Paul Eugen Bleuler (1857–1939)

Paul Eugen Bleuler studied autism and schizophrenia, among other psychiatric disorders, throughout continental Europe in the early twentieth century. Bleuler worked as a psychiatrist caring for patients with psychiatric disorders at a variety of facilities in Europe. In 1908, Bleuler coined the term schizophrenia to describe a group of diseases that cause changes in thought processes and behavior in humans as well as difficulties relating to the world. Bleuler also introduced the concepts of autism, which he defined as a disconnect from the outside world, and ambivalence, which he defined as the coexistence of conflicting ideas in one’s mind. Bleuler’s concepts enabled later researchers, such as Bernard Rimland, to study the causes of those disorders, and to suggest that abnormal development of fetal brains potentially caused those disorders.

Bleuler was born on 30 April 1857 in Zollikon (later a part of Zürich), Switzerland, to Pauline Bleuler and Johann Rudolf Bleuler. Bleuler’s parents were farmers who participated in the politics of their rural town. According to his granddaughter and biographer, Tina Joos-Bleuler, Bleuler was a dedicated student demonstrating an interest in science from a young age. He attended a gymnasium school where he was a member of the gymnastics team. When he was young, Bleuler’s parents hospitalized his older sister, Paulina, at the Burghölzli Asylum at the University of Zürich in Zürich, Switzerland. Bleuler later identified his sister, who remained mentally ill and a resident of Burghölzli throughout her life, as having schizophrenia. Bleuler’s experience with his sister motivated him to become a psychiatrist to help patients in similar situations.

In 1883, Bleuler graduated with a doctorate of medicine with a focus in mental and nervous diseases from the University of Zürich. Bleuler was the first in his family to go to a university. After graduating from medical school, Bleuler studied psychology in many different locations. He spent two years as an assistant physician at the Waldau Psychiatric Clinic near Bern, Switzerland. Following his assistantship, he traveled to Munich, Germany, where he worked in the laboratory of Bernhard Aloys von Gudden, a psychiatrist and neuroanatomist. In 1885, Bleuler became an assistant physician at the Burghölzli Asylum in Zürich, Switzerland. In 1886, Bleuler became the director of the Rheinau Psychiatric Hospital in Rheinau, Switzerland.

In 1898, after holding his position at Rheinau for twelve years, Bleuler became the director of the Burghölzli Asylum, a larger psychiatric hospital in Zürich. Bleuler lived in the Burghölzli in the director’s apartment on the first floor of the main building. Due to his proximity to his patients, he developed close relationships with his patients. He recorded many observations that he used in his research. In 1900, in addition to his clinical position at the Burghölzli Asylum, Bleuler became a professor of psychiatry at the University of Zürich. Throughout his career, Bleuler focused his research on defining the causes of mental illness and improving treatment options.

In 1901, Bleuler married Hedwig Waser, with whom he had five children. Bleuler and Waser met while both campaigning for the abstinence movement. Joos-Bleuler reported that the two were very different yet they bonded over their passion for people, social issues, and abstinence. Bleuler’s family lived with him in the director’s apartment at Burghölzli.

On 24 April 1908, Bleuler gave a lecture at the German Psychiatric Association meeting in Berlin, Germany. During that lecture, Bleuler coined the term schizophrenia. In his 1908 paper "Dementia Praecox Oder Gruppe der Schizophrenien" ("Dementia Praecox or the Group of Schizophrenias"), Bleuler first described schizophrenia in writing as a splitting of mental processes. He published the paper in 1908 and then added to and published the work again as a book in 1911. Bleuler developed an expanded of schizophrenia in that book, Dementia Praecox, order, Gruppe der Schizophrenien (Dementia Praecox or the Group of Schizophrenias). In his description of schizophrenia, Bleuler built off the concept of dementia praecox, established and named by Emil Kraepelin, a psychiatrist at the University of Munich in Munich, Germany. Kraepelin defined dementia praecox, later called schizophrenia, as a disease affecting young people that later develops into dementia. In contrast, Bleuler coined schizophrenia as a better name than dementia praecox because it alludes to the splitting of the personality, which Bleuler said was a main symptom of schizophrenia instead of dementia, which is not always associated with the disease.

Bleuler defined schizophrenia as a group of diseases rather than just one disorder. He defined the main symptoms of the disease as the four A’s: associations, affect, ambivalence, and autism. Bleuler explained the four A’s in his book Dementia Praecox or the Group of Schizophrenias. By associations, Bleuler meant the trouble schizophrenic individuals have making normal associations in their thoughts. He claimed that their thinking becomes illogical as they connect things that are not connected and disconnect thoughts and items that should be connected. With affectivity, Bleuler referred to a patient’s flat affect and the loss of expression when talking about subjects that normally evoke a lot of emotion. Bleuler defined ambivalence as two separate ideas or personas coexisting in one’s mind or having conflicting attitudes or emotions. Finally, Bleuler introduced and defined autism as separating oneself from reality. Bleuler’s concept of autism influenced other researchers including Hans Asperger, Leo Kanner, and Bernard Rimland’s work as they studied autism, distinguished it from schizophrenia, and tried to refine the term.

In 1916, while still working as director of the Burghölzli Asylum and a professor at the University of Zürich, Bleuler wrote a textbook that contained many of his theories and findings about mental illness, Lehrbuch der Psychiatrie (Textbook of Psychiatry). In the 1923 version of the textbook, George H. Kirby discussed in the introduction that Bleuler’s ideas are important because they move away from describing psychiatric diseases and towards trying to explain them. Kirby also noted that Bleuler had similar views towards the cause of psychiatric diseases to Sigmund Freud, psychologist at the University of Vienna in Vienna, Austria. Bleuler and Freud suggested that psychiatric diseases were caused by genetic or developmental factors and not simply the patient’s reaction to the world they live in.

Bleuler retired from both teaching at the University of Zürich and working as director of the Burghölzli Asylum in 1927. According to his granddaughter Joos-Bleuler, aside from his work, Bleuler enjoyed poetry, literature, nature, and spending time in the mountains with his wife and family. Bleuler died on 15 July 1939 in his birthplace, Zollikon, Switzerland.