The Subject of Madness in L. Binswanger's Existential Psychoanalysis

Tsvetkova Ol'ga Alekseevna ORCID: 0000-0003-4683-3705 Lecturer, Department of Fundamentals of Clinical Psychoanalysis, VO "Moscow Institute of Psychoanalysis"; Postgraduate student, Department of the History of Anthropological Doctrines, Institute of Philosophy RAS 109240, Russia, Moscow, Goncharnaya str., 12 tsvetkovaolgaal@gmail.com

Currently, the development of the concepts of transhumanism raises the acute question of whether a person can exist, or whether something else will replace him. This problem is relevant not only in philosophical discourse, but also in clinical. The definition of norm and pathology, the ethical framework of human impact, and, ultimately, the goals and strategies of patient treatment in psychiatry and psychotherapy depend on how a person is defined. History knows examples of abuse of psychiatric power. The tendency to reduce a person from a subject to an object, and further to a partial object, causes existential anxiety. We see that in some areas of modern psychoanalysis subjectivity is reduced to social agency, intersubjective interaction to interpersonal communication, and so on. This simplification of the understanding of man is the result of the application of scientific-objectivist research methods to the study of man, which discard everything that cannot be empirically proven.

At the beginning of the twentieth century . tendencies of objectification of a person suffering from mental illness prevailed in psychiatry. Against this background, psychoanalysis is developing as a method that opens the way to the study of subjective experience.

Freud strictly adhered to the naturalistic approach, but he did not always meet with agreement among his colleagues. For example, the Swiss psychiatrist Ludwig Binswanger, who is the first to begin using psychoanalysis in a psychiatric clinic, based on the experience of working with patients, comes to the conclusion that naturalistic ideas about a person, in particular about his psyche and the form of mental illness, are not sufficient either to understand the symptoms or to provide proper psychotherapeutic influence.

Treatment, according to Binswanger, is possible when the psychiatrist and the patient form a common space of We, which is affected by both subjects, at the same time changing under the influence of this space. We see the development of similar ideas in modern psychoanalysis, for example, in field theory, relational and intersubjective psychoanalysis. A comparative analysis of these directions shows that they are based on a different definition of the subject of psychoanalysis. In this regard, different accents are placed in the analytical process.

Freud's naturalistic view formed the basis of the postulate that instincts prevail over the subject. Binswanger complements these premises with the ontological foundations of human existence. He asserts that man is not only Homo Natura, but the "lumen of being", Dasein. He develops psychoanalytic theory in the context of Husserl's phenomenology and Heidegger's ontology. Ultimately, according to Binswanger, insanity is not organic in nature, but is a way of being in the world. The formation of the We-space, in turn, is possible only with the intentional orientation of the subject to the realization of the ontological a priori to We-being.

Psychoanalysis has never been an exclusively clinical method of research. The concepts of psychoanalysis have always come from psychology as a branch of medicine and moved into the field of philosophical and sociological sciences. This is what makes it so important to formulate the definition of the subject of psychoanalysis, in other words, whether a person is limited by his biological nature, or is an entity capable of transcendence not only in his own being, but also in being together.

Before the XIX century . psychology existed in line with philosophy and did not stand out as a separate discipline. Sigmund Freud made a significant contribution to this division, especially due to his commitment to scientific methodology, which in the future will become one of the main points of disagreement between psychoanalysis and phenomenological philosophy. "Freud was still struggling to stay within the framework of the ontology of the XIX century. Formally, he succeeded, but only at first. Already his second and third theories of the mental apparatus – the hypothesis about the instances of the Ego, Id and Super-Ego and the postulation, along with the instinct of life, of the death drive – completely destroyed the ideas of everyday psychology" ^{[1, p. 527.]}.

Freud's task was to introduce into clinical psychiatry a method of investigating the unconscious, which remained outside of scientific discourse. Freud's psychoanalytic concepts were criticized by the psychiatric community and this created an additional need to remain within the medical approach. He succeeded by formulating a new method of treating mental illness.

The doctrine of psychoanalysis was understood by Freud as a superstructure, which eventually had an organic structure as its basis. He described this in detail in the metapsychological theory, based on which the course and meaning of human life are based on bodily processes.

