binwanger and harry stack sullivan

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Journal of Humanistic Psychology

DOI: 10.1177/0022167800403009

2000; 40; 108Journal of Humanistic PsychologyRoger Frie

The Existential and the Interpersonal: Ludwig Binswanger and Harry Stack Sullivan

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The Existential and the InterpersonalR o g e r Fri e

THE E XISTENTIAL AND THE

INTER PERSONAL: LUDWIG

BINSWANGER AND HARRY

STACK SULLIVAN

R OGE R FR I E is current ly a univers it y fellow in

t h e p r o f e s s io n a l p s y c h o l og y d e p a r t m e n t o f

G eorge Wa s hingt on U niversit y a nd h olds a doc-

torate in phenomenological psychology, psycho-

a na lyt ic t heory, a nd philos ophy from Ca mbridge

U n i v er s it y , E n g l a n d . H e h a s t a u g h t a t t h e N e w School for S ocia l R es ea rch, Ha rva rd, a nd Nort h-

eastern Universities, and has trained in interper-

s on a l p s y ch oa n a l y s is a t t h e Wi l li a m Al a n s on

Whit e I ns t i t ut e. He ha s w rit t en w idely a bout t he

interfa ce of philosophy, psychoana lysis, and psy-

chology, and is t he aut hor of Subjectivi ty and I ntersubjecti vity in M odernPhi losophy and Psychoanalysis(Rowma n a nd Litt lefield, 1997).

S u m m a r y

The Sw is s psychia t r is t L udw ig B ins w a nger is commonly know n a s

the founder of existentia l an aly sis. The purpose of this ar ticle is to

introduce the larger scope and relevance of Binswangers work by

dra w ing, a bove, a l l on unt ra ns la t ed t ext s . The a ut hor s how s how Bin swa nger d eveloped a contemporar y perspective on self-other

intera ction wit h importa nt clinical implications for our underst an d-

ing of the t hera peutic process. The a rticle examines th e intera ction

between the psychotherapist and pat ient tha t forms the therapeutic

m a t r i x, a n d a r g u es t h a t B i n sw a n g e r u se d e l em en t s of M a r t in

Heideggers t hought a nd M a rt in B ubers dia logica l philos ophy t o

develop a n origina l a pproa ch t o ps ychot hera py t ha t ha s cons ider-

a b l e p a r a l l e l s w i t h t h e w o r k o f H a r r y S t a c k S u l l i v a n a n d m o r e

recent interpersonal and relational theory.

T h e S w i s s p s y c h i a t r i s t , L u d w i g B i n s w a n g e r , i s k n o w n a s t h e

fou n d e r o f e xiste n tial a n alysis , ye t h is w ork is n o t com m o n ly

stu d ie d to d ay. B in swan g e r was in tro d u ce d to En g lish - sp e ak in g

108

Journ al of Hu mani stic Psychology, Vol. 40 No. 3, Sum mer 2000 108-129

2000 Sage Publications, Inc.

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au d ie n ce s in th e late 1950s b y Ro llo M ay in Existence: A NewD i m en s i on i n P sy ch i a t r y a n d P sy ch o l og y ( M a y , A n g e l , &Ellenberger, 1958). A few year s lat er, J a cob Needleman t ra nsla ted

a se le ction of B in swa n g e rs e ssays an d case stu d ies in Being-in-the-World: TheSelected Papersof Ludwig Binswanger(Needleman,1963). Durin g th e 1960s and int o th e 1970s, Binsw a nger a chieved

a m e a s u r ed p op ul a r i t y w i t h i n t h e b u r ge on i n g m o v em e nt of

huma nistic psychology, but now he is relat ively unknown. G iven

the chan ges in th e menta l health profession, this is not a ltogether

surprising. Training in clinical psychology has often become very

n a r r ow i n f o cu s . A s a r e s ul t , t h e p h i los op h ica l n a t u r e o f

Binswangers writings is often deemed too abstract or too distant

from th e con cern s of con te m p ora ry p sych olog y. Th e re is also

another factor at work. Most of Binswangers writings, including

his chief text on the nature of human interaction, have not been

t r a n s l a t e d i n t o E n g l is h . Th u s , w h a t w e g en er a l l y k n ow of

B in sw an g e r is a lm ost e xclu sive ly b ase d o n d a te d com m e n tar ies

an d tra n slat io n s th at are f re qu e n tly im pre cise.

T h e si tu atio n is qu ite d i f fe re n t in cu rre n t- d ay G e rm an y an d

S w i t z e r l a n d , w h e r e t h e r e i s a r e n e w e d i n t e r e s t i n w h a t B i n s -

wa nger ha s to say . This is most appar ent in th e recent publicat ion

of his Selected Works(1992, 1993a , 1993b, 1994) a nd in t he pub li-cation of a series of monogra phs and a rticles tha t exam ine the sig-

n i f i ca n c e o f h i s p s y c h ol og y (H e r z o g , 1 99 4; H o f f m a n , 1 99 7;

Holzhey-Kunz, 1990; Passie, 1995; Vetter, 1990). Binswangers

wo rk co n tin u e s to b e im p le m e n te d an d e xp an d e d o n in p rivatepractice, clinic, a nd hospita l settings, pa rticularly in H eidelberg,

Ma rburg, Reihena u, Wrzburg, a nd Zrich. Clearly t he full ra nge

a nd import an ce of B inswa ngers w ork has yet t o be appreciat ed by

English-speaking clinicians.

The purpose of this a rticle is to reintroduce B inswa nger t o a

contemporary audience. To achieve this aim, I will draw on and

d i sc us s p r ev i ou s ly u n t r a n s l a t e d w o r k . A lt h o ug h s om e of t h e

s ou r ce s I u s e o r ig in a l l y a p p ea r e d i n M a y e t a l . (1958) a n d

Needleman (1963), I ha ve gone back to Bin sw a ngers origina l texts

to provide a consistent and more precise translation of his writ-

in g s; a l l tra n slat io n s of B in sw an g e r a re m y o wn . To acqu ain t t h e

r e a d er w i t h w h a t B i n s w a n g e r h a s t o s a y , i t w i l l b e n eces s a r y t o

p r ov i d e a p h il os op h ic a l g r ou n d i n g i n h i s w o r k . I m p li ci t i nB in swan g e rs wri t in g s are su ch co n te m p o rary h u m an ist ic co n -

ce rn s as au th e n tici ty , se l f- o th e r in te ractio n , an d th e to tal

Roger Frie 109



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human being. Indeed, Binswanger was the first to conceptualizema ny such idea s in a psychologica l fra mew ork, w hich makes revis-

iting his w ork all the more importa nt. I will seek, above a ll , to show

th e w ays in wh ich h is id eas can h e lp us th in k a b ou t a n d u n d e r-

sta n d t h e n at u re of in te rp erson al in te raction , p art icu larly w ith in

th e th e rap e u tic d yad . I wi l l arg u e th at B in swan g e r d e ve lo p e d a

contemporary theory of the self that accounts for the primacy of

h u m an re lat ion s a n d h a s im p orta n t c lin ical im p licat ion s fo r th e

theory a nd pra ctice of psychotherapy.

