PSYCHIATRIC PEARL
Paul Eugen Bleuler and the origin of the term schizophrenia
(SCHIZOPRENIEGRUPPE)
Ahbishekh Hulegar Ashok, John Baugh1, Vikram K. Yeragani2
Bangalore Medical College and Research Institute, Bangalore, Karnataka, India, 1St. Clair County Community Mental Health
Center, St. Clair, MI, USA; 2Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada, 2Department of
Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA, 2Department of
Biotechnology, Aacharya Nagarjuna University, Andhra Pradesh, India
“All the world’s mad except thee and me, and even thee’s a little
cracked.”
– Porter[1]
Professor Eugen Bleuler was born in Zollikon in 1857, a small
town in Switzerland. Bleuler studied medicine in Zurich ,
and later pursued his higher studies in Paris, London and
Munich. Then Bleuler was conferred doctor of medicine in
1883, and from 1881 to 1883 was an assistant physician
in Waldau near Bern. In 1884, Doctor Bleuler travelled
to France and England. In the winter term of 1884/1885,
Dr. Bleuler worked in the laboratory with Johann Bernhard
Aloys von Gudden in Munich. In 1885, Dr. Bleuler became
an assistant physician in Burghölzli near Zurich. Then, in
1886, Doctor Bleuler was appointed director of the Rheinau
Psychiatric Hospital at the age of 29. Twelve years later
Dr. Bleuler was appointed full Professor of psychiatry at
the University of Zurich–against the wishes of the Zurich
faculty of medicine. Professor Bleuler occupied that chair
until 1927.[2-4]
The term “schizophrenia” was coined on April 24, 1908,
when Professor Bleuler gave a lecture at a meeting of
the German Psychiatric Association in Berlin.[1] At that
meeting, Professor Bleuler argued that dementia praecox
was associated with neither dementia nor precociousness,
and emphasized that splitting of psychic functioning is
an essential feature of schizophrenia.[2-4] One of the most
striking differences between Emil Kraepelin and Bleuler
is that Kraepelin collected information about his patients
from their records while Bleuler obtained the information
by careful clinical observations. He practically lived in the
patients’ surroundings. Bleuler derived his concept from the
Address for correspondence: Dr. V. K. Yeragani,
# 103, Embassy Orchid, 8 Main, 6 Cross, Sadashiva Nagar,
Bangalore – 560 080, Karnataka, India.
E-mail: vikramyershr@yahoo.com
How to cite this article: Ashok AH, Baugh J, Yeragani VK.
Paul Eugen Bleuler and the origin of the term schizophrenia
(SCHIZOPRENIEGRUPPE). Indian J Psychiatry 2012;54:95-6.
Indian Journal of Psychiatry 54(1), Jan-Mar 2012
Greek verb schizein, indicating splitting. The second part of
the word goes back to the Greek phren, originally denoting
‘diaphragm’ but later changing to ‘soul, spirit, mind’.[5]
In this context, ancient Indian views about health deserve
a special mention. Hindu descriptions in Atharvana Veda,
one of the four Vedas, date back to approximately 1400
BC. Vedas are backbones of Hinduism. In these writings, it
has been hypothesized that health is the result of a balance
between five elements (Bhuthas) and 3 humurs (Doshas)
and that an imbalance between these various elements
might result in mental illness. This exemplifies a special
reference to mysticism in our postulations of various
illnesses especially that are related to mind. Later Bleuler’s
followers such as Carl Jung took to Eastern Phiosophy in
their writings.
In 1911, Bleuler wrote “I call dementia precox schizophrenia
because, as I hope to show, the splitting of the different
psychic functions is one of its most important features.
