Existentialism Meets Psychotherapy

8/2/2019 Existentialism Meets Psychotherapy

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International Phenomenological Society

Existentialism Meets PsychotherapyAuthor(s): Helm StierlinReviewed work(s):Source: Philosophy and Phenomenological Research, Vol. 24, No. 2 (Dec., 1963), pp. 215-239Published by: International Phenomenological SocietyStable URL: http://www.jstor.org/stable/2104462 .

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EXISTENTIALISMMEETS PSYCHOTHERAPYApproximately ince WorldWar I the ideas of existentialistwritershave influenced he theory andpracticeof psychotherapy. heir nfluencehas grownconstantly.With equal intensity hese ideaswere acceptedandrejectedby practicinganalystsand psychotherapistsere and abroad.Atthe sametime, these ideas changedwhile they were adapted o the needs

of psychotherapy.What is the actual contributionof existentialist hinking to psycho-therapy?With this question n mind I will, in the following,presentfirstan expositionof those existentialistdeas which, in my opinion,had thegreatest mpacton psychiatric hinking. will tryto showhow theseideaswere transformedwhile being adaptedto psychiatricneeds. I will then,second, attempta critiqueof these ideas as to their value in psychiatrictheory and practice. In order to sustainthis critique,I will introducesome insights which recentlyhave emergedfrom the study of schizo-phrenia the presently till mosttaxing andpuzzling herapeutic roblem.Whatis Man andwhat shouldMan be like?- Man,an animal,chainedto his perishableanimalnature, ts needs, enjoyments,ensions;but Man,also endowedwith imaginationand consciousness,drivinghim to findmeaning n his existenceand to perfecthimselfin the light of such self-found meaning?Can we, in answeringhis question,hope to know whatto aim for in psychotherapy?Will not this answersupply the guidingprinciplefor our workwith patients?

In a way, we raise this questionnot becausewe know too little, butbecausewe knowtoo much. Increasingly,we know of the man-madenessof our norms and institutions the family structure, eligiousbeliefs, themany intangibleaspects of a given culture- but we know also of thenorm-madeness f Man. Norms and institutions,we have learned,in afantasticallycomplexand variableinterplayof forces, shape our inner-most modes to feel, to express,to conceiverightand wrong.But normsand institutions,we also find, do change when our awarenessof theirrelativityand man-madenessmakes us challengethem. They lose theirunquestionedgrip on us and become eroded. The,matrixof this orien-* Assistance in preparingthis article for publication was given by the ChestnutLodge Research Institute under its grant from the Ford Foundation.

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216 PHILOSOPHYNDPHENOMENOLOGICALESEARCHtation to change is modern science. The sciences of comparative anthro-pology, sociology, child-psychology, the analytic study of ego functions,and especially of ego-development, all contribute from different angles toour knowledgeof the interplayof forces throughwhich Man'sexistenceis constantlythreatenedand precariouslymaintained.The modem ana-lytic scienceof Man, in otherwords,both revealsand accentuatesMan'sexistenceas an unstableequilibrium.Much the same can be said of existentialism.Existentialismalsodenotesa body of ideas aboutMan. These ideas, developedin the lastcenturyby writers uchas Kierkegaard, ietzsche,andDostoievski,n thiscenturywere revived,systematized,and furtherdevelopedby Heidegger,Jaspers,Camus,andothers(SeeBibliography). Althoughvarying reatlyin theirpointsof departure nd in theirmannerof elucidatingproblems,these writersemphasize he precariousness f Man'sexistencedue to theerosion of all traditional, outside-imposedvalues. But also, throughthoroughlyacingthe precariousness f humanexistence, hey point to anew dignity,a deepenedhumanity,whichmay result.The instabilityof humanexistence,in otherwords,as revealed n theever-questioning nd relativizingprocess of modernscience, is also thethemeof manyexistentialistwriters.But whilenaturalscience- and againI mean mainly the psychoanalytical tudy of Man - assesses this factrather ndirectly n conveying o us a sense of the open-endedness f allour endeavors,existentialistwritersoften do so relentlesslyand bluntly:"God is dead"(Nietzsche),"Beingis being toward death"(Heidegger),"Man on earthhas his existenceand nothingmore"(Camus).And fur-ther, while analytic scientistsoften expressthemselves n awkward ech-nical language,existentialistauthors,particularlyNietzsche,Dostoievski,Sartre, and Camus are-masters of style. Skillfully they use literarymedia such as the novel, the short essay, the aphorism,and the play,defyinga seeminglyclumsy scientificrespectability.Both the analyticscience of Man and the theories of Existentialism,we thus find, reflect as well as respondto the needs and mood of ourtime,to a sense of bewilderedprecariousness f our existence.Therefore,it is not surprising hat two ways of theorizingabout Man, originatingfrom seeminglydifferent raditionsof thinking the one, psychoanalysis,born out of the traditionof naturalscience,the other,existentialism, ornout of a mainly German philosophic tradition - succeeded in greatly in-fluencingand changing he climateof the Westernworld..Almost imperceptibly, he basic concepts of psychoanalysisas wellas those of existentialism(particularlyas representedby Heidegger),repeated,enlarged,popularized, ndsimplifiedover and over again,havebecome unquestionedreferencepoints and cliches for many a modemindividual'shinkingabout himselfand others- just as in anotherpartof


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EXISTENTIALISMEETSPSYCHOTHERAPY 217this world the basic concepts of Marxism have become unquestionedguide posts for self-understanding.'

It needed, however,time before the two bodies of theorycame face toface in the field of psychiatryand psychotherapy. or only recentlywerethe ideas and viewpointsof existentialism ppliedto illuminatepsychiatryand psychotherapy.This was done mainly by such psychiatricntermedi-aries as Binswanger,Boss, Straus,Rollo May, and others (See Bibliog-raphy I).Each in his individualmanner tried to make existentialistconcepts,mainlyderivedfrom Heidegger,psychiatrically alatable.As a result, the field of psychotherapyhas turnedinto an arena, inwhich these two differentbodies and traditionsof thinkingabout Manmeet andchallengeeach other. This meetingand challenging f ideas wewitness today.How does existentialismpresent itself in this arena?It presents itself,we notice at once, in many guises, such as Daseins-analysis,medicalanthropology,medical phenomenology, ogotherapy,and others. Oftenthese seem;bewilderingly t odds with each other. And are they, we mayask, genuine offshootsand variations, f existentialismand existentialisttherapy? do not know.Yet Heideggerand Jaspersthemselves, he twopersons who publiclyare-most strongly dentifiedwith existentialism,nolonger wantto be called existentialists.Heideggerconceivesof his philos-ophy as a fundamental ntology, Jasperssimplyrefersto his thinkingasphilosophy. Therefore, or lack of a bettername, I will keep the labelexistentialism.n the followingI will try to outline some of the featureswhich I considermost important.Although both Heideggerand Jaspers may be consideredoriginatorsof this existentialistrend in psychiatry,at presentHeidegger'snfluenceon psychiatric hinkingin Europe seems strongerthan that of Jaspers.This is somewhatpuzzling.For it is Jasperswho wastrainedas a psychi-atristbefore turning nto a professorof philosophy.And it is Jaspers,who, besides many minor psychiatric papers, wrote a comprehensivetextbook on psychiatry, his Allgemeine Psychopathologie. But Jaspers,paradoxically, used his psychiatric knowledge to prevent his "existential"insights from becoming influential in psychotherapy.Jaspers, n his psychiatricwritings,deniedthat psychotic,and particu-larly schizophrenicdevelopments,could be understood that they wereeinfiihlbar.He emphasized he gap betweenemotionalexperienceswhich

I One can draw further parallels. For example, just as Freud needed a Fenichelto demonstrate,in a systematized and relatively plausible manner, his wide clinicalapplicability to a wider audience, so Heidegger needed a Tillich to become morewidely known in this country. In each case the master found his characteristicemissaries, translators, and popularizers, not seldom in one and the same person.


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218 PHILOSOPHYNDPHENOMENOLOGICALESEARCHareaccessible o commonunderstanding nd psychoticexperienceswhichare not accessible.

