The Enigma “Ellen West”<br />
The Enigma “Ellen West”<br />Ludwig Binswanger’sfoundation case of existential analysis<br />
The Enigma “Ellen West”<br />Ludwig Binswanger’sfoundation case of existential analysis<br />“A mirror of twentieth-centur...
Vincenzo Di Nicola<br />Doctoral candidate <br />EuropäischeUniversitätfürInterdisziplinäreStudien<br />(European Universi...
Europe –Switzerland<br />
Die Schweiz – Switzerland<br />
Kanton Wallis – Canton du Valais<br />
Les langues de la Confédération suisse<br />
SwissPhilosophers<br />Jean-Jacques Rousseau<br />Richard Avenarius<br />Jean Piaget<br />Ludwig Binswanger<br />
SwissScientists<br />Paracelsus<br />Albert Einstein<br />Wolfgang Pauli<br />Paul Dirac<br />Albert Hofmann<br />
Psychiatres, psychologues et psychanalystes suisses<br />Henri Ellenberger<br />Jean Piaget<br />BärbelInhelder<br />Elisa...
The Case “Ellen West”<br />Ludwig Binswanger’sfoundation case of existential analysis<br />
“Ellen West” <br />(1888-1921) <br />
Ludwig Binswanger<br />(1881-1966)<br />
Der Fall Ellen Westby Ludwig Binswanger<br />1944-45: Der Fall Ellen West. Schweizer Archivfür Neurologie und Psychologie,...
Der Fall Ellen West résumé en français<br />Storch, Alfred (1958). « À propos de Schizophrénie de Ludwig Binswanger. » L’É...
Ellen West: childhood, youth<br />Born in 1888 into a Jewishfamily, Ellen arrives in Europe at the age of 10<br />As a chi...
Ellen West: attachments<br />Ellen falls in love numerous times<br />Forbiddeneach time by her parents who oblige her to b...
Ellen West: embodiment<br />Around the age of 20 Ellen begins to beafraid to gain weight<br />Sheexperiencesstrongcravings...
Ellen West: embodiment (ii)<br />She has a miscarriagefollowing a vigoroushikeduringwhichshe has a haemorrhage<br />She su...
Ellen West: psychiatriccareer<br />At31, after 3 years of marriage, nowamenorrheic, havingendedsexual relations for 2 year...
Ellen West: subjective experiences<br />Ellen almostconstantlyexperiences a pervasivedreadwhichisat once generalized and c...
Ellen West:  subjective experiences (ii)<br />Ellen lives a dichotomy: a split betweentheethereal world and thetomb-world(...
Ellen West: explication philosophique<br />« Tout le mouvement de son existence s’épuise dans la peur phobique d’une chute...
Ellen West: philosophical explication<br />« Tout le mouvement de son existence s’épuise dans la peur phobique d’une chute...
Michel Foucault<br />(1926-1984)<br />
Ellen West: philosophicalexplication (ii)<br />«  La mort, elle l’éprouve déjà là, inscrite dans ce corps qui vieillit et ...
Simone Weil<br />(1909-1943)<br />
Ellen West: “enforcedseparations”<br />Ellenexperienced a quite impressive list of “enforcedseparations” (RD Laing):<br />...
“Ellen West”<br />
“Ellen West”<br />
Kreuzlingen – Canton du Thurgovie<br />
Das Sanatorium Bellevue 1857-1980 - Kreuzlingen<br />
Famous Patients ofThe Bellevue Sanatorium<br />“Anna O” Bertha Pappenheim (1859-1936): <br />July-October1882 <br />Aby Wa...
Anno O Bertha Pappenheim (1859-1936)<br />
Anna O’sPhysicians<br />Dr Josef Breuer<br />Dr Sigmund Freud<br />
Aby Warburg<br />(1866-1929)<br />
The Constructions “ Ellen West”<br />“A Mirror of Twentieth-CenturyPsychiatry”<br />
Edmund Husserl<br />(1859-1938)<br />
Martin Heidedgger<br />(1889-1976)<br />
Être et Temps/ Being and Time (1927) <br />Emmanuel Lévinas :<br />« Heidegger est pour moi le plus grand philosophe du si...
Emmanuel Lévinas<br />(1906-1995)<br />
Hannah Arendt<br />(1906-1975)<br />
Giorgio Agamben<br />(Born 1943)<br />
Emil Kraepelin<br />(1856-1926)<br />
Eugen Bleuler<br />(1857-1939)<br />
Viktor Emil von Gebsattel<br />(1883-1976)<br /><ul><li>TheodorLipps (Munich)
Max Scheler (Munich)
Wilhelm Dilthey (Berlin)
Emil Kraepelin (Munich)</li></ul>1stPsychoanalysis of Ellen West:<br />February – August 1920<br />
Hans von Hattingberg<br />(1879-1944 )<br />Vienna<br />Munich<br />2ndPsychoanalysis of Ellen West:<br />1920 -  January ...
R.D. Laing<br />(1927–1989)<br />
Jean-Paul Sartre<br />(1905-1980)<br />
Salvador Minuchin<br />(Born 1921)<br />
MaraSelviniPalazzoli<br />(1916-1999)<br />
Karl Jaspers<br />(1883-1969)<br />
Freud<br />Psychotherapy<br />Psychoanalysis<br />Biology/clinicalpsychiatry<br />“Body”<br />Binswanger<br />Existential ...
Existential Psychiatry<br />Eugène Minkowski (1885-1972)<br />« Je donne une œuvre subjective ici, œuvre cependant qui ten...
