Clinical diagnosis as being there for death : the "Ellen West" files


Department of Psychology, Free University of Brussels, Belgium
Ijskelderstraat 49 A, 9000 Gent, Belgium
Tel/Fax. 32-92336526


In 1944-45, Ludwig Binswanger (1881-1966), the Swiss psychiatrist and founder of the Daseinsanalyse, published a lengthy existential analysis of a case of schizophrenia, which he had treated more than twenty years earlier. This "tragic story of Ellen West" was subsequently discussed by a variety of authors, such as Salvador Minuchin and Carl Rogers, pertaining to either its psychiatric diagnosis or its treatment. In this sense, Ellen West's "life" as a case-study closely resembles the dynamics present in her "struggle for life" and her eventual "choice for death". Moreover, both the diagnosis of her psychic suffering and its prognosis in terms of possible effective treatment, also marked Ellen West's final years of her life and the tragedy of her death by suicide at the age of thirty-three.

In this paper, I would like to present the conclusions of a close examination of the different diagnoses of the Ellen West case, taking into account the published case history as well as the original (and hitherto unexplored) case file of her stay at the Kreuzlingen Sanatorium. The results of my analysis are very instructive with regard to the process of diagnosis and the relation between diagnosis and treatment at the time. Additionally, my analysis also sheds light on the more subjective dynamics involved in this case-study, i.e. the position of the "patient" in relation to her diagnosis and her psychiatrists and psychoanalysts.


Panel 5B   (Classification)
Wednesday, 15 September 1999

The Neurosciences and Psychiatry: Crossing the Boundaries

Joint Congress of the European Association for the History of Psychiatry (EAHP), the European Club for the History of Neurology (ECHN), and the International Society for the History of the Neurosciences (ISHN)

Zurich and Lausanne, Switzerland, 13-18 September 1999