B inswa ngers shift from Freudian psychoa na lysis to existentia l

a na lysis is a shift from an int ra psychic to an interpersona l theory

of huma n nat ure, a nd from an impersona l to a n interpersonal ther-

a peutic technique. In elaborat ing B inswa ngers perspective, I w ill

therefore pa y part icular a tt ention to pa ra llels betw een existentia l

a na lysis a nd Ha rry St a ck Sullivans interpersona l psychoana lysis.

The recent ascendancy of interpersonal and relational perspec-

tives in psychotherapy and psychoanalysis (Aron, 1996; Mitchell,

1988) ma ke such pa ra llels especia lly notew orth y (P ortnoy, 1999).

F R O M F R E U D TO P H I L O S O P H Y

B in swan g e r b rid g e d th e d ivid e b e twe e n p sych iatry, p sych o -

a na lysis, and philosophy w ith relat ive ease. Ea rly in his ca reer he

wo rk ed close ly with S ig m u n d F re u d an d Eu g e n B leu ler. A s h is

in te rests in p h ilosop h y g re w, h e in i t iate d p erson al con ta ct an dentered into a subst a ntia l correspondence wit h Edm und Husserl,

M artin He id e g g e r, an d M artin B u b e r. Each wo u ld h ave a d ire ct

impact on the development of Binsw a ngers ideas. Yet B inswa nger

n ev er b eca m e a f ol low e r of a p a r t i cu l a r t h i n ke r or s ch ool of

thought. Instead, by drawing connections between different ways

of t h in k in g , B in swa n g er orig in at e d a p h ilosop h ical ap p roach to

p sych iatry.

Binswanger thus belonged to a continental European tradition

of intellectual thought that freely combined insights from philoso-

phy and clinical practice (Passie, 1995). He was born in Kreuzl-

in g en , S witz e rlan d in 1881 in to a fam ily o f p ro m in e n t p sych ia-

trist s. Binsw a nger at tended the universities of Lausa nne, Heidel-

berg, and Zrich, and received his medical degree from Zurich in

1907. He trained as a psychiatrist under Bleuler and J ung at the

110 Th e Existenti al an d th e In terpersonal



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B u r g h l zl i H o s pi t a l i n Z r ich . I t w a s t h e re t h a t h e b e ca m eacqu ain te d with th e b u rg e o n in g f ie ld o f p sych o an alysis an d , in

1907, accompa nied J ung to Vienna to meet Freud for the first tim e.

B in swan g e r d e ve lo p e d a f r ie n d sh ip with F re u d th at co n tin u e d

thr ough persona l visits a nd la rge correspondence until t he lat ters

death in 1939 (Fichtner, 1992). Binswanger was offered the direc-

to rsh ip o f th e B u rg h lz l i Ho sp ital wh e n B le u le r s te p p e d d o wn

(Spiegelberg, 1972), but chose instead to remain director of his

fam ilys B ellevue Sa na torium in Kreuzlingen, wh ich w a s founded

b y h i s g r a n d f a t h e r i n 18 57. As d i r ec t or f r om 1 91 0 t o 1 95 6,

B inswa nger dedicat ed much of his time to the integrat ion of theo-

retical a nd clinical insights from philosophy, psychoana lysis, an d

p sych iatry. B in swan g e r re t ire d in 1956 b u t re m ain e d an act ive

writer, publishing his last work just one year before his death in

1966.

Binswangers broad theoretical interests were reflected in his

personal a ssociat ions w ith m a jor t hinkers of the t ime. Among the

p rom in en t f ig u res wh o visi te d B in swan g e r in K re u zlin g e n w e re

F re u d , Hu sse rl, He id eg g er, B u b er, K a rl L with , E rn st Ca ssirer ,

Alexander Pfnder, and Max Scheler. Bellevue Sanatorium itself

b ec a m e a f a m o u s c en t e r f or p s y ch i a t r i c t r e a t m e n t . I n c lu d ed

a mong its pat ients w ere such w ell-know n persona lities as th e Ger-

m a n a c t o r G u s t a f G r n d g e n s , t h e S w i s s a r t i s t E r n s t L u d w i g

K irch n e r, th e Ru ssian d a n ce r V aslav N ijin sky, a n d t h e G e rm a n

sociologist Ma x Weber. The B ellevue Sa na torium fina lly closed in

1980 due to fina ncia l constr a ints a nd t he cha nging na ture of men-ta l h eal th care .

B in swan g e rs e arly asso ciat io n with F re u d h ad a s ig n if ican t

im pact on h is th e ore tical an d clin ical p u rsuits . B in swan g e r w as

initially a tt ra cted to psychoa na lysis because of the insights it pro-

vided into huma n behavior. In 1909, while working a t t he Un iver-

sity of J ena, Binswanger published the first psychoanalytic case

stu d y a t a G e rm a n u n ive rsity p sych iatric c lin ic . I n 1910, h e w as

president of th e Zrich P sychoa na lytic Society. H owever, even in

th is e ar ly p e riod , B in swa n g e r h ad re servat ion s a b ou t F re u d s

ideas. Binswanger cautioned Freud against scientific reduction-

ism an d was cri t ical o f th e p ro to - p h ysio lo g ical b asis o n wh ich

Freuds drive theory a nd models of the mind were ba sed. Nor did

he think t ha t psychoana lysis sufficiently a ccounted for th e role ofthe other people in t he development of the persona lity. In a lat er

Roger Frie 111



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recollection of his friendship wit h Freud, B inswa nger (1957b)remarked that his entire scientific development, in positive and

n e g ative re sp e cts , was d e te rm in e d b y h is e f fo rt to fo rm u late a

philosophical a nd scientific basis for psychoana lysis.

Although Binsw a nger never questioned the explana tory poten-

tia l of na tu ra l science, he sought a bove a ll to develop an a ccount of

human nature that was not reductionistic. This project culminated

in his first book, I nt rodu ction to th e Pr oblems of Gener al Psychol-ogy (1922). Although the book was dedicated to my teachers,B leuler and F reud, it a lso ma rked the turn t owa rd philosophy in

Binswangers work. Binswanger argued that the object of investi-

ga tion must a lwa ys be seen in its full phenomena l reality. H is pur-

pose wa s to understa nd and explain huma n beings in the tota lity of

th eir existence, not simply as na tu ra l objects constr ucted from va r-

ious pa rts. Husserls phenomenology provided B inswa nger w ith a

method to expla in the visual reality of his pa tients. I t wa s, how-

ever, Heideggers move beyond Husserl in Being and T i me(1927/1 96 2) t h a t i n f l u en c ed B i n s w a n g e r s t h i n k i n g m os t d i r e ct l y .

H e i de gg er s f u n da m e n t a l on t o log y , p a r t i cu l a r l y t h e n ot i on of

being-in-the-world, enabled Binswanger to develop a philosophi-

cally oriented approach to psychiatry that could account for the

huma n beings t otal existence.

