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‘The poetry of psychiatry’: existential analysis and the politics of psychopathology in Franco’s Spain

Published online by Cambridge University Press:  18 July 2023

Enric J. Novella
Enric J. Novella*
Affiliation:
López Piñero Interuniversity Institute for Science Studies, University of Valencia, P/Cisneros 4, 46003 Valencia, Spain
*
Email: [email protected]
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Abstract

This article examines the presence and influence of the work of Swiss psychiatrist Ludwig Binswanger and existential analysis (Daseinsanalyse) in Spanish psychiatry in the central decades of the 20th century. First, and drawing on various printed and archival sources, it reconstructs the important personal and professional ties that Binswanger maintained with numerous Spanish colleagues and describes the notable dissemination of his work in Spain through bibliographical reviews, scientific events, academic reports, university lectures and translations. Next, it reviews the incorporation of the postulates of existential analysis into the discourse of Spanish psychiatrists and assesses their most elaborate and original contributions to the foundations of ‘anthropological–existential’ psychiatry or the ‘existential–analytical’ interpretation of certain disorders or clinical conditions. And, finally, it tries to clarify the assessment according to which the (inevitable) instrumentalisation of existential analysis in the context of Franco’s Spain first compromised the critical recognition of its true possibilities (and limits) and later contributed to the discrediting of psychopathological research among Spanish psychiatrists.

Keywords

Ludwig Binswangerexistential analysisphenomenologypsychopathologySpainFrancoism
Type
Articles
Information
Medical History , Volume 67 , Issue 1 , January 2023 , pp. 74 - 88
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
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© The Author(s), 2023. Published by Cambridge University Press

Introduction

In 1950, Carlos Castilla del Pino, at that time a young Spanish psychiatrist who had recently joined the Mental Hygiene Dispensary in Córdoba, published a thoughtful article on ‘The concept of “gravity” in Kierkegaard’. In it, he characterised the ‘grave mode of existence’ that could be inferred from the Danish thinker’s work, and after equating it with the notion of ‘authenticity’ formulated by Martin Heidegger, he presented the ‘problematic of existential modes’ as the cornerstone of ‘understanding psychology’:

There is no life except in the world, and insofar as one is living in the world one is already living in one’s own way, in one’s personal way. Therefore, to exist means to conceive existence, that is, to have one’s own, subjective ‘conception of the world’. […] The motives that impel man to conceive the world and his existence in his own particular way serve, at each moment and in the face of each subject, to reveal to us his most intimate category.Footnote 1

A quarter of a century later, and in a well-known volume dedicated to Spanish culture under General Franco’s dictatorship (1939–1975), the same Castilla del Pino published an essay on the evolution of Spanish psychiatry during that period in which, after crudely describing the ‘ideology’ of the professionals most identified with the regime and their ‘internal struggles for power’, he recalled with great disdain the adoption of so-called ‘existential analysis’ by the ‘dominant psychiatric theory’:

The need […] to make psychiatry cultivated by the powerful appear as a psychiatry of high philosophical sophistication, which would lend it a sumptuous character, gave rise to one of the worst phenomena that can occur in the course of an intellectual life: the subjection to fashions imposed by the inauthentic pretension of être à la page. Thus, in recent years, we have witnessed the imposition of existential analysis as a spiritualist alternative to psychoanalytic interpretation, and a good number of Spanish psychiatrists have turned into imitators of Binswanger, Zutt, Gebsattel, etc.Footnote 2