Freud became a prominent representative of scientism, in his theory the mind turned into a thing, an encapsulated object containing consciousness and the unconscious. In an effort to conform to scientific principles, he was again criticized, now by philosophers.

According to Heidegger, Freud's approach ignored the ontological characteristics of what it means to be human, that is, Freud simply did not see the "enlightenment". Z. Freud uncritically accepted the fundamental premises of the metaphysical, epistemological tradition from which psychoanalysis arose – Cartesianism and Kantianism ^[2]. The end result was that Freud excluded being.

Although Z. Freud was convinced that his metapsychology could serve as a basis for philosophical thought (as well as for all humanitarian studies), Martin Heidegger was shocked by the use of scientism as a means to understand the meaning of human existence. M. Heidegger insisted that it is philosophy that underlies our understanding of any being in general.

Heidegger considered Freud's separation of consciousness and the unconscious to be "fatal". In the spirit of scientific thinking, Freud postulated a "complete explanation of mental life" (psychoanalytic medical history), that is, the continuity of causal relationships in mental life. Since there are gaps in consciousness, Freud considered it necessary to use the unconscious as a basic construct to explain continuity ^[3].

Despite M. Heidegger's criticism of Z. Freud's psychoanalysis, mainly for scientism, ignoring the ontological foundations of human existence and the division of being-in-the-world (Dasein) into the psyche, the body and the outside world, it was Heidegger's hermeneutical phenomenological ontology that served as the main impetus for the interaction of phenomenology with psychoanalysis. Further establishment of complementary links between the worldviews of Freud and Heidegger, in particular in the interpretation of L. Binswanger, allows for a more complete understanding of man as a whole ^{[4, p. 131]}.

The assumption that unconscious processes are simply physiological is understandable from the point of view of psychology of the XIX century, when it was proposed by Franz Brentano or William James. The objectivist concept of reality has been uncritically accepted by academic psychology for almost 100 years. Objectivism has become a dogma, a tyrannically imposed method of human research ^[5].

In the XX century . The objectivist method has borne great fruit in the natural sciences, but its application to the humanities is based on the epistemological position that nothing immeasurable exists, including in human research. The exclusion of the subject from psychology and objectification in culture as a whole have intensified reductionism, as a result of which psychopathologists are often content to characterize psychotic experience as a disturbed function of attention, perception and cognition or as a disorder of the sense of time.

Applying objectivism in the study of man, the nature of human existence is lost. American psychoanalyst Frank Summers argues that it is possible to know a person only by the method opposite to objectification, which allows us to study his way of existence in the world. And it cannot be done from afar, it can be understood only through the knowledge of his own idea of his existence and relationships ^[5].

The true understanding of a person cannot be measured by objectivist methods. There can be no consciousness without the world, and there is no awareness of the world without consciousness, as F. Summers asserts. They are given together. In any experience, the world is endowed with meaning. Being a subject means giving meaning to the world. To be human means to relate to the world, to live in it, and not just occupy space, as a material object does. As M. Heidegger showed, human existence is never an object. Instead, "Da" in Dasein means the ability to open up to what is given ^[6].

Subjective reason can be understood not only by describing general mechanisms, but also by understanding its individual and irreducible aspects. Robert van Gulik writes: "Phenomenal experience is not just a sequence of qualitatively isolated sensory ideas, but rather an organized cognitive experience of the world of objects and ourselves as subjects in this world" ^{[7, p. 91]}. Understanding and other related types of emerging mental states and processes are often burdened with a distinct phenomenal character that is not sensory and inherently includes the intentional content of what is understood.

The primacy of experience in knowing the Other is the approach to understanding a person, which follows from the philosophy of M. Heidegger. The attempt to formulate the inexpressible and the analyst's awareness of the patient's own experience constitute a way of attitude that cannot be measured by any objectivist methods. "Reflecting on the ontological nature of human existence, the way to study the human being is to immerse yourself in the being that you hope to know, which is the complete opposite of objectification. Understanding involves people in how they live in the world, their ways of being in this world. And it is impossible to study it from afar; it can be understood only by entering into their ways of existence and relationships. Isn't this an appropriate description of modern psychoanalysis?" ^{[5, p. 40]}. The clinical practice of psychoanalysis eventually came to formulate a special worldview based on the belief that human experience cannot be understood in objective terms.

