Book Reviews

Edward Shorter. A Historical Dictionary of Psychiatry. Oxford and New York: Oxford University Press, 2005. Pp. ix + 338. ISBN 0-19-517668-5. In the history of medicine, there are few scholars whose writings have sparked more debate than Edward Shorter of the University of Toronto. In a publishing career that stretches back to ground-breaking books such as A History of Women's Bodies (1982), Bedside Manners: The Troubled History of Doctors and Patients (1985), and From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (1992), Shorter time and again has questioned theories of social history which hold that medicine in general and psychiatry in particular construct illnesses for their own professional and political purposes. His book A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (1997) was a powerful application of this approach to the history of psychiatry. Shorter's stalwart defence of twentiethcentury biological psychiatry and his robust scepticism about the value of psychodynamic theories of mental illness won him few followers among historians of psychiatry, but the book's verve and impressive array of sources in a variety of languages made it impossible to ignore.

Shorter is now back with another contribution to the history of psychiatry, and true to style it is original and noteworthy. A Historical Dictionary of Psychiatry contains dozens of entries on a host of individuals, institutions, therapies and diagnostic concepts from psychiatry's past, as well as the history of neurology and psychology. Each entry comes with numerous crossreferences to other entries, and the overall product is a comprehensive encyclopaedia that charts the evolution of myriad key theories and practices throughout history. The biographical entries are almost worth the price of the book alone, as many historians of psychiatry who are unable to read languages cannot normally access this kind of information. Now they have it, in English, in a single volume.

As might be expected from Shorter, a true believer in the theory that psychiatry is a natural science, there is plenty of coverage of developments in psychopharmacology, the neurosciences and clinical psychiatry. No one will be surprised that the entry on 'schizophrenia/dementia praecox' is 12 pages long. Yet the section on 'personality disorders' is 8 pages long, 5 pages longer than the entry for 'manic-depressive illness', and 'obsessivecompulsive disorder' gets 5 pages. 'Psycho-therapy' gets 7 pages -curious, given Shorter's low estimation of such approaches in his earlier work. These and other entries suggest to those familiar with From the Era of the Asylum to the Age of Prozac that Shorter is now more charitable toward certain currents in the history of psychiatry than he used to be. A striking example is his treatment of nineteenth-century French psychiatry. Hitherto Shorter took a dim view of this chapter in the history of psychiatry, consigning it to the current in medicine that led to politically sinister, twentieth-century theories about degeneration. But in the book under review he gives full credit to the diagnostic skills of psychiatric pioneers such as Bénédict-Augustin Morel, Jean-Pierre Falret and Charles Lasègue. Shorter is even generous to Valentin Magnan, Emil Kraepelin's French rival in clinical psychiatry. Rather than dismiss Magnan's diagnostic concepts as inferior versions of Kraepelin's insights, Shorter grants that the Frenchman might have been onto something after all (p. 165).

Yet, the book's even-handedness may be precisely what disappoints Shorter's fans. Absent is the lively editorializing that has marked his previous publications. Every once in a while he cannot resist, for example, noting that the psychiatrically-trained, postmodernist philosopher Jacques Lacan succumbed to 'jargonaphasia' in the last years of his life (p. 159), or that the acclaimed anti-psychiatrist Thomas Szasz has close ties to the Church of Scientology (p. 23). Yet in writing A Historical Dictionary of Psychiatry, Shorter was obviously careful to restrain his taste for zesty statements. Patently, Shorter was trying to be as fair as possible, and the result is inclusivity at the expense of spicy commentary.

Justifi ably, there is a concerted effort to include women psychiatrists, notably Anna Freud, Melanie Klein and Nancy Coover Andreason, as well as a 6-page general entry on 'women in psychiatry'. Inevitably, however, with such an ambitious undertaking, historians will quibble that someone or something has been insuffi ciently recognized. There is nothing on psychiatric nursing, a topic that has long been neglected. Nor, apart from an entry on Clifford Beers, the founder of the mental hygiene movement, is there much about psychiatric patients' experiences of mental illness and medical treatments. Felicitously, Italian psychiatry receives the attention it deserves, but Russian psychiatry is hardly mentioned. John Gray, who did so much to build up the American Journal of Psychiatry in its earlier manifestations and struggled to put psychiatry on a surer patho-anatomical footing in the nineteenth century, is absent, as is the prominent Kraepelinian and Canadian psychiatrist C. K. Clarke, after whom Toronto's Clarke Institute of Psychiatry (now part of the Center for Addiction and Mental Health) was named. Shorter might also have said more about eugenics, to which psychiatrists in a wide variety of countries around the world paid at least lip service. But complaints such as these are the occupational hazards of an enterprise such as Shorter's A Historical Dictionary of Psychiatry. All in all, it is diffi cult to imagine anyone alive today more qualifi ed to undertake it.

IAN DOWBIGGIN

University of Prince Edward Island R. Gregor y Lande. Madness, Malingering , and Malfeasance:

The Transformation of Psychiatry and the Law in the Civil War Era. Washington, DC: Brassey's Inc., 2003. Pp. xii + 231. $27.95. ISBN 1-57488-352-6.

There is an old adage, namely, that military justice is to justice as military music is to music. R. Gregory Lande's study of military justice during the American Civil War is confi rmation of this saying even though that may not have been his intention in writing this book. During the Civil War the military was forced to confront various forms of misbehaviour. Although offi cers were occasionally brought before military tribunals, the overwhelming number of cases involved ordinary soldiers.