Undoubtedly, this is not the only issue on which such a multifaceted figure as Castilla del Pino changed his mind over the years,Footnote 3 but the contrast of these fragments is very revealing of the particularities that marked the reception of existential analysis and other related psychopathological currents in mid-twentieth-century Spanish psychiatry. As is well known, these currents crystallised in the period between the two World Wars within the framework of a broad movement of epistemological reform of psychiatry and psychology which, boosted by the emergence of psychoanalysis and phenomenology, tried to overcome the inadequacies of the traditional conception of mental illness and to tackle the fundamental problem of subjectivity for the understanding of madness and psychic suffering. Based on the holistic notion according to which the different phenomena of a given mental disorder form a ‘significant whole’, that is, a ‘structure’, those years saw the formulation of various approaches to psychopathological knowledge which, in contrast to the atomistic method of conventional semiology, aspired to provide a global vision of the behaviour and experience of psychiatric patients. From a plurality of theoretical references and conceptual strategies, authors such as Eugène Minkowski, Viktor Emil von Gebsattel, Erwin Straus and, above all, Swiss psychiatrist Ludwig Binswanger joined this project (often referred to as ‘phenomenological–anthropological psychiatry’).Footnote 4 Linked to the latter’s work and strongly influenced by Heidegger’s thought, existential analysis (Daseinsanalyse) sought to understand psychopathological symptoms not as discrete disturbances of a (hypothetical) set of psychic functions, but as expressions of living and developing one’s own existence, that is, of the pre-reflective way of ‘being-in-the-world’ (In-der-Welt-sein). In Binswanger’s view, psychopathology should not limit itself to the formal analysis of experiences (in the manner of Karl Jaspers’ ‘descriptive phenomenology’) but extend to the examination of the main coordinates of subjective experience (time, space, body, inter-subjectivity) and, finally, of ‘the constitutive and aprioristic structures that determine the worldly totality of the corresponding “being-in-the-world” and its uniqueness’.Footnote 5

Although, as we shall see, the first signs of its presence in Spanish psychiatry date back to the years immediately prior to the Civil War (1936–1939), the influence of Binswanger’s work and existential analysis was at its peak in the 1950s and reached its climax in 1958 with its stellar prominence at the 4th International Congress of Psychotherapy, which took place in Barcelona and was one of the main psychiatric conventions held in the country during Francoism.Footnote 6 In fact, at that time, there was hardly any psychiatrist in Spain with an academic career, professional reputation or simply intellectual ambition who did not show interest in, dealt with or dedicated publications to the philosophical foundations, the clinical contributions or the (alleged) therapeutic applications of existential analysis. Undoubtedly, it was not so much the interest in the holistic epistemology of the interwar period as the popularity of the ‘philosophies of existence’ (or, directly, ‘existentialism’) in the years after the Second World War that most contributed to this,Footnote 7 but – taking into account this striking prominence and the peculiar institutional and socio-political context of the country during the dictatorship – it can be assumed that other additional and specific factors were also involved in the Spanish case.

From this point of view, then, it is somewhat surprising that, except for the studies devoted to the figure and career of Luis Martín-Santos,Footnote 8 the reception of Binswanger’s work and the ‘appropriation’ of existential analysis have been scarcely addressed by the recent historiography of Spanish psychiatry.Footnote 9 Certainly, some of Ángel González de Pablo’s important works on the evolution of psychiatric thought during Franco’s regime include very accurate considerations on existential analysis, although his treatment is far from being exhaustive and is basically subordinated to other focuses of attention. Thus, for example, it is true that – as he stresses – receptiveness to the existential–analytical approach was closely related to the imprint of the influential Heidelberg School in the period following Kurt Schneider’s direction of the German city’s University Psychiatric Clinic (1946–1956)Footnote 10; but, as we shall see, Binswanger’s work was known, discussed and assimilated by Spanish psychiatrists simultaneously and in a way relatively independent of the contributions coming from Heidelberg. Likewise, it is undeniable that existential analysis was favourably received in Spain because, in the opinion of some prominent authors, it allowed overcoming Freudian ‘reductionism’ and reformulating ‘in a Christian way’ some of the most problematic notions of psychoanalysisFootnote 11; but a closer look also suggests that, in the end, its appeal resided more in its theoretical sophistication and in its harmony with the intellectual concerns of the time than in its potential to articulate what González de Pablo has dubbed a ‘psychopathology for believers’.

In the context of a growing interest in the history of phenomenological–anthropological psychopathology,Footnote 12 this article examines the presence and influence of Binswanger’s work and existential analysis in Spanish psychiatry in the central decades of the twentieth century. First, and drawing on various printed and archival sources (mainly the unpublished correspondence between Binswanger and various Spanish psychiatrists and patients’ relatives from 1923 to 1958, which is kept at the Tübingen University Archives), it reconstructs the important personal and professional ties that he maintained with some outstanding Spanish colleagues and shows the notable dissemination of his work in Spain through bibliographical reviews, scientific events, academic reports, university lectures and translations. Next, it reviews the incorporation of the postulates of existential analysis into the discourse of Spanish psychiatrists and assesses their most elaborate and original contributions to the foundations of ‘anthropological–existential’ psychiatry or the ‘existential–analytical’ interpretation of certain disorders or clinical conditions. And, finally, it tries to clarify the assessment according to which the (inevitable) instrumentalisation of existential analysis in the context of Franco’s Spain first compromised the critical recognition of its true possibilities (and limits) and later contributed to the discrediting of psychopathological research among Spanish psychiatrists.

