Medicine: Meeting on the Mind

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.