Paul Eugen Bleuler: Schizophrenia and Contributions to the Science of Psychiatry

 Paul Eugen Bleuler was born on April 30, 1857 in the town of Zollikon, next to the city of Zurich, to a farming family. After completing his medical studies at the University of Bern, he was made professor of psychiatry at the University of Zurich and director of the Burghölzli Mental Hospital. Between 1898 and 1927, he observed 647 patients at the hospital and published his findings in 1908. As a result of these observations, he used the term schizophrenia for the first time in this research and greatly helped to understand the illness.  

The term 'schizophrenia' was introduced on April 24, 1908 in a congress given by Professor Paul Eugen Bleuler at a meeting of the German Psychiatric Association in Berlin. In the lecture, he explained that ''Praecox Dementia'' was not related to dementia or precociousness and emphasized that the disintegration of psychic functions was a feature at the origin of schizophrenia. Bleuler's knowledge on this subject was obtained from clinical observations and practicing with patients. As a result of his observation studies in the 20th century, he created a book and detailed his knowledge there. In his work, Praecox Dementia or Schizophrenia Group, he ignored the accepted ideas on this subject; he rejected the belief that early dementia is not a single disease, that recovery is not possible and that complete dementia will eventually occur. In the same work, he called 'schizophrenia' all disorders that involve the progression of memory recollections without a clear pattern and personality segmentation. He derived the name schizophrenia from the Greek verb 'schizein', meaning to split. The other half of the word is 'phren', meaning soul, mind. Based on this, by calling early dementia schizophrenia, he explained that the division of psychic functions is common and revealed that the personality structure is lost as the division becomes evident in the later stages of the disease. Bleuler argued that schizophrenia was not fully externalized and could not always be a disorder. He elaborated on schizophrenia by distinguishing between positive and negative symptoms of schizophrenia. Positive symptoms include the absence of hallucinations or delusions, while negative symptoms describe the absence of features such as social avoidance or the inability to enjoy pleasure. In addition, he distinguished between core and subsidiary symptoms and between first and second symptoms. Core symptoms describe criteria that are present in all schizophrenics. Subsidiary symptoms are those that differ according to the individual. Bleuler explained the first symptoms as being related to neurological problems and included affect, association, autism and indecision, and the second symptoms as attitudes and reactions to neurological symptoms. The separation and categorization of these symptoms contributed to the understanding of schizophrenia.  

Bleuler found that several factors must be together for schizophrenia to be specific in patients. He argued that hallucinations, delusions, psychotic ideas and psychotic behaviors tend to coexist. He also argued that the disease is not completely genetically inherited, and that different divisions will emerge from the emotions and psychic functions of the person. For this reason, he favored the early discharge of schizophrenics from the hospital in order for them to participate and adapt to society. But Bleuler's patients did not recover, and it was revealed that he had castrated the patients he experimented on, resulting in the suicide of several patients.   

 In addition to schizophrenia, he also conducted research on psychoids. He defined the psychoid as the power to respond and adapt to stimuli. Believing that psychoid is a cause of psychic development, he stated that it emerges from differences in life. It also shaped future responses by creating permanent differences in the brain. In Additionally, he was one of the first supporters of Sigmund Freud. He tried to prove that the different structures that Freud detected in patients with mood disorders could also be found in patients with psychosis. He tried to prove that psychosis could be caused by psychological phenomena, as opposed to the destruction of brain tissue. Even though he acted as an adopter of Freud's theories, he opposed some concepts. He did not accept the facts about libido and sexuality.   

Paul Eugen Bleurer, who gave his life to the science of psychiatry, created the term schizophrenia and became a pioneer in this field, died on July 15, 1939. His contributions to the field of psychiatry are validly read today and benefit us.  

REFERANCE: Schizophrenia Bulletin, Volume 37, Issue 6, November 2011, Pages 1131–1135