Existential Psychiatry<br />Binswanger<br />RD Laing<br />Binswanger’saccountis not about the person of Ellen but rather“o...
Evolution of Psychiatry<br />ClinicalPsychiatry  – 					Mental illness+ biology<br />DynamicPsychiatry – 				Psychoanalysi...
Evolution of CriticalPsychiatry<br />Systems<br />Gregory Bateson<br />RD Laing<br />Whitaker/Andolfi<br />Minuchin<br />S...
Evolution of CriticalPsychiatry<br />Feminism<br />MaraSelviniPalazzoli<br />Susie Orbach<br />Kim Chernin<br />Julie Kris...
Ellen West: interventions<br />Internalmedicine<br />Psychiatrists – 	“psychoanalysts” <br />Psychiatric consultations<br ...
Ellen West: diagnoses<br />Duringhertreatment<br />Readings of the case<br />Melancholia(Kraepelin)<br />Hysteria(vonGebsa...
Ellen West: diagnoses<br />Duringhertreatment<br />Readings of the case<br />Melancholia(Kraepelin)<br />Hysteria(vonGebsa...
The Gestalt“Ellen West”<br />Psychiatricphenomenology<br />Existential<br />Relational<br />Sociocultural<br />Phobia/obse...
Pierre Janet<br />(1859-1947)<br />
Janet’s Case of Nadia<br />Chapter:« L’obsession de la honte du corps »The obsession withbodilyshame<br />Young woman of 2...
“Ellen West”<br />Binswangerdiscusses the question of embodiment in psychosis<br />Dressedexclusively in pants until the a...
TheSchizophrenias<br />Kraepelin<br />Dementia praecox oderGruppederSchizophrenien(1911)<br />Dementia Praecox or The Grou...
WhoKilled“Ellen West”?<br />A Philosophical-Psychiatric Investigation<br />
TheDeath of “Ellen West”<br />I becamefascinated by the question of responsability.<br />Whocausedherdeath, directly or in...
Aftertwo suicide attempts by Ellen West, begins a series of consultations with the founders of modern psychiatry: Emil Kra...
Their opinions notwithstanding, Ellen’smelancholy and her suicide attemptspersist, accompanied by seriouseatingproblems. <...
After 3 dayswithherfamily, Ellen appearstransformed: she has breakfast, atnoonsheeatswell for the first time in 13 years, ...
Binswangerreassures the reader not lessthan 17 times thather suicide is“authentic.”<br />Laing concludes his reading with ...
The Death of “Ellen West”<br />Asuicide? - authentic?<br />An assisted suicide?<br />A psychic-ontological homicide?<br />
The Deathof “Ellen West”<br />« An authenticsuicide » <br />according toBinswanger(1944-45)<br />Binswanger, Ludwig (1944-...
The Death of “Ellen West”<br />« An assisted suicide » <br />according toAkavia (2008)<br />Akavia, Naamah (2008). « Writi...
The Death of “Ellen West”<br />« A psychic homicide » <br />according toLester (1971)<br />Lester, David (1971). « Ellen W...
The Death of “Ellen West”<br />An assisted suicide<br />The authenticity of whichisprecisely question <br />A psychic homi...
The Death of “Ellen West”<br />A psychic homicide, an ontological annihilation<br />Binswangererrswith the diagnosis of sc...
The Doctor-Patient Relationship<br />Von Gebsattel<br />Littleknown in the English or French literature<br />He speaks to ...
Alfred Erich Hoche<br />(1865-1943)<br />
Karl Binding<br />(1841-1920)<br />
« VernichtunglebensunwertenLebens »<br />The Permission to Annihilate <br />Life Unworthy of Life:<br />Its Measure and It...
Medscape 2010 PhysicianEthics Survey<br />“Palliative care is one thing, but suicide is not within the scope of acceptable...
Medicine and the GermanJews<br />There are verydeephistorical and socioculturaltiesbetweenGermans, Jews, and medicinesince...
Ellen West : victim of herself, of life, of assisted suicide?<br />How could a sophisticated and brilliant man likeBinswan...
Reflections<br />In spite of the efforts of manygreatthinkers of the 20th century – fromKraepelin, BleulerandBinswanger to...
Reflections<br />« Ellen West »is a mirror of 20th centurypsychiatry but the issues and the riskswefindthere are stillpres...
Reflections<br />Is contemporarypsychiatry more in the spirit of Kraepelin who inspires the thinkingbehind the DSM and evi...
Reflections<br />So thatourhumanencounters in the clinical do not become or stayenigmatic (seevonGebsattel, Sartre, Foucau...
Réflexions<br />« On ne peut comprendre les troubles psychiques du dehors » mais par « un effort constant pour saisir la s...
Reflections<br />“One cannotunderstandpsychologicaldistubancesfrom the outside, on the basis of a positivisticdeterminism,...
Alain Badiou<br />(né 1937)<br />Pour guérir quelle blessure, pour ôter quelle écharde dans la chair de l’existence suis-j...
Alain Badiou<br />“What wound was I seeking to heal, what thorn was I seeking to draw from the flesh of existence when I b...
Ludwig Wittgenstein <br />(1889-1951)<br />The philosopher’streatment of a question islike the treatment of an illness.– §...
Bibliography<br />Agamben, Giorgio (2008). Signaturarerum. Sur la méthode (trad. de Joël Gayraud). Paris : Vrin. <br />Aka...
Binswanger, Ludwig (1944-45). « Der Fall Ellen West. » Schweizer Archivfür Neurologie und Psychologie, 1944, 53 : 255-277,...