But more importantly,he also denied the necessity of scientificallyinvestigating he nature of the interactionbetweendoctor and patient,neuroticor psychotic;or, in psychoanalytic erminology,of the existingtransference and countertransference elationship. Such examination,which is characteristic or psychoanalyticprocedure,would, he argued,destroy he qualityof trust andprivacy nherent n a correctdoctor-patientrelationshipsIn holdingthese two positions- that psychotic experiencesare inaccessible o commonunderstanding nd that the therapeutic nter-action must not be subjectedto scientific investigation Jaspers madecertain that his "existentialwritings"remainedwithoutdirect relevancefor psychiatry.3Thus, despite the central place of "communication"nhis generalphilosophizing, e greatly imited the possibilityof communi-cation with psychotic patients and hindered he study of communicationwhereit counts most in psychotherapy:n the relationshipbetweendoctorand patient.Not surprisingly, e becameprobably he strongest orce in denyingtoGermanpsychiatry he analyticand dynamicapproachdeveloped n thiscountry. Insteadof encouragingpsychiatrists o become participantob-servers,he furtherentrenched,as I described n anotheressay (35), theposition of the distant observer with its strong organic orientation.Heidegger,on the other hand, suffered no such handicap:not being apsychiatristby training,he had no opportunity o disqualifyhimself inthe field of psychotherapy s did Jaspers.But this does,not seem reasonenoughto explainhis great nfluence.How thencanHeidegger'snfluencebb explained?The reasons,undoubtedly,are many. But one, I believe,stands out. Heideggerseems to answerthe questionI raised in the be-ginning; namely, what is Man and what should he be like? And thisanswerseems to arise out of an intriguing irsthandgrasp of the phe-

2 Jasper's many bitter attacks on Freud are consistent with these positions.Jaspers thinks little of Freud's clinical contributions. He likes to compare Freudto Marx as a provider of an ideology with a wide appeal, and as the popularizerand simplifier of insights which were, however, more deeply grasped and moremovingly expressed by authors like Nietzsche and Kierkegaard.3 These comments do not do justice to the complexity of Jasper's psychiatricthinking, particularly to his ability, amply reflected in his Allgemeine Psychopa-thologie, to illuminate clinical phenomena and problems under many differentangles. However, one can identify certain central themes and positions which hada most characteristicand fateful impact on German academic psychiatry. Of these,the two mentioned above appear to me the most important. For a more extensivediscussion of Jaspers' psychiatric thinking, especially in regard to his stand onanalytic and dynamic theories see references (41, particularly pp. 296-300), (29)and (36), all in Bibliography II.


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EXISTENTIALISM MEETS PSYCHOTHERAPY 219nomena n question,out of a thinkingwhich in some ways appears o bemore immediate,more penetrating,and more revealingthan the moreconventionalormulations boutMan,be they donein a more philosophicor in a more scientificframework.This is not the place to give a detailedoutline and critiqueof Heideg-ger'sthinking See Bibliography ). The followingremarks,gearedto thesubjectof this study,must suffice.How did Heidegger,we may ask, arriveat his statementsaboutMan?The answer is - oversimplified - by a complex detour, an unrelentingpreoccupationwith Being, with that which is.However,Heideggeradmits, the questfor the truthof Being, for thatwhich underlies and determinesall there is, is the most difficult questpossible.For from whicheverangle we attempt this quest, we run intothe problemof speech and language.Language s the mediumthroughwhich Being revealsitself, but it is a medium throughwhich Being, inthe very momentof its revelation, s also distorted, imited,and obscured.To expressthis differently,any seeminglysuccessfulattemptto concep-tualize Being in languagehas already ost sight of the truth of Being. Ina way, much of Heidegger's hinking,including that in Sein und Zeit(19), is an ongoingcommenton this state of affairs,at the same time sopuzzling, rustrating, nd challenging.One can, I believe, differentiatethree aspects of this never-endingquest, all amply reflectedin Sein und Zeit. Firstly, Heideggerattackstradiational tatementsabout Being, about Man's nature, about humanvalues, etc., in the light of the fact that Being is both illuminatedandconcealedthrough language.Thus the Western philosophysince Plato,Heideggerconcludes,essentiallyhas obstructed he graspof the truthofBeing. This Westernphilosophy,according o Heidegger,becamefalselypreoccupiedwith Seiendem nsteadof with Sein, withless relevantaspectsof being instead of real being.4 Secondly, intertwinedwith this morenegative approach,Heideggeralmost constantly- appearingsometimespointed,sometimesodd - endeavors o think with and out of a languagethat is closer to Being than the more traditionaland conventional an-guage,including he traditionalanguageof philosophy.Hencehis preoc-cupationwith diggingup originalmeaningsand roots of words, mainlyGermanor Greek,whichhe then uses in an oftenstartlingmanner o coinor reintroduceuncommon ines of thought.Most well-knownand most

4At this point the almost unsurmountable difficulties in translating the twoGerman words Sein and Seiendes - so central in Heidegger's thinking - must betaken into account. Both words stand for "being" or "something existing." ButSein in Heidegger's terminology implies a genuine ontological dimension, Seiendesdoes not, or perhaps less so.


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220 PHILOSOPHY ND PHENOMENOLOGICALESEARCHcentral to his basic thesis - but also most disputed! - is his redefinitionand reconceptualization f truth as unconcealednessUnverborgenheit),a-leteia (aA7208ta), concept that seeminglydoes away with truth as arepresentationalelation and, as a consequence,also with the subject-object split as a precondition f humanunderstanding. hirdly- andthisis perhaps he most important spect- Heidegger'shinking s a prodding,relentless, argumentationn circles.This can hardly be otherwise.For this is very muchthe result of hishaving committedhimselfto an obviouslyunsolvable ask:makingBeingtransparent y reconciling he above-mentionedouble aspectof languageas both revealingand concealingBeing. Constant stimulationand frus-tration, in other words, appear built into this. task. But neverthelessand this is perhaps Heidegger'suniqueness- he. developed an almostmonomanicdeterminationo relentlesslypursueit.The resultof this pursuit s ratherparadoxical.At the end of the in-vestigation,which Heideggerhas carriedout so far, Being remainsasmysteriouslyelusive as ever. This Heideggerappearsto admit himself,yet he also seems to constantlynourish he hope that its discovery s justaround the corner.AlthoughBeing remainselusive, something,nonethe-less, emerges n its pursuit: omethinghatperhapsmightbestbe describedas a differentclimate and way of thinkingabout Man.And along with this new thinkingabout Man, Heideggercomes todesigna kindof blueprintof Man'sexistence,of his "being-in-the-World."Like a Phoenixout of the ashes of the traditionalconceptsand values,there arisesafter all, so it seems, the answer o the-question:whatis Manand what should he be like?Man'sexistence,according o Heidegger n Sein und Zeit is embeddedin and markedby such central determinantsas man's finding himselfthrown into the world - thrown-ness (Geworfenheit) - forfeiture (Verfal-lensein), death, time and above all care (Sorge), conceptswhich are allgiven a new and specialmeaningby Heidegger.On the stage of life, asstakedout by these basic determinants r "existentials"Existentialien),Man can live eitherunauthentically r authentically:unauthenticallynthe manner of the great majorityof Men, in Heidegger's anguagethe"Man,"the "One as everybody,"who is busily immersinghimself inchatterand distractions; r authenticallyn the mannerof the few, whodare to face deathand theirbasic loneliness.

Until today, it must be added,Heidegger's hinkinghas remained nflux. And many of the conclusionshe reached n Sein und Zeit, stressingand elaboratingMan's confrontationwith nothingness,appearout-datedin the light of more recentformulations. n these, for example,Man isconceived of as the "shepherd f Being."SummarizingHeidegger'sposition,we find it embedded n a peculiar


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EXISTENTIALISM MEETS PSYCHOTHERAPY 221glisteningwilight.His fundamental ntology- this seemsto be the claiminherentn much of his writings will supplyan answerto the question:what is Man and what shouldhe be like? The analysisof Man~shrown-ness, of his Beingin the worldas Beingtowarddeath,of time and of theother basic conceptselaborated n Sein und Zeit, appearsto verify thisclaim. Thence also his final differentiationof the authenticversus theunauthenticmode of Being- Heidegger'sanswerto the question:"WhatshouldMan be like?"But Being, afterall, remains, lusive.His argumentationften appearsquestionably ied to his private use of the Germanlanguage,and hisposition s. shifting.This all invalidateshis claimthathe has answeredhequestion- although t makeshis work intriguing.And it is this.twilight,this, intriguingunclarity,which we encounteragain,whenwe turnnext to thoseschoolsor trendsof "modemexistentialpsychotherapy," hich,directlyor indirectly,receivedtheirmainimpetusfrom Heidegger.Each of these schools,we notice,focuseson certainaspectsof Heideg-ger'sthinkingand neglectsothers.Heidegger'swork appears ike a com-plex and intriguing ymphony. ts variousthemesand elementsare nowsubjectto many interpretationsnd variations,all carriedout with greatdifferencesn skill andsophistication.But uponcloserscrutiny,we realize,the discordsand problemsbuilt into the originalsymphonyrevealthem-*selvesn these variations. n a way,the application f Heidegger'shinkingto clinicalproblemseven seems to bring out more sharplythe originalinconsistencies nd ambiguities.5In the followingI wantto deal with someof the themesand variationscontained n Heidegger'soriginalwork, as they have been developedbyhis followers n theirattempt o inducepsychiatricunderstanding. et me