BEING-IN-THE-WORLD

B in swan g e r was th e f irst to re co g n iz e th e co n trib u tio n s th at

Heideggers philosophy could ma ke to psychiat ry. Heidegger w a s

initially intr igued by Binsw an gers work and t he tw o men entered

into a correspondence in the lat e 1920s (Frie, 1999a ), w hich w a s

p un ct u a t e d b y p er s on a l v is i t s ov er t h e n e xt f ou r d eca d e s .

B inswa nger bega n sending Heidegger his texts in the ear ly 1930s,

a nd t he philosopher responded in kind . In t he ear ly 1940s, follow -

i n g H e i d e g g e r s e x a m p l e , B i n s w a n g e r a d o pt e d t h e t e r m

Daseinsanalysis tran slate d b y M ay e t a l . (1958) as existentialanalysisto describe his approach.

F ro m t h e la te 1940s on wa rd s, h owe ve r, He id eg g er wo rk ed

clo se ly to g e th e r with an o th e r S wiss p sych iatrist , M e d ard B o ss.

Today the t erm Daseinsanalysisis commonly used t o refer t o thework done by the Da seinsana lytical Inst itute in Zrich, wh ich wa s

fou n d e d b y B oss. I n con tra st to B oss, B in swa n g e r wa s cri t ical of




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some aspects of Heideggers philosophy. Binswangers interpreta-tion of Being and T ime(Heidegger , 1927/1962), w hich for a tim ese t th e stan d ard fo r in te re ste d p sych o lo g ists an d p sych iatrists

(Weigert, 1949), did n ot rem a in loya l t o the philosophers text . In

a ddition, B inswa nger drew on other t hinkers to develop a th eory of

human interaction that he felt was missing in Heideggers funda-

ment a l ont ology. This led to Heidegger an d B osss lat er critiqu e of

B i n s w a n g e r s w o r k i n t h e Z ol l i k o n er S em i n a r e (B oss, 1957;H eidegger, 1987). Though t he B insw a nger-B oss-Heidegger deba te

is outside t he scope of th is a rt icle (see Frie, 1997, 1999a ), I w ill

demonstrate that the question of philosophical interpretation in

no wa y les-sens t he import a nce of B inswa ngers ideas for contem-

porary psychotherapy.

According to Binswanger, Heideggers fundamental ontology

provided an a na lysis of the primar y str uctures of huma n existence

and constituted a necessary foundation for the human sciences.

B in swan g e r was p rim ari ly in te re ste d in He id e g g e rs an alysis o f

existence, which is oriented toward an ontological end. In Beinga n d T i m e (1927/1962), Heid egger ca lls for th e retu rn t o t he mea n-in g o f B e in g as su ch . H e id e gg e r re fe rs to th e h u m an b ein g th a t

questions the meaning of Being as Dasein. Heidegger argues thatD a se in is n e i th e r a u to n om ou s n or se lf-con ta in ed , b u t alw ay s

a lready situa ted in t he world. Thus, Da sein exists a s being-in-the-

wo rld . A s in te rp rete d b y B in swa n g e r, th e n otion of b ein g -in -

the-world signified that we are not isolated, encapsulated egos but

b ein g s wh o are alw ay s in re lat ion to oth e r h u m an s an d th e wo rldar ou n d u s. Th is im plies th a t th e re is n e ith e r a su b je ct-ob je ct

d i ch ot o m y n or a d i v is i on b et w e en s u b je ct i v e a n d ob je ct i v e

experience.

According t o Binsw a nger, H eideggers conception of w orldth e

m atrix o f re lat io n s in wh ich D ase in e xists an d d isco ve rs m e an -

ingthus provides the clinician with a key conceptual tool for

u n d ersta n d in g a n d d e scrib in g h u m an e xp erien ce. B in sw an g e r

enla rged H eideggers ontological conception of world t o include the

h o r i z o n i n w h i c h h u m a n b e i n g s l i v e a n d t h r o u g h w h i c h t h e y

understa nd themselves. At t he same time, B inswa nger recognized

th ree simult a neous modes of being-in-th e-w orld: th e Umwel t , con-s t i t u t i n g t h e e n vi r on m en t w i t h i n w h i ch a p er s on e xi s t s ; t h e

M i t w e l t , or w orld of social rela tions; a nd th e Eigenwelt, the priva tew orld of self . According to B inswa nger, th e thr ee modes together

constitute a persons world-designthe general context of mean-

Roger Frie 113



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ing wit hin wh ich a person exists. In th e first of his existentia l ana -lyt ic s tu d ie s, Dr eam and Existence (1930/1993c), B ins w a ngerdescribed dreams in terms of the dream ers w orld-designs ra ther

tha n psychic processes. Similar ly, in h is st udies on ma nia (1992)

a n d s ch i z op h r en i a (19 57 a ), B i n s w a n g e r u s ed t h e n ot i on of

world-designs of patients to elaborate manic experience and the

s p a t i a l , t e m p o r a l , a n d v e r b a l s t r u c t u r e s o f s c h i z o p h r e n i c

existence.

B inswa nger argued tha t the ma in goa l of psychopat hology stud-

i es w a s t o a c h i ev e k n o w l ed g e a n d s ci en t i f i c d e sc r ip t i on of

world-designs, tha t is, t o see how pat ients relat e to the people a nd

s o c i a l e n v i r o n m e n t a r o u n d t h e m a n d t h u s t o u n d e r s t a n d h o w

p atie n ts s tr u ctu re t h e wo rld in w h ich t h e y e xist . I n oth e r w ord s,

B inswa nger does not int erpret the pa tients experiences in terms

of a m enta l appara tus. Nor does he simply elabora te the physica l

reality of the patients world. Rather, from Binswangers point of

view, person and w orld are one. I t is thus a question of at tempting

to understa nd a nd explain t he human being in the tota lity of his or

h e r e xiste n ce , wh ich always in clu d e s h is o r h e r re lat io n sh ip to

others.

Th e p ara l lels b e twe en B in swan g e r an d S u ll ivan on th is p o in t

a re clear ly evident. Like B insw a nger, Sulliva n (1953a , 1953b)con-

centr a tes on the wa y in which the pa tient st ructures reality, not on

b u ild in g stru ctu re with in th e p e rso n ali ty . Rath e r, fo r S u ll ivan ,

psychotherapist and patient attempt to achieve consensual vali-

d at ion of t h e p at ien t s e xpe rie n ce o f re lat in g to o th e rs a n d th eworld. Consensual valida tion signa ls the a rriva l of the pat ient at a

syntaxic or interpersonally verifiable view of reality. The goal of

i n t e r p e r s o n a l p s y c h o a n a l y s i s i s t o i d e n t i f y a n d e l a b o r a t e t h e

p atie n t s p ara ta xic m o d e of re lat in g : th e a rb i trary , p rivat e , an d

f r e q u e n t l y d i s t o r t e d m o d e o f i n t e r p e r s on a l e x pe r i en c e. F o r

B inswa nger and S ulliva n, the aim of psychothera py is not to ma ke

th e unconscious conscious in the tr a ditiona l Freudia n sense, but t o

free p at ien ts f rom d istorte d m o d es o f re lat in g to o th ers an d th e

wo rld ar ou n d th e m .