The overriding concern of military commanders was, of course, combat effi ciency, and anything that proved a barrier had to be dealt with quickly and effectively. Misbehaviour, desertion, malingering, malfeasance and alcoholism -all of which threatened to undermine morale and reduce the number of soldiers available for combat -were causes for the convening of courts martial. In theory the military legal system had built in safeguards to inhibit prosecutorial bias and protect the rights of the accused. In practice, however, the accused had few rights. Prosecuting offi cers were generally experienced, whereas soldiers had no right to legal counsel. In many cases the mental status of the individual became an issue, yet military tribunals lacked the expertise required to identify mental illnesses or mental defi ciency.

Courts martial were by no means trivial occurrences. Penalties were often harsh. Between 1861 and 1865, 267 enlisted men were executed. With but a few exceptions, those who received the death penalty were privates; not a single offi cer was executed. More than half had been convicted for desertion; a quarter for murder; and less than ten per cent for rape or mutiny. African Americans were far more likely to face execution; no less than fi fty-two received the death penalty (a number far in excess of their representation in the army).

Madness, Malingering, and Malfeasance is a bifurcated book. Its research base is impressive. Lande has mined unpublished military records at the National Archives, and supplemented these with published government documents, military legal treatises and selected medical texts, as well as newspaper accounts, memoirs and diaries. His description of specifi c courtsmartial proceedings provides an invaluable insight into the workings of the military justice system during the Civil War.


Eugen Bleuler

Thomas G Dalzell
email: tdalzell@eircom.net

Bleuler's reception of Freud

Keywords: Eugen Bleuler, psychiatr y, psychoanalysis, schizophrenia, Sigmund Freud

On the 150th anniversary of Eugen Bleuler's birth, this article examines his reception of Sigmund Freud and his use of Freudian theory to understand the symptoms of schizophrenia. In addition, in contrast to earlier interpretations of Bleuler's relationship with Freud in terms of an eventual personal and theoretical incompatibility, the article demonstrates that, although Bleuler did distance himself from the psychoanalytic movement, he remained consistent in his views on Freud's theories.

Born 150 years ago -in 1857, the year after Kraepelin and Freud -Eugen Bleuler is still best known in the history of psychiatry for his 1911 book, which questioned the early onset and ominous prognosis of dementia praecox, related its secondary symptoms to the mind rather than the brain and changed its name to 'schizophrenia' [START_REF] Bleuler | Dementia Praecox oder Gr uppe der Schizophrenien (Special Part, division 4.1 of Handbuch der Psychiatrie[END_REF]. But he is also a signifi cant fi gure in the history of psychoanalysis as he was the fi rst professor of psychiatry to engage positively with Freud and to introduce the theory and practice of psychoanalysis into his psychiatric hospital. As Freud put it in his 'History of the psycho-analytic movement', referring to the Burghölzli in Zürich: 'nowhere else had a public clinic been placed in the service of psychoanalytic research or an academic clinician accepted psycho-analytic ideas as an integral part of psychiatric teaching' (Freud, 1914: GW, 65-7;SE, 27-8). Furthermore, numerous Burghölzli doctors, including Jung, Abraham, Binswanger, Eitington and Brill, became followers of Freud because of Bleuler's introduction of psychoanalysis into his hospital (Hell and Baur, 2006: 38-9;[START_REF] Walser | Psychoanalyse in der Schweiz[END_REF]. 1 Bleuler had already encountered Freud before he became director of the Burghölzli. While still director of the Rheinau clinic, he had spoken positively about Freud's study on aphasia [START_REF] Bleuler | Zur Auffassung der subcorticalen Aphasien[END_REF][START_REF] Freud | Zur Aufassung der Aphasien. Eine kritische Studie[END_REF] and had praised his translation of Charcot's polyclinical lectures [START_REF] Bleuler | Charcot: Poliklinische Vorträge[END_REF][START_REF] Charcot | Poliklinische Vorträge I. Trans. Sigmund Freud[END_REF]. And although his review of Freud's and Breuer's 'Studies on Hysteria' [START_REF] Breuer | Deuticke); Studies on hysteria[END_REF] was critical of what to his mind was not yet proved, he evaluated the work as one of the most important to have appeared in the fi eld of normal and pathological psychology in recent times [START_REF] Bleuler | Sigm. Freud: Studien über Hysterie[END_REF]. More importantly, a letter to Freud in 1905 (Küchenhoff, 2001: 58;2006: 42) and an article on psychoanalysis in 1910 describe how he was introducing psychoanalytic ideas into the Burghölzli (Bleuler, 1910: 660). In his letter, Bleuler told how he, his wife and the other doctors had interpreted one of his dreams. In the 1910 article, he reported how he and his colleagues in the Burghölzli not only interpreted their dreams together, but paid attention over the years to their complexes as revealed in slips of the tongue and pen, mistakes while writing, symbolic actions, humming unconscious melodies, and forgetting things. Indeed, in relation to Freud's aliquis example, he spoke of having observed thousands of such unconscious associations over the years (Bleuler, 1910: 650).

Explanation of schizophrenic symptoms in the light of psychoanalytic theory

Earlier, [START_REF] Bleuler | Freud'sche Mechanismen in der Symptomatologie von Psychosen[END_REF] had applied to psychosis the mechanisms that Freud had recognized in the field of neurosis. In his book on schizophrenia, Bleuler (1911: 317) acknowledged his indebtedness to Freud that the symptomatology of schizophrenia could be explained. In the preface to the book, Freud is named alongside Bleuler's other great teacher, Emil Kraepelin. If the whole idea of dementia praecox originated with Kraepelin, Bleuler states, an important part of enlarging the pathology further is nothing but the application of Freud's ideas to dementia praecox (Bleuler, 1911: vii).