At the end of the XIX century, extensive criticism of positivism unfolded. At the same time, the problem of schizophrenia becomes a central issue of psychiatry. To understand the pathological world of the mentally ill, Ludwig Binswanger turns to psychoanalysis, but not finding it sufficient, complements the method with the ideas of M. Heidegger's ontology and E. Husserl's phenomenology ^{[8; 9]}. This is how he formulates the method of existential analysis, and insanity becomes the subject of research not only in psychoanalysis, but also in phenomenological psychiatry and philosophical anthropology.

L. Binswanger values psychoanalysis precisely for trying to penetrate into the inner world of the patient, to establish an understanding of his subjective meanings and values ^[10]. On the other hand, he criticizes Freud for his reductionism and attempt to describe art and morality – the creations of the human spirit, in terms of the influence of instincts. Criticism of Freud's natural-scientific naturalistic approach to understanding man is presented in Binswanger's article "Freud and his concept of man in the light of anthropology" ^[11].

Freudian psychoanalysis considered man as a set of individual instincts and mechanisms and ignored the problem of the self as a whole. He could not solve the most important human problem – the problem of self-determination. The main theme that L. Binswanger found in all his clinical cases is the fanatical, desperate desire of patients to achieve some one ideal or life goal. It was in relation to this ideal that they felt inadequate, were subjected to accusations and contempt from others and themselves, it was this ideal that caused their being the greatest suffering.

Binswanger considered science to be the same mode of existence as art and religion, and therefore unable to give a holistic view of man. Scientific constructions are not able to describe an individual's experience, which must be expressed in his own language, in the language of his personal meanings ^[12]. The world of a person, including the world of a mentally ill person, is set by his mood, it can be comprehended through understanding the anxieties and emotions inherent in this person. He considers the world of a madman as meaningful as the world of any other person, he just has different meanings, he has his own reality, just like everyone else. He denies the existence of a single reality for all, unlike psychoanalysis and psychiatry.

In the initial presentation of the existential point of view, L. Binswanger considered it necessary to develop anthropology, which he declared a prerequisite for humanistic psychology. In one of his articles about Z. Freud, he stated that the natural–scientific approach to man, embodied by Freud, an approach that considered man only from the point of view of mechanism and organism, will never be able to explain why a person takes on the divine mission of productive work in search of scientific truth, why he turns this mission into meaning its existence.

L. Binswanger made one of the first attempts at a systematic conceptual analysis of psychoanalytic theory. He formulated the structure of psychoanalytic theory, consisting of three levels – personalistic, mechanical and biological. It is the first level that distinguishes it from contemporary clinical psychiatry and academic psychology ^[13].

The key to L. Binswanger's approach was a new interpretation of the main psychoanalytic themes in what could be called deep anthropology ^[14]. All biological terms have been replaced by identity terms.

But Binswanger did not ignore the psychological and interpersonal dimensions of the patient's world in favor of philosophical abstractions. Rather, he was trying to show that his anthropological categories were the deeper meaning of these mental conflicts and relationships. The feeling of finiteness and the patient's need for security were embodied and reinforced by his parental environment, his dependent relationships, contradictory identifications and punitive conscience, manic triumph was a fantasy escape from the inability to achieve self-integration through any relationship ^[15].

Binswanger writes about the existing opposition of natural science and phenomenology, the main difference of which is that natural science is related to really existing things or processes of nature, and phenomenology, on the other hand, to phenomena, types or forms of consciousness that do not belong to nature, but have a being that can be comprehended "in direct vision". The subject grasps the act of external perception not in external perception, but in internal – in internal feeling, internal experience or introspection. The influence of S.L. Frank's intuitionism is especially noticeable here ^[16].

The naturalist considers the act of external perception as a natural process, as a real phenomenon, a real function in the mental organism. Phenomenology, although in itself a scientific doctrine, returns to a very simple contemplation of phenomena, teaches us to accept only what was actually seen, and to beware of mixing what was seen with any theory, no matter how well it was substantiated.

Psychopathology and phenomenology, as Binswanger believed, need each other for a more holistic understanding of mental processes. Psychopathology is based primarily on the perception of others, the perception of Another or someone else's Self, much less often one's own ^[17]. The object of research should be grasped not by an inner feeling or introspection, but by a way of perception. But, according to Scheler, the perception of others is also a kind of "internal" sensory perception, with the help of which the subject directly grasps the events of someone else's soul. The basic concepts of phenomenology are necessary in order to be able to capture the essence of a person and fix it phenomenologically.