5 Following Heidegger, his daseinsanalytic disciples constantly stress the differ-ence between what is considered basic, grund-legend, a priori and that which ismerely a derivative or less basic aspect of a phenomenon. This clearly reflectsHeidegger's dichotomy between Sein and Seiendem, the ontic and ontological, asmentioned earlier, something which more popularly has come to be known as the"ontological difference."The problems built into such differentiation are obvious.For example, by definition, the empirical observationsof clinical psychiatrycannotbelong in the realm of a basic structurewhich has an ontic dimension. Thence thenecessity to constantly ascertain levels of basicness, to reconcile in some mannerthe stuff of clinical practice with "that transcendentalstructure which foremostlyor a priori underlies all emotional structureas the condition of its possibility" (dieFestigkeit des transzendentalenGeffiges, das allem seelischen Geflige als die Be-dingung seiner Miglichkeit von vornherein und apriorischzu Grunde liegt). Out ofthis dilemma much discussion and many attempts at - as it seems to me ratherunconvincing and sterile - differentiation have arisen, (4, p. 304), (20), (37), (38),(39, particularlypp. 300-315).


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222 PHILOSOPHY ND PHENOMENOLOGICALESEARCHbegin with the theme which in many respects has become most central.I have in mind that aspect of theorizingabout Man which most conciselyseems to be reflected n the termDaseins-analysis.The analysisof humanDasein in the psychiatric iterature s now most strongly dentified withBinswanger nd Boss. In a way this Daseins-analysiss perhaps he mostdirect psychiatricapplicationand continuationof Heidegger'sexpositionof Dasein - probably best translated as, "human existence" - as "Being-in-the-World," s carried through n Sein und Zeit. It was in the expo-sition of Dasein as "Being-in-the-World"hat Heidegger,so to speak,arrivedat the blueprintof Man'sexistence,as describedearlier.What then will such a blueprintreveal when used to illuminate aclinical case? In orderto answer hisquestion et me turn to Binswanger'sanalysis of the case of Ellen West (I, 12). In this case the term "world-design" (Weltentwurf, Daseinsentwurf) denotes the framework withinwhich a given patient, Ellen West, is understoodand analyzed.Here asin other daseinsanalyticwritings the terms "world-design,",Dasein,",,Daseinsentwurf," nd "Mode-of-being-in-the-world"ppear not clearlydistinguishable.Ellen West's world-design,accordingto Binswanger, smadetransparentn the light of suchbasic conceptsas the World- therefurther differentiated into Umwelt, Mitwelt and Eigenwelt - Time andDeath. Heidegger'smidwiferycan easily be recognized.But Binswangeradds color and differentiation.He sees Ellen West, for example, as tornbetween the Temporalityof the EtherealWorld and the Temporalityofthe Tomb World,while failing n the world of practicalaction.Binswangertries to graspwhat is basic andessential n this girl's life, thus relegating,he believes, any possiblepsychoanalytic r other interpretationo some-thing which is only ephemeraland partial.That which is basic, essential- that which in Heidegger's ermswould be Sein as opposedto merelySeiendem- is describedwith poetic affluence.But eventually t seems tobe something athersimple.Binswanger oncludes,"The entire ife historyof Ellen West is nothingbut the historyof the metamorphosis f life intomold and death"(p. 318).Boss (6), similarly,makes us see the world-design f a coprophiliacashis "dark,narrowmode of existence." t is, writesBoss, "thedirtyhole-worldof a worm"(p. 60). And also von Gebsattel(43), almostequallyindebted o Heidegger although ess outspokenabout it - sees his com-pulsivepatientsexisting n a lovelessworldof "mire,dirt,anddeepholes."In these and other analysesdifferentaspectsare emphasizedand dif-ferentdescriptiveerms areused- the focusingon the worldof deathandmire is, of course, only one among a numberof possibilities- but theunderlyingapproachto patients is similar:their neurotic or psychoticsymptomatologys seen as the manifestationand result of an existencewhichin someway has gone wrong,or remainedundeveloped.However,


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EXISTENTIALISMEETSPSYCHOTHERAPY 223amongthese psychiatricwriters hereis now less talk about the authenticversusunauthentic xistence,as mightbe expectedfrom an acquaintancewith Heidegger.Instead we read of the unlivedd,unrealized,and unful-filled existence,"about ,,Formen missglackten Daseins," about modes ofbeingthathave failed or goneshipwreck.These modes of a frustrated ndcrippledexistence are then described,often extensivelyand expressively.Yet can we, in makingsuchjudgments bouta givenexistence,dispersewith an explicit standard or such judgments?What, in other words, isthe norm, the measuringstick against which the unfulfilled and ship-wrecked characterof an existence is evaluated?And with this questionin mind - central as it is to the understanding f many existentialistwritings we once more have to go backto Heidegger.Tryingto answerthis questionwill also permit us to throw light on some other themeswhich seem essential n existential herapy.To Heidegger,we must remember, he authenticityor unauthenticityof given modes of existencerevealed tself in his analysisof Dasein as"Being-in-the-World."he standards or judgingauthenticity merged nthe processof this analysis.Heidegger'spsychiatricollowers,particularlyBoss, also refer to this analysis as the basis, - Grundlegung - for all theirclinicalconsiderations.But again,what in the case of Heideggerappearsas a perplexinglyopen-endedand ambiguousweb of conceptualizations,in his psychiatricdisciples often narrows itself down to a number ofclosely related argumentsand assertions,not seldom broughtforwardwith a certaindogmaticfinality.Let me, in the following, take up the main argumentby which Boss,for example, while leaning on Heidegger,tries,to make plausibleandlegitimatehis manner of seeing a given existence as either fulfilled orunfulfilled.

Existenceor Dasein, Boss contends n seemingly ollowing Heidegger,is revealed n the manner n which a light ray sheds light on itself. Thelight ray,by its very existence, lluminates tself as somethingboth distinctfrom and related to its environment. n other words:Existence, and thegrasp of this existence,in a given world, come all in one package. (Al-thoughthis is., admittedly,a somewhat ll-fittingmetaphor,as would beany other.) In this is reflectedthe ,,Erschlossenheit des Daseins," the"revealedness f humanexistence"so centralto Heidegger'swhole expo-sition of Dasein as "Being-in-the-world."We miss, and that is the nextconclusiondrawnby Boss, the one-package, haracterof existence whenwe tryto analyze t in the mannerof a subjectconfrontedwith an object.For once we make ourselves at home in this subject-object plit, wealreadyhave allowedourselvesto becomeentangled n the ill-fatedana-lyticalandscientificapproaches f WesternMan.We have lost the imme-diate hold on Being, in which the roles of observer,participant,and