B i n s w a n g e r s cr i t iq u e o f F r e u d p l a y e d a n i m por t a n t p a r t i n

d e velop in g a m o re com p re h en sive a cco un t of h u m a n n a tu re .

I n d e ed , B in swan g e r r e je cte d th e w h ole F re ud ian m e n tal ap p ara -

tus. I n criticizing Freuds st ructura l a ccount of the psyche, Bins-wanger (1955) argues when the self is objectified, isolated and

theorized int o an ego, or into a n id, ego and superego, it is driven




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out of its authentic sphere of being, namely existence (p. 181).Binswanger was particularly opposed to the concept of causality

tha t F reud derived from his model of menta l functionsnamely,

t h e i d ea t h a t h u m a n b eh a v i or i s c a u s a l ly d et e r m in ed b y t h e

instinctual energy of the id. In a particularly significant passage,

Binswanger (1992) states that

Human existence never becomes apparent exclusively as mind orexclus ively a s ins t inct ; i t is a lw a ys bot h, ins t inct a nd mind. Onlytheoretically and abstractly can the mind and the instincts be dif-ferent ia t ed. . . . I f Niet zs che a nd ps ychoa na lys is ha ve s how n t ha tinstinctua lity, especially in the form of sexua lity, reaches up to thehighest pinnacle of human consciousness, I have tried to show thedegree to which consciousness extends its reach down to the deepestground of vitality. In other words, religious, moral, and aestheticl if e m u s t b e a ck n ow l e d ge d w h e r e t h e h u m a n b ei n g u n t i l n ow a p p ea r e d t o b e d o m i n a t e d e n t i r el y b y t h e v i t a l o r i n s t i nc t u a lspheres. . . . One speaks of religion, morality a nd a esthetics not onlyw here t he huma n being ha s a chieved in a clea r s elf-a w a renes s , ap er m a n e n t s e n se o f s e l f, b u t e v er y w h e r e w h e r e t h e r e i s as elft hough not a lw a ys a perma n ent or cons t a n t s elfint endingan object. As is readily a pparent, t his is concerned wit h th e positiveclarification of the term, an unconscious m ind. (p. 221)

For Binswanger, the psychoanalytic conception of an unconscious,

a s th e source of psychic energy a nd center of repressed menta l pro-

cesses, was not compatible with the conception of being-in-the-

world. Binsw a nger makes this point most sha rply when he a rgues

th a t F re u d b etra ys h is m o st p rofou n d in sigh t b y m a k in g th e u n -conscious into an it (the literal translation of E s). B in swa n g er(1947) sta tes tha t

It w as a fter all precisely Freud who taugh t us tha t the I-cannot ofp a t i e n t s m u s t a l w a y s b e u n d e r s t o o d a s a n I w i l l n o t , i n o t h e rwords, tha t th e I-not-I relat ionship must be understood as an I-Imyself relationship. . . . Psychoanalysis in general has its existen-t ia l jus t i f ica t ion only in s o fa r a s t his t ra ns la t ion is pos s ible or a tlea s t mea ningful. Yet Freud t ra ns forms , w it h a l i t era lly s uicida lintention, the I w i l l not t o a n i t can not. (p. 117)

Binswanger did acknowledge the role of unconscious processes as

an explanatory hypothesis for human behavior. However, in his

view (Binsw a nger, 1955), alt hough th e unconscious may r efer to a

par t of th e hum a n mind, it does not exist a s a w orld of its ow n, nor

does it relat e to itself through a w orld. Ra ther, B inswa ngers view

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of the unconscious can be understood along the lines of Sullivans(1953a) notion of unformulated experience. The unconscious re-

fers t o expe rie n ce th a t h as ye t t o b e art icu late d , e lab o rate d , a n d

fully understood.

The dilemmas that stem from Freuds attempt to demonstrate

tha t a part of the self can determine the whole a lsoform the basis of

B inswa ngers critique of the psychoa na lytic theories of libido and

instinct. Although the concept of libido experienced numerous

reformula tions, it refers genera lly to instinctua l or sexua l energy.

Fr euds th eories of libido a nd inst inct a lso form the ba sis for a con-

ception of interpersonal rela tions tha t is inst inctually oriented. In

Freuds metapsychology, other people primarily take the role of

objects for the gratification of instinctual desires. Interpersonal

relat ions t hus ha ve their origin in t he discovery t ha t other people

can a id in t he reduction of tensions. This mechanist ic view espe-

cial ly d e term in e s F re u d s u n d e rstan d in g of th e love re lat ion .

Though he discusses various forms of love, it is nevertheless true

th a t for Fr eud, the libido underlies all a spects of love. The diverse

fo rm s o f lo vin g can u l t im ate ly b e trace d b ack to th e in st in cts ,

wh ose function is t o provide instinctua l sa tisfa ction.

Whereas Fr eud at tempts t o account for love though a causa lly

determined theory of instincts, Binswangers aim is to elucidate

l o v e s a n t h r o p ol o g i ca l a n d p h e n o m e n o l o g i ca l d i m e n s i o n .

B insw a ngers rejection of a ny form of biologica l determinism lea ds

him to dismiss outright the protobiological basis of the libido. To

th is end, B insw a nger (1942/1993a ) rema rks, The monst rous dif-ference betw een the geneti c d eri vati onof all forms of love from asingle source a nd t he disclosure of love a s a unified a nt hropologica l

origina ry phenomenon, forbids any a tt empt t o even compar e our

concept with that of psychoanalysis (pp. 234-235). Referring to

the psychoa na lytic expla na tion of love, B inswa nger sta tes further

tha t if love were simply an i l lus ion, in the explana tory sens e of . . .Fr eud, then it w ould be difficult to conceive how love can constit ute

a re al i ty ; a re al i ty can n o t b e b ase d u p on som e th in g un re al

(p. 135). In B insw a ngers view , Freuds theory of libido plainly fa ils

to a ccount for the phenomenologica l realit y of love, which is cent ra l

to t he interpersona l f ield of psychotherapy.

B inswa nger initia lly turn ed to Heidegger in sea rch of develop-

ing a more satisfactory conception of human interaction. However,just as he dismissed Freuds concept of libido, Binswanger also

found Heideggers conception of interpersonal interaction to be




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la cking. In his chief theoretical w ork, Basic Forms and Knowledgeof H u m a n E x i s t en c e (1 94 2/1 99 3a ), B i n s w a n g e r a r g u e s t h a tHeideggers treatment of social dimension in Being and Tim e(1927/1962) does not sufficiently account for the role of other human

beings in the achievement of authenticity and entirely omits the

notion of interpersonal love. Binswangers argument follows the

ear lier critique ma de by Heideggers one-time stud ent, Ka rl Lwith

(1981), an d ha s more recently been elabora ted by such t hinkers a s

Micha el Theunissen (1977) an d J rgen Ha berma s (1985).

