to the Freudian movement in a different sense. In 1906, Freud’s Viennese followers were almost all Jewish. If psychoanalysis was perceived as a “Jewish science,” it would face institutional resistance in European academic circles. Bleuler, Jung, and their Swiss colleagues were Christians whose academic standing could deflect that charge (Makari, George, 2008). After the break with the Zurich school, Freud acknowledged that his strategy had failed: “What is most regrettable about the changes in Zurich is the certainty that I did not succeed in the union of Jews and Anti-semites whom I hoped to unite on psychoanalytic ground” (Makari, George, 2008).

Legacy

The term dementia praecox was effectively extinct within two decades of Bleuler’s monograph. Berrios and Porter document its disappearance from the Journal of Mental Science index by 1937 and from American usage by approximately 1951 — a terminological replacement of unusual speed (German E. Berrios & Roy Porter (eds.), 1995). The speed reflected how thoroughly the prognostic pessimism embedded in “dementia” had become a liability.

The cultural transmission of the word “schizophrenia” generated a misreading that Bleuler could not have anticipated. T.S. Eliot’s 1933 usage — the first recorded OED citation of “schizophrenic” — introduced the understanding of schizophrenia as “split personality,” a meaning wholly absent from Bleuler’s original concept of Spaltung (splitting of psychic functions, not personality splitting into distinct selves) (German E. Berrios & Roy Porter (eds.), 1995). This reading has proven effectively ineradicable in popular usage.

R.D. Laing’s The Divided Self (1960) offered the post-Bleuler generation of existential psychiatrists a pointed critique of the diagnostic tradition Bleuler had helped establish. For Laing, Bleuler’s categories remained third-person behavioral descriptions that failed to understand the patient from the inside. “No one has schizophrenia, like having a cold,” Laing wrote. “The patient has not ‘got’ schizophrenia. He is schizophrenic” (Laing, R. D., 1960). But even this critique presupposed the diagnostic category that Bleuler had created — a category capacious enough to generate the dispute about what it meant.

The WHO international pilot study revealed higher prevalence rates of schizophrenia in the United States than in other countries – a finding that proved to reflect over-broad American diagnostic criteria rather than genuine epidemiological difference (German E. Berrios & Roy Porter (eds.), 1995). This discrepancy contributed directly to the tightening of schizophrenia criteria in DSM-III (1980), which brought American usage closer to international norms (German E. Berrios & Roy Porter (eds.), 1995).

Human Notes

See Also

• emil-kraepelin
• sigmund-freud
• carl-jung
• burghölzli
• schizophrenia
• dementia-praecox
• ambivalence
• international-psychoanalytical-association
• wilhelm-griesinger

Sources

Evidence cited from: makari-revolutioninmind-2008, berrios-porter-historyclinicalpsychiatry-1995, laing-dividedself-1960, porter-greatestbenefit-1997