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224 PHILOSOPHYNDPHENOMENOLOGICALESEARCHexistantare as yet inseparable.Given this state of affairs, for example,Hora, anotherDaseins-analyst livingin the UnitedStates,6appearsquiteconsistent n describingexistential herapyas uncausal,unhistorical,un-teleological,uninterpretativenduninterpersonal.or only in this, seem-ingly absurd manner, it appears, can he emphasize the character ofunbrokennessof Existence as, revealedin and throughBeing, as it isexperiencedn therapy.And it is along with this immediate llumination hroughand rooted-ness of existence in Being that the authenticityor unauthenticity,hefulfillmentor unfulfillment f a givenexistenceor Dasein is revealed.Thelight ray, throughrevealing tself in the world, at once revealsitself, soto speak,also as eithera dim or a shiningray.Anothertheme closely related to the above describedone, is perhapsrepresentedbest by ErwinStraus (37), Straus'centralinterest- sensoryphysiology gives it its characteristicoloration.More than to Heideggerhimself, Straus appears indebted to Husserl, Heidegger's teacher andpredecessorat the philosophicchairin Freiburg.Straus,in order to elucidate his own position, likes to begin with acritiqueof Descartes.Descartes,according o Straus,was the mainphilo-sophiclegitimizerof the subject-objectplit. He decisivelyestablishedhetraditionwithinwhichmodernscientificMan learned o thinkabouthim-self and the world."The Cartesiandichotomy,"Strauswrites,"notonlyseparatesmind from body, but severs the experiencingcreaturefromthe world, sensationfrom motion"(p. 141). Straus, n contrast,tries tobreak up, so to speak,the grooves of theorizingcreatedby Descartes.Inorder to achieve this.he emphasizes, rom numerousangles,what mightbest be describedas the importanceof the unbrokencontinuumof expe-rience.Thisunbroken xperience ontinuum r"experience-whole,"trausasserts, s the matrix n whichall that traditionally arries.he name per-ception, takes, place. The word sensory perception,it thus follows. ismisleading,when used in the traditionof Westernanalyticthought."Atthe very outset,"Heidegger,for example, points out, "we never hearnoises andsoundcomplexes.We hearthe squeaking ar,the motorcycle.One hears the marchingcolumn,the northwind, the hammeringwood-pecker,the bristling ire"(19). We are therefore ed astray,Strauscon-cludes, when we try to break up this immediateexperience-wholebyintroducingsuch entities as a "perceivingobject," "perceptions,"and"objectsperceived." n doing so, we have alreadypermittedour investi-gative positionto becomedistortedand perverted.The emphasison the illuminationof the immediateexperience-whole,

6 Speaking at a panel discussion at a meeting of the Washington PsychoanalyticSociety on October 13, 1961.


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EXISTENTIALISMEETSPSYCHOTHERAPY 225to be grasped without bias, constitutes the essence of what has come tobe known as the phenomenologicalapproach.This approach,we thusfind, applies to a special field of clinicalexperience, he first-mentionedline of thought,designed to illuminatethe rootedness of Existence inBeing.This approach ends itself, we notice at once, not only to the investi-gation of seeingand hearing,but also of feeling(or mood). Mood adds afurtherdimension.Mood is, so to speak,a centralconstituentof the imme-diate experience-whole. n Heidegger'sexpositionof Dasein as "Being-in-the-World"mood is consideredan ontic phenomenon:a given mood(Stimmung,Gestimmtheit) unes us to the world, both illuminatingandconstitutingt for us. It is, to extendthe metaphorused earlier,an essen-tial element of the light ray which, by its very existence, sheds light onitself and the world.But this approach and herewithwe observea furtherbranchingoutof the above-mentionedhemes - may throw light also on areaswhichseem only more or less remotelyrelated to sensory physiology. Thus,among others, von Weizsicker (44), Christian 12), and Buytendijk 11)have focused much of their interest on body movementand posture.Gabriel Marcel (22) and Merleau-Ponty (26) tried to throw light - thoughfrom somewhat different viewpoints - on the nature of the experience ofone's own body.In the followingI want to brieflydeal with some aspectsof the lastmentionedproblem- the nature of the experienceof one's own body -in orderto furtherhighlightsome featuresand vicissitudesof this phe-nomenologicalapproachwhen appliedto the clinicalrealm.In tryingto understandmy experienceof my own body I at once findmyself entangled n a web of seemingcontradictions.What,for example,is the "I"whenI speak of "I"and "my body?"The perhapsmost fittinganswer,proposedby GabrielMarcel,mightbe: I ammy body.Thiswouldavoid the necessityto think of "I" as somethingother than my body,such as the soul, consciousness,a sense of self, etc., all notionsresultingin further contradictions and inconsistencies. Yet this formulation cannot,it becomes evident at once, altogetherdo away with the dichotomyI -my body. In many contexts t is meaningfulo view the "I"- in whatevermanner "I"mightbe conceived- and my body as interactingwith eachother."I"mightbe the victimof an illness."I" sufferfrom it and reflectabout it. This illness, I feel, occurs in deep and seemingly unreachablestrata of my body, inaccessible to my voluntary control. And yet - thereseem to existways in whichI may nonetheless nfluencethis illness.Notonly can I decide to take medication,but undergoinga psychoanalysisor a deep emotionalexperience,by tuning myself more smoothly,moresensitively, more feelingly to my body, I may also change the course of


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226 PHILOSOPHY ND PHENOMENOLOGICALESEARCHthe illness.Changesn my emotionalattitude,occurring ubtlyandgradu-ally, mightjust as subtlyand graduallyalterthe manner n whichI feelaboutand throughmy body. And again,the courseof the illness mightbe changed.But in whateverway I may conceiveof this interaction, nthe final analysismy ties to my body remainelusive,a mystery.Just as Heidegger oundconstantstimulationand frustrationbuilt intohis questfor Being,so we encounter he samewhiletryingto understandour relationshipo our body.And alsoin thisquest,as in the moreencompassing uestfor Being,westumble ntothe formidableproblemof language.Here,as there, anguageappearsas both the primeobscureras well as revealerof truth.

In the quest for Being, just as in the quest for our body, the use ofwordsas conceive,grasp,etc., at once appears nadequate.Wordssuchas these imply some sort of handling,manipulation.They fashion theunderstanding f our body after the understanding f some mechanicalmodel. Similarly, n stating"I possess my body" - a point analyzedbyGabrielMarcel- I imply an understandingmodeledafterthe possessionof tools or instruments.This again proves to be an insufficient ormu-lation.And so it goes on: everyformulation use will be foundwanting.It appearschainedto its establishedusage, this immediatelydooms itsusefulnesswhenappliedto illuminate he uniqueproblem n question.Heidegger,we will remember, riedto bridgethe gap betweenan un-derstanding f Beingand our limitedlanguageby developingnew wordsand word conceptions.These new conceptionsseeminglygave an alto-gethernew slantto the problemin question.Thus Heideggerattemptedto bypassthe originalgap betweenBeing and language.The authors, nturn,who areinterestedn the bodyproblem, requentlyattempta similarbypass.Theyoften resortto unusual ormulationshat give an unfamiliartwistto the problem.ThusZutt (49), to mentiononly one example, ikesto speak ,,vom gelebtenwelthaftenLeibe,"of a body which is, to trans-latethis somewhatiberally, ivedin a world-revealingnd world-orientedmanner- a formulation hat might appear,at first glance,to avoid thepitfalls inherent n understandinghe relationship"I-body" n the moreconventionalterms mentionedearlier. Similarly,many other problemsfallingbroadly nto the realmof psychosomaticmedicineappear o reveala new anglethrough he use of such newlycoinedwords.Frustrations nd stimulationsas describedhere - andherewithI wantto take up onemoretheme- appearnot onlybuiltintothe questfor Beingandmy body, but we also encounter imilarones in tryingto understandthe natureof the therapeutic elationship.This relationship,whenviewedfrom the therapist'spoint of view, can be seen as a peculiarmixtureofdetachmentand involvement.Whilea relationship volves, certaintrans-ferencepatternsof the patientcan be identified.Part of the identifying


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EXISTENTIALISM MEETS PSYCHOTHERAPY 227process,we knowthrough he studiesof E. Weigert 45), M. Cohen(14),and many others, are the therapist'sown countertransferenceeactions.But the analysisof the transference-countertransferenceynamics,revealsonly one amongmanyotheraspectsof the analyticrelationship.Thereis,in otherwords,moreto the relationshiphanmere transference ndcoun-tertransference. or example,there must exist in the relationship ome-thing which makes possible a therapeuticrelatedness,n the first place,whichbrings nto play the elementsof trust, growth,and solidarity.Andagain: t is this "something"whichappearselusive,just as Being andtheties to my body turnedout to be elusive. And just as,in the two afore-mentioned nstances,a new word conceptionseems to offer a solution.Binswanger1) andElrod(16) madeperhaps he most successfulattemptat coining it. They introduced he term Tragungas that which makespossiblethe Uebertragung. he Germanword Tragung- which, in thiscontextwouldbe the equivalentof "ference"n "Trans-ference"denotes"holding,bearing,carrying." t thus quite vividlyseemsto expressboththat whichconstitutesand complementsa therapeutic elationshipwithinwhicha transference-countertransferenceynamicpropercan develop.This outline of themesmust suffice. In applyinga daseins-analyticaland phenomenological pproachto illuminatepsychiatricproblems,welearnthat our traditionalor moreconventional rameof reference s, soto speak, loosened. Old structuresof thought,we might feel, suddenlyseemto crumble; omething rulynew andoriginalseemsto come withinour grasp.Suchexperience,however,andherewith cometo animportantaspect,almost inevitablybrings. o mind a period in all our lives in which wemake new discoverieseveryday, when the world still has a glow of in-exhaustiblenewnessandrichness,a senseof promiseandunendingpoten-tiality.That periodis childnood.Duringthis periodwordscharacteristicallyave a muchmoremagical,world-revealing nd world-containingmeaningthan they have in laterlife. They have not yet become unquestionedgivens, somethingjust asavailableand routinelyresortedto as the clothes which we wear everyday.And also, such words,newly experienced n childhood,revealingtheworldwhile havinga magicalfascinationof' their own, seem to promisean immediatecommunionwith the world, an unbrokenness. t is thisunbrokenness,which may appearas the promised and to the adultwhois painfullyawareof the brokenness, ragmentation, nd Heillosigkeitofthe actual worldhe must live in.Is not then, we may ask, the above-describedexistential, daseins-analytic,and phenomenological pproacha legitimateand perhapsonlyway to find a new sense of wholeness?Are not the graspof a particular