T h e p ro b le m , as B in swan g e r saw i t , was n o t th at He id e g g e r

overlooked human sociality. Rather, the difficulty lay in the fact

th a t D a se in a ch ie ved i ts au t h e n tici ty in e ssen tial isolat io n from

others. As B insw a nger (1942/1993a ) sta tes, H eidegger sees only

the inauthentic They-self besides the authentic self, and omits the

a uthent ic positive possibility of B eing-wit h-one-a nother: t ha t is,

th e being in one an other of first a nd second person, of I a nd Thou,

t he We-self (p. 217). As we sh a ll see, it is precisely t he I-Thou rela -

tionship tha t B inswa nger sees as crucial to the psychothera peutic

p r oc es s . A s a c li n ici a n , h e b el ie ve d t h a t p s y ch ot h e r a p y w a s

dependen t on the emerg ence of a t ype of loving I-Thou rela t ionship

b etw e en th e rap ist a n d p atie n t .

In contrast to Heidegger, then, Binswangers specific concern

wa s to show t ha t self-realiza tion ca n be achieved through enga ge-

m e n t in a re cipro cal , au t h e n tic re lat ion . Th ou g h B in sw an g e r

ack n owle d g es t h at in certa in si tu a tion s a u th e n tici ty m ay fol low

from a confrontation with the possibility of ones own death, hebelieves th a t a ut hent icity is a lso a chieved through the I-Thou rela -

t i o n s h i p , w h i c h h e r e f e r s t o a s t h e d u a l m o d e o f l o v e . A s

B in sw an g e r (1993a) stat e s, we d o n ot ag re e th a t th e au th e n tic

tr ut h of Da sein can be achieved only in this ma nner of resolute a u-

th e n tic se l f, b e cau se th is tru th lack s lo veth e orig in al b ein g -

with-one-another (p. 218). His objective was thus to supplement

Heideggers project of funda ment a l ont ology w ith a th eory of recip-

rocal love.

THE I-THOU RELATION

Binswangers critique of Heidegger provided the stimulus for

his own elaborat ion of the int erpersonal dimension. To this end,

B in swan g e r tu rn e d to th e p h ilo so p h y o f d ialo g u e , wh o se ch ie f

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proponent is Buber. Binswanger entered into a lifelong correspon-d e n ce a n d fr ien d sh ip with B u b e r. A s e arly as 1936, B in swan g e r

wro te to B u b er,

I not only follow in your every step, but see in you a n a lly, not onlya ga ins t Kierkega a rd, but a ls o a ga ins t Heidegger. A lt hough I a mmethodologically deeply indebted to Heidegger, [I take exceptionto] . . . his conception of Da sein (a s mine). . . . It is very im porta nt [tome]t ha t you wa nt t o achieve a conceptua lization of the public wh ichis not limited to the multit ude a nd t he They. (Buber, 1973, p. 621)

The impact of Bubers philosophy on B inswa ngers t heory of the

se lf is m o st ap p ar e n t in Basic F orm s and K nowledge of H um an

Existence (1 94 2/1 99 3a ) . I n f a c t , i n t h e p r ef a c e t o t h a t t e x t ,B inswa nger acknowledges an equa l indebtedness to B ubers short

tre atise , I a n d T h o u (1923/1970), a nd to H eidegger s Being andT i m e (1927/1962).

The problem of relation, or dialogical life, is central to Bubers

entire philosophy. He argues that the human being can never be

fully understood apart from relation. As Buber (1965) states, each

component of a relat ion considered by itself is a mighty a bstra c-

tion. The individual is a fact of existence insofar as he steps into a

living relat ion w ith other individual. . . . The fundam enta l fact of

hum a n existence is huma n being wit h hum a n being (p. 203). The

ch aracte r o f a re lat ion sh ip is a lwa ys d e te rm in ed b y wh ich of th e

ba sic words is s poken: When I-Thou is sa id, th e I is different from

th e I tha t spea ks th e prima ry w ord I-It . As B uber (1923/1970) putsit, the I-Thou can only be spoken with the whole being. The pri-

mary word I-It can never be spoken with the whole being (p. 54).

Dia logue, in th is sense, is not only a m ode of linguist ic communica -

tion but denotes th e interhuma n dimension generally.

According to Buber, the primacy of relation also implies that

authenticity is constituted in relationship to an other. Acknowl-

edgment of the other person (not a s a mea ns to an end but in his or

her t otality ) as a Thou is the condition of possibility for a uthent ic

e xiste n ce . I n con tra st to He id eg g er, B u b er in sists th a t au t h e n tic

selfhood ca n only be comprehended in ter ms of th e reciprocity of I

a nd Thou. The G erma n philosopher, Micha el Theunissen (1984),

e lab o rate s th is p oin t w h e n h e stat e s th at

While accordin g to Heid egger, the self ca n only come to itself in a vol-untary separation of itself from the other self, according to Buber,




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[th e self]ha s its being solely in the rela tion. . . . P ersona l subjectivit ydoes not possess its substa ntia l fullness beyond the rela tionship tothe Other in t he same sense as t he subject its being present-at-hand.Ra th er, its fullness is ent irely encompass ed by the relat ion. (p. 284)

From this perspective, then, Bubers theory of relation provides

B inswa nger with a more a dequa te conceptua l underpinning from

which to elaborate his conception of self-realization in a loving

I-Thou rela tionship.

SELF-REALIZATION THROUGH THE OTHER

L ik e B u b e r, B in swan g e r e m p h asiz e s th e d ialo g ical n atu re o fhuma n existence. The huma n being develops a nd exists thr ough

intera ction wit h others. In Basic Form s and K nowledgeof Hu manExistence(1942/1993a ), B insw a nger delineat es different forms ofsocial existencedua l, plura l, and singular modestha t a re ori-

ented toward the achievement of authenticity in loving dialogue

wit h an other person. Binsw a ngers aim is to elaborat e the a nth ro-

pologica l str uctur e of a loving I-Thou relat ionship, which permit s

th a t ach ievem e n t o f a u th e n tici ty . A n d for B in sw an g e r, i t is p re -

cisely in and through a loving I-Thou relationship that growth and

change become possible. Whereas some may dismiss the manifes-

tat io n s o f in te rp e rso n al lo ve as u n re al ist ic , fo r B in swan g e r th e

I -Th ou re lat ion is ch a racte riz ed b y m u tu a l i ty , o p en n e ss, a n d

immediacy. Sullivan (1953a) ma kes a closely related point, st a tingtha t w hen love occurs, a nother person mat ters a s much to you as

do you yourself; under such conditions, it is q uite possible to ta lk

to th is p e rso n as yo u h ave n e ve r talk e d to an yo n e b e fo re . F o r

S u ll ivan , th e re lat ive ly u n com p licate d e xpe rien ce o f lo ve is

entir ely ennobling. Sym pat hy flows from it. Tolera nce a s a r espect

for peoplenot a s a n int ellectua l deta chment fr om prejudicefol-

lows it like a bright shadow (p. 43).

B inswa ngers proximity t o Sullivan a lso underscores his diver-

gence from Buber. Binswanger professes an allegiance to Buber,

but works out his own theory of I-Thou interaction. Thus, in con-

tra st t o B uber, B inswa nger brackets the theistic dimension of the

I-Thou relationship; he understands it as existing only between

human beings. Binswangers aim throughout is to emphasize the

n o tio n o f se l f- re al iz at io n , ach ie ve d th ro u g h a lo vin g re lat io n -

sh ip w ith t h e oth e r. A s su ch , h e p ays l i t t le at te n tio n to B u b e rs

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concept of confirma tion, w hich includes opposing t he other t o helpthe other find his or her personal direction (Friedman, 1998).