The key primary symptom he proposes is a 'primary loosening of associations' which amounts to a fundamental splitting of the psyche (Bleuler, 1911: 296). While this can be traced in part to Wernicke's concept of 'severance' (Sejunktion) and the 'association psychology' of Herbart (Scharfetter, 2001: 34-5;2006: 169), it is understood by Bleuler, despite its organic origin, in terms of the illogical pathways Freud found in the dreams of neurotics. Similarly, fi rst among his fundamental secondary symptoms are 'disturbances of association', and he understands them in terms of Freud's mechanisms of displacement, condensation and symbolization (Bleuler, 1911: 10-31, 288, 290-6). Secondly, in contrast to the traditional understanding of dementia praecox in terms of absence of affect, Bleuler (1911: 31-43, 289) argues that 'affect' tends to predominate in schizophrenic patients because of the weakness of their logical functions. In addition, where Freud spoke of repression of cathected ideas, Bleuler understands the 'blocking' of associations to be a matter of 'unpleasant associations' being repressed at their point of origin. In his view, whatever confl icts with the dominant affect is split off and gives rise not only to the logic grounding delusional ideas, but a splitting of the psyche according to 'complexes charged with affect'. Freud did not speak of the repression of affect as such, but of repressed ideational representatives of the drive (Freud, 1915a: 250;148) and 'suppressed' affects (Freud, 1915b: 277;178), but Bleuler (1911: 289-90, 354) maintains that the blocking of affect is a matter of affect being repressed and inhibiting other affects.

As for the third fundamental symptom, 'autism', Bleuler believes it constitutes the greatest part of an affect-disturbance in severe cases of schizophrenia and leaves the patients living in a world of their own. Here, reality can be 'displaced' or, in severe cases, blocked out completely (Bleuler, 1911: 52-6, 304-5). What the patient fi nds unpleasant in reality is split off and can be re-shaped in various delusional forms. Associations that contradict a cathected complex are excluded, and free rein is given to phantasy as a substitute for inadequate reality because it does not confl ict with the patient's affective needs. But an important theoretical difference with Freud here is Bleuler's disagreement on the proximate cause of what he calls 'autism'. Where Freud understands the repression proper to dementia praecox in terms of a withdrawal of libidinal cathexis and a return to autoeroticism, Bleuler (1912: 347-8) prefers not to speak of libido, but affect in general. Furthermore, regarding the withdrawal, he argues that the schizophrenic patient does love things, the things his phantasy places in an imagined outer world. The patient creates a new outer world which he loves, while the real world remains unpleasant and threatening. And, more importantly, regarding autoeroticism, while Bleuler (1910-11: 185;1911: 52) would con-cede that by 'autism' he understood more or less (ungefähr) the same as what Freud meant by 'autoeroticism', he contends that the patient doesn't so much love himself as the objects in the phantasy world he has projected outwards (Bleuler, 1911: 348). To understand this theoretical difference, we should note that Bleuler had initially resisted Freud's ideas on infantile sexuality, having had the same reaction as Freud's critics, until he came to notice, in his own life, conscious similarities between his wife and his mother, and then to admit unconscious similarities in his dream condensations (Bleuler, 1910: 647-8). He had already suggested to Freud in 1908 that he should speak of 'autism' rather than 'autoeroticism', the eros having been left out of the word (McGuire and Sauerländer, 1974: 192), although he conceded in 1910 that of the hundreds of patients treated at the Burghölzli, none was without a sexual complex and, in most cases, it formed the dominant symptom (Bleuler, 1910: 643). Nevertheless, where Freud spoke of libido, Bleuler still tended to speak of affect in general, and so, despite his acceptance of the Oedipus complex, what he later called Freud's 'pan-sexuality' (Alexander and Selesnick, 1965: 7-8) would remain one of their main theoretical differences.

Fourthly, however, Bleuler does draw on Freud to make sense of schizophrenic ambivalence. In Bleuler's experience, the splitting of associations can lead to pathological ambivalence in which contradictory feelings or thoughts co-exist without infl uencing each other. Likewise, as in Freud's dream theory, and in the speech of children in which the same word can be used for opposites, Bleuler notes that conceptual opposites can be exchanged and he cites Schreber's 'fundamental language' in which 'reward' means 'punishment' and 'poison' means 'food' (Bleuler, 1911: 43-5, 306).

It is, however, the accessory secondary symptoms, in Bleuler's experience, that usually bring people to the psychiatric hospital, not the fundamental symptoms; and to the foreground in the clinic are hallucinations and delusions, the content of which he fi nds intelligible, thanks to Freud. Hallucinations are always based, he thinks, on wish-fulfi lments or fears (Bleuler, 1911: 78-9). In delusions, the obstacles to the wish-fulfi lment are no longer con-sidered, and this, in his view, is what gives them their sense of reality. Again, the mechanisms thought to be at work here are displacement and condens-ation, the patient's wishes often being distorted to unrecognizability as in Freud's dream censorship (Bleuler, 1911: 290, 301, 313-14, 317-18, 353-5). The main hallucinations of schizophrenic patients, Bleuler fi nds, are deceptions of hearing and bodily sensations and, in terms of content, every type of sexual pleasure can be undergone. As for delusions, he thinks they can be the result of the thinking in the unconscious caused by the independence of split-off functions, but he contends that the fundamental delusions -being persecuted, being loved, a prophet, powerful -usually have an affective origin and are egocentric. Furthermore, correction is regarded as impossible and the affects, which are unconcerned with reality, are thought to create phantasy worlds at the behest of wishes in delusions of love, power or wealth, and of fears in delusions of sexual manipulation, annihilation or persecution. However, another difference with Freud is that where he believed that even frightening dreams were in fact based on wishes, Bleuler (1911: 330) proposes that a negative affect could be responsible for the delusion just as much as a positive one. On the other hand, Bleuler (1911: 327, 100) does accept that delusions of persecution can be due to a wish that has been inhibited and, like Freud, he fi nds that the persecutor is often someone loved. Again, Bleuler understands the content of delusions in terms of displacement and condensation, and, following Freud's understanding the sexual life of children in terms of the Oedipus complex, Bleuler (1911: 336-7, 344-7) also fi nds that the latter frequently forms the basis of schizophrenic delusions.

