Eugen Bleuler Research Articles

The social understanding of Eugen Bleuler - his viewpoint outside of the psychiatric clinic

Based on writings from different periods in the life of Eugen Bleuler, the present work represents a consistent recognizable concept of ethics, social order and race hygiene in his scientific work. These subjects are set by Bleuler in a more general connection of nature and culture; it can be shown that the scientific understanding of social and cultural phenomena is founded on principles which can be easily identified by looking at nature. Bleuler's position is a clear-cut deterministic and materialistic one; the crisis of the post-world-war era can be solved only by rational reasonable ethics rules of a science applied on social questions. Bleuler outlines the general importance of race hygiene; practical consequences of this position remain unaffected. Euthanasia is to be planed in certain cases of difficult and incurable disease - including also mental illness; mental deficiency as such does not legitimize a such step yet.

Insights and treatment options for psychiatric disorders guided by functional MRI.

The advent of functional imaging has led to a new wave of insights into the pathophysiology and treatment of psychiatric disorders. In this Perspective, schizophrenia is used as an example of such a psychiatric disorder to illustrate these advances. Schizophrenia is a chronic and debilitating disorder characterized by a heterogeneous group of symptoms, including positive symptoms (delusions, hallucinations, disorganized thought), negative symptoms (flattened affect, stereotyped thinking, difficulty in abstract thinking), and multifaceted cognitive deficits, most prominently in the areas of attention, memory, and executive functioning (1). Emil Kraepelin gave us the first clinical account of schizophrenia in 1896. He named it dementia praecox, literally, early or premature deterioration of one’s mental faculties. In using this term, Kraepelin was referring to the fact that the disorder often strikes in adolescence or early adulthood and runs a chronic, lifelong, disabling course. In his writing about the disorder, Kraepelin emphasized the evident cognitive impairment in individuals that he studied, which comprised deficits in attention, motivation, problem solving, learning, and memory. He was also the first to link these cognitive impairments with poor functional outcome in patients with schizophrenia, such as deficits in social functioning, independent living, and self-care abilities. The term “schizophrenia” (schizo, split; phreno, mind) was coined by the Swiss psychiatrist Eugen Bleuler in 1911. Although Bleuler disputed Kraepelin’s assumption that the disorder struck only in early adulthood and always entailed dementia-like cognitive degeneration, he agreed that cognitive impairment was a core feature of schizophrenia, or its fundamental symptom. Other “peculiar” features, such as hallucination and delusions, were considered by Blueler to be secondary or “accessory” symptoms. The discovery of antipsychotics in the 1950s revolutionized the treatment of schizophrenia and directed emphasis toward positive symptoms. At that time, treatment with antipsychotics, with their encouraging effect on psychotic symptoms, led to the closure of most hospitals for chronic patients with severe and enduring mental illness and offered much hope for these patients to be reintegrated into society. However, by the 1960s it became obvious that a reduction in positive symptoms did not lead to recovery from schizophrenia and did not significantly improve functional outcome (2). The understanding of the fundamental deficits in schizophrenia came full circle as it came to be accepted that cognitive dysfunction plays a central role in the illness, just as Kraepelin and Bleuler had suggested at the dawn of the 20th century. Cognitive deficits are a core feature of schizophrenia, which (a) may precipitate psychotic and negative symptoms (3); (b) are relatively stable over time, with progressive deterioration after the age of 65 in some patients (4); (c) persist upon the remission of psychotic symptoms (5); (d) are related to but separate from negative symptoms (6, 7); and (e) determine functional impairment characteristic of the patients with this disorder (8). Functional brain imaging in schizophrenia was originally intended to elucidate the underlying physiological disturbances that lead to manifest illness. This Perspective will deal mainly with attempts by researchers to understand the pathophysiology and the mechanism of drug action using functional magnetic resonance imaging (fMRI), a technique that has the obvious advantages of minimal invasiveness, no radioactivity, widespread availability, and virtually unlimited study repetitions. These attributes make it ideally suited to the study of in vivo brain function in psychiatric illness like schizophrenia, facilitating the characterization of developmental changes in brain function from childhood and throughout the clinical course of the illness, and in response to treatment. In this article, some current issues surrounding the interpretation of functional imaging data in schizophrenia will be considered. Various investigators have examined links between brain activation, cognitive functioning, and symptoms, in the hope of identifying those regions and circuits that may be abnormal in schizophrenia. Ultimately, fMRI may help delineate disease pathways based upon pathophysiological correlates that may complement nosology. If this is successful, neural network models might be built to emulate brain malfunctions for each disease. This, in turn, may lead to better therapeutic options.

