Eugene Bleuler's four As

Abstract

One hundred years have passed since Eugene Bleuler first coined the term schizophrenia. In that time, a simple mnemonic, the Four As, has come to distort his complex descriptive pathology. However, at no stage did Bleuler give precedence to the Four As or describe them in such a fashion. The Four As are a caricatured representation of Bleuler's schizophrenia that distorts the later conceptualization of schizophrenia. Despite historical attempts to signal this error, it remains virulent in the schizophrenia literature, masquerading as historical fact. This article corrects this distortion and clarifies the precise relationship of the Four As to Bleuler's thinking. It discusses their emergence and persistence, and draws attention to Bleuler's emphasis of other important symptoms--most notably splitting.