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.

The entry into the English language of the informal usage of schizophrenia as split personality/Jekyll and Hyde is traced and commented upon. The metaphor of split personality is followed from Eugene Bleuler via his translators and the wider psychiatric community into the present day. It, and to a lesser extent the Jekyll-Hyde personality, is found to be as much a product of the psychological professions as a product of lay misinterpretation. The informal definition of schizophrenia as split personality has outlived the scientific theory with which it was initially associated.

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This work examines the historical conceptualization of schizophrenia through definition from 1908–1987. Rather than reveal an essentialist definition of schizophrenia in North America, it reveals a history of varying and competing professional definitions. It demonstrates and historically contextualizes how widespread conceptual instability and disagreement over the nature of the concept gave rise to a new, but still contested, theoretical emphasis on operational definitions. As made manifest through definition, schizophrenia has not been a stable transhistorical object. Rather, the characteristic feature in schizophrenia definition appears to be instability and variance rather than stability or long historical periods of agreement. This analysis nevertheless cautions against overstating the importance of fluctuating definition in assessing the ontological status of contemporary interpretations of schizophrenia.

Richard Noll (2012) usefully noted in this journal that Heinrich Schüle (1840-1916) appears to have been the first alienist to use the Latin term dementia praecox in the third edition of his textbook, Klinische Psychiatrie: Specielle Pathology und Therapie der Geisteskrankheiten (1886). Noll (2012) also wondered if the French alienist Bénédict-Augustin Morel (1809-73) influenced Schüle. Readers of this journal may be interested in a number of further developments on this subject. To begin with, it is worth observing that Schüle also used the term dementia praecox in the second edition of his Handbuch der Geisteskrankheiten (1880). Here we find clear evidence for the influence of Morel on Schüle. Schüle's fifteenth chapter has a single paragraph discussing him; the opening line notes how Morel had shown the various transformations of hereditary insanity as a progressive development to more severe and finally incurable conditions ('Morel hat die verschiedenen Umbildungen des hereditären Irreseins als eine fortschreitende Entwicklung zu immer schwereren und schliesslich unheilbaren Zuständen dargestellt'; Schüle 1880: 237). Accompanying this sentence is a footnote citing Morel's Traité (1860: 513ff.); this is a chapter on 'Aliénations ou Folies Héréditaires', and the term démence précoce appears on p. 516. Schüle (1880: 237-8), in the same paragraph, observes that Morel distinguished four stages; in the fourth stage, Schüle uses the Latin term dementia praecox: '4. Generation: mutism, congenital mental weakness and Dementia praecox [Generation: Taubstummheit, angeborene Geistesschwäche, Dementia praecox]' (Schüle, 1880: 238). In the following line, Schüle declares Morel to be an ingenious author. Thus, we have Morel lauded, his work summarized and cited, and the Latin dementia praecox all linked in one paragraph. Later we also find the statement that dementia praecox is one of the most common sequelae of hereditary degeneration ('Die Dementia praecox, einer der häufigsten Folgezustände der erblichen Entartung…'; Schüle, 1880: 345). Additionally, Morel is heavily referenced throughout Schüle's textbook. Therefore there seems to be clear evidence that Morel influenced Schüle at least as early as 1880. Second, when Schüle's 1886 edition of Klinische Psychiatrie was translated into French two years later by Dagonet and Duhamel, the term dementia praecox is repeatedly translated back into French as démence précoce. For example, the following line discusses the tendency to