A break with Freudian theory?

It is commonplace today to claim that Bleuler broke with Freud not long after the publication of Bleuler's book on schizophrenia. For example, interpreting Bleuler's relationship with psychoanalysis in terms of a personal and theoretical incompatibility, De Ridder and Corveleyn (1992) argued that, after an initial period of his open appreciation of Freud, there followed a period of theoretical disagreement and opposition to Freud's group building, before he clearly dissociated himself, not only from the psychoanalytic movement, but also from its theory. But, while Müller (1998: 232) prefers to speak of Bleuler's 'ambivalence' 2 towards Freud, it can be argued that, although Bleuler did distance himself from the organizational side of psychoanalysis, it would be more accurate to speak of Bleuler continuing to reject those aspects of psychoanalytic theory which had still not been verifi ed and to accept those which had been borne out by his personal life experience and his clinical experience as a psychiatrist (Bleuler, 1906: 339;[START_REF] Bleuler | Die Psychanalyse Freuds. Verteidigung und kritische Bemerkungen von Prof. Bleuler[END_REF]. As we will see, even towards the end of his life, he still accepted what he called Freud's 'essential' theories despite objections from colleagues, and respected the man he regarded as having brought about 'the most important progress in psychology since it had become scientifi c' (M. Bleuler, 1965-66: 4).

In the same year as Bleuler's schizophrenia book was published, Freud's text on the Schreber-case appeared in the psychoanalytic yearbook [START_REF] Freud | Psychoanalytische Bermerkungen über einen autobiographisch beschriebenen Fall von Paranoia (Dementia Paranoides)[END_REF], co-edited by Bleuler and Freud, and Bleuler himself reviewed it the following year [START_REF] Bleuler | Freud, Psychoanalytische Bemerkungen über einen autobiographisch beschriebenen Fall von Paranoia (Dementia paranoides)[END_REF]. In this review, Bleuler gives a detailed summary of Freud's interpretation of the Schreber case and outlines Freud's understanding of paranoia in terms of regression to narcissism, as opposed to autoeroticism; but he also raises serious objections to Freud's interpretation of the case. In particular, he does not agree with Freud's inclusion of dementia praecox among the neuroses, since it had not been disproved that it was based on a primary physical disturbance. Nor does Bleuler agree with Freud's characterizing of Schreber's illness as 'paranoia'. The group of illnesses Kraepelin had described under the old name of 'paranoia' is, in Bleuler's view, different from the group of schizophrenias, in that the logical nonsense of schizophrenia does not emerge in it. As for the cornerstone of Freud's argument on the origin of Schreber's illness -his rejecting his homosexuality in relation to his father -Bleuler thinks it is not obvious that this is correct without more evidence. In fact, in his opinion, Freud's idea of the paranoiac being fi xated at the level of narcissism amounts to an overemphasis of the sexual. Again, Bleuler prefers to speak of affectivity in general where Freud speaks of libido, and he even questions if repression is really a withdrawal of libido and if phantasies of the end of the world, like Schreber's, have to be understood that way. Likewise, Bleuler does not accept Freud's understanding of dementia praecox in terms of a return to the 'autoeroticism' of the child, since the child also has a strong tendency to grasp the real outer world (Bleuler, 1912: 348), although, as we have seen, he was elsewhere willing to grant that what he meant by 'autism' was what Freud meant by autoeroticism. On the other hand, it is interesting that, in an otherwise critical review, Bleuler distinguishes his criticisms from the theories of Freud he does accept. More important is the positive tone of the fi nal paragraph. Here he states that Freud's work gives us much to think about, to ask and to research, which, he says, is the best sign that it is an 'important work' (Bleuler, 1912: 348).

However, more criticism from Bleuler was yet to come, in the form of a lecture the following year to the congress of German psychiatrists, for which he also asked Freud's help in advance. This lecture on psychoanalysis [START_REF] Bleuler | Kritik der Freud'schen Theorien[END_REF] is often taken as marking a break in Bleuler's relationship with Freud, but a careful reading of the text suggests otherwise. It is important here to take account of the context of his remarks. If we accept that Bleuler might downplay his differences with Freud in personal letters, the context of this lecture explains his stressing of the differences. Bleuler had been asked to take a position on Freud at a congress of German psychiatrists, many of whom were anti-Freud. Indeed, the second speaker at the congress, Alfred Hoche, not only regarded the psychoanalytic movement as a sect, but was collecting information from his psychiatrist colleagues on the damage psychoanalysis had done to patients. 3 Bleuler began this more critical lecture by referring back to his positive reception of Freud in his 1910 article. He explains that, if his present talk brought out the negative more than before, it is because in the meantime none of Freud's views which were plausible, but not yet proved, have found a better foundation. On the other hand, Bleuler (1913: 665) also states that he fi nds no reason to modify anything of what he had earlier accepted in Freud's thinking, not even minor points, since further experience has only brought confi rmation. While he is not convinced by Freud's ideas on the origin of schizophrenia, he still believes its symptoms are explicable by processes analogous to Freud's dream symbolism. Furthermore, he concludes his lecture by inviting his listeners to pay closer attention to Freud's thinking and still to fi nd so many correct observations by Freud that are useful building blocks, so many 'brilliant architectonic ideas', that it would be wrong to throw out the baby with the bathwater. Freud had given us an insight, he says, into that earlier unknown part of psychology, in which the symptoms of an illness are elaborated and, even if more of his ideas were to be discounted than kept, Freud has done us 'a great service' (Bleuler, 1913: 718).