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228 PHILOSOPHY ND PHENOMENOLOGICAL,ESEARCH"world-design,"f the ties to one's body, of the natureof the psycho-therapeutic elationship, ll partsof an attempt o establisha new imme-diacy of experience,a new unbrokenness?Maybethis is so. But, in whateverway this wholenessand immediacymight be sought, it cannothave the same qualityfor the adultthat it hasfor the child. The adult has been exposed and accustomed o the expe-rience of abstractthinking,of separateness,of the subject-object plit.The attempt o undothis state of affairsappears raughtwith vicissitudes.And nowhere, t seems,can we better studythese vicissitudes han in theendeavors, outlinedabove, to apply the existentialistapproachto psy-chotherapy.It is these vicissitudes,the problematicalaspects of theabove-described pproaches,with which I have to deal next.In orderto do so, I once againmust turnto language.It is a charac-teristicuse of language,we remember, hroughwhichHeideggerand hisfollowerssucceeded n giving a new slant to the whole problem n ques-tion. This use of languagewe now must studymore carefully.We canobserve in it (1) an evocative, (2) a reifying,and (3) a de-differentiatingelement.Let me take them up one after the other.By "evocative" mean that quality n language,hardlydefinable,whichsparksin the readerindistinctmoods and associations. t is that qualityin the wordingand formof communicationwhich transmitsan immediacyof feeling. Evokingan unconventionaleeling-response ften requires.hebreak-upand simultaneous ubstitution f the traditionalwordclichesinwhichfeelings have tended to be expressedbut also encrusted.This kindof communication ften must proceedin a somewhatrambling,groping,and loosely descriptive ashion.It is that elementin the style of a poet,that part of his communicative xpressiveness,which seems both mosteffectiveand most privateand elusive, but also that whichmay makehisproductiona work of art.

This evocative power of language finds, in a way, its parallelin thepersonalcharismaor style of a psychotherapist sometimesrather latlydescribedas his mode of nonverbalcommunications somethingwhichappearsalmostequallyelusivewhen, for example,studiedvia some,sortof factor analysis.But just as the charismaof the therapistneeds to bechecked so as to not degenerate nto interpersonaldemagogery thischecking usually being done by self-analysis, supervision,and otherdevices outlined by the authorelsewhere(34) - so also the evocativepower of languagemust, in a way, be counterbalanced y clarity andprecision.And the more we move with our thoughtsinto that borderrealm- the realmof the poet and speculativephilosopher wherewe tryto speak aboutthe seeminglyundescribable,he greaterthe need to try


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EXISTENTIALISM MEETS PSYCHOTHERAPY 229for clarity- by definingthe scope of relevanceand using words whichareunequivocal.The German anguage,morethan other anguages, eemsto offer itselffor moves into this borderrealm.But the German anguagealso, morethan otherlanguages, eemsto offermeansto becloudoneselfand othersby addingandsuperimposingew shadesof meaningon wordswhichare equivocalfromthe very beginning.Thisuse of equivocal anguage,particularlywhen appliedto illuminateclinical facts and observations, hus frequentlyresults in formulationswhich suggestpoetry- a processfor which Heideggeralso providedthemodel with his dichtendemDenken,his poetizingthinking! 27). But, asit turnsout, the use of highlyevocativeand equivocallanguage n psy-chiatryvery often seems to bring out neitherthe richnessand depth ofgreatpoetrynor the claritythat would really deepenour understanding.instead,not a few of the daseins-analyticnd phenomenologicalwritingsleave with us foremostthe impressionof a frustrating nd wordyambi-guity.Next I have to deal with the reifyingqualityinherentin the above-describeduse of language.By reifying I mean a tendencyto treat aconceptnot as representing, ut as mergingwith an object. (Again it isdifficultto describe n the languageof the subject-object plit somethingwhich seemsto transcend his split.)A studyof the writingsof Boss (8),for example,can makeclearerwhatis meant.Boss' whole polemicagainstFreud appearsbased on the assumption hat Freud, insteadof creatingwithhis theoriesmodelsof understanding hichare revisable n the lightof new clinical evidence, tried to introducesome sort of mechanicalemotional reality.Again his polemic is reminiscentof a child's use ofwords:the child is not yet clearlyaware that a word serves as a symbolor metaphorfor somethingelse. For the ability to make distinctionsbetween words and the thingsthey denote, developsonly graduallyas aresultand concomitantof the growth,differentiation, nd integrationofbodily and mentalfunctions.Only recently- throughresearchdone inthe fields of childand comparativepsychology,and last-but not least, ofschizophrenia! have we come to-graspthe enormous ntricacyof theseprocessesof growthand differentiation.The pricepaidfor the often revealingandilluminating se of languageas practicedby Heideggerand his followers- and this is probablythemostimportantaspectof this use of language is thereforea de-differen-tiationin the abilityto recognizeand distinguish evels of relevance,akind of reversalof the processesas observed n a child'sdevelopment.7

7-Harold Searles (32) has extensively elaborated on the significance of this con-cept in schizophrenia.


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230 PHILOSOPHY.NDPHENOMENOLOGICALESEARCHA certainrichnessand immediacyof expressiveness,n other words, ispaid for with a loss of distinctions betweenwords and things and wordsand related words. Along with this loss of distinctionsgoes an egotisticnarrowing f one'sway of experiencing he world,a certain nflatedsenseof one's own importance again similar to the attitudeof a child who,stillhighly unawareof the laws of causality o whichhe is heir, tendstointerpret he happeningsn the world n a highly ego- andanthropocentricmanner, ust as many primitivepeople mightdo. (Cf. Piaget 28), Werner46, and others.)Certainly,a de-differentiation s practisedby Heideggerand his fol-lowers is of a different order than the primary ack of differentiationobservable n children. And yet it is this comparativeack of differen-tiation of concepts and of levels of relevance,which proves to be mostfateful when these concepts are appliedto illuminateclinical phenomenaand the process of psychotherapy. n the following I want to only dealwith a few aspectsof such de-differentiationn the psychiatric ealm.First, a "World-design" r "mode of Being," immediatelygrasped nits wholeness,greatlyexcludesthe possibilityof acknowledging dimen-sion of the unconsciousor the latent.Such an approachaddresses tselfto what is given, to what reveals itself. It brings forth neitherthe readi-ness nor the theoretical ools to cope with those aspects n a person's ifeor relationshipswhich, in a more dynamicframeof reference,we havecome to consider as being out of awareness,dissociated, or repressed.Boss, for example, clearly demonstrates his "neglectof the hidden" nhis work The Analysis of Dreams (8). Dreams for Boss are just anothermanifestationof a given person's mode-of-being-in-the-world,ccessibleto an immediateunderstanding s are the manifestations f that person'swakinglife. He attacksFreud'snotion that dreamsreflectwishes which,through the dream, are both partially fulfilled as well as coded anddisguised. Freud, however, in providing a key for the decipheringofdreams, for translating nto the language of rationality (or secondaryprocesses) somethingwhich had seemed simply irrationaland irrelevant,enlarged he humanrealm of self-confrontation nd self-examination.Heenlargedthe stage on which a person's seeminglyhidden and manifestmotives could come to grips with each other - in increasinglysubtlerstrategiesof self-understandingnd self-concealment.This "moraldimen-sion," by necessity,is eithergreatly neglectedor dilutedby the daseins-analytic or related approaches. For self-examination,worthy of thisname, requiresthe abilityboth to establishdistancefrom oneself and -fromsuch a position of distance- to make distinctions.And it is exactly