The essence of the phenomenological consideration of psychopathological phenomena is that they are never considered as isolated phenomena, but always occurring against the background of human existence, that is, as an expression or manifestation of a person. In a particular phenomenon, a person gives information about himself, and vice versa, a person can be seen through the phenomenon.

The natural science approach integrates external perception into the processes of sensations, associations and memories that are derived from it, and brings them into connection with psychological, neurophysiological and other theories. The phenomenological approach divides perception into the characteristics of the relationship between the perceiving subject and the perceived, which is given to internal perception and can be found with an in-depth study of oneself.

L. Binswanger believed that it was impossible to understand anything about insanity, treating the mentally ill as not involved, that is, as an external object ^[18]. The inevitable basis of psychiatry is Dasein.

As long as psychiatry has not realized that its true basis is human existence as being-in-the-world, as Binswanger believed, it will have to remain a conglomerate of heterogeneous scientific concepts of understanding and methods that arose exclusively from the scientific paradigm.

The true meeting of the therapist and the patient will consist in the therapist's ability to open up to the patient's world. In order for the patient to regain the ability to be himself, to be able to open up to his existence, he needs to show that he is still closed in his world ^[19]. However, unlike Freud's psychoanalytic methods, the psychotherapist will not explain the patient's life story in accordance with any teachings and categories, and in general will not clothe it in theoretical terms, such as the principle of pleasure or reality, Ego, Id and Super-Ego, sexual and aggressive drives, rather he classifies the story the patient's life from the point of view of its existential structures and will explore the history of structural changes. This means that the psychotherapist acts as an active participant on the stage of the world of the mentally ill, his language and his symbolism, in order to gradually return them to the language and the world of natural experience. Thus, Dasein analysis will be psychotherapeutically effective only to the extent that this meeting is also possible on the part of the patient ^[20].

Heidegger's turn in Binswanger's work dates back to the 1930s, but since the 1910s he has been criticizing the anatomopathological approach of contemporary psychiatrists (E. Kraepelin, K. Wernicke), suggesting a neurological description of psychiatric diseases. That is why he was forced to turn to psychology in search of a "scientific method" to investigate the subjective nature of mental facts.

At the same time, the criticism of Z. Freud's psychoanalysis by academic psychiatry was based precisely on the accusation of the lack of "scientific". In response to this, L. Binswanger sought to give psychiatric knowledge a new kind of scientific character, which would differ from the natural science paradigm and epistemological structure characteristic of medical psychiatry of the early XX century. First of all, Binswanger's existential approach sought to clarify the nature and status of schizophrenia. Nevertheless, the criticism of L. Binswanger's existential psychoanalysis lies in the insufficient effectiveness of the treatment method, as well as in the accusation of the Swiss psychiatrist in the reformulation of psychoanalysis into the language of phenomenology.

L. Binswanger's appeal to phenomenology is often associated with his commitment to anti-naturalism. However, in addition to his intention to abandon the exclusively physiological understanding of insanity inherent in the psychiatric movement of his time, he needed to create an epistemological system capable of producing an anthropological turn in psychiatry ^[21], which consists in rejecting the perception of pathological experience as abnormal, and understanding it through the prism of the phenomenological concept of Dasein – as another way of structuring human existence.

The concept of Binswanger's world project assumes that a person is capable of transcendence and it can be conscious, meaningful and strong-willed. When a person begins to consider his own behavior as a product of the disease, it contradicts the preservation of the understanding of himself as a morally competent person who remains responsible for himself and his actions. The assumption that a person is mentally ill and that his behavior sometimes results from his illness does not give decisive grounds for perceiving himself simply as a patient, and not as a person who preserves his dignity in the face of the law and his own life.

At the same time, by rejecting the biological dimension of being, a person loses his corporeality. The human is indeed irreducible exclusively to it, but it is also impossible without it. Man is always being-in-the-world. Being outside the world, as well as being outside the corporeality, is impossible.

Binswanger's line of phenomenological anthropology finds development in phenomenological psychiatry and existential psychoanalysis, however, in the general flow of modern psychoanalytic research, it has a critically small share.

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