Indeed, in contra st t o Buber a nd t he movement of dialogical psy-

chothera py, Bin sw a nger uses th e concept of I a nd Thou in the con-

text of a more genera l interpersona l or int ersubjective th eory of

h u m a n i n t er a c t i on (F r i e, 199 7), w h i ch a l w a y s i n cl u de s w h a t

Buber calls the I-It relation. Although Binswangers theory of love

ha s an obvious affinity w ith B ubers interhuma n dimension, his

a pproach is perha ps closer t o the perspective on t he self and oth er

developed in int erpersonal a nd r elational psychoana lysis.

B in swa n g e rs th e ory of se lf-re al izat ion is i tsel f in d eb te d to

Hegels dia lectic of recognit ion. In deed, B insw a nger (1942/1993a )

suggests that recognition, in Hegels sense, not only is very simi-

la r t o love, it is . . . a specia l form of love. In th is sense, wha t H egel

sa ys a bout th e unity of tw o self-consciousnesses, which cont inue to

exist ea ch for t hemselves, is definitive (p. 390). In H egels ma st er-

slave dialectic (1977), the need for recognition conflicts with the

need for a bsolute independence. The na tur e of this t ension is pa ra -

doxical. Self-consciousness must not only win the recognition of

th e oth e r, b u t a lso a ck n owle d g e th e o th e r a s e xist in g for h im se lf

or herself. Thus, for Hegel, ea ch self-consciousness mus t exist for

i t s e lf a n d f or t h e ot h e r , w i t h t h e r e s u lt t h a t b ot h s e lf -

consciousnesses recognize themselves a s mut ua lly recognizing one

an o th e r.

Re lat ion al th e orists h a ve re ce n tly ta k en u p a n d e xp an d e d on

the H egelian dia lectic to expla in the na tur e of an a lytic interaction(B e n ja m i n , 1 98 8; M od e ll , 1 99 3). I n a n a n a l og ou s f a s h i o n ,

B inswa nger seeks to demonstra te tha t th e idea of mutua l recogni-

tion is implicit to the I-Thou relation. He argues that within the

we-dimension of love, each part ner ha s t he need to recognize the

other as both distinct from, and similar to, himself or herself. The

significance of this model for understanding the process of self-

rea lizat ion is ela borat ed by J essica Benja min (1988), w ho suggest s

tha t the need for recognition gives rise t o a contr a diction:

recognition is tha t response from the other wh ich makes mean ingfulthe feelings, intentions, and actions of the self. I t al lows that self torealizeits agency and authorship in a tangibleway. Bu t such recog-nition can only come from an other wh om we, in turn , recognize as aperson in his or her own r ight. (p. 12)




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I n o th e r wo rd s, re co g n it io n m u st always b e acco m p an ie d b ya cknow ledgment of difference. As B insw a nger (1942/1993a ) puts

it, t he para dox betw een t he relat ive recognition of the singular

a nd par ticular, a nd the moment of existence a s we . . . implies tha t

th e being of love, th e loving being-w ith -one-a nother, is t horoughly

dia lectica l (p. 459). Only th us can th e we become a ba sis for the

a chievement of self-rea liza tion. It is th is we tha t ma kes possible

mys elf and y ourself in th e sense of loving self hood a nd a utonomy

(p. 116).

I t is im p orta n t to n o te th a t in B in swa n g ers con cep tion o f th e

I-Thou or interpersona l love rela tion, t he other person is n ot sim-ply a mean s to an end, but a part ic ipant in the process of self-real-iza tion. When th e oth er person is described simply a s a n object for

self-reflection or a s t he mea ns t o self-discovery, t he rela tionship is

drained of attachment, intimacy, and engagement. When applied

to th e t h e rap eu tic re lat ion sh ip, th is in sig h t su g g e sts th a t th e ra-

pist and patient meet face-to-face and come to know each other as

tw o intera cting huma n beings. I f this is not t he ca se, then the self ,

though placed in a context of a relationship, is defined only in

te rm s o f se p aratio n . I n d e e d , wh e re as classical p sych o an alysis

str esses sepa ra tion and a utonomy from the other, the empha sis in

the existentia l-interpersona l a pproach I a m outlining is on deep-

ening our underst a nding of our cont inuing relat ionship to others.

B i n s w a n g e r w r o t e r e la t i ve ly l it t l e a b ou t a c t u a l t h e r a pe ut i c

technique. However, he published n umerous st udies of his w ork

wit h schizophrenics (1957a ) tha t demonstra te the wa y in which heintera cted with his pa tients. The best known of Binsw a ngers stud-

ies is undoubt edly Th eCaseof El len West(B insw a nger, 1958). H ow-ever, because B inswa nger uses th e case to exemplify the descrip-

t i v e a n d e xp la n a t or y p ot e n t ia l of D a s ei n sa n a l y si s, i t u n for t u -

n at e ly fa i ls to sh e d l igh t on h is a ctu al a p pro ach t o wo rkin g with

pat ients (Ch ernin, 1981; La ing, 1982).

Binswangers case studies stem primarily from the 1920s and

1930s, when schizophrenics were often seen simply as medical

objects t o be observed and t reat ed in wha tever wa y possible. Un like

many of his contemporaries, Binswanger viewed his schizophrenic

p atie n ts as se n tie n t h u m an b e in g s wh o h ad lo st th e ir se n se o f

re lat e d n ess. L ik e S u ll ivan , wh o is s im ilarly k n own for h is w ork

wit h schizophrenics, Binsw a nger usually beca me well a cquaint edwit h his pat ients. As B inswa nger (1955) sta tes, it is of the essence

of being a psychiatrist, therefore, that he (or she) reach beyond all

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factua l knowledge and the a bilities tha t go wit h it , and t ha t he (orshe) reach beyond scientific knowledge found in the fields of psy-

chology, psychopathology, and psychotherapy. For Binswanger,

psychotherapy is properly to be understood not as a curative tech-

nique, but a s a type of friendship. To this end, he writ es tha t w ha t

is crucial in working with a patient is the relationship itselfa

relation based equally in care and love (p. 277).

We can in fe r , th e re fo re , th at B in swan g e rs e m p h asis o n th e

I-Thou relat ion wa s genera ted not only by his rejection of th e tra di-

tional psychiatrist-patient relationship, but also by the classical

p sych oan a lytic re lat ion sh ip. Wh e reas classical an a lysts at te m p t

to re m ain n e u tral an d th e re fo re can b e d istan t , e xiste n tial an a-

lysts te n d to in te ract w ith th e ir p atie n ts an d e n g ag e th e m to th e

b e st o f th e ir ab i l i ty . S e e n fro m th is p e rsp e ctive , B in swan g e rs

a pproa ch to the thera peutic encounter ha s intriguing similar ities

to the work of recent interpersona l and r elational t heory. In w ha t

follows, I will sketch the wa ys in w hich I think B inswa ngers con-

cep t of in te rpe rson al love a n d se lf-re al iz at ion tra n slate s in to a

th era peutic cont ext. I do th is in the belief th a t th e best compliment

we can p ay a th in k er is t o expan d on h is o r h e r id e as to d e m on -

str a te th eir continued relevance.