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EXISTENTIALISM MEETS PSYCHOTHERAPY 231thesedistinctionswhichdaseins-analyticpproaches, n their tendencytode-differentiation, ppear to neglect.8Second, the trend toward de-differentiation, s evident in the exist-entialapproaches,precludesan effectiveexaminationof the relationshipbetweendoctorand patient.It is characteristic f many modemtreatmentsituations - to repeat a point I have made elsewhere (34) - exactlybecauseof an existingclimate of change-orientednessndthe breakdown

8 At this point I must mention one work which seems to present an exception tothe trend discussed here - at least in some respects. Unlike most others, it reflectsan awareness of the drama of self-confrontation and self-concealment as manifestin the polarity "hidden, unconscious versus manifest, conscious." This is the bookPsychotherapie in anthropologischerSicht, Stuttgart: Enke, 1961, by Walter Brdu-tigam, in my opinion a work that stands out among the others mentioned.Briutigam uses mainly the poles "depth" and "surface" in order to unfold,between them, the panorama of a person's precarious existence between self-alien-ation from and overexposure to what might be considered the deep and hiddenin him.In one respect, Briutigam makes clear, the polarity between the hidden or deepand the manifest or superficial is relative to a shifting center. This seems in linewith much modern theorizing about mental functioning - including, for example,such processes as perceiving, memorizing, and thinking. In these theories mentaland emotional functioning is a matter of a relative balance of forces. Central tothis balance is the concept of focusing. Focusing implies the shutting out of theunessential. The unessential then, to some degree at least, becomes the hidden. Theability to focus, in other words - and along with it the ability to shut out - alsostructures the realm of the hidden or unconscious, preventing adequate mentalfunctioning. Psychotic states, for instance, as observed either in cases of fragmentedschizophreniaor in LSD experiments,reflect an upset of this balance. There occursan uncontrolled flooding of the mental arena with the normally hidden or uncon-scious.

But also, in order that the conscious mental functioning may not become driedup, stereotyped and, eventually, equally inefficient, channels to the hidden orunconscious must be kept open. A sort of dialectical communication of the con-scious personality must be maintained with its hidden, unconscious parts. In theframework of psychoanalytic thinking, this dialectical communication with theusually hidden has been conceptualized in various ways. One aspect, for example,can be understood as regressionin the service of the Ego as this was done by Kris.On the other hand, Briutigam emphasizes also, there exists a more hierarchicalrelationshipbetween surface and depth. And it is in this respect that we speak moreproperly of an arena of self-confrontation as mentioned above. But it is this hier-archical relationship which appears also more elusive. This is the case particularlywhen the "deep"becomes more identical with bodily feelings and processes, withmore archaic sensations. The "deeper' these seem to be, the harder they can, itseems, be conceptualized in everyday rational terms (or secondary processes), andbe illuminated in operationalframeworks.In trying to illuminate these more elusiveaspects Briutigam also seems to resort more to the de-differentiationof conceptsas described above. But in doing so, he also becomes increasingly vulnerable tocritical considerations outlined there.


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232 PHILOSOPHYNDPHENOMENOLOGICALESEARCHof traditionalrole concepts of therapistand patient - that they invitesymbioticentanglement,obscure manipulations,and the mutual satis-faction of fringe-needs.This is ofteninevitableor even desirable n orderto reach the patient at all. But the more the therapistmakes himselfvulnerable o such entanglements,he greater he necessity to demarcatehimself, in a dialecticalprocess, from the patient. Transferenceandcountertransferenceatternsmust, as soon as they becomeapparent,beconceptualize andmadeavailable or discussion.As part of the matchingof sensitizing actorsby stabilizing actors,describedelsewhere(35), thethreat and temptationof fusion and ambiguity n the relationshipmustbe counterbalanced y differentiationand clarity about the respectiveroles and contributionsof patient and doctor.Characteristically,many existentialistwritersextol the value and sig-nificanceof the "encounter."Yet they fail to carrythrougha conscien-tious and ifitrospectively nlightenedexaminationof the social contextof therapy,particularly f those aspects which have come to be knownas the dynamicsof transference nd countertransference.learly,the de-differentiationypicalof their approachneitherprovides the intellectualclimate nor the theoretical ools to attemptsuch examination.9Third,this.de-differentiationand this is,probably ts most importantaspect)preventsan articulationwith the social sciences and schools ofthoughtwhich link individualbehaviorto social and political conduct.The trend towardde-differentiation ot only forces. he existentialana-lysts into an often unenlightened nd defensivelyrejectingoppositiontopsychoanalysis nd its furtherdevelopment,t also causesthem, as Szasz(39) has.rightlypointed out, to ignore the significantcontributionsofsocial psychology[e.g., Dewey (15) and Mead (24)], empiricism Bridg-man (10), Russell (31)] and the philosophyof science movement[Frank(17), Rapoport(30)]. The over-allresultappears o be an isolationfromthe social, political, and scientificstreamof life of much of the Westernworld.Along withthe isolation,they often have becomeencapsulatedna rather esotericworld of a semi-ideology,whichhas providedboth aninflatedsense of importanceand the possibilityof findingan easy con-firmationof personalbiases.Heidegger eems to providea model for this trendalso:his philosophyappeared o providelittle push nor conceptual nstrumentariumo dealeffectivelywith the social and politicalfield in whichNazismdeveloped.

Again, Brautigam'sbook appears in this area also as an exception. It providesa very perceptive account of the physician's complex and peculiarly two-sidedrelationship with his patient, in which involvement and distance, expertness andignorance, participationand analysis of this participation are all significant elements- although here also some of the above critical considerations apply.


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EXISTENTIALISM MEETS PSYCHOTHERAPY 233On the contrary,as evidenced n his speech as newly appointedRectorof the Universityin Freiburgin 1933, he became spokesman of thisregime's rrationalism.'0

Similarly, n many modem existential and daseins-analyticwritings,the combinationof de-differentiation lus a notion that the values andnorms of human existence are intuitivelygiven leaves the door wideopen to an uncriticalperpetuationof one's own biases, vested interests,and prestige needs.In the field of modem psychiatry, t appears, he problemsposed bya trendtowardde-differentiationeem to be highlighted n our dealingswith schizophrenicpatients.A peculiar paralleland similarity hereforeseems to exist between the special human situation commonly calledschizophrenia, nd the more general humansituationwhich is the con-cern of existentialism.Many aspects in the writingsof existentialistanddaseins-analyticwriters seem to have directrelevancefor understandingessentialelementsof the schizophrenic ondition;and problemsencoun-tered in schizophrenicpatients - on a therapeuticas well as on anepistemological evel - may more sharplyreveal the value and short-comingsof the existentialapproaches.Therefore, n the followingI wantto brieflymentionsome of these parallelsandproblems,confiningmyselfto those aspects which I have outlined aboveunder the generalheadingof de-differentiation.In many schizophrenicpatients the de-differentiation f the mentalorganization eems striking.Those mentalcapacities- usuallysubsumedunder the term ego functions which makepossible an effectivefocusingand structuringof the personality,have greatly broken down. Experi-ences definablein termsof an inner reality can no longerbe differen-tiated against experiencesconventionallyattributed o outer reality:hal-lucinationsand delusionsare the result. The disturbances f thoughtandfeeling, as first describedby Bleuler(5) - such as the disorderof asso-ciation,lack of continuity,and hierarchical tructureof ideas, etc., - canbe seen, among other elements,in many a schizophrenic's ehavior,asthe manifestationsof a far-reachingde-differentation.Equally, manyothersymptomsor traitscan be understoodas desperatead hoc attemptsto control this de-differentiation.These traits serve as some sort ofprimitive strait jacket, matching,in their crudeness,the looseness ofde-differentiation.This strait jacket makes ideas concrete and over-generalized.It causes behavior to become frozen in catatonicrigidity.

10 And although, in 1935, he felt the need to dissociate himself from the "phi-losophy" of the party hacks, there is nothing to suggest that the Nazig' systematicinhumanityappalledhim. W. KaufmanndiscussesHeidegger'srelationshipto Nazism(11), p. 343.