Bleuler distances himself from the psychoanalytic movement

At the end of 1913 Bleuler stepped down as co-editor of the yearbook, a position he had shared with Freud since 1908. He had already left the International Psychoanalytic Association at the end of 1911, having expressed his misgivings to Freud about it from the start. When the Freudsche Vereinigung in Zürich, which he had chaired since its foundation, was to about to become the local branch of the new international association, Bleuler was not willing to be a member. We can only speculate about how much he was infl uenced by the fact that Jung was its president. Bleuler had made Jung aware of psychoanalysis and had asked him to lecture on Freud's Traumdeutung in 1901, although Jung would later claim that he had 'converted' Bleuler to Freud's principles (Möller, Scharfetter and Hell, 2003: 86). By the end of Jung's time in the Burghölzli, however, Bleuler found Jung's 'hatred' towards him very diffi cult to bear (Alexander and Selesnick, 1965: 5).

Freud, for his part, had been keen to have Bleuler's support against his opponents. He was pleased that his work was recognized by an established university professor of psychiatry (Masson, 1985: 461) and that the protestant pastor, Pfarrer Oskar Pfi ster, was interested in his ideas (Müller, 1998: 231). Moreover, he had seen Bleuler as an important link to the world of institutional psychiatry. He therefore pleaded with Bleuler to reverse his decision to leave the association, since his opponents would only use it to confi rm their caricature of the psychoanalytic movement (Alexander and Selesnick, 1965: 3).

Although Bleuler replied that Freud's work was comparable to that of Darwin, Copernicus and Semmelweis, and he could understand Freud devoting his whole life to having his theory accepted, he also stated that he was not prepared to sacrifi ce himself for the advancement of the psychoanalytic cause (Alexander and Selesnick, 1965: 5). In reply, referring to what Bleuler called the 'closed-door' approach of the association, for which Bleuler blamed Jung, Freud offered to modify whatever 'foreign policy' of the association Bleuler required, but without success (M. Bleuler, 1965-66: 3-4). However, Bleuler also said his resignation was a loss to himself and mentioned the possibility of continuing to collaborate with Freud from outside the association.

For Alexander and Selesnick (1965: 9), Bleuler's separation from the psychoanalytic movement pointed to a future isolation of psychoanalysis from academic psychiatry. But, in fact, psychoanalysis continued to be represented in the Burghölzli. After Bleuler's death, the famous psychoanalyst, Gustav Bally, worked there, and the recent book on psychoanalysis and psychiatry edited by the psychoanalyst Heinz [START_REF] Böker | Psychoanalyse und Psychiatrie. Geschichte[END_REF], who works there now, shows not only that psychoanalysis continues to be represented among the staff, but also that the dialogue between psychiatry and psychoanalysis begun by Bleuler still continues at the Burghölzli.

Bleuler's adherence to psychoanalytic theory

Although Freud had told Binswanger at the end of 1913 that he would continue to shake off of the 'Zürcher' (Fichtner, 1992: 135), he referred again, in his 'History of the psycho-analytic movement' (Freud, 1914: 65-7;27-8), to the great service of the Zürich school, especially Bleuler and Jung, in spreading psychoanalysis. Bleuler replied that he was happy with this paper, despite their differences, but he wished Freud would not speak as generally as he did about 'the Swiss', since the less well informed might think he was including the Burghölzli; Bleuler also thought that Freud should make clearer distinctions so the reader would know that, despite his reservations, he (Bleuler) stood much closer to Freud's ideas than to Jung's (Alexander, and Selesnick, 1965: 7-8).

Indeed, in terms of theory, while Bleuler distanced himself from the psychoanalytic movement, he continued to hold and teach the essential ideas of Freud which he had accepted from the beginning. Daniel Hell, the current medical director of the Burghölzli, has pointed out that Bleuler remained loyal throughout his life to the idea of the unconscious (Hell, 2000: 40), and Bernhard Küchenhoff 's painstaking examination of the various editions of Bleuler's psychiatry textbook, fi rst published in 1916, has confi rmed that Bleuler did not break with Freud (Küchenhoff, 2001: 65-8;2006: 48-50). 4 It is true that Bleuler did not give Freud the same prominence in this work as he did in his schizophrenia book: in 1911 he had placed Freud on a par with Kraepelin, but this was no longer the case in 1916. But again we need to understand the context. This was a psychiatry textbook and mainly concerned with psychoses, whereas Freud's efforts had been mainly in the fi eld of the neuroses.