The mut ua lity a nd directness of t he I-Thou relat ion described

b y B in swan g e r is se e n as cru cial to th e th e rap e u tic p ro ce ss b y

m a n y re ce n t th e orists . Th u s, fo r e xa m p le, th e B ri t ish o bje ct

relat ionist, Ha rry G untr ip, a rgues that t he vehicle for substa ntive

ch an g e is a n u rtu rin g r e lat ion sh ip b etw e en th e p sych oth e rap ista n d p a t i en t t h a t i s b ot h h i gh l y p e r son a l a n d i n t er p er s on a l .

G untr ip (1969) sta tes th a t

P sychotherapy can only be carried on by those who are prepared tobe exposed to all the subtle rea ctions tha t go on betw een two huma nbeings w ho meet on a n emot iona l ra t her t ha n on a n int ellect ua lplane; and w ho are prepared to accept aw ar eness of these reactionsas essential to trea tment . . . . Wha t is thera peutic wh en it is achievedis the moment of real meeting of two persons as a new t ra nsform-ing experience for one of them, wh ich is as Rona ld La ing sa id, Notw ha t ha ppened before (i. e. t ra ns ference) but w ha t ha s never ha p-pened before (i.e. a new experience of relationship). (p. 353)

Th e co n te m po rary in te rp erso n al th e orist , D a rle n e Eh r e n b erg(1992), refers to such m oments a s t he intima te edge of thera py.

S h e s t a t e s t h a t




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[thera peutic]w ork does not stop wh en conta ct is made or when ea chis t ruly t ouched in s ome profound w a y by t he ot her a nd by t heirintera ction; ra ther, it ta kes on new dimensions as th e affective com-plexity of wha t gets a ctivat ed in the moments of meeting can be clar-ified and explored in an endless progression. (p. 40)

As we h a ve se en from wh a t B in swa n g er h a s to say a b ou t t h e n a-

tu re of th e I-Thou rela tion, t he moment of face-to-fa ce meeting is

b ot h a n e nd i n i t s el f a n d w h a t en a b l es f u t ur e m e et i n gs t o t a k e

place with others outside of the therapeutic context. The moment

of face-to-face meeting a lso allows for a n ongoing intera ction be-

tw een the thera pist and pa tient, w hich generat es new experiences

of mutuality and self-awareness. And for Binswanger, expanded

aw ar e n ess a ch ie ved th ro u g h a n au t h e n tic, re cip rocal re lat ion iscrucial for self-realization. In this way, the I-Thou relation also

h e lp s u s to u n d ersta n d th a t g e n uin e th e rap eu tic wo rk alwa ys re -

quires th e active involvement of both part icipant s.

As B insw a nger points out, the a im in the I-Thou relat ionship is

not to dissolve th e sense of individua l self in its pa rt icipa nt s, but to

e n h a n ce i t t h r o ug h m u t u a l i n t er a c t i on . L i ke B u b e r (19 65),

B in swan g e r cau tio n s ag ain st th e n aive b e l ie f th at th e th e rap ist

can e ver b e e n tirely e qu al w ith th e p at ien t . F o r B in swa n g er, th e

goal of the thera peutic relat ionship is not to tr a nscend dista nce or

achieve fusion. Differences between the therapist and patient in

term s of th eir roles, functions, an d pow er must be responsibly hon-

ored. I ndeed, tw o-person int eraction is only possible if personal

bounda ries a re r espected a nd individual difference is r ecognized.As E hrenberg (1992) point s out, in effect, a n a uth entic encount er

can be facilita ted by a cknowledging the limits of w ha t ma y be pos-

sible a t an y g iven m om e n t, w h e re ig n orin g t h e se or p rete n d in g

these do not exist precludes a more genuine a nd penetra ting kind

of enga gement (p. 39). Of course, ma int a ining a n I-Thou dyna mic

between thera pist and pa tient w ill not alw a ys be possible or even

d e sirab le. Yet I am su g g estin g th a t b y r e m ain in g at t u n e d to th e

p atie n t w ith in th e t h e rap eu tic con te xt , th e t h e rap ist can h e lp to

g e n e r a t e a c o n s t r u c t i v e e n g a g e m e n t t h a t c a n , i n t u r n , l e a d t o

increa sed mutua lity an d a better understa nding of the dynam ics of

interaction.

B insw a ngers conception of the I-Thou relat ion a nd th era peutic

e ncou n t er t h u s r ef le ct s a g en er a l s h if t i n e m ph a s i s f r om t h eintra psychic to the interpersona l dimension. Indeed, from th is per-

spective, clinical phenomena can only be understood in the inter-

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p erson al con te xts in w h ich t h e y ta k e form . P at ien t an d th e rap isttogether form a n indissoluble dya d, and it is t his relationship tha t

becomes the doma in of th era peutic inqu iry. Thus, phenomena t ha t

ha ve been t he tr a ditional focus of psychotherapeutic investigat ion

a re not un derstood a s products of isola ted int ra psychic processes

but as having been formed in an interpersonal f ield of existence

(Atw ood & Stolorow , 1984). The role of th era py, in my view, is t o

reach a n understa nding of such phenomena a s they emerge in the

in te raction b e twe e n th e rap ist a n d p at ien t .

THE PRIMACY OF RELATEDNESS

Once the int erpersonal f ield becomes t he focus of t herapy, the

qu e stion of w h at h ap p en s to in tra p sych ic an d in d ivid ual e xp eri-

e n ce m a y fair ly b e ra ised . B in swan g e rs cri t iqu e of t h e F re u d ian

unconscious suggests t ha t intr a psychic experience must a lwa ys be

se en as se con d ary to t h e in te rp erson al f ield . An d alo n g sid e th e

sh if t f ro m an in trap sych ic to an in te rp e rso n al th e o ry o f h u m an

nature, Binswanger sees individual experience as subordinate to

relational experience.

Th u s, B in sw an g e r su g g e sts th a t in con tra st to th e fu l ln ess o f

being experienced in th e I-Thou rela tion, t he individua l self must

constitute a deficient mode of existence. To express the relation-

ship of love to individual existence, he quotes a phrase from the

yo un g He g el (1948): th e ra g in g o f love ag a in st in d ivid uali ty(p. 306). This reference to Hegel is sym ptoma tic of a cert a in a nt i-

individualistic tendency in Binsw a ngers work. A similar tendency

can be found in Sulliva ns w ork. Like Bins w a nger, Sulliva n (1950)

argues that the content of consciousness is always socially derived

and therefore gives rise to an illusory sense of self: no such thing

a s th e dura ble, unique, individua l personality is ever clea rly justi-

fied (p. 221). On a nother occa sion, Sulliva n (1953b)not es tha t t he

unique individuality of the other fellow need never concern us a s

scie n tists (p . 12) . F o r b o th th in k e rs, h u m an activi ty an d th e

h u m an m in d d o n ot re sid e in th e in d ivid ual , b u t ar e con tin u ally

generated within the interpersonal f ield. Human nature, then, is

only comprehensible within the complex interactive process in

w hich it is sha ped. P sychothera py itself is conceived of as a form on

intera ction, in which the therapist is a pa rticipant observer a nd

t h e t h e r a p e u t i c m a t r i x p r o v i d e s a w a y t o u n d e r s t a n d h o w t h e




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patients personality is shaped. In other words, because the indi-vidual is in continua l intera ction w ith other people, the personal-

ity does not reside specifica lly inside the individual but a ppears

in interactions with others.