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The Enigma Ellen West - McGill University - 15.12.10

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The case of "Ellen West," reported by Ludwig Binswanger as the foundational case of "Daseinanalyse" or existential analysis, is revisited and shown to be a mirror of 20th century psychiatry’s core dilemmas

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The Enigma Ellen West - McGill University - 15.12.10

  1. 1.
  2. 2.
  3. 3. The Enigma “Ellen West”<br />
  4. 4. The Enigma “Ellen West”<br />Ludwig Binswanger’sfoundation case of existential analysis<br />
  5. 5. The Enigma “Ellen West”<br />Ludwig Binswanger’sfoundation case of existential analysis<br />“A mirror of twentieth-centurypsychiatry”<br />
  6. 6. Vincenzo Di Nicola<br />Doctoral candidate <br />EuropäischeUniversitätfürInterdisziplinäreStudien<br />(European University for Interdisciplinary Studies)<br />Saas-Fee, Wallis, Schweiz<br />
  7. 7. Europe –Switzerland<br />
  8. 8. Die Schweiz – Switzerland<br />
  9. 9. Kanton Wallis – Canton du Valais<br />
  10. 10.
  11. 11.
  12. 12. Les langues de la Confédération suisse<br />
  13. 13. SwissPhilosophers<br />Jean-Jacques Rousseau<br />Richard Avenarius<br />Jean Piaget<br />Ludwig Binswanger<br />
  14. 14. SwissScientists<br />Paracelsus<br />Albert Einstein<br />Wolfgang Pauli<br />Paul Dirac<br />Albert Hofmann<br />
  15. 15. Psychiatres, psychologues et psychanalystes suisses<br />Henri Ellenberger<br />Jean Piaget<br />BärbelInhelder<br />Elisabeth Kübler-Ross<br />Alice Miller<br />Carlo Strenger<br />Auguste Forel<br />Hermann Rorschach<br />Carl Gustav Jung<br />Oskar Pfister<br />Eugen Bleuler<br />Ludwig Binswanger<br />
  16. 16. The Case “Ellen West”<br />Ludwig Binswanger’sfoundation case of existential analysis<br />
  17. 17.
  18. 18. “Ellen West” <br />(1888-1921) <br />
  19. 19. Ludwig Binswanger<br />(1881-1966)<br />
  20. 20.
  21. 21.
  22. 22. Der Fall Ellen Westby Ludwig Binswanger<br />1944-45: Der Fall Ellen West. Schweizer Archivfür Neurologie und Psychologie, 1944, 53: 255-277, 54: 69-117; 1945, 55: 16-40.<br />1957: Schizophrenie. Pfullingen: Neske.<br />1958: The Case of Ellen West: An Anthropological-ClinicalStudy  (trans. by Werner M. Mendel & Joseph Lyons, pp. 237-364), in Existence: A New Dimension in Psychiatry and Psychology (ed. Rollo May, Ernest Angel & Henri F. Ellenberger). New York: Basic Books.<br />
  23. 23. Der Fall Ellen West résumé en français<br />Storch, Alfred (1958). « À propos de Schizophrénie de Ludwig Binswanger. » L’Évolution Psychiatrique, 3 : 577-602.<br />Ellenberger, Henri F. (1974/2001). À la découverte de l'inconscient, Paris : SIMEP. Réédité sous le titre Histoire de l'inconscient, Paris : Fayard.<br />Postel, Jacques (1993/2003). Dictionnaire de psychiatrie et de psychopathologie clinique. Paris : Larousse. <br />
  24. 24. Ellen West: childhood, youth<br />Born in 1888 into a Jewishfamily, Ellen arrives in Europe at the age of 10<br />As a child, she expresses hercharacterearly: stubborn, mischievous, disobedient<br />Also: a good student, lively, ambitious, sheappliesherselfintenselyintoeverythingsheundertakes<br />Intelligent and sensitive, shetakes the matura and then passes the exams to become a teacherwhichallowsher to enter university<br />Ellen reads a great deal – notably R.M. Rilke and J.W. von Goethe<br />Afterthesereadings, shebecomes an atheist and adopts a rebellious attitude towards bourgeois life<br />
  25. 25. Ellen West: attachments<br />Ellen falls in love numerous times<br />Forbiddeneach time by her parents who oblige her to break up her engagements<br />At the age of 28, withher parents’ permission at last, she marries a cousin<br />
  26. 26. Ellen West: embodiment<br />Around the age of 20 Ellen begins to beafraid to gain weight<br />Sheexperiencesstrongcravings for food, accompanied by the fear of getting fat<br />All of whichbringsher to feeldepressed<br />Ellen’s solution: taking laxatives to staythin, up to 60 packets a day<br />
  27. 27. Ellen West: embodiment (ii)<br />She has a miscarriagefollowing a vigoroushikeduringwhichshe has a haemorrhage<br />She suspends taking laxatives as shewants a baby<br />Her intense desire to loseweightreturns: Ellen refuses to eatnormally and startstaking laxatives again<br />Hermenstrualperiodsdisappear, yetsheismotivated to staythinwhichattenuateshersadness/depression<br />At the age of 30, shebecomes a vegetarian<br />