The fact that Bleuler still respected Freud's contribution, however, is clear from the fact that half a page is devoted to him, in which Bleuler (1916: 392) adjudges the attitude of those who disparage Freud to be wrong and unscientifi c. Just as hypnosis and suggestion had been contested, and yet had provided the initial basis of a scientifi c psychopathology, so Freud himself, Bleuler maintains, had laid a whole range of foundations, which had given science a completely new shape. Even if, as in every 'scientifi c fi nding', some of the ideas were not completely new, Freud had clarifi ed them and used them to develop a perspective, which was the basis for further research. Psychopathology, Bleuler contends, would not have made progress without these ideas, and he highlights the following, in particular: the role of the unconscious in symptom formation; the concept of repression; the ubiquity of inner confl icts; the deferred effect of earlier affective experiences; the transference of affect to unrelated ideas; the mechanisms of condensation, conversion symptoms, abreaction; and the importance, if perhaps exaggerated, of sexuality. As Küchenhoff (2001: 66-7;2006: 49-50) has pointed out, it is only with the fourth edition of Lehrbuch (1923) that we fi nd small but signifi cant re-workings of the text. I would add that there is an interesting qualifi cation of the remark about Freud's exaggeration of sexuality: Bleuler (1923: 384) now speaks about a 'somewhat' exaggerated (etwas übertriebene) emphasis. More signifi cant, however, is the fi fth edition (1930), in which Bleuler completely reworks and reduces what he had said about Freud, but still retains his positive stance. Bleuler recognizes again the emotional reaction of Freud's opponents to his theories, and adds that he himself cannot accept some of Freud's views as correct, but demonstrates his enduring adherence to Freudian theory with his statement that we owe the 'greatest step forward' (größten Fortschritt) in psychology and psychopathology to Freud, and that his enemies have long since been unable to avoid his infl uence (Bleuler, 1930: 361). This attitude was unchanged in Bleuler's sixth and fi nal edition in 1937. It can be argued, therefore, that Bleuler's textbook represents his scientifi c consistency in terms of his earlier acceptance of the theories of Freud borne out by his personal and clinical experience, as well as his continuing to question what he thought unverifi ed or false. As for Bleuler's respect for Freud, this remained undiminished, despite their differences on the psychoanalytic movement.

Theoretical differences as 'side-issues'

Perhaps the most signifi cant testimony to Bleuler's lasting fi delity to Freudian theory, apart from his later recommendation of Freud for the Nobel Prize, is to be found in a letter on 17 February 1925(M. Bleuler, 1965-66: 4), written after Bleuler received Freud's autobiography. In this letter of thanks, he addresses Freud's remarks about their theoretical differences appearing substantial. For Bleuler, we read, it was a question of unimportant 'side-issues' (bedeutungslosen Nebensachen) -which De Ridder and Corveleyn (1992: 258) omit in their citation -whereas he had taken Freud's essential theories to be 'self-evident' once he had thought them through.

As for his ongoing commitment to Freud's discoveries, this 1925 letter also reveals that Bleuler continued to stress psychoanalysis in his clinic in spite of the objections of his colleagues; that he had long since conducted his winter (theoretical) lectures as an instruction on psychoanalysis; and, more importantly, that he still held Freud's teaching to be the 'greatest advance' that 'psychology had made since it had become scientifi c' (M. Bleuler, 1965-66: 4). If we need to take account of the context of these remarks -a personal letter to Freud -it is not the case that Bleuler was playing down their differences out of politeness, since he repeated his remarks in a completely different context twelve years later, in 1937. Two years before he died, in a letter to the president of the Nobel Committee, recommending Freud for the Nobel prize for medicine (Scharfetter, 2006: 477), Bleuler used the same word in relation to his theoretical differences with Freud: side-issues (Nebensachen). He wrote that Freud's discovery of the 'symptomatics' of the unconscious, and how to investigate them scientifi cally, were of the greatest practical and theoretical importance, even if some 'side-issues' needed correction, and that the whole of psychopathology, including that of his opponents, had undergone a substantial reshaping by Freud's work, which was also important for the therapy of nervous and mental illnesses. 5 While Freud was pleased that his work had been recognized by the professor of psychiatry in Zürich, he always maintained a theoretical distance from the Swiss, including Bleuler. Freud maintained his distinctive starting point in relation to psychopathology -whereas Bleuler, with his descriptive approach, interpreted symptoms in the light of Freud's discoveries, Freud (1915-17: 62;67) was not content to describe and interpret symptoms but was more interested in the inner dynamics of the psyche of which the symptoms were but a sign. In addition, Freud (1914: 68;29) continued to hold his position on the vicissitudes of libido in both neurosis and psychosis, or what Bleuler had criticized as his 'pan-sexuality' (Alexander and Selesnick, 1965: 7). On the other hand, Freud did not hesitate to recognize the service the Zürich school had rendered in the development of psychoanalysis. Bleuler in particular, he granted, had shown how a whole series of psychiatric cases could be explained by the processes that psychoanalysis had recognized in neurosis and dreams, and in such a way that psychoanalysis could no longer be ignored. Whereas Jung had spoken sarcastically about [START_REF] Bleuler | Dementia Praecox oder Gr uppe der Schizophrenien (Special Part, division 4.1 of Handbuch der Psychiatrie[END_REF]book, Freud (1914: 65-7;27-8) referred to it as his 'great work on schizophrenia', which had placed the psychoanalytic approach on an equal footing with the psychiatric one. Furthermore, Freud continued to send Bleuler fi rst editions of his latest work for review, such as his autobiography in 1925. Likewise, after [START_REF] Bleuler | Zu Sigmund Freuds siebzigstem Geburtstag[END_REF] had written a front-page newspaper article about Freud for his seventieth birthday, which forecast a time when people would speak about 'psychology before Freud, and psychology after Freud', Freud revealed his ongoing appreciation of Bleuler to Marie Bonaparte, saying that the best newspaper articles had been by Bleuler in Zürich and Stefan Zweig (Küchenhoff, 2006: 50-1).

