Bleuler E (1919)
Das Autistisch-Undisziplinierte Denken in der Medizin und Seine Überwindung [Autistic-undisciplined thinking in medicine and how to overcome it]. Berlin: Springer.
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Title page(s)

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Key passage(s)

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Translation

Foreword

“The desirability of writing this book stems from my student days, when I was upset about many seemingly useless or even damaging, in any case unsatisfactorily based, medical prescriptions in practice and teaching. Furthermore, I aimed, amongst other things, to try to compare the usual uncontrolled and therefore completely insignificant statistics on heredity in mental diseases with a study of the incidence of neurological and mental diseases in the families of mentally healthy people. For many years I did not consider myself competent to openly criticise [the situation], and hoped that more experienced [colleagues] would take up the issue. Unfortunately this did not happen, and perhaps 40 years of further observing these imperfections now give me the right, or even the duty, to say something about the matter…

Of course, it made no sense to write anything exhaustive, nor did it matter from which fields examples came to mind. After all, our superstition mainly concerns therapeutics, and this is much too often autistic, that is, it is still too often based on the age-old soil of desires and imagination rather than on reality and firm, logical conclusions (see paragraph A).”

Summary

A. Introduction. “Wherever experience and logic do not suffice in problems charged with emotions one has always had recourse to autistic thinking, which actively ignores realities and probabilities if mere negligence in thinking has not previously shrouded the difficulties or has produced, rather accidentally, a flawed logic favouring the desired scope. There is probably no science in which the negligent and autistic forms of thinking remain so little weeded out as in medicine. On the one hand, medicine is the most complicated and unsupervisable [field] and poses many problems that are unsolvable in principle, but, on the other hand, the overwhelming desire to fight suffering and death has always driven [medicine] towards insufficiently balanced, “primitive reactions”, towards magic and the “supernatural”, that is, towards unintelligible measures.”

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Translation

B. “Autism in treatment and prevention. Despite all modern medicine’s progress, many things remain as autistic as they are within primitive societies, even if we have abandoned the actual form of magic. This holds particularly, but not exclusively, for treatment and prevention. The methodology for testing the effects of medicines often remains wholly insufficient. We still treat patients with remedies for which we have no proof of any utility, or even of their safety; we also treat diseases that resolve spontaneously, and those that are incurable. We do not know for which cases it would be better to do nothing at all, nor do we try to identify them, for instance in internal medicine. Despite the consolation which unnecessary treatment may offer, it is associated with a list of serious drawbacks. The proof of utility is lacking in electrotherapy, intelligible indications are absent for hydrotherapy; the utility of the many artificial nutrients has been insufficiently examined; and we often disinfect our bodily cavities without any evidence of utility or innocuousness. We often damage [our patients] with unwise prescriptions of idleness and relaxation. We still do not think enough about the late consequences of our advice (analgesics, alcohol). The conception of sexuality in pathology and therapy is particularly autistic; autistic thinking has fuelled enthusiastic battles against the theories of Semmelweiss, hypnosis, deep psychoanalysis, and these are all things of the utmost medical importance. Although it has probably made the biggest progress, the fight against epidemics still has severe autistic angles, as shown in the recent epidemic of influenza against which all possible unusable and even damaging remedies have been recommended…”

F. “Requirements for the future. Even observation requires a scientifically trained technique. This holds even more for medical statistics about the factual data, as well for the mathematical expression of probabilities, which together with the variance, the probable error, accompanying reciprocal probabilities and many other things have to be conceived precisely, and then presented in logical relation to each other using a kind of calculus. Concerning the success of many treatments, one will achieve a faultless result only if one treats alternate patients with one of the measures to be compared. Conceptions of disease and the differences to be compared must be much more sharply formulated. Only when scientific work in research institutes and with practitioners is organised methodically will it be possible to avoid our many mistakes.”

Translation by Ulrich Tröhler