Binswanger in Spain

Ludwig Binswanger was born in 1881 into a prominent family of Bavarian psychiatrists. His grandfather Ludwig had established the Bellevue Sanatorium (later run by his father Robert) in Kreuzlingen on the Swiss shore of Lake Constance in 1857, and his uncle Otto was Professor of Psychiatry at the University of Jena. After completing his medical studies in Lausanne and Heidelberg, Binswanger trained with Eugen Bleuler and Carl G. Jung at the famous Burghölzli Hospital in Zurich, and, after spending a year as his uncle’s assistant in Jena, in 1908 he joined the family sanatorium, which he took over in 1910 after the sudden death of his father. At that time, Bellevue already enjoyed an excellent reputation among mental health professionals and the wealthy classes throughout Europe, and in his more than 45 years at its helm, Binswanger did all he could to ensure its sustainability and increase its prestige.Footnote 13

This was probably the main reason for his first visit to Spain in October 1923, apparently at the invitation of the relatives of some patients hospitalised at Bellevue, including the aristocrat and senator Francisco Agustín Silvela and the businessman and politician of Hungarian-Jewish origin Ignacio Bauer.Footnote 14 In Madrid, Binswanger gave a lecture on 18 October at the Royal Academy of Medicine in which – under the title ‘Development of a hysterical neurosis in a child’ – he spoke in Spanish (thanks to the collaboration of Luis López-Ballesteros, renowned translator of Sigmund Freud’s works) on the treatment of the so-called ‘Gerda case’, also known as the ‘analysis of the heel’ (Absatzanalyse).Footnote 15 It is striking that, at a time when he had already distanced himself considerably from psychoanalysis (because of its ‘objectifying naturalism’ and its therapeutic limitations),Footnote 16 Binswanger decided to offer an introductory review of the psychoanalytic theory of neurosis together with the interpretation of a case that moved within the strict margins of Freudian orthodoxy:

In our opinion – he stated in the lecture – Freud’s main merit lies in having revealed and clarified these expressive forms of the human soul to the point of making it possible for us to link them to the mental life of normal, conscious man, thus extending, to an unsuspected extent, the domains of psychology and becoming the founder of a new psychological method: that of transforming psychic manifestations that previously defied all our efforts to understand them into intelligible ones.Footnote 17

In any case, everything indicates that his stay in Madrid was very fruitful: firstly, he was able to meet Gonzalo Rodríguez Lafora, José Sanchis Banús and other prominent colleagues, who in the following years referred patients to BellevueFootnote 18; shortly afterwards, he was appointed as corresponding foreign member of the Royal Academy of MedicineFootnote 19; and finally, he began negotiations with López-Ballesteros to translate his first book, the Introduction to the Problems of General Psychology (1922), into Spanish.Footnote 20 Binswanger then stopped in Barcelona, where he also made contact with the families of some patients, gave another lecture on the Gerda case at the Faculty of Medicine and spent much of his time with Emilio Mira y López and Belarmino Rodríguez Arias, two of the city’s best-known and most active neuropsychiatrists.Footnote 21 From then on, both Mira and Rodríguez Arias referred patients to Bellevue, and, like Lafora, visited Binswanger in Switzerland, met him on friendly terms at international conferences and maintained a regular epistolary relationship with him which was almost completely interrupted after the Civil War.Footnote 22