Conclusion

Eugen Bleuler was the fi rst university professor of psychiatry to introduce psychoanalytic theory and practice into his psychiatric hospital and to understand the symptoms of psychosis in terms of the mechanisms Freud had discovered in the fi eld of the neuroses. In spite of claims that he later turned away from Freud and his theories, we have seen that, while he did distance himself from the psychoanalytic movement, Bleuler remained consistent regarding the theories of Freud he accepted and those he questioned. The year 2006 saw the 150th birthdays of Emil Kraepelin and Sigmund Freud. This year, 2007, we celebrate 'Bleuler 150'. If we are to make sense of psychopathology in our own time, it can be argued that the way forward is not to draw on Kraepelin or Freud, but on Kraepelin and Freud, as Bleuler did. 2. I am grateful to Prof. Dr Müller for his personal correspondence (5 Jan. 2006) on this point. 3. Hoche would later fall from grace by co-authoring with the jurist Karl Binding a text on eugenics which would be used by the Nazi euthanasia programme [START_REF] Binding | Die Freigabe der Vernichtung lebensunwerten Lebens. Ihr Maß und ihre Form[END_REF]. 4. I am grateful to Dr med. Küchenhoff, currently Leitender Arzt at the Burghölzli, for discussing with me his research on the Bleuler-Freud relationship and for allowing me access to the Bleuler Archiv. 5. A facsimile of Bleuler's letter of 7 Sept. 1937 is reproduced in Scharfetter, 2006: 477.

Notes 1 .

 1 This article is based on a paper read in November 2006 at a joint conference of the School of Psychotherapy, St Vincent's University Hospital, Dublin, and the Association of Psychoanalysis and Psychotherapy in Ireland, in honour of Dr Cormac Gallagher.


Constantinos Trompoukis
email: trompoukis@med.uoc.gr

Keywords: classics, Greece, hellebore, history, medicine, Melampous, mythology, psychiatry

Although psychiatry was the last among the major branches of medicine to be recognized, taught and practised as a separate speciality, it is commonly accepted that even in antiquity there was a clear desire to study and understand mental illnesses, although they were not seen as distinct from physical diseases. Melampous is a fi gure balanced between historical reality and myth. Reading between the lines of the enchanting narrative preserved by Greek mythology, we can see the desire to comprehend mental illnesses and to propose systematic and credible treatments for them. In this article, an account is given of the myth of Melampous, with emphasis on the details that present him as a pioneer of contemporary psychiatric treatment and as having introduced pioneering approaches to psychiatric disorders.

Introduction

Identifying the roots and the pioneers of a medical discipline is not always simple. There are many approaches to defi ning psychiatry, and just as many answers to the question of who was the fi rst psychiatrist. Johan Christian coined the term 'psychiatry' in 1803, but Filippe Pinel is undoubtedly the dominant fi gure in the history of modern psychiatry, as is Sigmund Freud for psychoanalysis [START_REF] Morel | Au delà du consient. Histoire illustrée de la psychiatrie et de la psychoanalyse[END_REF]. Looking further into the past, Plato is one particularly celebrated fi gure who also proposed psychotherapeutic techniques. Yet for those who believe that psychiatry is in fact a mixture of medicine, art and magic, the mythological Greek healer Melampous was a prophet and a psychiatrist before psychiatry (Precope, 1961: 32).

The story of Melampous

Melampous, the mythological son of Amythaon and Eidomeni, is believed to have been born in Pylos in the south-west Peloponnese around 1400 B.C. [START_REF] Apollodorus | The Library[END_REF]. The name Melampous derives from his black foot: just after his birth his mother left him to lie in the shade, but his feet stuck out and were burned by the sun: melas (μέλας) = black; pous (πους) = foot (Grimal and Picard, 1976: 281-2). Preller, however, also notes that his name may perhaps symbolically refl ect his role as a priest of Dionysus and a prophet [START_REF] Preller | Griechische Mythologie[END_REF]. According to the second-century B.C. Greek author Apollodorus, there was a nest of snakes in Melampous's yard [START_REF] Apollodorus | The Library[END_REF]. The servants had killed the adult snakes and Melampous, pitying the orphaned baby snakes, took them into his care. In gratitude, the tiny serpents licked Melampous's ears while he was sleeping, thus giving him the unusual ability to understand animal speech. The astonished Melampous woke and realized that he could foresee what was to happen in the future.

The cleaning of Melampous's ears by the snakes is considered to be the origin of the use of the snake as a medical symbol, although Asclepius was later associated with this symbol. There are, however, many other theories that attempt to explain why the snake is the most commonly used medical symbol [START_REF] Wilcox | The symbol of modern medicine: why one snake is more than two[END_REF].

Melampous, therefore, had great powers and gifts -but this was not all. It was also said that Apollo himself had taught Melampous medicine. Apollo 'purifi ed' Melampous at the River Alpheios, the waters of which were believed to have curative powers [START_REF] Strabo | The Geography of Strabo[END_REF]. Several ancient writers also claim that Melampous travelled to Egypt, where he learned yet more about mysteries and medicine [START_REF] Clement | The Exhortation to the Greeks: The Rich Man's Salvation, and the Fragment of an Address entitled, To the Newly Baptized[END_REF][START_REF] Siculus | Diodorus of Sicily[END_REF].

Melampous became famous for curing Iphiclus, the son of Phylacus. When Melampous's brother Bias wished to marry the beautiful maiden Pero, her father insisted that any suitor must show his cunning and bravery by stealing the cattle of the mighty King Phylacus. As Phylacus's wild dogs made the theft impossible, Bias asked Melampous to help. He went to Phylacus's territory, but was soon captured by Phylacus's men. In his prison cell, Melampous observed the movements of the termites, and concluded that the ceiling would collapse (according to the myth, he overheard two termites talking). He called out to the guards and demanded to be moved immediately; they fi nally moved him, and the next morning the ceiling did collapse. The amazed guards believed that Melampous must be some kind of holy person to predict the collapse, and told the whole story to Phylacus who released Melampous from prison and begged him to heal the impotence of his son, Iphiclus [START_REF] Apollodorus | The Library[END_REF].

