Der Binswanger-Lotmar-Disput über Aphasie (1926-1963)

Abstract

The at the time famous but now practically forgotten controversy between the psychiatrist Ludwig Binswanger (1881-1966) and the neurologist and neuropathologist Fritz Lotmar (1878-1964) about the concept of aphasic disorders dragged on - with a few interruptions - over a period of more than 30 years. This controversial issue was dealt with mainly in the journal Swiss Archives of Neurology and Psychiatry and at meetings of the Swiss Neurological and Psychiatric Society. Furthermore, the dispute triggered off an exchange of letters between Binswanger and Lotmar; this correspondence is evaluated here for the first time. The specific point of dispute was the extent and degree to which amnestic aphasia (aphasic anomia) can lead to a change in the patient's overall personality and thus, in a broader context, became a controversial question concerning the subject-object split of mind and brain. Binswanger did not consider amnesic-aphasic performance impairments as primarily linguistic anomia but rather as changes in the total personality, in the overall function of the brain. For Lotmar, however, aphasic disorders were purely a matter of brain pathology, strictly localist and primarily explainable as linguistic. Binswanger, approaching the problem from the perspective of a new holism, sought to overcome the subject-object split. Lotmar, however, espousing the view that in aphasias no intelligence disorder is present, attempted to further develop the classical aphasia doctrine; to this end he utilised the dissection of speech into its constituent parts and their localisation in distinct areas of the brain. The controversy between Binswanger and Lotmar concerning the concept of aphasic disorders can be understood within the broader context of the body-mind problem, the question of the relationship between body and soul, and can also be regarded as a continuation of the famous debate between Pierre Marie and Jules Dejerine about the classical doctrine of aphasia. In the background of this discussion are two processes whose intense interrelationship affects us even today: on the one hand, the establishment of scientific medicine as a primarily body-oriented discipline, the position represented by Lotmar; on the other hand, the opposite process propagated by Binswanger, entailing a rediscovery of the mental-spiritual connection that, inter alia, is associated with the development of modern psychotherapeutic and psychosomatic medicine and, above all, with the name Sigmund Freud. Which interpretation of aphasia doctrine might ultimately prevail - according to Minkowski in the discussion following Lotmar's lecture on Newer Conflicts Concerning the Concept of Aphasic Disorders 1935 - will be revealed by the history of science. After the contentual dismantlement of classical doctrine begun by Marie was continued until the Second World War, the work of Norman Geschwind in the sixties resulted in the recurrence of an anatomically based, and also by Lotmar advocated, connectionistic aphasia doctrine, one which was assumed would become the dominant paradigm for the remainder of the century. Despite Binswan-ger's improved work environment and the justified criticism of Lotmar's overly rigorous separation of physis (organism) and psyche, Lotmar's position on aphasia doctrine, which was primarily body oriented, mostly prevailed.