In this period, the Swiss psychiatrist was also in close contact with Ignacio Bauer, who at that time was a member of the Spanish Parliament, a member of the Madrid City Council and president of the Beneficence Commission of the Madrid Provincial Council.Footnote 23 Bauer had a relative being cared for at Bellevue and had great admiration for Binswanger (whom he appointed in 1928 as ‘honorary corresponding member’ of the Spanish Doctoral College over which he himself presided), so that he sought his advice and endorsement in the various initiatives he launched with the aim of erecting a new provincial asylum.Footnote 24 This involvement was the reason for Binswanger’s second trip to Madrid in December 1930, when Bauer asked him to visit the (private) psychiatric sanatorium in San José de Ciempozuelos and issue an opinion on the advisability of acquiring it to install the planned (public) asylum there. On his return, Binswanger wrote a brief report in which, despite recognising a favourable impression of the management and ‘orderliness’ of the institution, he expressly advised against its acquisition because the age of the facilities, the lack of rooms for women, the excessive number of beds and the need to undertake costly extensions and refurbishments.Footnote 25 It is difficult to estimate the effective influence that this report may have had, but the fact is that, after officially announcing the purchase, the Provincial Council went back on its initial project to build a new asylum in Alcalá de Henares, which, though finally built during the years of the Second Republic, was never inaugurated.Footnote 26

Binswanger apparently planned to visit Spain again in order to present a paper on the ‘flight of ideas’ (the subject of his first ‘existential–analytical’ interpretation) at the 11th International Congress of Psychology, which was to be held in Madrid in September 1936 under the presidency of Mira and which the outbreak of the Civil War forced first to postpone and then to move to Paris.Footnote 27 From then on, he also maintained contact with Enrique Escardó (director of the first Mental Hygiene Dispensary opened in Madrid), who referred some patients to him and visited Bellevue on several occasions, and with José Germain (former head of the Psychiatry and Mental Hygiene Section of the General Directorate of Health and Director of the National Institute of Psychotechnics), who spent part of the war at the Malévoz Psychiatric Sanatorium in Monthey (Switzerland).Footnote 28 And, during the war, Binswanger supported the publication of a Spanish version (translated by Mira and his disciple Víctor Hernández) of the important lecture he gave in May 1936 in Vienna on the occasion of Freud’s eightieth birthday.Footnote 29

Once the isolation of the immediate post-war years had been overcome, Binswanger’s name gradually recovered its presence in the (depleted) circles of Spanish psychiatry. The first testimony of this was offered by Juan José López Ibor, one of the central figures of the new professional elite established by the victors, in the voluminous academic report he presented in the competitive examinations for the Chair of Psychiatry at the (Central) University of Madrid, which were resolved in 1947 with the appointment of his arch-rival Antonio Vallejo Nágera.Footnote 30 In this report, published two years later under the title Los problemas de las enfermedades mentales [The Problems of Mental Illnesses], López Ibor outlined an overview of the ‘phenomenological method’ in which, starting from its incorporation into psychopathology by Jaspers and its foundations in the philosophies of Edmund Husserl and Martin Heidegger, he gave a pre-eminent place to the work of Binswanger. In his opinion, the overcoming of ‘the disjunction between object and subject’ achieved with the notion of ‘being-in-the-world’ made it possible to investigate the ‘modifications of this fundamental structure’ in mental disorders and ‘to understand the reality of the psychotic world […] without deforming it by previous interpretations’,Footnote 31 just as Binswanger had done in his studies on the ‘flow of ideas’ [sic] and the well-known (and controversial) case of Ellen West.Footnote 32 However, after commenting at length on these studies and defining the ‘anthropological–existential’ perspective as the ‘authentic phenomenology’, López Ibor wondered whether its cultivation entailed anything more than an exercise in ‘psychiatric pedantry’, a question that he responded expeditiously with the following words:

It is not at all necessary to dwell on these analyses for the clinic, despite what Binswanger says. […] Existential interpretation has another value for me. It is like the poetry of psychiatry. Just as in poetry we find a purer vision of the reality of the outside world, so existential anthropology offers us a poetic interpretation of the sick person. […] We can do without it, just as we can do without poetry in everyday life.Footnote 33

Not surprisingly, these words did not go unnoticed by Binswanger when López Ibor sent him a copy of his book with a request for a review. In a letter dated 31 January 1950, Binswanger politely declined the request and, after congratulating López Ibor for his ‘astonishing command of the international psychiatric literature’ and for ‘the clarity with which he approached and grouped psychiatric problems’, he thanked him for the ‘great understanding’ with which he dealt with his works and ‘defended them against irrelevant objections’, but could not avoid to add:

In any case, I believe that the existential–analytical and phenomenological research of psychosis is not the poetry of psychiatry, but rather its most sober prose, since it only aims to apprehend and present in an impartial way the true content of the projects of the world and the ways of experiencing it of our patients as they reveal themselves in their own manifestations. Significantly, this part of its task has so far been neglected by psychiatry.Footnote 34

The two men had the opportunity to meet personally that same year on the occasion of the First World Congress of Psychiatry held in Paris, and, shortly afterwards, López Ibor sent him a copy of his extensive monograph on La angustia vital [Vital Anguish], which Binswanger praised again as a complete and unique work of its kind.Footnote 35 From then on, their contact was sporadic, although López Ibor regularly expounded the outlines of existential analysis in his university lectures, encouraged his disciples to take an interest in its contributions, promoted the publication of a paper by Binswanger on ‘Existential Analysis and Psychotherapy’ (as well as the reprint of his 1923 Madrid lecture) and, finally, reviewed and supported the translation into Spanish of his Selected Lectures and Essays (originally published in 1947 and 1955).Footnote 36 In this way, and regardless of any personal reservations he may have had about the ‘poetry of psychiatry’, there is no doubt that, considering his privileged institutional position and thanks to his extensive intellectual, teaching and editorial activity, López Ibor played a leading role in the dissemination of Binswanger’s work in Spain during the 1950s and 1960s.

In those years, however, López Ibor had a firm competitor in this respect in the person of Ramón Sarró Burbano, the true ‘viceroy’ of Catalan psychiatry during the dictatorship and very interested since his youth in the epistemological and doctrinal ‘revision’ of psychoanalysis.Footnote 37 To prepare a paper on the value of the ‘new anthropological orientations’ for psychotherapy, which he was to present together with fellow psychiatrist Luis Valenciano Gayá at the 7th Annual Meeting of the Spanish Association of Neuropsychiatrists to be held in Madrid in 1935, Sarró had already asked Binswanger in 1934 for an offprint of his well-known essay on ‘Dream and Existence’ (1930).Footnote 38 Their contact intensified after the 1950 Paris congress, where they both participated in a well-attended symposium on ‘Existential Analysis in Psychiatry’.Footnote 39 After visiting Bellevue in the spring of 1955, Sarró was commissioned to organise the 4th International Congress of Psychotherapy in Barcelona, and he immediately wrote to Binswanger to announce that the central theme of the meeting would be devoted to existential analysis:

The time is ripe to raise the issue of psychotherapy in Western culture. Through American colleagues that come to Barcelona I have the impression that a certain weariness is being felt in relation to psychoanalysis. Despite its apparent success […], its problems are beginning to be considered in a more critical spirit and the need for a new anthropological conception of psychiatry and psychotherapy is being perceived.Footnote 40

Praised by Sarró as the ‘creator of the new ideas’, Binswanger’s presence at the congress was considered essential, and so he was repeatedly urged to travel to the Catalan capital. Very reluctant to do so at the age of 77, Binswanger initially proposed that Heinz Häfner, a young assistant at the University Psychiatric Clinic in Heidelberg, participate in his place with a paper on ‘Consciousness and existential psychotherapy’Footnote 41, but Sarró did not give up:

Our satisfaction would be complete if you were to attend the Congress, which will be, without exaggeration, a ‘Binswangerian’ congress whose significance will be that of a homage of world medicine to the master of the new orientation. Even at the risk of hurting your veneration for Freud, I believe that Freud’s ideas have already fulfilled their historical mission and that new times are coming. Heaven willing, you will decide to come and preside over the advent of a new era for psychological medicine.Footnote 42

After a last attempt a few weeks before the start of the sessions on 1 September 1958 (in which Sarró sent to Binswanger a copy of a highly laudatory article on his work and his figure published in the ‘official journal’ of the congress),Footnote 43 Binswanger definitively declined the invitation and limited himself to sending a brief ‘message’ to the attendants on the ‘evolution of his work’ and the ‘paths of his research’, which was circulated as a preamble to the numerous papers and communications presented and in which he retrospectively defined his intellectual project as that of ‘discovering forms of human existence which psychiatry had undoubtedly always had “in view”, but whose complete vision was always obscured because of its natural-scientific method’.Footnote 44