In each case there is a more or less clear splitting of the
psychological functions: as the disease becomes distinct,
the personality loses its unity”. He recognized that
dementia was not a usual characteristic of dementia precox,
suggesting the term schizophrenia (splitting of the mind)
for the disorder. Bleuler introduced the concept of primary
and secondary schizophrenic symptoms; his four primary
symptoms (the four As) were abnormal associations, autistic
behavior and thinking, abnormal affect and ambivalence. The
central symptoms of the illness are the loss of association
between thought processes and emotion and behavior. In
his view depending on the individual’s adaptive capacity
and environmental circumstances, this fundamental process
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 Ashok, et al.: Eugen Bleuler
could lead to secondary disease manifestations such as
hallucinations, delusions, social withdrawal, and diminished
drive.[3-5]
Professor Bleuler had a special interest in hypnotism,
especially in its “introspective” variant. He became
interested in Sigmund Freud’s Studies on Hysteria. Like
Freud, Bleuler believed that complex mental processes
could be unconscious. He encouraged his staff to study
unconscious and psychotic mental phenomena. Influenced
by Bleuler, Carl Jung and Franz Riklin used word association
tests to integrate Freud’s theory of repression with empirical
psychological findings.
This short note would not be complete without a small note
on the relationship between Eugen Bleuler and Sigmund
Freud. Although this relationship has been reported as
ambivalent,[6] it appears very clear that Eugen Bleuler always
was very cautious about his enthusiasm toward Freudian
psychoanalysis. Although he embraced it with open arms
and introduced psychoanalysis into his Hospital, he did not
agree with the meaning of libido and other concepts. Bleuler
also was not enthusiastic about the attachment of sexuality
to some of the phenomena and felt it was too premature
to accept without scientific proof. Eugen Bleuler always
believed that schizophrenia was an organic illness and that
it could be inherited. Professor Bleuler used the concepts of
psychoanalysis to explain the coloring of symptoms rather
than attributing etiological importance.
Professor Bleuler’s son, Manfred Bleuler, continued his
work with respect to familial (hereditary) aspects, early
intrafamilial environment and personalities, long-term
outcome, and therapeutic interventions. In the summary
of this work by Modestin et al. schizophrenic illness
remains heterogeneous with regard to illness course and
outcome even when narrowly diagnosed with the help
of modern operationalized diagnostic criteria. Manfred
Bleuler mentioned that the diagnosis was made according
to the original concept of Eugen Bleuler and that the
illness was considered as a syndrome. They found that the
96
differentiation between schizophrenic and schizoaffective
disorders is prognostically valid. One interesting thing
was a better agreement of the diagnosis between DSM
(diagnostic and statistical manual of mental disorders)-III-R,
DSM-III-R, international classification of diseases (ICD) and
researh diagnostic crtieria (RDC) whereas there was much
less agreement with Bleuler’s and Schneider’s criteria.[7]
In the obituaries of Bleuler, one of his students, Robert
Gaupp, wrote “the short, delicately built man with his
expressive features was intellectually active to the last”.
According to Binswanger, Eugen Bleuler always displayed
broad tolerance, though he was not without traces of
fanaticism. Eugen Bleuler knew of only two tasks, to which
he devoted himself with the entire strength of his unique
personality: to be a rational psychiatrist and a genuine
human being until his death in 1939.
Foot note
Although there are some excellent reviews and translations
in the German language about the history of schizophrenia
and Eugen Bleuler’s life, due to the space constraints, only a
few of the important references have been cited.[8]
REFERENCES
1. Kyziridis TC. Notes on the history of schizophrenia. German J Psychiatry
2005;8:42-8.
2. Bleuler E. International Encyclopedia of the Social Sciences. 1968.
Available from: http://Encyclopedia.com. [Last cited on 2011 June 07].
3. Kuhn R. Eugen Bleuler’s concepts of psychopathology. Hist Psychiatry
2004;15:361-6.
4. Bleuler. Dementia Praecox: Or the Group of Schizophrenias. New York:
International Universities Press; 1911.
5. Fusar-Poli P, Politi P. Paul Eugen Bleuler and the Birth of Schizophrenia.
(1908). Am J Psychiatry 2008;165:1407.
6. Falzeder E. The story of an ambivalent relationship: Sigmund Freud and
Eugen Bleuler. J Anal Psychol 2007;52:343-68.
7. Modestin J, Huber A, Satirli E, Malti T, Hell D. Long-term course of
schizophrenic illness: Bleuler’s study reconsidered. Am J Psychiatry
2003;160:2202-8.
8. Rosenthal D. Eugen Bleuler’s thoughts and views about heredity in
schizophrenia. Schiz Bull 1978;4:476-77.
Source of Support: Nil, Conflict of Interest: None declared
Indian Journal of Psychiatry 54(1), Jan-Mar 2012
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