Issue 8/2015 summary

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Issue 8/2015 summary

Alice Holzhey-Kunz (Switzerland) The Philosophical Basis of Psychopathology: Ludwig Binswanger and Jean-Paul Sartre

Psychiatrist Ludwig Binswanger and philosopher Jean-Paul Sartre, separately from each other, discovered psychopathology, which is based on Heidegger’s hermeneutic anthropology. While sharing the basis, their concepts differ significantly. Binswanger does, just as Sartre, rejects any possibility to define health normatively and interprets separate symptoms as meaningful components of the individual world-project of a person. However, he introduces the normative view by describing neurotic and psychotic symptoms as deformed expressions of world-projects. Sartre has a completely different approach – based on a radical definition of the subject, he understands the world-project as a “fundamental choice” (“choix fundamental”), which causes the individual “to become what he is”. His “existential psychoanalysis” therefore allows use of a body of tools to interpret psychopathological phenomena, on the basis of the person’s metaphysical suffering regarding his finiteness.

Both of these perspectives on psychopathology that allow philosophy to be a leading force in research have a history of half a century. Yet, despite being seemingly antiquated, they make a good material to reflect upon.

Ludwig Binswanger (1881-1966) and Jean-Paul Sartre (1905-1980) are in contrast to each other not just as a psychiatrist and a philosopher. This allows a comparison between them without confusing different aspects of their work.

Binswanger and Sartre are not the only authors who productively used philosophy to discuss psychopathology. Their affinity goes deeper, yet acknowledging both Husserl and Heidegger as their philosophy teachers. Therefore they share both the claim to a phenomenological type of action, and two of Heidegger’s essential concepts – being-in-the-world and (world) project. But, still, it makes sense to compare, because, despite common notions, both authors’ views on psychopathology, surprisingly, have fundamental differences.

However, before determining these differences, it is necessary to discuss their commonality. It is in the conviction that only philosophical determination of a human being may provide for the basis for an understanding approach to individual life and behaviour of an individual. From their point of view, only philosophy may raise questions about a person radically enough for him to be conceived as a whole. For Binswanger, just as for Sartre, this wholeness is best expressed through the Heidegger’s term “being-in-the-world”.

The most important here, first of all, is the definition of the “world”. This refers, in fact, not to the external world as opposed to the internal or spiritual world, but to the wholeness of human life in the meaning of a mutual connection of beings, where everything is in motion – experiences, thoughts and actions. Actually, this definition of the world appears quite productive, especially when applied to the individual. It may seem reasonable that openness towards such a world project may allow its meaning – originally hidden – to reveal itself. Thus a hermeneutic approach to the phenomena of psychopathology appears possible. The medical-psychiatric questioning about the symptoms of a disease or a disorder may be replaced by the hermeneutic inquiry about their meaning within the framework of a specific world project. Both Binswanger and Sartre chose to go this way. Sigmund Freud was the first who employed this approach consistently and along with claims of scientific explanation. Binswanger and Sartre, with their hermeneutic approach, took the side of psychoanalysis, but it did not become a foundation for their further ideas. Instead of the dichotomy “healthy-sick”, Freud introduced the “conscious-unconscious”. Binswanger and Sartre claimed to have transcended both these pairs of definitions in the notion of being-in-the-world. However, their criticism of Freud is moderate, and they blame him only for insufficient radicalism.

The path of the two authors parts when it comes to defining what this “world-project” specifically is.

According to Binswanger, it is obvious that the psychiatric perspective of psychopathology’s phenomena is undoubtedly included in the philosophical view towards human beings. Moreover, it could be said that the wholeness of the image of man and the psychiatric perspective mutually determine each other – the psychopathological diagnosis based on labels such as “sickly” or “disordered” requires an integral picture; and vice versa, when viewed from the position of wholeness, mental affliction is defined only as a deficient form of being.

Sartre, on the other hand, shows us that the hermeneutic approach to the phenomena of psychopathology is possible only on the basis of anthropology that reminds human beings of their finiteness and includes potential, though often unfulfilled, wholeness as a crucial element of its philosophical definition. This is the moment of agreement between Sartre and Freud. Whatever the differences in details, they do share the viewpoint of human beings as live beings who are basically too demanding of their own existence. It is the anthropological “pessimism” that allows both of them an overall hermeneutic approach to the phenomena of psychopathology, which Binswanger lacks. It seems appropriate to conclude – only if a human being is philosophically defined as someone who may suffer from his own existence, the so-called mental disorders may be defined by and interpreted in relation of the desire which deprives all men tranquillity and is unfulfillable altogether – a desire to free oneself from the “burden of being” (Heidegger).

These opposing views on psychopathology define therapy accordingly. First of all, two differences should be noted:

  1. While therapy which sees the suffering of the soul as an illness is directed towards “recovery” in the sense of fixing faults, regardless of the method used, the analytical-hermeneutic therapy will seek an explanation, starting again from the unavoidable fault of being.
  2. If in the first case the therapist can reckon with a more or less un-ambivalent desire of the patient to recover, then in the second case he will take into account that the patient has chosen his suffering as a receptive environment for the fulfilment of his desires, and therefore the desire to recover is principally ambivalent, as recovery not only has its benefits, it also requires a sacrifice.
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