Jakob Klaesi on his 120th birthday

Jakob Klaesi was born on the 29th May 1883 in Glarus Canton (Switzerland) and was assistant and later head physician at the Psychiatric University Hospital in Zurich, directed by Eugen Bleuler. Klaesi directed the new Psychiatric Outpatient Department in Basel from 1923 to 1926 and later founded the Schloss Kronau private clinic in the Zurich Canton. In 1933 he became director of the Psychiatric University Hospital in Bern. His attitude toward somatic treatment methods was skeptical, although about 1920 he founded a psychiatric sleep cure with Somnifen. Klaesi was primarily a psychotherapist and interested in the psychodynamics of his patients. With his great empathy, he was able to understand especially well their expressive behaviour. This capacity for empathy and his philosophic orientation enabled him to develop a phenomenological analysis of expression. He died on the 17th August 1980. Differences and parallels to the thinking of Alfred Adler and Karl Jaspers are discussed.

Eugenisch motiviertes Denken und Handeln im «Burghölzli» am Anfang des 20. Jahrhunderts

Eugenic theories and practice were widespread in Europe and the United States in the early decades of the 20th century. B. A. Morel's theories of degeneration, social Darwinism and Galton's concepts (Galton defined the term eugenics) were precursors of eugenics in the 19th century. The introduction of eugenics led to a biologically biased interpretation of social issues. Psychiatry was used to intervene with eugenic measures in healthcare and social policy issues. Eugenic concepts were important in the Swiss psychiatry of the time as well; it is noteworthy that the first castrations in Europe were carried out in Switzerland. The present article explores this subject concentrating on the Psychiatric University Hospital Zurich, Burgholzli, as an example. It deals in more detail with the dissertation of Emil Oberholzer, who wrote his thesis Castration and sterilisation of mental patients in Switzerland in 1911. This dissertation was submitted to Eugen Bleuler, who was the medical director of the Burgholzli at that time. E. Oberholzer worked as a resident at the Burgholzli from 1908 to 1910; he later became renowned in the international psychoanalytic association. In his thesis, he reports 19 cases: 11 from the Burgholzli and 8 from the asylum of Wil; 15 women and 4 men; diagnoses: mental deficiency (6 cases), moral insanity (3 cases), combination of mental deficiency and moral insanity (4 cases), epilepsy (1 case) and developmental defect (1 case). He uses eugenic arguments as indications for castration or sterilisation, which were performed in most of the cases. A detailed case history of 5 patients are given in this paper. E. Oberholzer's primary concern was to advance the thinking of birth control for subjects. To generate ill and degenerated children was for him the worst crime and also the greatest misery for the government and race. He therefore stressed the need to prevent such descendants. Oberholzer criticised the extensive bureaucracy and missing legal framework for eugenic measures. He claimed a new law, which would facilitate castrations and sterilisations. While there was no legal framework for eugenic treatments, Oberholzer for example suggested to use other medical indications for sterilisations. This article also examines to which extent sterilisations took place under coercion or under the patients' informed consent. The patients pften had only two alternatives: to agree to sterilisation or castration or to remain in the hospital for the rest of their lives. In order to complete Oberholzer's material, unpublished medical records and forensic expertises were used. The additional information from Eugen Bleuler and his co-workers allows us to understand the official contemporary policy concerning eugenic practice of the Burgholzli. Eugenic theory and practice was promoted even though there is no evidence for any racial hygiene, with the ultimate goal to prevent any hereditary diseased offspring, as was the case in Germany.