  28. 28. Ellen West: psychiatriccareer<br />At31, after 3 years of marriage, nowamenorrheic, havingendedsexual relations for 2 years, Ellen decides to sharehersufferingwithherhusband<br />In thisperiod, shemakes 8 suicidal“gestures”<br />Ellen encountersmedicalspecialists, visits Sanatoria, beginspsychoanalysis and meets the psychiatricelite of the time: Eugen Bleuler, Emil Kraepelin and Ludwig Binswanger …<br />The psychiatrists are not in agreement about the diagnosis<br />
  29. 29. Ellen West: subjective experiences<br />Ellen almostconstantlyexperiences a pervasivedreadwhichisat once generalized and connected to weight gain<br />Sheexhibits an obsession withthinness and a fear of gainingweight<br />Shefeels an “emptiness,” an “existential anxiety”<br />
  30. 30. Ellen West: subjective experiences (ii)<br />Ellen lives a dichotomy: a split betweentheethereal world and thetomb-world(according to Binswanger)<br />The spiritual versus the physicaltranslated/experienced by Ellen as the ideal of the soul (pure and empty) versus the fear of herownembodiment (the heaviness/gravity of feeling full, pregnant, a bourgeoise)<br />
  31. 31. Ellen West: explication philosophique<br />« Tout le mouvement de son existence s’épuise dans la peur phobique d’une chute dans la tombe, et dans le désir délirant qui planerait dans l’éther et cueillerait sa jouissance dans l’immobilité du mouvement pur. Mais ce que désignent cette orientation et la polarité affective qu’elle implique, c’est la forme même selon laquelle se temporalise l’existence. L’avenir n’est pas assumé par la malade comme dévoilement de sa plénitude et anticipation de la mort. La mort, elle l’éprouve déjà là, inscrite dans ce corps qui vieillit et que chaque jour alourdit d’un poids nouveau ; la mort n’est pour elle que le pesanteur actuelle de la chair, elle ne fait qu’une seule et même chose avec la présence de son corps. » <br />—Michel Foucault (1954). « Introduction ». Le rève et l’existence, L. Binswanger<br />
  32. 32. Ellen West: philosophical explication<br />« Tout le mouvement de son existence s’épuise dans la peur phobique d’une chute dans la tombe, et dans le désir délirant qui planerait dans l’éther et cueillerait sa jouissance dans l’immobilité du mouvement pur. Mais ce que désignent cette orientation et la polarité affective qu’elle implique, c’est la forme même selon laquelle se temporalise l’existence. L’avenir n’est pas assumé par la malade comme dévoilement de sa plénitude et anticipation de la mort. La mort, elle l’éprouve déjà là, inscrite dans ce corps qui vieillit et que chaque jour alourdit d’un poids nouveau ; la mort n’est pour elle que le pesanteur actuelle de la chair, elle ne fait qu’une seule et même chose avec la présence de son corps. » <br />—Michel Foucault (1954). « Introduction ». Le rève et l’existence, L. Binswanger<br />
  33. 33. Michel Foucault<br />(1926-1984)<br />
  34. 34. Ellen West: philosophicalexplication (ii)<br />«  La mort, elle l’éprouve déjà là, inscrite dans ce corps qui vieillit et que chaque jour alourdit d’un poids nouveau ; la mort n’est pour elle que le pesanteur actuelle de la chair, elle ne fait qu’une seule et même chose avec la présence de son corps. » —Michel Foucault (1954)<br />See: Simone Weil (1947), La Pesanteur et la grâce/Gravity and Grace<br />Wassheanorexic? Simone Weil isconsideredanorexic in the eatingdisorders and feministliterature<br />
  35. 35. Simone Weil<br />(1909-1943)<br />
  36. 36. Ellen West: “enforcedseparations”<br />Ellenexperienced a quite impressive list of “enforcedseparations” (RD Laing):<br />Herfatherorderedher to break her first engagement.<br />Her second engagement was“temporarilydiscontinued”at the instigation of herfather and mother.<br />Her first analysisisterminated for “externalreasons.”<br />Her second analystorderedherhusband to leaveher.<br />A psychiatristorderedher to end her second analysis.<br />
  37. 37.
  38. 38. “Ellen West”<br />
  39. 39. “Ellen West”<br />
  40. 40. Kreuzlingen – Canton du Thurgovie<br />
  41. 41. Das Sanatorium Bellevue 1857-1980 - Kreuzlingen<br />
  42. 42. Famous Patients ofThe Bellevue Sanatorium<br />“Anna O” Bertha Pappenheim (1859-1936): <br />July-October1882 <br />Aby Warburg (1866-1929): <br />1921-24<br />“Ellen West” (1888-1921): <br />January-March1921<br />
  43. 43. Anno O Bertha Pappenheim (1859-1936)<br />
  44. 44. Anna O’sPhysicians<br />Dr Josef Breuer<br />Dr Sigmund Freud<br />
  45. 45. Aby Warburg<br />(1866-1929)<br />
  46. 46. The Constructions “ Ellen West”<br />“A Mirror of Twentieth-CenturyPsychiatry”<br />
  47. 47.
