Myth and Forgetting: Bleuler’s ‘Four As’

Abstract

In this chapter we now turn to examine how a process of historical forgetting and myth-making further compromised the conceptualisation of schizophrenia in the twentieth century. As previously noted, the Swiss psychiatrist Eugen Bleuler (1857–1939) first coined the term schizophrenia in 1908. In doing so he described one of its most important characteristics as a splitting, or tearing up, of the psychic functions. Bleuler subsequently outlined his concept in detail in his 1911 text Dementia Praecox or the Group of Schizophrenias, which is some 500 pages in length (Bleuler, 1908, 1911/1952). As this chapter now explores, recent generations of psychiatrists frequently describe and synopsise Bleuler’s schizophrenia in terms of the ‘four As’ mnemonic. Namely: disturbances of affect, associations, ambivalence and autism. Therefore, it is not uncommon to find statements such as the following from an article entitled ‘Notes on the History of Schizophrenia’:

It was Bleuler who first coined the divisive term ‘schizophrenia’ in 1911. Bleuler defined schizophrenia with his four ‘A’s’, referring to the blunted Affect (diminished emotional response to stimuli); loosening of Associations (by which he meant a disordered pattern of thought, inferring a cognitive deficit), Ambivalence (an apparent inability to make decisions, again suggesting a deficit of the integration and processing of incident and retrieved information) and Autism (a loss of awareness of external events, and a preoccupation with the self and one’s own thoughts) (Kyziridis, 2005, p. 45) (n.b. Kyziridis is in error about the date 1911).