The "Psychopathologic laboratory" at Burghölzli. Development and termination of the working relationship of C.G. Jung and Eugen Bleuler

C.G. Jung was on the staff of the University Psychiatric Clinic in Zurich ("Burghölzli"), headed by Eugen Bleuler, from 1900 to 1909; he became a senior physician in 1905. In correspondence with Sigmund Freud, Jung claimed that he had informed Bleuler about the subject of psychoanalysis and had recruited him for the movement. In fact, it can be shown that Bleuler was familiar with Freud's publications even before Jung came to Burghölzli and that he had written a very positive review of the hysteria study. Jung received his doctorate (1902) and postdoctoral qualification as university lecturer based on Bleuler's reports to the Department of Medicine and continued to give lectures on certain recurring topics, such as the theory of hysteria, until the summer semester of 1914, well after his resignation. Minutes of department meetings that have not previously been evaluated appear to indicate that the department's rejection of the founding of a "psychopathologic research laboratory," expected by Jung,was a major factor leading to his resignation on March 7, 1909. The importance of other events for Bleuler's relationship with Jung--the unsuccessful attempt at an analytical treatment of Otto Gross or Jung's relationship with Sabina Spielrein--cannot be demonstrated based on current sources.

Development and termination of the working relationship of C. G. Jung and Eugen Bleuler 1900-1909.

From 1900 to 1909, C. G. Jung was on the staff of the University Psychiatric Clinic in Zurich ('Burghölzli'), headed by Eugen Bleuler, where he became a senior physician (Sekundararzt) in 1905. Jung received his doctorate (1902) and postdoctoral qualification as a university lecturer (Habilitation) based on Bleuler's reports to the department of medicine, and he continued to give lectures on certain recurring topics, such as the theory of hysteria, until summer semester 1914, well after his resignation. Minutes of department meetings that have not previously been evaluated appear to indicate that a major factor leading to Jung's resignation on 7 March 1909 was the department's rejection of the founding of the 'psychopathologic research laboratory' that he had expected. The importance of other events for Bleuler's relationship with Jung - the unsuccessful attempt at an analytical treatment of Otto Gross, and Jung's relationship with Sabina Spielrein - cannot be determined from current sources.

Eugen Bleuler and forensic psychiatry

The list of Eugen Bleuler's writings shows that he grappled with forensic issues quite early, even before he became a full professor in 1898. Bleuler regularly prepared forensic criminal expert's reports himself until emeritus status was conferred on him in 1927. Analysis of his writings indicates that his position remained explicitly deterministic. In Bleuler's later work, that position was integrated into the natural philosophy vitalistic theory of mnemism, itself part of a more comprehensive theory, without any corrections to its content. Eugen Bleuler always remained a critic of criminal law, although it can be seen from later expert's reports that he for the most part accepted the existing system for the administration of justice for practical reasons. However, Bleuler always defended the idea that punishment should not be based on the moral guilt of the perpetrator but rather on the prospect of curing him.

Schizophrenia and the Void

It was Eugene Minkowski who, from the 1920s on, introduced the French to the work of Eugen Bleuler, whose student he had been. In the introduction to his first book, Schizophrenia: Psychopathology of Schizoids and Schizophrenics (Minkowski 1927), Minkowski nevertheless notes with regard to Bleuler that he could not allow himself "to be restricted to this student's task." For Minkowski, Bleuler certainly enjoys the great merit of having substituted the notion of schizophrenia for that of dementia praecox and of having described autism with precision. But—Minkowski says—autism is badly defined when, relying upon the concept of Spaltung, Bleuler fails to break free of associationist psychology. Minkowski justifies his critical attitude by appealing, as does Binswanger, to Husserl and above all to Bergson. For Bergson, dissociation is a normal feature of thought. If, for Minkowski, it is important to pay attention to autism, it is because it attests not to a certain fragmentation of consciousness, but rather to an attitude whereby the subject seeks to preserve the precarious equilibrium of a personality that is threatened by a void.