Melampous took the opportunity to ask for Phylacus's cattle in exchange, and he agreed. Melampous used his peculiar method of 'listening' to the birds: he sacrifi ced an ox and 'spoke' to the vultures that gathered around. Melampous learned that the last time Phylacus had made a sacrifi ce, Iphiclus had been terrifi ed of the enormous bloody knife used. In order to calm the little boy, the king had thrown the knife aside, and it had hit a tree and become stuck in it. In order for Iphiclus to be cured now, the knife had to be removed from the trunk of a tree and heated in boiling wine which Iphiclus would then drink.

Melampous declared that if the knife were found, he would scrape off the rust, put it into wine and give it to Iphiclus to drink for ten days, after which Iphiclus would father a child. This is what happened, and Iphiclus had a son, Podarces. Bias was thus fi nally granted permission to marry his beloved Pero, by Melampous's assistance [START_REF] Apollodorus | The Library[END_REF].

The rust was generally believed to have healing properties. It has been argued that it was the rust that could have strengthened Iphiclus physically, but the psychological dimension is more likely to have been involved in the cure of his impotence. Professor Kouretas, one of the pioneers of psychoanalysis in Greece, discussed Melampous's cure [START_REF] Kouretas | The psychocathartic method of treatment of Iphiclus' sterility by Melampus[END_REF]. He emphasized the diachronic dimension of the psychoanalytic concepts: Iphiclus is the son who is beloved but also castrated. Melampous's inspired inquiry into Iphiclus's past must have been seen, in his time, as an unusual way of explaining symptoms and their causes. Yet this is exactly the psychoanalytic method of analysing the creation of a symptom. Recalling the trauma and resolving the pathological complexes is the next step. Melampous's therapeutic intervention is confi rmed by basic psychoanalytic theories. Melampous is a diviner, a sacred person. He is in the process of becoming a myth, and through his perception he is able to cure. Kouretas compares the modern psychotherapist to Melampous. In the patient's view the therapist has mythical skills and abilities. In this way, transference is established and changes will take place. The symbolism of the wine with which the rust of the father's knife was mixed had a magical, miraculous character. The regressive patient incorporates the therapist's interpretations as a result of the enormous power of the therapist. Melampous is certainly not a typical psychoanalyst, but he acted as though he was aware of the verity of the main principles of psychodynamic analysis. This is not the only reason for calling him a psychiatrist before psychiatry.

Proitos, the king of Argos, called Melampous to cure the women of Argos whom the god Dionysus had turned mad. The famous healer asked for a third of Proitos's kingdom as payment, but the king refused [START_REF] Apollodorus | The Library[END_REF]. As the women's health was worsening, the king was forced to recall Melampous. This time Melampous asked for a double reward: a third of the kingdom for himself and another third for his brother Bias. Proitos unwillingly accepted the offer, and Melampous and his brother Bias became rulers of Argos.

Melampous treated the manic women by allowing them to dance and scream, believing that in this way the women's mania would be suppressed [START_REF] Sigerist | A History of Medicine: II. Early Greek, Hindu, and Persian Medicine[END_REF]. He then used hellebore to treat their delusions, and fi nally made sure that they had a bath in river waters. Melampous had noticed that goats which ate hellebore purged themselves profusely, an observation that encouraged him to study the qualities of this fl ower further. The ancient writers do not agree on the colour of the hellebore. Dioscurides (1829) talks of black hellebore, while Galen (1821) notes that white hellebore was prescribed. In another version of the above story, Melampous is said to have used hellebore to treat delusions, prescribing it to women who believed that they had been transformed into cattle, while elsewhere his patients appear to have suffered from a tendency to murder children. Hellebore in large doses is said to cause convulsions, and it seems that Melampous was very familiar with the properties of hellebore. He appears to have been the fi rst healer to use a pharmaceutical to treat mental disorders, and this was recognized by later doctors in antiquity who named his pharmaceutical, made from hellebore, 'melampodion'. He may justly be considered the pioneer of psychopharmacology. Melampous's successors in antiquity also prescribed hellebore: Hippocrates noted that it was successful in the treatment of depression, while Orebasios used it to treat hysterical women and epileptics. Even today, homeopathy uses medication, the main ingredient of which is hellebore, to treat psychosis, epilepsy and infections of the central nervous system. After his death, Melampous was worshipped as a hero and as a god. A temple was built to him at Aigosthena, and his grandson Amphiaraos was considered the greatest seer and therapist of his day (Pausanias, 1918).

Conclusion

Melampous used the principles of depth psychology, interpreted phenomena that seemed inexplicable and was familiar with the properties of herbs. At the same time, he used psychotherapy and pharmacotherapy. It is almost certain that Melampous was either a legendary or real fi gure upon whom the explorations and achievements of all the healers of his era have been focused. He thus represents the efforts that were made to treat psychiatric disorders with scientifi c criteria, free of superstitions and prejudices, although the later insistence that he was a priest of Dionysus refl ects the conviction that such illnesses also had a metaphysical character. Melampous represents medicine's effort to free itself of non-scientifi c conceptions, an effort that peaked with Hippocrates, and this is why confl icting philosophical traditions attempted to appropriate him, adding to the original myth written by Hesiod other elements that insinuate the philosophical preferences of a seer [START_REF] Kontogiannis | Melampus[END_REF]. In every circumstance, Melampous is recognized above all as a doctor of the soul (psyche) who used the art of the seer to discover the causes of illnesses and the medicines that would cure them. It is clear that the achievements of the ancient Greeks were not only in philosophy, theatre, historiography and poetry: in the fi eld of medicine, and psychiatry in particular, they were formulating theories and attempting new and effective therapies.