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234 PHILOSOPHY ND PHENOMENOLOGICALESEARCHBut even so, the underlyingchaos and de-differentiation emains proneto eruptat the slightestprovocation be it in the form of excitement,ofhebephrenic ragmentation r others- unremittingly ringing-itselfo theobserver'snotice.Many a schizophrenic's ehavior and herewith return o the polarityof the hidden versus the manifest- may thereforesuggest an emergingto the surface of that which usually appearshidden deepest in a person.Incestuousstrivings,crude incorporative, annibalistic,and other "primi-tive" impulses,accordingly eem to be expressedmore openly than wouldbe possible in "normal"people.In its very primitivity uch a patient'sDasein, his "mode-of-Being-in-the-world"may appear mmediately evealed.His need for attention,hisrage, his lonelinessmay seem more transparent nd thus more accessibleto all-encompassingnterpretationshan it is in normal adults. But sucha view, seemingly ending tself to illuminate chizophrenia,would greatlyobscure and make trivial the dimensionof the hidden.On the contrary, t is exactly in the understanding f the schizophrenicpatient, that this dimensionof the hidden takes on a special depth andcomplexity. In exposing ourselves to this dimension we find furtherwidened- in ourselvesand in the patient - the stage of self-revelationand self-concealment, s originallystaked out for conscious penetrationand responsibleexaminationby Freud.The reasonsfor the growingsignificanceof this dimensionof the hid-den are similarto those that make the quest for the "immediate xperi-ence-whole"difficult or the adult whose differentiationmakesa thinkingin the subject-object plit second nature to him. In the schizophrenicpatient who is an adult there does not exist a simple lack of differen-tiation, as would be the case with small children (relativelyspeaking),but a de-differentiation, xperiencedout of a positionof differentiationalreadyachieved. Consequently, his de-differentiations uneven.Differ-entiatedand functioningaspectsof the personalityexist dove-tailedwithde-differentiated nd chaotic ones. Certainabilitiesand functions, like,for example, a peculiar interpersonalsensitivity, may be even morehighly developed n schizophrenic atients han in more "normal" eople.This can be the result of an adaptation o a strongerperson's reality(35). It is this combination, nterplay,and defensivebalancingof differ-entiated and de-differentiated,of over and underdeveloped kills andattitudes,wherea wide panoramaof possiblehumanconflicts andmodesof self-alienationbecomes visible - more deep-seated,more intense,andmore complexthan we commonlyencounter.This dimensionof the hidden is relevantfor understandinghe intra-psychicrealmas well as the family and the more generalsocial field ofthe schizophrenic atient.


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EXISTENTIALISMEETSPSYCHOTHERAPY 235Intrapsychically, e mustlook behindthe manifestattitudeswhich thepatientpresents: he dissociatedaspects,the need for tendernessbehindthe outwardaloofness, the rage behind the smile, the sensed failuresbehind the demonstratedachievements, he chaos behind the conven-tional orderliness.The dimensionof the hidden may appearwell sealedoff. Then the firsthand mpression s one of more ordinarynormal orneurotic behavior.Or the seal, so to speak, may leak: The hidden mayreveal tself in a certainauraof uncanniness ndbrokenness.Thepainful,thoughwardedoff, realizationof not being "whole,"of beingthreatenedby disintegration nd the breakthrough f dissociated mpulsesmore orless colors such a person'sway of behaving or presentinghimself. But

whethersealed off or leaking, the "hidden"poses a challengeto ourability to become sensitive to the complexity and multi-level-characterof the intrapsychicield.To the bewildering iddencomplexityof the familyfield of the schizo-phrenicwe have become' xposed onlyrecently.The studiesof Lidz (21),Bowen (9), Wynne (47, 48), and many others, have sensitizedus to adrama of fateful interpersonal entanglements that lie hidden behind theoften conventional facades presented by such families.The seal, to extend the comparison used above, which in these familieswards off the hidden, may be seen in a particular way of interactingwitheach other, which Schaffer (33) and Wynne (47, 48) variously have-described as the "rubber fence" or "pseudo-mutuality." In penetratingthis rubber fence we recognize, on the family level, a peculiar andprecariously explosive integration, both paralleling and reinforcing theuneven differentiation observed on an individual level.Finally, as I have mentioned in another essay ("The Concept of Cure,"unpublished), there exists, on the level of the more general social field,a similar seal. This seal, too, normally prevents or restricts an awarenessof the hidden. This seal is our unquestioned identification with manysocially sanctioned, but often implicitly conflictual value standards andmodes of defining our feelings and interactions. The poet, who often ismost acutely aware of the shallowness, conflictfulness, or inhumanity ofthese standards and modes., is also, as I tried to show in my commentson Chekhov's Ward No. 7, often most prone and qualified to open oureyes to the dimension of the hidden as it prevails in this sphere.Next, the therapy of schizophrenic patients, more so than in any othertreatment situation, appears to invite symbiotic entanglement and de-differentiation of the roles of therapist and patient. It lends itself, there-fore, to be viewed in those existentialist terms which are marked byde-differentiation, which emphasize the meaningfulness of the "encoun-ter," but which preclude an effective examination of the relationship.Such examination, to repeat a point, requires us to clearly distinguish


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236 PHILOSOPHYNDPHENOMENOLOGICALESEARCHbetweenpatternsof interactionand to demarcateroles. Such makingofdistinctions n the treatmentof schizophrenicpatients is part of thestructuringwhich makes possible the widening of the stage of self-concealmentand self-revelationas describedabove.Finally, the conditionof many schizophrenicpatients, unevenly de-differentiated ndelusiveas it may seem, often invitesus to projectintoit our pet theoriesaboutman and life. There exists, hus a similarity othe manner n whichthe de-differentiationnherent n Heidegger's,uestfor Being seeminglylends supportto the greatestvarietiesof notionsabout man, just as the very vaguenessand open-endedness f the Nazimovementmade it possiblefor manyto find in it whatthey wanted.

Suchevidence, t is only natural pointing,as it may, in the directionof organicity,cultural conditioning,or the like - then tends to becomeorganizedinto viewpoints, theories, and ideologies, dependingon theneeds and abilitiesof the observer."These comments point to a seeming affinity and complementaritybetween the schizophreniccondition and existentialism.But they alsopoint to the difficultieswe encounter n tryingto illuminate his humanconditionin the light of the viewpointswhich existentialistauthorssofar have developed.These difficultiesappear typical for the existentialapproachwhenappliedto illuminateotherareas,of psychotherapy ndhumanlife. Theycast doubton the claimsmadeby manyof the existentialistauthors.Thetask of graspingmore exactlywhat is.essential- in the schizophrenic sin otherhumanconditions- and relating t meaningfullyo the total ofour knowledgeand actions,still remains.HELM STIERLIN.

SANATORIUM BELLEVUE, KREUZLINGEN, SWITZERLAND.

11 Many existentialist and daseins-analytic interpretationsof schizophrenia, al-'though implying or professing an immediate grasp of the essentials of another per-son's existence, nevertheless often continue to reflect in this grasp the attitudes ofthe organically oriented observer which I described in another essay (136), ascharacteristicfor much of the present European scene. Binswanger, for example,after having analyzed Ellen West in a daseins-analytic framework, seems to con-ceive of her illness nonetheless as a process in the Kraepelinian tradition. Hewrites "... in our case (Ellen West) we see no other possibility than this: anunknown something, which cannot be entirely explained from Anlage, milieu andexperience, appears to initiate and maintain this process" (p. 355).


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EXISTENTIALISMMEETS PSYCHOTHERAPY 237BIBLIOGRAPHY I

Numerous books about existentialism and existential psychotherapy have beenpublished in the English language. The following introductorytreatments, in addi-tion to the references mentioned in the text of this essay, can be recommended.These references contain ample bibliographies of the works of Kierkegaard,Nietzsche, Sartre, and Camus.