Cognitive dysfunction in schizophrenic psychoses. Drug and psychological treatment choices

Primarily from the perspective of psychopharmacology, schizophrenic symptomatology has recently been dichotomized into "plus" and "minus" symptoms, although the role of cognitive dysfunctions has been regarded as particularly important for the diagnosis since the time of Eugen Bleuler. Many studies show that schizophrenic patients suffer consistently from cognitive dysfunction. Among these, are impairments of attention and memory functions as well as executive functions such as planning and problem solving. These impairments are stable or progressive and often continue into the remission phase of schizophrenia and impair both social integration as well as occupational performance. In this overview, research results on cognitive dysfunction in patients with schizophrenic illnesses and their relation to psychosocial disabilities are described first. The therapeutic value and possible clinical-practice implications of atypical anti-psychotics and various cognitive therapy methods are then presented. Methodological weaknesses and open questions, both pharmacological and with regard to cognitive interventions, are discussed.

Eugen Bleuler's schizophrenias - synthesis of various concepts

Eugen Bleuler's schizophrenias - synthesis of various concepts

AN ASSESSMENT OF QUALITY OF LIFE IN AMBULATORY SCHIZOPHRENICS: WORLD HEALTH ORGANIZATION QUALITY OF LIFE ASSESSMENT SCALE (WHOQOL-100) CONCEPTS QUALITY OF LIFE OF AMBULATORY SCHIZOPHRENICS

The name “schizophrenia” indicates “a fragmented mind” and it was coined by Eugen Bleuler. Schizophrenia affects nearly 1 percent of the US population and its estimated annual direct and indirect c...

The Zürich School of Psychiatry in theory and practice. Sabina Spielrein's treatment at the Burghölzli Clinic in Zürich.

The remarkably caring and privileged treatment of Sabina Spielrein at the Burghölzli Hospital 1904/05 (as shown by the records) exemplifies the standards and key concepts of the Zürich School of Psychiatry, founded by Auguste Forel and represented by the then current director Eugen Bleuler, as well as the specific dynamics between Bleuler, his first assistant C. G. Jung, and Spielrein herself. Bleuler, in accordance with the trauma theory of hysteria, steadfastly promoted the separation from her traumatizing family and supported her scientific education. Jung, deeply and emotionally involved, revealed how she had been traumatized, but in focusing on her masochistic feelings rather than on the victimization, he established a rather conflicted personal relationship with her, foreshadowing his later ambivalent attitude to Freud's sexual theory. Thus Sabina was discharged with a reasonable psychiatric and scientific education but an unreasonable need for personal dependency.

Fundamentals of scientifically based ethics in the works of Eugen Bleuler

The name Eugen Bleuler is almost exclusively linked with matters concerning the nosology of schizophrenia, general psychopathology, and the relationship of clinical psychiatry with psychoanalysis. His bibliography lists various works dealing with contemporary themes about legislation, the fight against alcoholism, and, for the most part from later years, with themes about general psychology. In this article, material from Bleuler's texts are reviewed, including some which have been inaccessible up to now, which either allow interpretative conclusions on ethical grounds or have this explicitly as a topic. In particular, the analysis focuses on Bleuler's work "The Scientific Fundamentals of Ethics", published in 1939. Written in a time widely viewed as disorientated, the author coherently and systemically comments on the issue of a 'new' ethic. The anti-religious and anti-philosophical positions already demonstrable in some of his earlier works will be shown. According to his conception of a scientifically based ethic, the idea of social suitability is of utmost importance and also recognisable in the animal world as a general principle of nature. Bleuler perceives the ethical 'instinct' as inherent; its absence characterises the image of an 'moral idiot', which was already a theme in his earlier works. His statements about matters concerning euthanasia are presented and, furthermore, it will be attempted to construct from his texts an underlying global view. Concerning these ethical issues, it also can be shown once more that the elderly Bleuler was hardly influenced by psychoanalytical perspectives.

Epistemological aspects of Eugen Bleuler's conception of schizophrenia in 1911.

