Eugen Bleuler, Dementia Praecox or the Group of Schizophrenias, 1911

Eugen Bleuler, Dementia Praecox or the Group of Schizophrenias, translated by Joseph Zinkin (New York: International Universities Press, 1950), 63-68.

Complete original source available here.

The term “autism” was first used by the Swiss psychiatrist Eugen Bleuler. In this excerpt from his 1911 book on schizophrenia, a term he also coined, Bleuler used autism to describe a signature characteristic of adults with this severe mental illness: a state of insulation from reality so complete that it excluded other human beings. For Bleuler, autism indicated detachment from others and autistic thinking pointed toward an interior life full of fantasies, hallucinations, and delusions.

Eugen Bleuler

Relation to Reality: Autism

The most severe schizophrenics, who have no more contact with the outside world, live in a world of their own. They have encased themselves with their desires and wishes (which they consider fulfilled) or occupy themselves with the trials and tribulations of their persecutory ideas; they have cut themselves off as much as possible from any contact with the external world.

This detachment from reality, together with the relative and absolute predominance of the inner life, we term autism.19 ….

19. Autism nearly coincides with what Freud has termed auto-erotism. Since, however, for this author the concepts of libido and erotism are so much broader than for other schools of thought, his term cannot very well be used here without giving rise to many misunderstandings. In essence the term, autism, designates in a positive way the same concept that P. Janet formulated negatively as “the loss of the sense of reality.” However, we cannot accept Janet’s term without discussion because he understands this symptom in a far too general sense. The sense of reality is not entirely lacking in the schizophrenic. It fails only in relation to matters threatening to contradict his complexes.

Autism is not always to be detected at  the very first glance. Initially the behavior of many patients betrays nothing remarkable. It is only on prolonged observation that one sees how much they always seek their own way, and how very little they permit their environment to influence them…..

Autism is also manifested by many patients externally. (Naturally, this is, as a rule, unintentional.) Not only do they not concern themselves about anything around them, but they sit around with faces constantly averted, looking at a blank wall; or they shut off their sensory portals by drawing a skirt or bed clothes over their heads. Indeed, formerly, when the patients were mostly abandoned to their own devices, they could often be found in bent-over, squatting positions, an indication that they were trying to restrict as much as possible of the sensory surface area of their skin. ….

The autistic world has as much reality for the patient as the true world, but his is a different kind of reality. ….

Autistic thinking is directed by affective needs; the patient thinks in symbols, in analogies, in fragmentary concepts, in accidental connections. Should the same patient turn back to reality he may be able to think sharply and logically.

Thus we have to distinguish between realistic and autistic thinking, which exist side by side in the same patient. In realistic thinking the patient orients himself quite well in time and space. He adjusts his actions to reality insofar as they appear normal. The autistic thinking is the source of the delusions, of the crude offenses against logic and propriety, and all the other pathological symptoms. The two forms of thought are often fairly well separated so that the patient is able at times to think completely autistically and at other times completely normally. ….

Autism must not be confused with “the unconscious.” Both autistic and realistic thinking can be conscious as well as unconscious.



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