This perspective on individual experience a lso ha s importa nt

implications for B inswa nger and S ulliva ns understa nding of men-

ta l health . To expla in a nd elaborat e the myria d experiences of the

self, B inswa nger (1942/1993a ) uses a scale on wh ich he dist in-

guishes between t he I-Thou relat ion on one end, a nd individua l-

ized existence wit hout rela tedn ess to someone or someth ing on th e

other end. Huma n na ture, according to Binsw a nger, finds its high-

est fulfillment in the I-Thou relation. The opposite of an I-Thou

m o m e n t can b e u n d e rsto o d as th e fro z e n iso lat io n o f sch iz o id

d e tach m en t or a p sych otic d e lu sion . I n th e p rocess, h owe ve r,

B inswa nger and Sullivan both tend to neglect the w a y in wh ich our

individuality identit ies constitute a centr a l featur e of our sense of

self. And although Binswanger allows for the possibility of achiev-

ing happiness through self-reflection or introverted creativity, he

n e verth e less see s su ch e xp erien ces as se con d ary to th e sh are d

moments of an I-Thou relationship.

B inswa ngers discussion of an utt erly individualized existence

is replete w ith meta phor. H e describes the experience in w hich I

e xist with o u t re lat io n to so m e o n e o r so m e th in g e lse as n ak e d

horr or (1942/1993a, p. 402). It is a st a te in w hich I a m a bsolut ely

helpless; I ca nnot be helped, nor can I help myself. In na ked horror,

existence loses even a sense of self hood. The self is not simplybeside itself, as it is in th e ra ges of pa ssion, alt hough intense pas-

sion can t hreat en existence. Instead, a ccording to B inswa nge, the

experience of naked horror leads almost inevitably to suicide.

Binswanger also relates his discussion of individualized exis-

tence t o t he experience of severe loneliness, w hich is sometimes

chara cterized by a sta te of utt er hopelessness. As Frieda F romm-

Reichman (1990) states in her essay on loneliness, I think that

B in sw an g e r h as com e n e are st to a p h ilosop h ical a n d p sych iat ric

definition of loneliness when he speaks of it as naked existence,

mere existence, and naked horror, and when he characterizes

lonely people as bein g devoid of a ny in ter est in a ny g oal (p. 318).

This t ype of loneliness is not merely phy sical but emotional. I t r en-

ders people w ho suffer from it emotionally pa ra lyzed a nd helpless,because it carries the threat of being entirely incommunicable. As

S u ll ivan (1953b ) sta te s, a b je ct lon e lin e ss is th e e xce ed in g ly

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unpleas a nt a nd driving experience connected with a n inadequa tedischarge of the need for human intimacy, for interpersonal inti-

macy (p. 290).

I n d e ed , B in swa n g er se es t h e loss o f re lat e d n ess a s ce n tral to

mental disorders. In regard to the experience of manic-depressive

disorder, Binswanger (1992) states that manic existence swings

up to dizzy heights in w hich no sta nd is ta ken and no self-sufficient

d e cision is p o ssib le. L ove a n d fr ien d sh ip h a ve , in th e se a iry

heights, lost their power. Human interaction is reduced tothe level

of psychiatric care (pp. 245-246). Binswanger develops a similar

a rgument in his explora tion of schizoid a nd schizophrenic stat es.

He a rgues th a t schizoid or schizophrenic existence is only possible

wh ere Da sein is despa iringly exiled from t he home and eterna l-

n e ss o f love a n d fr ien d sh ip . . . w h e re i t h a s isolate d i tse lf f ro m

i n t e r a c t i o n o r t r a f f i c w i t h o t h e r s , a n d f r o m t h e c h a l l e n g e a n d

understa nding t ha t is only possible from such continued int erac-

tion. For Binswanger, the descent into madness is characterized

by the concomitant experience of essential isolation: Dasein is

withdrawn into mere interaction or traffic with itself alone, until

even this peters out an d becomes a sheer Medusa -like st a re, a psy-

chotically rigidified problem, a n idea l, or t he nothin gness of anxi-

et y (pp. 246-247).

In the development of psychotic states, contact with others thus

becomes meaningless, determined by neither desire nor will. The

loss of relat edness described by B inswa nger is a lso closely a ssoci-

a ted w ith J a cques La cans (1977) conception of th e Real, in wh ichpsychotic experience is characterized by the loss of meaningful

speech. Like Laca n, w ho suggests tha t t he psychotic still resides

wit hin lan guage even if the a bility t o communica te is tempora rily

lost, Binsw a nger ma inta ins tha t the psychotic continues to exist as

b ein g -in -th e -wo rld , h owe ve r d e lu sion a l ly d istorte d th a t wo rld

may be (Frie, 1998; 1999b). In a similar sense, Sullivan (1953a)

con sid ers t h e loss o f re lat e d n ess th at , a s h e sa ys, a ctu al ly m e n -

aces ones survival the core of psychotic symptom formation. For

B inswa nger and Sullivan alike, the psychotic is a ble to return from

a sta te of delusion only through t he repair of his or her rela tions

wit h other people a nd t he world.

O n t h i s b a s i s , t h e n , B i n s w a n g e r s h o w s u s t h e w a y i n w h i c h

relat edness is crucial to human existence a nd to menta l health. Hesu g g e sts th at th e p sych iatrist o r p sych o th e rap ist is n o t s im p ly

tre at in g a p atie n t b u t sh arin g in th e e xiste n ce of a p erson . On ly




21/23

th us is it possible for psychothera py to provide th e pat ient wit h theopport unit y t o experience the dua lity of existence. The dua l expe-

rience of th era py works to ena ble th e pat ient to actua lize his or her

own existence within the context of a loving I-Thou relationship.

This is a lso the point a t w hich the perspectives of B inswa nger a nd

Sullivan a re most similar. B oth see psychothera py as a process of

expa nding int erpersonal relat ionships. The t herapeutic relat ion-

ship ca n help th e pat ient to esta blish an d experience a form of int i-

m acy with an o th e r p e rso n . I t is th ro u g h su ch in tim acy th at o n e

becomes sensitive to t he needs, possibilities, an d limita tions th a t

ch ara cte riz e in te rp erso n al e xiste n ce . B in swa n g e r t h u s m o ve s

beyond Freuds understa nding of love t o include a conception of

personal gr owth a nd self-realiza tion, achieved t hrough increased

in tim acy a n d re lat e d n ess to o th e rs.

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Reprint requests: Roger Frie, 1530 16th St., NW, # 402, Washington, DC 20036;

e-ma il: r [email protected].

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