Eugen Bleuler, in 1911, renamed the group of mental disorders with poor prognosis which Emil Kraepelin had called "dementia praecox" "group of schizophrenias", because for him the splitting of personality was the main symptom. Biographical, scientific and methodological influences on Bleuler's concept of schizophrenia are shown with special reference to Kraepelin and Freud. Bleuler was a passionate and very experienced clinician. He lived with his patients, taking care of them and writing down his observations. Methodologically he was an empiricist and an eclecticist with a wide reading knowledge. In an impaired association of ideas, in disordered affectivity, in marked ambivalence and autism Bleuler saw the main symptoms of schizophrenia. For him these so-called pathological phenomena actually seemed to be only exaggerations of normal psychic functions. So there were only a quantitative, not a qualitative difference between schizophrenia and normal psychic processes and studies on schizophrenic "pathology"--seen as a disturbance, not as a disease--might analogously illustrate normal psychic reactions and vice versa. In etiology as well as in therapy Bleuler took into account psychological and (neuro)physiological (somatic) mechanisms--thus combining organicism and dynamic psychiatry and coming very close to modern concepts, e.g. the one of stress and vulnerability. Bleuler's main merit is the stressing on an idiographic "understanding" of the patient and a plausible and subtle explanation of schizophrenia which helped to reduce the alienation of the affected persons.

Highlights of the 1999 Institute on Psychiatric Services

Highlights of the 1999 Institute on Psychiatric Services

Cognition, schizophrenia, and the atypical antipsychotic drugs.

Schizophrenia was originally called dementia praecox by Emil Kraepelin, the great 19th century psychiatric nosologist, who coined the term to categorize a group of young psychotic patients who went on to develop dementia. A decade later, Eugen Bleuler, noting that most patients who had similar psychotic and affective features did not become severely demented, renamed the illness schizophrenia and in the process decreased the central importance of cognitive impairment to the broader entity, although he, too, conceptualized schizophrenia as a neurocognitive disorder (1). Recognition of the central importance of cognitive impairment to schizophrenia further diminished in the 1950s, after the development of antipsychotic drugs such as chlorpromazine and haloperidol, which had, as their signature characteristics, the ability to improve delusions and hallucinations, although, at the same time, causing significant extrapyramidal side effects (EPS). The evolution of diagnostic schema for schizophrenia during the 1970s and 1980s further emphasized delusions and hallucinations (now generally referred to as positive symptoms), which, in about 70% of cases, respond to the haloperidol-like drugs (now called typical antipsychotics, for reasons explained below). However, these drugs were found not to improve cognitive function and, sometimes, to impair some aspects of cognition, such as memory and fine motor function (2–4). Research on the cognitive impairment of schizophrenia, nevertheless, went forward, and its major features were reliably described: (i) all domains of cognition, including attention, executive function, secondary (storage) memory, working memory, and semantic memory, may be affected (5); (ii) the pattern of deficits may vary widely among individuals with schizophrenia (5); (iii) the mean deficit in these domains may be 1–3 standard deviations below normal (5–7), although about 15% of patients with schizophrenia test within the normal range in all domains (8); (iv) for most patients, impairment is only slowly progressive after the first …

The general psychological concept in the later work of Eugen Bleulers. Comparison with a summarized description from a forgotten theory 60 years after the final publication (1939)

Documents by Eugen Bleuler from 1921 to 1939 that go into general psychological topics of meaning of consciousness, formation of motive and will, are presented. An effort towards integration of seemingly incompatible, side by side standing, unrelated biological and psychological concepts that probably is most likely explainable by the contemporary background of ideas, is recognizable. In this context, Eugen Bleuler refers to an already (especially by Richard Semon) systematically developed theory called "Mnemism" that he interpreted and applied to the psychological circumstances mentioned above. That theory of "mnemism" that can be most adequately described as a biogenetic-vitalistic theory, is assuming, that all organic life--independent of the possibility of a self-reflecting consciousness--is able to learn experiences made by analysis of environment and to pass it on following generations. Pattern of stimulus reactions are in the sense of this theory memorized ("engraphiert") and reactivated under similar situational circumstances ("ekphoriert") by the psychological mode of association.--It can be shown that Bleuler pursued this theory for a period of more than ten years. It represents the benchmark for Bleuler's standpoints, for example for the question of determination of human acting, that as itselves are already known from his earlier documents, but here have found a more theoretically based explanation. The assumption of the efficacy of specific, not necessary consciously remembered "engramms" of memory, suggests the hypothesis of the existence of unconsciousness; in this context textual points of contact to the psychological concepts of S. Freud and C. G. Jung--mnemic memory and collective unconscious--are shown.

