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Medicine: Meeting on the Mind

4 minute read

Zurich’s broad, winding streets were plastered last week with cryptic blue and white signs—a Swiss artist’s stylized version of the Greek letter psi. The ψA sign had been adopted by the city as an emblem to guide 2,000 visiting psychiatrists from 58 nations to their scattered meeting places. Occasion: the Second International Congress for Psychiatry (the first was held in Paris in 1945). Since the theme was “the present status of our knowledge about the group of schizophrenias,” Zurich was an appropriate meeting place, for it was here that the late Psychiatrist Paul Eugen Bleuler (rhymes with broiler) formulated the modern concept of the most widespread mental illness and named it schizophrenia.*

Appropriately, the president and keynoter of the congress was Eugen Bleuler’s son Manfred, 54, who 15 years ago took over his father’s post as head of Zurich’s famed University Psychiatric Clinic at Burgholzli. In his opening speech last week, Dr. Manfred Bleuler estimated that one in every hundred people in the world is afflicted with schizophrenia. Medicine’s war against schizophrenia, Bleuler argued, is as urgent as the drives against infectious diseases or cancer, but until now it has woefully lacked public support, largely because psychiatrists themselves differ so strongly about its causes and treatment.

Emotion v. Metabolism. Some psychiatrists lay heavy stress on heredity, but Bleuler insisted that nobody knows whether the disease is hereditary through specific genes or whether it is passed on from generation to generation because children are emotionally damaged by schizophrenic parents who subject their offspring to a sick environment. As for opinions about treatment, said Bleuler, some psychiatrists see schizophrenia as primarily emotional in origin and give top marks to psychotherapy; others seek the cause of the disease in the chemical or metabolic abnormalities that are known to mark schizophrenia, hence downgrade psychotherapy to a mere adjunct of physical treatments (drugs, shock, coma).

It was this division between the physical and the psychological view that ran through most of the 700 papers read at the congress. Psychiatry’s grand old man and Zurich’s first citizen, Dr. Carl Gustav Jung, 82, was on hand to define the issue. Stooped but hale and quick-witted, Jung reiterated his longstanding position on the psychological side of the fence. His view: the emotional disturbance comes first and causes the chemical disturbances that accompany schizophrenia.

The Latest on Drugs. Jung notwithstanding, drugs and other physical treatments, notably a new version of shock therapy (see below), got the big share of attention. Main points:

¶For all their well-deserved publicity, tranquilizers are far from the whole answer. In the U.S.. the tranquilizers have been suitable only for a minority of state-hospital patients because many of them are already too “tranquilized” and actually depressed.

¶The opposite of tranquilizers, e.g., energizers such as iproniazid, are being widely tested in the U.S. and Europe. Rockland (N.Y.) State Hospital’s Dr. Nathan S. Kline, who introduced iproniazid as an energizer, suggested that it may prove as important as all the tranquilizers combined in releasing big numbers of patients from hospital wards. Then, taking a flying leap into the future, he foresaw a brave new world in which mind-improving drugs will be used not only to alleviate illnesses but to improve the performance of the healthy.

In tune with this hopeful emphasis was Topeka’s famed Dr. Karl Menninger, who pleaded for more practical help for patients, less theory of a kind that often inspires fear: “The word schizophrenia becomes a damning designation. To have it once applied to a young man can be to ruin a career, despite all evidence of subsequent healthiness.” Psychiatrists, argued Dr. Menninger, ought to regard all mental illness as the same in quality and differing only in quantity: “We all have mental illness of different degrees at different times, and sometimes some of us are much worse or much better.”

* I.e., “divided mind.” Bleuler (1857-1939) was not satisfied with the rigid 19th century view of “dementia praecox” as a single, precisely definable disease whose victims were doomed to progressive deterioration. In 1911 he characterized the various forms of withdrawal from the real to an unreal world as “a group of schizophrenias.” Most importantly, he insisted that continuous deterioration was not inevitable.

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