  48. 48. Edmund Husserl<br />(1859-1938)<br />
  49. 49. Martin Heidedgger<br />(1889-1976)<br />
  50. 50. Être et Temps/ Being and Time (1927) <br />Emmanuel Lévinas :<br />« Heidegger est pour moi le plus grand philosophe du siècle, peut-êtrel’un des trèsgrands du millénaire ; mais je suistrèspeiné de cela, parceque je ne peuxjamaisoubliercequ’ilétait en 1933, mêmes’il ne l’étaitque pendant unecourtepériode. Cequej’admiredans son œuvrec’estSein und Zeit. C’est un sommet de la phénoménologie. Les analyses sontgéniales …. Rassurez-vous : je ne suis pas ridicule, je ne sauraisméconnaître la grandeur spéculative de Heidegger. » <br />
  51. 51. Emmanuel Lévinas<br />(1906-1995)<br />
  52. 52. Hannah Arendt<br />(1906-1975)<br />
  53. 53. Giorgio Agamben<br />(Born 1943)<br />
  54. 54. Emil Kraepelin<br />(1856-1926)<br />
  55. 55. Eugen Bleuler<br />(1857-1939)<br />
  56. 56. Viktor Emil von Gebsattel<br />(1883-1976)<br /><ul><li>TheodorLipps (Munich)
  57. 57. Max Scheler (Munich)
  58. 58. Wilhelm Dilthey (Berlin)
  59. 59. Emil Kraepelin (Munich)</li></ul>1stPsychoanalysis of Ellen West:<br />February – August 1920<br />
  60. 60. Hans von Hattingberg<br />(1879-1944 )<br />Vienna<br />Munich<br />2ndPsychoanalysis of Ellen West:<br />1920 - January 1921<br />
  61. 61. R.D. Laing<br />(1927–1989)<br />
  62. 62. Jean-Paul Sartre<br />(1905-1980)<br />
  63. 63. Salvador Minuchin<br />(Born 1921)<br />
  64. 64. MaraSelviniPalazzoli<br />(1916-1999)<br />
  65. 65. Karl Jaspers<br />(1883-1969)<br />
  66. 66. Freud<br />Psychotherapy<br />Psychoanalysis<br />Biology/clinicalpsychiatry<br />“Body”<br />Binswanger<br />Existential analysis<br />Phenomenology/clinicalpsychiatry<br />“Existence”<br />Bühler, Karl-Ernst (2004). Existential analysis and psychoanalysis: Specificdifferences and personalrelationshipbetween Ludwig Binswanger and Sigmund Freud. American Journal of Psychotherapy,58 (1): 34–50.<br />
  67. 67. Existential Psychiatry<br />Eugène Minkowski (1885-1972)<br />« Je donne une œuvre subjective ici, œuvre cependant qui tend de toutes ses forces vers l'objectivité. »<br />I amoffering a subjective workhere, whichaimsneverthelesstowardobjectivitywith all its force. <br />FoundedL’Évolution psychiatrique<br />
  68. 68. Existential Psychiatry<br />Binswanger<br />RD Laing<br />Binswanger’saccountis not about the person of Ellen but rather“of the existential Gestalt to whichwe have given the name of Ellen West” based on documents written by Ellen and her husband<br />Hismethodis to lay out beforehim all of the life-history of Ellen in as muchdetail as possible, leaving out as far as possible all moral, aesthetic, social, medical or anykind of judgements, free of all pre-judgements.<br />He will direct his gaze at the finishedform of her existence in the world, dissecting a deadbutterfly of hisfancy, not depicting the pathetic life of a defeatedperson.<br />… exactly“becausehedid not know herpersonally” the “conditions wereparticularlyfavourable to an existential analysis”<br />“No need to pass time in the presence of a personwhosepresence in the world issototallyunfortunate and miserable.<br />“The existential Gestaltthatis Ellen Westisunable to ‘relate.’ Hisstudy exemplifies exactlywhatheattacks.”<br />
  69. 69. Evolution of Psychiatry<br />ClinicalPsychiatry – Mental illness+ biology<br />DynamicPsychiatry – Psychoanalysis + clinicalpsychiatry<br />Existential Psychiatry – Psychoanalysis + phenomenology + clinicalpsychiatry<br />CriticalPsychiatry – Psychiatry + or psychiatry –<br />
  70. 70. Evolution of CriticalPsychiatry<br />Systems<br />Gregory Bateson<br />RD Laing<br />Whitaker/Andolfi<br />Minuchin<br />SelviniPalazzoli<br />Culture<br />Frantz Fanon<br />Wittkower, Murphy, Prince<br />Arthur Kleinman<br />Georges Devereux/Tobie Nathan<br />
  71. 71. Evolution of CriticalPsychiatry<br />Feminism<br />MaraSelviniPalazzoli<br />Susie Orbach<br />Kim Chernin<br />Julie Kristeva<br />Luce Irigary<br />Politics<br />Frantz Fanon<br />Gilles Deleuze/Félix Guattari<br />Franco Basaglia<br />RD Laing/David Cooper<br />Thomas Szasz<br />
  72. 72. Ellen West: interventions<br />Internalmedicine<br />Psychiatrists – “psychoanalysts” <br />Psychiatric consultations<br />Hospitalization<br />Interventions<br />Medical care, management<br />vonGebsattel, vonHattingberg<br />Kraepelin, Hoche, Bleuler, Binswanger<br />Bellevue Sanatorium<br />Closed unit vs discharge, assisted suicide, existential analysispost hoc<br />
  73. 73. Ellen West: diagnoses<br />Duringhertreatment<br />Readings of the case<br />Melancholia(Kraepelin)<br />Hysteria(vonGebsattel)<br />Obsessionalneurosiswithmanic-depressive oscillations (vonHattingberg)<br />Psychasthenia(Hoche)<br />Schizophrenia Simplex (Bleuler, Binswanger)<br />Anorexie hystérique (Charles Lasègue)<br />Anoressia mentale (MaraSelviniPalazzoli)<br />Folie hystérique (Jean- Claude Maleval)<br />Anorectic(Salvador Minuchin)<br />Bulimiawithobsessive-compulsivephenomenology, dysphoriaassociatedwith borderline personalitydisorder(NassirGhaemi)<br />Anorexia, melancolia, neurosenarcísica (ManoelBerlinck& Ana CecíliaMagtaz)<br />Insécurité ontologique, honte du corps (Jean-Claude Marceau)<br />