As a culmination of this episode, which practically closed Binswanger’s correspondence and personal and professional contact with his Spanish colleagues, Sarró wrote to him a few months later to inform about the success of the congress and openly declared himself as his ‘disciple’:

But I doubt that I will ever deserve this title, because, even without counting my own limitations, my function as a Professor of Psychiatry in Barcelona absorbs my activity in many directions and robs me of the time and strength to devote myself to that which is expressed in the quotation from Hegel that I have taken from you and reproduced in some of my essays, ‘the striving of the concept’ (Die Anstrengung des Begriffs).Footnote 45

Philosophy and existential analysis

The first recognisable attempt to incorporate the existential–analytical perspective into psychopathological discourse took place in Spain in 1934 with the publication of a ‘Contribution to the Study of the Schizoid’ by the young physician from the Psychiatric Department of Madrid’s General Hospital (and future prestigious neuroscientist) Justo Gonzalo. After reviewing the descriptions of this personality profile and its clinical implications in the work of great names of Central European psychiatry such as Eugen Bleuler, Ernst Kretschmer and Josef Berze, Gonzalo proposed the need to grasp the ‘psychological essence of the schizoid […] avoiding particular clinical concepts’, something which required ‘going back to the general concept of human existence’.Footnote 46 In this way, and in line with Binswanger’s ‘research on the flow of ideas’, the various psychological features of the schizoid (psychoesthesia, apperceptive irritability, etc.) could be subsumed into a certain ‘psychic attitude’ or, more concretely, into a ‘schizoid existence’ marked precisely by ‘anguish and existential preoccupation’.Footnote 47 Despite its tentative character, Gonzalo’s essay did not go unnoticed, and a few months later, neuropsychiatrist Dionisio Nieto published an acid commentary in which he described as ‘a fundamental error of principle’ any ‘application to psychiatry of certain philosophical conceptions’; as a natural science ‘embedded’ within medicine ‘with limited problems and its own methods’, psychiatry could not entrust to foreign disciplines the clarification of its own phenomena without incurring in ‘erroneous elucubrations’ and promoting an ‘untenable confusionism’.Footnote 48 But Gonzalo countered by pointing out that such a conception of psychiatry as a natural science was far from unquestionable; that psychopathology could not do without phenomenology as the ‘science of the intuition of the essentialities of consciousness’; and that – inspired by ‘the study of manic existence by Binswanger’– he had only intended to suggest a ‘fundamental nucleus for all that is most typical of the schizoid’.Footnote 49

In December 1935, Sarró and Valenciano finally presented their aforementioned paper to the 7th Annual Meeting of the Spanish Association of Neuropsychiatrists, in which they proposed to undertake no less than a ‘revision of the fundamental concepts of psychotherapy’ (and, particularly, of psychoanalysis) by means of a ‘fragmentary appropriation of the new existential anthropology’.Footnote 50 In his intervention, Sarró did not forget to quote Binswanger in order to contrast the ‘existential interpretation’ of symbols with the Freudian ‘fixation’ in its exclusively sexual character: ‘flying or falling in dreams reflects the “essential ontological structure” of the ascent or descent of life that can manifest itself in an erotic, ethical, economic or religious sector’.Footnote 51 And, for his part, Valenciano referred with approval to the Swiss psychiatrist’s thesis according to which the ‘psychotherapeutic situation’ constitutes a particular form of ‘existential encounter’ that goes far beyond the framework of the psychoanalytic transference: ‘as a psychotherapist the doctor can never be merely the friend of the patient, […] but neither can he ever give himself exclusively to the “service to the thing”’.Footnote 52

