Existential encounter in the asylum: Ludwig Binswanger's 1935 case of hysteria

This paper examines the Swiss psychiatrist Ludwig Binswanger's view of the doctor-patient relationship as a direct and trusting existential encounter in a 1935 clinical case of hysteria. Drawing upon unpublished materials from the patient record and correspondence, I show that his conception of existential encounter emerged from the Bellevue asylum context, where treatment choices were linked to maintaining order in a communal setting, and addressing a complex array of bodily and psychological symptoms. Binswanger touted the underlying, positive relationship with his patients as the critical factor in the efficacy of a wide variety of treatments, including some of the most forceful and authoritative. Sources from the patient's perspective, however, demonstrate that, in this case, a mutual relationship of trust was not clearly achieved.