Eugen Bleuler: biography of this Swiss psychiatrist.

He was one of the great referents of Freud, and pioneer of schizophrenia research.

The history of psychopathology is full of important figures who made numerous contributions to the field of psychology and mental health. One of these is Eugen Bleuler (1857-1939), the Swiss psychiatrist who coined the term "schizophrenia," which included a group of heterogeneous disorders.

Bleuler also discussed the symptoms of schizophrenia, and differentiated them into two groups: basic and accessory. In this article you will find a brief biography of Eugen Bleuler, tracing his educational and work trajectoryand knowing the contributions he made, especially in relation to schizophrenia.

Eugen Bleuler: beginnings

Paul Eugen Bleuler (1857-1939) was a Swiss psychiatrist who was born in 1857 in a town near Zurich, Zollikon, and 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 became a professor of psychiatry.

In 1881, he graduated as a physician graduated as a medical doctor and began working as an assistant physician at the Waldau Psychiatric Clinic in Bern, Switzerland. in the Swiss city of Bern. There he worked for Gottlieb Burckhardt, another important Swiss psychiatrist. Three years later, in 1884, Bleuler left that clinic and began to travel to continue his medical training with figures such as 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). Then, in 1886, Eugen Bleuler became director of a psychiatric clinic in Rheinau.

Bleuler's work there was very important, as 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 overall clinical condition of the patient, i.e., he observed all the symptoms that the person presented at a particular time, and made a global assessment.

Freud's influence

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. In addition, he was especially interested in hypnosis, he was particularly interested in hypnosis.

Bleuler was of the opinion that complex mental processes could be unconscious, as advocated by Freud's psychoanalysis. That is why Bleuler was interested in enabling his employees at the Burghölzli Hospital to study such processes from a psychoanalytic perspective.

However, although Eugen Bleuler was nourished by psychoanalysisand followed this theoretical orientation for a large part of his academic and professional career, he ended up distancing himself from it, because he did not share its 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: Dementia praecox. The Schizophrenia Group (1993) y Treatise on Psychiatry (1924) (1st Spanish edition). As for his contributions, Bleuler is especially known for coining the terms "schizoid", "schizophrenia" and "autism"..

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

The term "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 he wrote, which was based on the study of 647 patients he had treated.

The term "schizophrenia", for Bleuler, alluded to a dissociation of normal brain functions that appeared in this type of patient.. The word comes from Greek, and means "division" or "splitting" (schizo) and "mind" or "reasoning" (frenia).

According to the author, in people with schizophrenia, there was a separation or fissure between ideas (thinking) and feelingsThus, he defended that these two elements were detached, separated or disintegrated.

Group of schizophrenias

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

Bleuler insisted strongly on the heterogeneity of the concept of schizophrenia, since his "group of schizophrenias" included very heterogeneous disorders from one patient to another.

Simple schizophrenia

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

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

Bleuler's 4 A's

Another very interesting contribution made by Eugen Bleuler was that of the "4 A's" of schizophrenia. These 4 A's referred to the basic symptoms of the disorder, and the accessory symptoms of schizophrenia..

For Bleuler, the basic symptoms were those that are always present in schizophrenia (not necessarily all of them); that is, according to him, manifesting one of them was already indicative of having the disorder. Accessory symptoms, however, need not always appear.

The 4 A's (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 that the patient expresses; that is to say, it is a lack of association between the ideas expressed by the patientthat is to say, it is an alteration in the thought that is translated in the language through incoherences, 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 seems "as if he/she does not feel anything".

3. Ambivalence

Ambivalence is manifested in the behavior of the patient, who is somewhat incoherent, disorganized, "off to one side", etc.from one side to the other", etc. Today we would translate this as disorganized behavior, a typical positive symptom of schizophrenia.

4. Autism

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

Accessory symptoms

The accessory symptoms proposed by Bleuler were: delusions, hallucinations, negativism, language disturbances, somatic symptoms and catatonia. That is to say, only positive symptomsaccording to the classification of schizophrenia symptoms.

Eugenics

An important fact about Eugen Bleuler that is also worth commenting on is that advocated forced eugenic sterilization in people diagnosed with schizophrenia (or predisposed to schizophrenia). (or predisposed to schizophrenia).

This implied sterilizing these people without their consent, and without prior medical or clinical justification. Eugenics, on the other hand, is a current, or philosophy, that advocates the "perfecting" of the human species through the application of the Biological laws of heredity.

Bleuler believed that this would prevent the perpetuation of the disorder, thus avoiding "racial deterioration".thus avoiding the "racial deterioration" of the human species. He expressed these ideas in his work "Tratado de psiquiatría" (Treatise on Psychiatry), dated 1924 (1st Spanish edition).

Bibliographical references:

• Bleuler E. (1993). Dementia praecox. The Schizophrenia group. 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). By way of cards on classics of psychiatry: Eugen Bleuler. Lmentala.net, 35: 1-5.