  74. 74. Ellen West: diagnoses<br />Duringhertreatment<br />Readings of the case<br />Melancholia(Kraepelin)<br />Hysteria(vonGebsattel)<br />Obsessionalneurosiswithmanic-depressive oscillations (vonHattingberg)<br />Psychasthenia(Hoche)<br />Schizophrenia Simplex (Bleuler, Binswanger)<br />Thesolepsychiatristwhoresisted to diagnosisher?<br />R.D. Laing, The Voice of Experience (1982)<br />He concentrateshis critique rather on Binswanger’smethod<br />Hisstudy of Ellen West contributed to distancinghimselffromtraditionalpsychiatry, from the diagnostic perspective and from the concept of simple schizophrenia<br />
  75. 75. The Gestalt“Ellen West”<br />Psychiatricphenomenology<br />Existential<br />Relational<br />Sociocultural<br />Phobia/obsession/delusion?<br />Emptiness, ontologicalinsecurity<br />All relationships/Rxinterrupted<br />A woman in a traditional/patriarchalfamily/society<br />A Jewish patient in an antisemiticsociety<br />
  76. 76. Pierre Janet<br />(1859-1947)<br />
  77. 77. Janet’s Case of Nadia<br />Chapter:« L’obsession de la honte du corps »The obsession withbodilyshame<br />Young woman of 27 yearswhoadopted a bizarre eating pattern for fear of gainingweight (twosoups, an eggyolk, a spoon of vinager and a cup of strongteawithlemonjuice)<br />Shealternatedbetweenbulimic crises and hours of rumination on food and eating as torture<br />Dx:“anorexie hystérique” – hysterical anorexia<br />Janet, Pierre (1903). Les obsessions et la psychasthénie. Paris : Alcan.<br />
  78. 78. “Ellen West”<br />Binswangerdiscusses the question of embodiment in psychosis<br />Dressedexclusively in pants until the age of 16 years<br />Deathis for herisjust the heaviness of herflesh, Ellen speaks of the ethereal world<br />“Nadia”<br />Cited by Binswanger<br />Seeks to hidehersex/gender by dressing like a man; shewouldreallylike to bewithoutanysex, withoutany body<br />Beyondbeingthin, Nadia wishes to no longer be in her body and speaks of the existence of an angel<br />
  79. 79. TheSchizophrenias<br />Kraepelin<br />Dementia praecox oderGruppederSchizophrenien(1911)<br />Dementia Praecox or The Group of Schizophrenias<br />Bleuler introduces the new termschizophrenias for dementiapraecox<br />Klinische Psychiatrie (1899)<br />ClinialPsychiatry<br />Kraepelin proposes the dichotomybetweendementiapraecox etmanic-depressiveillness<br />Bleuler<br />
  80. 80. WhoKilled“Ellen West”?<br />A Philosophical-Psychiatric Investigation<br />
  81. 81. TheDeath of “Ellen West”<br />I becamefascinated by the question of responsability.<br />Whocausedherdeath, directly or indirectly?<br />—Salvador Minuchin (1984)<br />
  82. 82. Aftertwo suicide attempts by Ellen West, begins a series of consultations with the founders of modern psychiatry: Emil Kraepelin (1856-1926), architect of today’spsychiatricnosology, diagnoses melancholiafinds a simple psychasthenia. <br />Alone in perceivingwhat the Gestalt revealsisBinswanger, confirmed by the authority of Eugen Bleuler (1857-1939)whonamed the emblematic condition of psychiatry: SchizophreniaSimplex(simple schizophrenia), a progressive schizophrenicpsychosis<br />
  83. 83. Their opinions notwithstanding, Ellen’smelancholy and her suicide attemptspersist, accompanied by seriouseatingproblems. <br />Convinced of the grave and incurable diagnosis, withouthope, all therapiesinterrupted, suspended or withdrawn, Binswangeraccedes to the patient’srequest: Ellen isdischargedfrom the Sanatorium.<br />
  84. 84. After 3 dayswithherfamily, Ellen appearstransformed: she has breakfast, atnoonsheeatswell for the first time in 13 years, during the afternoonshegoes for a walkwithherhusband, readspoems and writesletters. <br />All the heavinessisliftedfromherbeing. <br />That night, shetakes poison.<br />The nextday, at the age of 33 years, Ellen West isdead.<br />
  85. 85. Binswangerreassures the reader not lessthan 17 times thather suicide is“authentic.”<br />Laing concludes his reading with bitter irony: Poor little rich girl.<br />
  86. 86. The Death of “Ellen West”<br />Asuicide? - authentic?<br />An assisted suicide?<br />A psychic-ontological homicide?<br />
  87. 87. The Deathof “Ellen West”<br />« An authenticsuicide » <br />according toBinswanger(1944-45)<br />Binswanger, Ludwig (1944-45). « Der Fall Ellen West. » Schweizer Archivfür Neurologie und Psychologie, 1944, 53 : 255-277, 54 : 69-117; 1945, 55 : 16-40.<br />
  88. 88. The Death of “Ellen West”<br />« An assisted suicide » <br />according toAkavia (2008)<br />Akavia, Naamah (2008). « Writing “The Case of Ellen West” : ClinicalKnowledge and HistoricalRepresentation. » Science in Context, 21 : 119-144.<br />
  89. 89. The Death of “Ellen West”<br />« A psychic homicide » <br />according toLester (1971)<br />Lester, David (1971). « Ellen West’s suicide as a case of psychic homicide. » PsychoanalyticReview, 58 : 251-263.<br />
