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Despite the degree of recognition it achieved in Europe and its selection by Rapaport for inclusion in his Organization and Pathology of Thought, this small volume has remained untranslated into English since its original publication in 1919. The appearance of the work in English is to be welcomed.
Bleuler describes autistic thinking as dominated by wish-fulfilment and analogous to that found in dreams and schizophrenia. Bleuler was familiar with Freud's ideas concerning the primary process, and he does not use the concept of autistic thinking as a synonym for it. He believed autistic thinking to be much more common in 'normal' adults than is usually accepted. He distinguishes between this form of thinking and the more malignant disturbance of thinking to be found in schizophrenia on the one hand and careless thinking on the other. He recognizes the drive character of autistic thinking and how it leads to conclusions that are unshakable because they are determined by, and fulfil, affective needs. Careless thinking also fulfils affective needs but to a lesser degree. Therefore its errors can be given up relatively easily, while autistic thinking leads to convictions which are firmly held, i.e., delusions. While primary process, autistic, and careless thinking may differ only quantitatively, they form a hierarchy or spectrum when included with the secondary process. The use of intermediate forms which do not belong either to the primary or secondary process makes a dichotomous variable better approximate a continuous one.
Bleuler attacks with much passion and justice a variety of medical practice reflecting undisciplined autistic thinking. While it may be reassuring to see that our current blunders have historical precedents, it only highlights the severity of the problem. If it were easy for men to abandon this form of thinking and to approach reality more rigorously, they would have done so to a greater degree over the last fifty years. In this sense then,