Academic journal article American Journal of Psychotherapy

Rediscoverig Existential Psychotherapy: The Contribution of Ludwig Binswanger

Academic journal article American Journal of Psychotherapy

Rediscoverig Existential Psychotherapy: The Contribution of Ludwig Binswanger

Article excerpt

Ludwig Binswanger, a founder of the existential school of psychiatry, attempted to apply philosophical ideas derived from Martin Heidegger, such as Heidegger's views on the mind-body problem, to the understanding and treatment of psychiatric patients. Binswanger also interpreted Heidegger's concept of the existing individual (Dasein) as Being-in-the-World, in the sense of seeking out the existential structure of individuals' lives. I discuss concrete clinical cases from Binswanger's work, along with a contemporary example of how to use these existential methods in psychiatric practice.

The "existential" school of psychiatry has three main branches, based on different aspects of its philosophical fathers. The first, based on Husserl, emphasizes the phenomenological reduction; Karl Jaspers worked in this tradition, which formed the mainstream of Continental psychiatry for decades. The second, resting on the early Heidegger, emphasized the existential structure of each individual's world; here Binswanger made his mark. The third, building on the late Heidegger, centered itself on the importance of authenticity for the understanding of persons; Sartre belonged to this approach, along with assorted others such as Laing and Erich Fromm (1).

Existential psychiatry, much in vogue three decades ago, is largely ignored today. Identified with extreme views, such as those of Szasz and Laing (2, 3), mainstream psychiatry has distanced itself from it. Yet, there is another tradition in existential psychiatry, developed through interpretations of the work of Martin Heidegger by the Swiss psychiatrist Ludwig Binswanger that focuses on the methods of phenomenology and should be useful to contemporary psychiatrists (4). Binswanger will be the source of the ideas presented here, since he wrote extensively, as a psychiatrist grounded in clinical work, on how to relate Heidegger's existential ideas to psychiatry. Contrary to his own protestations in his main philosophical text Being and Time (5), Heidegger took a keen interest in pursuing the psychiatric implications of his ideas. For over 16 years, Heidegger persistently tried to teach his ideas to medical students and young doctors in Boss' Zurich clinic. His student, Medard Boss (6), has provided a painfully truthful transcript including long delays with Boss' own exclamation points (`seven minutes delay!') in between profound Heideggerian questions met with complete silence. Binswanger tried to make Heidegger's ideas clinically relevant.

In this paper, I will discuss some of Heidegger's philosophical ideas, then demonstrate three of Binswanger's cases applying those ideas, and one of my own cases illustrating how this existential work can be attempted today.

1. HEIDEGGER'S PHILOSOPHY AND ITS RELATION TO PSYCHIATRY

For Binswanger, Heidegger's ideas, mainly as described in section one of Being and Time, provided an understanding of normal human psychology. One could not fully understand psychopathology, he thought, unless one first understood normal psychology. Freud failed to fulfill this role for Binswanger; he was too averse to explicit philosophizing. When Being and Time was published in 1927, Binswanger found a theory that fit his needs better.

Binswanger identified two aspects of Heidegger's thought which were particularly important for psychiatry. First, he felt that Heidegger could lead psychiatry beyond the mind-body problem and thus provide psychiatry with a tolerant overarching theory that could allow an integration of its different approaches, ranging from the biological to the psychoanalytic. Second, he believed that Heidegger's analysis of human existence, as "Being-in-the-World," provided a lodestar in reference to which abnormalities in mental illness could be understood. Binswanger felt that abnormal existential structures, or ways of Being-in-the-World, underlay the primary pathologies of mental illness, and provided the key to understanding their origins and treatment. …

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