BLEULER, EUGEN (1857-1939)

One of the major contributors to dynamic psychiatry, Bleuler was bom in Zurich, received his medical training at its university, and later became professor of psychiatry and director of the city’s mental hospital. In the early 1900s he and his assistant, C. G. Jung, became interested in the work of Sigmund Freud, and in 1908 these three, with a number of other psychiatrists, held the first scientific conclave on psychoanalysis. This was followed by a second meeting two years later at which the group founded the International Psychoanalytic Association, which published the yearbook Imago under their editorship.With the assistance of Jung, Bleuler made original and far-reaching contributions to psychoanalysis by showing how the various mechanisms which Freud had found in neurotic patients could also be applied to psychotic behavior. This new approach—later termed “interpretive psychiatry”—represented a radical departure from the classificatory approach of the time, since it was not limited to a mere description of symptoms, but sought to understand their etiology and dynamics. Moreover, this theory offered an alternative to the widely accepted view that attributed psychosis to organic brain damage and ruled out psychological causes entirely.Bleuler formulated his new theory in a volume published in 1911, Dementia Praecox or the Group of Schizophrenias, a work which Zilboorg and Henry (1941) have called “the most important contribution to psychiatry made by the twentieth century.” Prior to this publication the clinical picture of dementia praecox, as it was then called, was based on the work of Emil Kraepelin, who not only believed the disorder was caused by brain damage but that it inevitably led to progressive deterioration. In spite of statistics to the contrary, this negative conclusion became the “official” view in psychiatry, and, as Roback (1961) has pointed out, “it was because of Kraepelin’s supposition that schizophrenia was incurable that so little was done in most institutions to find better treatment than the hospital routine.”Bleuler’s work challenged the Kraepelin view at every point. He looked beneath the symptoms to find their hidden meaning; he insisted that the disorder could be effectively treated; and he even discarded the name dementia praecox because it not only failed to describe the disease but implied an early and irreversible deterioration. Bleuler renamed the illness “schizophrenia” (literally, split personality), pointing out that this label described a group of psychotic reactions rather than a single disease. The common denominator, however, was not a splitting into several personalities, but a loosening of associations that causes the personality to disintegrate. This internal splitting occurs because the patient develops patterns of thinking and reaction which are dictated by his own inner emotional life rather than by the laws of logic or the realities of the external world. To an outsider, however, his mental processes appear to be dissociated, his verbalizations disconnected, and his thoughts full of strange condensations and gross generalizations. He is also torn by contradictory feelings, which Bleuler called “ambivalences,” a term quickly adopted into the vocabulary of psychoanalysis.Bleuler placed special emphasis on schizophrenic delusions. He attributed them to what he called dereistic or autistic thinking, a form of fantasy which is controlled by unconscious dynamics rather than by objective reality. This concept, which probably stemmed in part from Freud’s concept of narcissism, was a radical departure from the prevailing view that schizophrenics were emotionally “flat” and had no affective life at all. In contrast, Bleuler showed that they actually had an affective life, and, in fact, were creating an entire inner world of their own in response to their emotional needs. For the first time this suggested a rationale for their fantasies and delusions, for it meant that they were retreating from an outer reality with which they could not cope into an inner reality which they could master.In Bleuler’s view, then, schizophrenia was largely if not wholly a matter of faulty, inappropriate reactions adopted by the patient as a means of meeting inner needs. His interpretation suggested that analysis of unconscious mechanisms operating in the individual case might lead to successful treatment along psychological lines. This aroused new hope that psychiatry’s greatest single problem was about to be solved, but unfortunately the hope has not been realized. There still remains a wide gap between understanding the dynamics of the disease and discovering its causes and its cure. See BRILL, KRAEPELIN, SCHIZOPHRENIC REACTIONS (GENERAL), NARCISSISM, AMBIVALENCE, DYNAMIC PSYCHIATRY, DEREISTIC THINKING, AUTISTIC THINKING.