  90. 90. The Death of “Ellen West”<br />An assisted suicide<br />The authenticity of whichisprecisely question <br />A psychic homicide in which suicide as a solution wasinducedfrom the outside<br />An ontological annihilation by the family, herhusband et herphysicianssuppported by the psychiatrist Alfred Hoche and hisjustfication to “annihilate life unworthy of life”<br />
  91. 91. The Death of “Ellen West”<br />A psychic homicide, an ontological annihilation<br />Binswangererrswith the diagnosis of schizophrenia, heconsults Alfred Hoche, a psychiatristknown for histextwith the jurist Karl Bindingjustifying suicide and euthanasie for “life unworthy of life”<br />He takes away her hope for living and collaborates with her husband to induce her suicide<br />After—more than 20 years later, he reconstructs The Case Ellen West to justify himself: he tries to convince us that his distance helps him to understand and insists 17 times in the text that the suicide was authentic<br />
  92. 92. The Doctor-Patient Relationship<br />Von Gebsattel<br />Littleknown in the English or French literature<br />He speaks to the doctor-patientrelationship<br />He insists on the presence of the person in boththe patient and the doctor to resist the dehumanization of medicine (what Foucault will call desubjectivation)<br />Welie, Jos VM (1995). Viktor Emil vonGebsattel on the Doctor-Patient Relationship. TheoreticalMedicine, 16: 41-72.<br />
  93. 93. Alfred Erich Hoche<br />(1865-1943)<br />
  94. 94. Karl Binding<br />(1841-1920)<br />
  95. 95. « VernichtunglebensunwertenLebens »<br />The Permission to Annihilate <br />Life Unworthy of Life:<br />Its Measure and Its Form<br />By Professors <br />Karl Binding, JD, PhD et Alfred Hoche, MD<br />(1920)<br />
  96. 96. Medscape 2010 PhysicianEthics Survey<br />“Palliative care is one thing, but suicide is not within the scope of acceptable physicianbehavior.”<br />“I do not believe in assisted suicide, but I do believe in withdrawal of support. If the patient isterminallyill and suffering and thereisabsolutely no hope to survive, then I withdraw the support (eg, antibiotictreatment, bloodtesting, or transfusions).”<br />“Assisted suicide ismurder.”<br />
  97. 97. Medicine and the GermanJews<br />There are verydeephistorical and socioculturaltiesbetweenGermans, Jews, and medicinesince the Middle Ages<br />In the evolution of Germanmedicine, a language of the degenerating body and the metaphor of regenerationwaselaborated and inscribedintotheories and practices, to whichJewishphysiciansthemselvesadhered and withwhichtheydescribedthemselves<br />The Jewish body wasperceived as sick and diseased, the sign of a national disease due to theirpowerlessness as a people with a country (adopted by the earlyZionists)<br />This perception—let’s call it an episteme or discoursefollowing Foucault—becomesdistorted and abused by the Nazis whospeakincessantly of racial purity and the degenerateJews<br />John M. Efron (2001). Medicine and the GermanJews: A History. New Haven : Yale UniversityPress.<br />
  98. 98. Ellen West : victim of herself, of life, of assisted suicide?<br />How could a sophisticated and brilliant man likeBinswanger,comingfrom a medical tradition of great distinction (practically noble) on severallevels—nationally (Switzerland), culturally (German) and in hisfamily, and havingJewishfriends, mentors and interlocutors (notably Freud) bringhimself to consult a man like Hoche as a consultant for a patient whowasJewish, suicidal and in despair due to the diagnosis of an incurable illness? <br />Wenow know that Ellen West and herhusbandcontestedthischoice of consultant and did not findhim acceptable knowingverywellhisreputationbased on hisideas about euthanasia and assisted suicide, whichacceleratedherdepartturefrom Bellevue Sanatorium<br />Hoche’s and Binding’stextwillbecome the inspiration and justification for the final solution of the Jewish question, thatis to say, the extermination of the Jews of Europe, declared by the Nazis at the WannseeConferencenear Berlin in 1942<br />
  99. 99. Reflections<br />In spite of the efforts of manygreatthinkers of the 20th century – fromKraepelin, BleulerandBinswanger to SelviniPalazzoli, LaingandMinuchininpsychiatry and Foucault en philosophy– « Ellen West »remains an enigma for us. <br />Whatremainspossible for us is to undertake a philosophicalarchaeologyto create new constructions of this case in order to integrate the phenomenological, systemic, sociocultural and ethical dimensions of her life. <br />
  100. 100. Reflections<br />« Ellen West »is a mirror of 20th centurypsychiatry but the issues and the riskswefindthere are stillpresent and salient<br />Whatis the central task of psychiatry: to comprehend, to classify or to cure?<br />Is it possible to accomplishit (or them) objectively and atwhatprice?<br />Whitherthensubjectivity?<br />
  101. 101. Reflections<br />Is contemporarypsychiatry more in the spirit of Kraepelin who inspires the thinkingbehind the DSM and evidence-basedmedicine or ratherthat of Bleuler, disciple of Freud, whoinspireddynamicpsychiatry?<br />Is it the critical and humanistic spirit of Laing whoinspired the family and communitypsychiatrymovement in Britain and beyond or that of Minuchinwhodeclaredthatfamilytherapywouldtake over psychiatry in the US?<br />
