The Burgholzli Hospital: Its history and legacy.

The Burgholzli Hospital Zurich has a very important place in history, as part of of modern era in Psychiatry. Founded in 1870 by the efforts of Griesinger, it was here many eminent path breakers in Psychiatry like Bleuler, Jung, Adolf Meyer and others once worked. From here, Bleuler coined the term "Schizophrenia". Now the University Hospital of Zurich, Burgholzli's transformation from a mental hospital to a centre of excellence speaks of a rich legacy. It is a model worth emulating in many parts of the world.

INTRODUCTION

The starting and development of the Burgholzli Hospital in Zurich are a must-read for all those interested in the history of psychiatry. Working here, Eugene Bleuler had coined the term schizophrenia in 1911 to replace “dementia-praecox.” The establishment of this hospital is often considered as the beginning of the modern era in Swiss psychiatry. It was here, famous names in psychiatry such as Wilhelm Griesenger, Eugene Blueler, Carl Jung, Karl Abraham, Adolf Meyer, Ludwig Binswanger, Eugene Minkowski, Hermann Rorschach, Manfred Bleuler and others had once worked. Burgholzi is now the Psychiatric University Hospital of Zurich.

As students of psychiatry for DPM (1978–1980), we were first introduced to Burgholzli by Prof. A Venkoba Rao in Madurai Medical College. This interest was continued after I joined PGIMER, Chandigarh, as a junior resident for MD psychiatry in 1982, where Prof. Vijoy Varma talked to us about Sigmund Frued, Carl Jung and the psycho-analytic movement. Hence, I eagerly looked forward to a visit to this hospital, which finally materialized on April 14, 2016, through my friend Hans Pfeifer, a practicing psychiatrist and psychotherapist in Zurich, who had earlier worked in Burgholzli for 7 years. At the hospital, we were received by Florian Riese who is the co-chair of our WPA Section for Early Career Psychiatrists. Florian took us for a tour of not only the entire hospital but also the neighboring woods and the hill surrounding the hospital. Burgholzli in German meant “castle in the woods.” We also visited the first-floor residential rooms where Eugene Bleuler lived for nearly 30 years. We also heard about Freud's visit to Jung at the Burgholzli. Rumors say, Freud came here without informing the director of the hospital, Eugene Blueler, had sneaked past his room and met his friend Carl Jung. Moreover, when Blueler finally came to know about this, it led to damage in his relationship with Jung! Others spoke to us about the Beverian King who was treated here, who later went for boating with his treating psychiatrist and both having got drowned! The truth, of course, could not be verified!

HISTORICAL PERSPECTIVES

The parliamentary committee enquiry (1815) into the “madhouses of England” and the exposure of the pitiable conditions at the Bethlem and other hospitals are well known. Similar conditions were existing in Switzerland even in the 1850s.[1] The condition of the mentally ill was quite appalling. They were sometimes herded together or isolated in cell blocks. There was a severe deficiency of nursing staff; the situation made worse with untrained administrators. While the humane treatment in England was initiated by Prichard, Conolly, and Henry Maudsley, it is attributed to Griesinger in Switzerland after he became Professor Medicine in Zurich University. Burgholzli is often compared to the Maudsley Hospital in England, although the former was founded nearly five decades after the latter. The two respective founders Griesinger and Henry Maudsley were contemporaries and had respect for each other.[1] Griesinger published his book “Pathology and Therapy of Mental Diseases” in 1871 at the age of 28 years and Maudsley wrote his book “The Physiology and Pathology of Mind” (1968) at the age of 32 years – both at almost the same period in history! Both have been accused of “biological reductionism” but it should be understood, their fight was primarily against the concept, mental illness was a punishment for evil deeds and against other superstitious beliefs. While Maudsley became superintendent of the mental hospital in 1860, Griesinger started his first psychiatric clinic at the University of Zurich at the same time.

HISTORY OF BURGHOLZLI

While at the University of Zurich, Griesinger started work on an institution which provided humane treatment for the mentally ill in the 1860s. Within 2 years, Griesinger had purchased the present property of Burgholzli with public funds for starting a mental hospital! Although he died before the completion of the hospital in 1870, he is considered the founder of Burgholzli. Griesinger and the other early directors at Burgholzli such as Gudden, Huguenin, and Hitzig strongly believed in the biological causation of mental illness. It was Auguste Forel as the director here for nearly two decades who combined the “dynamic approach” of the French psychiatry and the “biological model” of the German psychiatry. In 1894 Gottlieb Hagi, a former employee of Burgholzli made a publication highly critical of the asylum model and its management.[2] This received wide-spread attention and investigation. However, the government was largely supportive of the sincere efforts being made at the hospital to improve the situation. This encouraged psychiatry in the 19th century.

EUGENE BLEULER

E. Bleuler became the director here in 1898 and served at this post until 1927. This period is considered the “golden age” of Burgholzli. It was in a lecture in Berlin on August 24, 1908, that Bleuler introduced the term “Schizophrenia” for the first time, replacing Emil Kraepelin's “dementia-praecox.” In 1911 in his work “Dementia-praecox, or the group of schizophrenias,” Bleuler expanded and refined his new concept arguing that ambivalence, affective impairment, association loss, and autism (Bleuler's four A's) were the primary symptoms, and dementia if at all, was only secondary. He spoke about the splitting between the emotional and intellectual aspects of the personality. He was interested in hypnotism and favorably reviewed “Studies on Hysteria” by Josef Breuer and Freud. Although he encouraged the study of the unconscious mind by bringing in psychoanalytic teachings into practice here, along with by Carl Jung, he later found Freud's theories to be over-dogmatic and resigned from the International Psychoanalytic Association in 1911. He had believed, dogma is harmful to science. Bleuler taught against institutionalization and recommended early discharge. He was thus one of the founders of community psychiatry movement. His “Text book of Psychiatry” (1916) also became very popular. Bleuler had the gift of keen clinical observation and skillful writing.

CARL JUNG

Carl Jung had worked in Burgholzli under Bleuler from 1900 to 1909 and became a senior physician in 1905. Jung had received his doctorate in 1902 after positive appraisal from Blueler. One case that received great attention during the period was the treatment of Sabina Spielrein.[3] Jung became deeply and emotionally involved with her, often regarded as a conflicted personal relationship. It is believed, Sabina was discharged well but in need of personal dependency. Jung had resigned from Burgholzli in 1909 actually because his proposal for a “psychopathologic research laboratory” was rejected.[4]

THE LEGACY OF BURGHOLZLI

Burgholzli is now the Psychiatric University Hospital of Zurich and it is one of best teaching, academic, clinical, and research centers of the world. The name Burgholzli evokes memories of the old lunatic asylums and is still stigmatizing in Zurich and Switzerland. However, the hospital has always kept pace with the current advances in medicine and psychiatry. To cite an example, in 1985, it participated in the “WHO Collaborative Study on the Assessment and Reduction of Psychiatric Disability,”[5] underlining its social commitment. Several postgraduate programs in psychiatry, clinical psychology, psychiatric nursing, and other disciplines of mental health are offered here. Its environment is healthy and welcoming. Burgholzli is one of the best examples for the developing world on how a “mental hospital” can be converted to a “center of excellence.” Today, the hospital with its progressive outlook, beautiful, and ancient buildings and pristine environment engage our attention and appreciation.

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Conflicts of interest

There are no conflicts of interest.