The End of Phenomenology

Abstract

The Case of Ellen West by Ludwig Binswanger [The case of Ellen West: An anthropological-clinical study (trans. by Werner M. Mendel and Joseph Lyons). In: Existence: A new dimension in psychiatry and psychology (Rollo May, Ernest Angel, and Henri F. Ellenberger, Eds.). New York: Basic Books, pp. 237–364, 1958] is at once the founding case of existential analysis, one of the most famous cases in modern psychiatry, and a “whodunit” mystery involving the founders of psychiatry. Its aporias – hidden problems and unresolved questions – cast a shadow on existential analysis and phenomenological psychiatry. Binswanger proposed an analysis of “the existential Gestalt to which we have given the name Ellen West.” The complexity of her case triggered a series of consultations with Emil Kraepelin, pioneer of psychiatric classification, who diagnosed melancholy (a profound depression), while an unnamed “foreign” psychiatrist found simple psychasthenia (obsessive-compulsive disorder). Binswanger diagnosed schizophrenia, confirmed by Eugen Bleuler, who named this emblematic condition of psychiatry. Convinced of her incurable diagnosis, Ellen West demanded to be released. After 3 days with her family, she wrote that she felt relieved, yet that evening she took poison and died. Writing more than 20 years after her death, when the principals of the case were dead, Binswanger declared her suicide “authentic.” Was her death an “authentic suicide” as he insists, an “assisted suicide” (Naamah Akavia, Sci Context 21:119–144, 2008), or a case of “psychic homicide” (David Lester, Psychoanal Rev 58:251–263, 1971)? Despite numerous consultations and multiple rereadings of her case from psychiatry and psychoanalysis to history and philosophy [Michel Foucault, “Introduction et notes,” in Ludwig Binswanger, Le reve et l'existence (trans. by Jacqueline Verdeaux) Paris: Vrin, pp. 65–119, 1954], “Ellen West” remains an enigma. The case of “Ellen West” is a mirror of twentieth-century psychiatry, declares phenomenology as a dead end for psychiatry (Vincenzo Di Nicola, Letters to a young therapist: Relational practices for the coming community . New York/Dresden: Atropos Press, 2011), and is presented as a case study for evental psychiatry based on the work of philosopher Alain Badiou. The striking range of psychiatric opinions expressed about Ellen West’s predicament leads to philosophical reflections about what constitutes a “case” in psychiatry.