  102. 102. Reflections<br />So thatourhumanencounters in the clinical do not become or stayenigmatic (seevonGebsattel, Sartre, Foucault),we have the choice to practice our profession – thisimpossible profession according toFreud – in a waythatisalways more human and empathic. <br />
  103. 103. Réflexions<br />« On ne peut comprendre les troubles psychiques du dehors » mais par « un effort constant pour saisir la situation de base et pour la revivre », ce qui nous rapprochera au « temps où la psychiatrie sera, enfin, humaine.» —Jean-Paul Sartre à l’avant-propos de Raison et violence (Laing et Cooper, 1964)<br />
  104. 104. Reflections<br />“One cannotunderstandpsychologicaldistubancesfrom the outside, on the basis of a positivisticdeterminism, or reconstructthemwith a combination of concepts thatremainoutside the illness as lived and experienced … without a constant effort to grasp the basic situation and to reliveit, without an attempt to rediscover the response of the person to that situation …whichwillbringcloser the daythatpsychiatrywill, at last, become a trulyhumanpsychiatry.”<br />—Jean-Paul Sartre, Foreword, Reason and Violence (Laing & Cooper, 1964)<br />
  105. 105. Alain Badiou<br />(né 1937)<br />Pour guérir quelle blessure, pour ôter quelle écharde dans la chair de l’existence suis-je devenu ce qu’on appelle un philosophe? – Alain Badiou<br />Préface, Après la finitude de Quentin Meillassoux (Paris, Éditions du Seuil, 2006)<br />
  106. 106. Alain Badiou<br />“What wound was I seeking to heal, what thorn was I seeking to draw from the flesh of existence when I became what is called ‘a philosopher’?”<br />“It may be that, as Bergson maintained, a philosopher only ever develops one idea. In any case, there is no doubt that the philosopher is born of a single question, the question which arises at the intersection of thought and life at a given moment in the philosopher's youth; the question which one must at all costs find a way to answer.” <br />Preface, After Finitude, Quentin Meillassoux (Continuum, 2008)<br />
  107. 107. Ludwig Wittgenstein <br />(1889-1951)<br />The philosopher’streatment of a question islike the treatment of an illness.– §255 <br />Ludwig Wittgenstein, Philosophical Investigations (1953)<br />
  108. 108. Bibliography<br />Agamben, Giorgio (2008). Signaturarerum. Sur la méthode (trad. de Joël Gayraud). Paris : Vrin. <br />Akavia, Naamah (2008). « Writing “The Case of Ellen West” : ClinicalKnowledge and HistoricalRepresentation. » Science in Context, 21 : 119-144.  <br />Basaglia, Franco (1965). « Corps, regard et silence. L’énigme de la subjectivité en psychiatrie. » L’Évolution Psychiatrique, 1 : 11-26.<br />Berlinck, ManoelTosta & Magtaz, Ana Cecília (2008). « Reflexões sobre O caso de Ellen West : estudoanthropológico, de Binswanger. » RevistaLatinoamericana de PsicopatologiaFundamental, 11(2) : 232-238.<br />
  109. 109. Binswanger, Ludwig (1944-45). « Der Fall Ellen West. » Schweizer Archivfür Neurologie und Psychologie, 1944, 53 : 255-277, 54 : 69-117; 1945, 55 : 16-40.<br />Binswanger, Ludwig (1954/1955). Le Rêve et l’Existence, trad. de Jacqueline Verdeaux, introduction et notes de Michel Foucault. Paris, Desclée de Brouweret /Rééd. Aux Éditions de Minuit.<br />Binswanger, Ludwig (1957). Schizophrenie. Pfullingen : Neske. <br />Binswanger, Ludwig(1958). « The Case of Ellen West : An Anthropological-ClinicalStudy » (trad. de Werner M. Mendel & Joseph Lyons, p. 237-364), Existence : A New Dimension in Psychiatry and Psychology (éd. par Rollo May, Ernest Angel & Henri F. Ellenberger). New York : Basic. <br />
  110. 110. Foucault, Michel (1954). « Introduction et notes. » Le Rêve et l’Existence par Ludwig Binswanger (trad. de Jacqueline Verdeaux). Paris : Desclée de Brouweret.<br />Ghaemi, S. Nassir (2001). « Rediscovering existential psychotherapy : The contribution of Ludwig Binswanger. »American Journal of Psychotherapy55 (1) : 51–64.<br />Laing, Ronald (1986). La Voix de l’expérience. Paris : Éditions du Seuil. <br />Laing, Ronald D. et Cooper, David G. (1976). Raison et violence (avant-propos de Jean-Paul Sartre). Paris : Petite BibliothèquePayot.<br />
  111. 111. Lester, David (1971). « Ellen West’s suicide as a case of psychic homicide. » PsychoanalyticReview, 58 : 251-263.<br />Marceau, Jean-Claude (2002). « La question de la corporéité dans le cas Ellen West de L. Binswanger. » L’Évolution Psychiatrique, 67(2) : 367-378.<br />Minuchin, Salvador (1984). « The Triumph of Ellen West : An Ecological Perspective » (pp. 195-246), Kaleidoscope : Images of Violence and Healing. Cambridge, MA : Harvard UniversityPress.<br />SelviniPalazzoli, Mara (1982). L’anoressia mentale : Dalla terapiaindividuale alla terapiafamiliare.Nuovaedizioneinteramentariveduta. Milano : Feltrinelli Editore.<br />

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