Orthodoxy against heretics. Correspondence of Gaupp and Kretschmer to Eugen Bleuler

A letter of R. Gaupp to Eugen Bleuler (1906) illustrates the contradictory reception of psychoanalysis. Letters from E. Kretschmer to Eugen Bleuler (1920) reflect the devalorization of Kretschmer by E. Kraepelin. The orthodox systems of the authorities are intolerant towards heretics.

Zur Entwicklung kriminalpsychologischer Grundanschauungen im Werk Eugen Bleulers

The study refers to Eugen Bleuler's first systematic publications on "the natural born criminal" (1896) and his subsequent forensic-psychiatric expertise, written by Bleuler as Director of the psychiatric Department of Psychiatry of the University of Zurich ("Burghölzli"). It could be clearly shown that Bleuler was influenced by a deterministic understanding of human behaviour. He referred to the Anglo-American concept of "moral insanity" as a circumscribed defect of altruistic feelings despite other psychic functions being normal and tended to include this psychopathic deviation in psychiatry. Although this theoretic position remained unchanged, the elderly E. Beuler--under pragmatic points of view--accepted the traditional differentiation between mental illness in a narrower sense and "moral insanity" as a personality feature of most delinquents, falling under the responsibility of law and penal institutions. In his publications as emeritus (after 1927). Bleuler was influenced by the natural philosophic and vitalistic concept of the so-called "Minemism", which, however, still made him reject the postulate of "freedom of will".

Cruel Compassion: Psychiatric Control of Society’s Unwanted

THOMAS SZASZ: Cruel Compassion: Psychiatric Control of Society's Unwanted. John Wiley and Sons, New York, 1994, 264 pp., $19.95. Thomas Szasz maintains in Cruel Compassion his antipsychiatric stance but has moved on to deal with an issue he calls adult dependency and the society's unwanted. In the first part of the book, he makes the case that modern psychiatric treatment is similar to segregating paupers in workhouses, incarcerating default debtors in prisons, and exiling epileptics to colonies. His argument is almost entirely based on analogy. In the past paupers, debtors, epileptics, et al. were coerced and controlled because they were unwanted by society. He asserts that the same thing is happening today with the so-called mental housed in mental hospitals. His argument lacks one thing: proof. Later in the book, he turns his attention to the de-institutionalized people on the street who he admits can be disruptive and dangerous. De-institutionalization seems o be what he has always advocated, i.e., a liquidation of psychiatric hospitals. However, now he blames psychiatry for homeless people. In this approach, his style is to attack psychiatry and disabled patients, and his technique is provocative. The primary target of his anger is the general psychiatrist, but he speaks ill of a wide range of people and organizations: the American psychiatric Association, the National Institute of Mental Health, parents of the mentally ill, the National Alliance of the Mentally Ill, Hobbes, John Stuart Mill, John F. Kennedy, the Joint Commission on Mental Illness and Health, Philippe Pinel, Eugene Bleuler, Henry Maudsley, Sigmund Freud, Anna Freud, Carl Menninger, Nathan Kline, E. Fuller Torrey, Paul Applebaum, Richard Lamb, Bruno Bettleheim, and Lewis Thomas among others. He does have heroes and quotes approvingly from Shakespeare, Adam Smith, and himself. One might think his attacks on psychiatry are some form of professional autogenocide, however this is not quite the case. He never speaks of himself as a member of the profession. He gives no personal case material to indicate how he would actually take care of patients. Nor can one really imagine Szasz conducting his own receptive, nondirective interview with patients. He is so certain he knows what is wrong, how could he possibly listen to ill patients describe bizarre delusions, auditory hallucinations, poor concentration, threatening thoughts, and marked ambivalence in speech and action. …