1. Barret, W., Irrational Man. New York: Doubleday, 1958.2. Grene, M., Introductionto Existentialism(first published as Dreadful Freedom).Chicago: Phoenix Books, Univ. of Chicago Press, 1959.3. , Heidegger. New York: Hillary House, 1957. (A readable intro-duction to Heidegger).Only a few of Heidegger's works have thus far been translated into English.4. Heidegger, M., Existence and Being. Chicago: Regnery, 1949. (This book con-tains a 235-page introduction by Werner Brock to Sein und Zeit, as well asan account of the remaining four essays of the volume, which are "On theessence of truth,""What is Metaphysics?"and two essays on the German poet,Hoelderlin.)5. Jaspers, K., The Way to Wisdom. New Haven: Yale Univarsity Press, 1951.6. , Man in the Modern Age. London: Routledge, 1933.7. , The Perennial Scope of Philosophy. London: Routledge, 1950.8. , The Origins and Goal of History. New Haven: Yale UniversityPress, 1953.9. , Reason and Anti-Reason in Our Time. New Haven: Yale Univ.Press.195 3.10. Kaufmann,W., Existentialism from Dostoevsky to Sartre.New York: Meridian(Contains an introduction written by Heidegger to the essay, "What is meta-physics?"translatedby Kaufmann.)11. , From Sheakespeare to Existentialism. New York: Doubleday,1960. (This book contains a bibliography of the works of Martin Heideggerwhich appearedup to 1958.)12. May, R., E. Angel, and H. F. Ellenberger (eds.), Existence: A New Dimensionin Psychiatryand Psychology. New York: Basic Books, 1958. (This work con-tains an extensive introduction by the editors, as well as representativesamples

of the writingsof L. Binswanger,E. Minkowski,E. Straus,V. E. von Gebsattel,and others.)13. May, R. (ed.), Existential Psychology. New York: Random House, 1961. (Thiswork contains a bibliography of most of the important works on existentialpsychotherapy and phenomenology presently available to the English reader.It was arrangedand annotated by Joseph Lyons.)14. Rossman, K., and K. Kolle, (eds.) Offener Horizont, Festschrift far KarlJaspers. Munich: Piper, 1953.15. Schilp, P. (ed.), The Philosophy of Karl Jaspers. Library of Living philoso-phers, Tudor Publishing Co., 1957. (German edition, Stuttgart:Kohlhammer,1957.)16. Weigert, E., "Existentialism and its Relations to Psychotherapy,"Psychiatry,12:399-412, 1949.

BIBLIOGRAPHY II1. Binswanger L., Grundformen und Erkenntnis menschlichen Daseins. ZUrich,Niehaus, 1953.


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238 PHILOSOPHY ND PHENOMENOLOGICALESEARCH2. , ,,Geschehnis und Erlebnis," in Ausgewdhlte Vortrdge und Auf-satze I. Bern: Huber, 1947.3. , Schizophrenie. Pfullingen: Neske, 1957.4. , Ausgewdhlte Vortrige und Aufsitze, Bd. II. Bern: Francke,1955.5. Bleuler, E., Dementia Praecox or the Group of Schizophrenias, (1911). NewYork: International Universities Press, 1950.6. Boss, M., Meaning and Content of Sexual Perversions: A daseins analyticapproach to the psychopathology of the phenomenon of love. New York:Grune and Stratton, 1949.7. , Psychoanalyse und Daseinsanalytik. Bern-Stuttgart:Huber, 1957.8. , The Analysis of Dreams. New York: Philosophical Library, 1958.9. Bowen, M., "A Family Concept of Schizophrenia," n: The Etiology of Schizo-phrenia, Jackcon, D. D., (ed.) .New York: Basic Books, 1960.10. Bridgman, P., The Way Things Are. Cambridge: Harvard University Press,1959.11. Buytendijk, F., Allgemeine Theorie der menschlichen Haltung und Bewegung.Heidelberg: Springer, 1956.12. Christian, P., Das Personverstindnis im modernen medizinischen Denken.Tiibingen: J. C. B. Mohr, 1952.13. , ,,Zur Phiinomenologie des leiblichen Daseins," Jahrbuch furPsychologie, Psychotherapie and Medizinische Anthropologie, Vol. 7: 2-9,1960. Freiburg-Munich:Alber.14. Cohen, M., "Countertransference nd Anxiety," Psychiatry, 15:231-245, 1952.

15. Dewey, J., Human Nature and Conduct. An Introduction to Social Psychology.New York: Henry Holt, 1922.16. Elrod N., ,,Ungliick steckt an," Psyche, 14:336-359, 1960.17. Frank, P., Modern Science and Its Philosophy. New York: George Braziller,1955.18. Heidegger, M., Die Selbstbehauptungder deutschen Universitit. Breslau:Korn,1933.19. , Sein und Zeit. Halle: Niemeyer, 1927.20. Kunz, H., ,,Die Bedeutung der Daseinsanalytik Martin Heidegger's fur diePsychologie und philosophische Anthropologie," in: Martin Heidegger's Ein-fluss auf die Wissenschaft. Bern: Francke, 1949.21. Lidz, T., "Schizophrenia and the Family," Psychiatry 21:21, 1958.22. Marcel, G., The Mystery of Being. Chicago: Regnery, 1960. Gateway edition,2 volumes. (Cf. particularly Vol. I, pp. 127-153.)23. , ,,Qu'attendez-vousde Medicine?" Paris: Librairie Plon, 1949.24. Mead, G., Mind, Self and Society. From the Standpoint of a Social Behaviorist.Edited with an Introduction by Charles W. Morris. Chicago: The Universityof Chicago Press, 1936.25. Merleau-Ponty, M., Phenomenologie de la perception (4th edition). Paris:Gallimard, 1945.26. , La Structure du Comportment.Paris: Presse Universitaire- de France, 1949.27. Muschg, W., ,,Zerschwatzte Dichtung," in: Die Zerstorung der deutschenLiteratur. Bern: Francke, 1956.28. Piaget, J., The Construction of Reality in the Child. Translated by M. Cook.New York: Basic Books, 1954.29. Pfister, O., ,,Karl Jaspers als Sigmund Freud's Widersacher,"Psyche 6:241,1952/1953.


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Schuster, 1948.32. Searles, H., "Integration and Differentation in Schizophrenia,"J. Nerv. Ment.Dis. 129:542-50, 1959.33. Schaffer, L., Wynne, L. C., Day, J., Ryckoff, I., Halperin, A., "On the Natureand Sources of the Psychiatrist's Experience with the Family of the Schizo-phrenic." Psychiatry, 25: 32-45, 1962.34. Stierlin, H., "IndividualTherapy and Hospital Structure," in: Arthur Burton(ed.), Psychotherapyof the Psychoses. New York: Basic Books, Inc., 1961.35. , "The Adaptation to the Stronger Person's Reality," Psychiatry,22:143-152, 1959.36. , "ContrastingAttitudes toward the Psychoses in Europe and theUnited States," Psychiatry, 21:141-147, 1958.37. , "Verstehenund wissenschaftliche Theoriebildung in der Psycho-analyse," Psyche 6:389-400, 1952/1953.38. Straus, E., "Aesthesiology and Hallucinations,"in: Rollo May (ed.), Existence.New York: Basic Books, Inc., 1958. (See pp. 139-160.)39. Szasz, T., The Myth of Mental Illness. New York: Hoeber-Harper, 1961.40. Szilasi, W., "Die Erfahrungsgrundlageder Daseinsanalyse," Schweiz. Arch.Neur. Psychiatr. 67:74, 1951.41. Thiel, M., "Die Distanzproblematik in der Philosophie," Stud. Generale,4:297, 1951.42. Thomas, H., Anorexia Nervosa. Stuttgart: Klett, 1961.43. von Gebsattel, V., ,,Die Welt des Zwangskranken,"Monatsschrift fur Psychi-atrie und Neurologie, 99:1074, 1938. Abridged English translation by SylviaKoppel and Ernest Angel in: Rollo May (ed.), Existence. New York: BasicBooks, Inc., 1958. (See pp. 139-160.)44. von Weizsdcker, V., Der Gestaltkreis. Stuttgart:Thieme, 1947.45. Weigert, E., "Countertransferenceand Self-Analysis," Int. J. Psa. 35:242-7,1954.46. Werner, H., Comparative Psychology of Mental Development, (2nd rev. ed.)New York: International Universities Press, 1957.47. Wynne, L., Ryckoff, I. M., Day, J., and Hirsch, S. I., "Pseudo-mutuality nthe Family Relations of Schizophrenics,"Psychiatry, 21:205-221, 1958.48. , Day, J. and Ryckoff, I. M., "Maintenanceof Stereotyped Rolesin the Family of Schizophrenics," Arch. Gen. Psychiatry, 1:109-115, 1959.49. Zutt, J., ,,Vom gelebten welthaften Leibe," Congress Report, 2nd InternationalCongress for Psychiatry, Zurich, 1957. Vol. IV:444-445.50. , and C. Kulenkampff, Das paranoid Syndrom in anthropologischerSicht. Berlin-Gottingen-Heidelberg:Springer, 1958.

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