As we have seen, references to Binswanger’s work and existential analysis in Spanish psychiatry did not re-emerge until the late 1940s, but then they did so with unusual intensity and largely amalgamated with the discussion of the postulates of the ‘philosophies of existence’. Initially, this presence was particularly noticeable in the psychiatric circles of Madrid and Barcelona and, more specifically, in the respective spheres of influence of López Ibor and Sarró. In the case of the former, while he himself elaborated his concept of ‘vital’ or endogenous anguish (which should be strictly distinguished from ‘reactive’ or ‘existential’ anguish)Footnote 53 and seasoned some of his articles and talks with phenomenological and existential considerations,Footnote 54 some of his closest collaborators began to read the works of Kierkegaard, Heidegger, Jaspers, Jean-Paul Sartre and Gabriel Marcel. Apart from Castilla del Pino, two young doctors (who, curiously enough, ended up participating in the political opposition to the Franco regime) were particularly involved in this endeavour: José Aumente Baena (who in 1951 stressed the close affinities between ‘true, authentic or resolute existence’ and the ‘Christian attitude to life’)Footnote 55 and Luis Martín-Santos, who – albeit in a rather scattered way – produced the most significant contributions of this group. In fact, and beyond his (early) familiarity with Sartrean ‘existential psychoanalysis’ and (later) acquaintance with Heideggerian ‘existential analytics’,Footnote 56 Martín-Santos was not only interested in this perspective from a psychotherapeutic point of view, but also incorporated it into his contributions to psychiatric epistemology and clinical psychopathology. Thus, although in his doctoral thesis he placed the existential–analytical approach outside the perimeter of proper ‘psychological understanding’ because of its recourse to a ‘broad auxiliary system that is difficult to accept as “simple description”’,Footnote 57 in a later essay he defended ‘the primacy of existential understanding over other forms of psychopathological understanding’ (‘static, dynamic and deep’) because of its potential to reveal, ‘from the fundamental existential disturbance, […] the total picture of psychosis and not just some isolated symptoms’.Footnote 58 And, precisely with this intention, in 1961 he published a brilliant study on acute epileptic psychoses in which, based on a detailed ‘phenomenological description’ of their ‘ecstatic’ and ‘anguished’ variants, he tried to grasp the ‘coherent or total alteration of the being-in-the-world’ of the patients with a close examination of spatiality, relationship with objects, corporeality, ‘being-with’ (Mitsein), ‘finding oneself’ (Befindlichkeit) and the temporality of ‘care’ (Sorge). Thus, he suggested that such clinical conditions were characterised by the ‘kineticism of delusional spatiality’, the ‘degradation of the structure of being-to-hand’ (Zuhandenheit), the loss of the ‘instrumental character of the body’, a ‘radical estrangement from communication with others’ (devoid, however, of the self-referentiality characteristic of schizophrenic and paranoid psychosis), ‘ataraxia without action’, ‘throwness (Geworfenheit) without abandonment’ and, finally, the insertion of experience in a ‘time of eternity’ or in the ‘eternity of the instant’.Footnote 59

As far as Barcelona is concerned, while Sarró continued to insist on the need to renew psychotherapy ‘without losing contact with the realities discovered by Freud but giving them an interpretation in accordance with the new anthropology’ (and in particular with the ‘phenomenological analytics of human life’ outlined by Heidegger),Footnote 60 some of his disciples participated assiduously in the philosophical readings that took place at the Erasmus Centre for Anthropological and Humanistic Studies (founded in 1947).Footnote 61 Among them were Juan Obiols Vié (who in 1971 succeeded Sarró to the Chair of Psychiatry at the University of Barcelona) and Delfí Abella Gibert (who, in addition to his work as a psychiatrist, became well known as one of the members of the famous group of Catalan singer-songwriters Els Setze Jutges). The former presented in 1958 (and published in 1969) a doctoral thesis devoted to the phenomenological and existential interpretation of a single case of schizophrenia in which – following closely the studies of Minkowski and Binswanger – he concluded that his patient’s peculiar way of ‘being-in-the-world’ (marked, among other aspects, by the ‘disinsertion’ from time, the ‘widening’ of lived space and a striking coexistence of the ‘alienated’ and the ‘shared’ world) allowed for a global ‘understanding’ of the articulation of his florid delusional symptomatology.Footnote 62 For his part, Abella presented in 1957 a doctoral thesis on hypochondria (in which he claimed its ‘syndromic substantivity’ through a ‘phenomenological-anthropological’ analysis)Footnote 63, and in 1961 he received the 2nd Martí i Julià Prize from the Institute of Catalan Studies for a short monograph on the ‘anthropological–existential orientation of psychiatry’ in which, after summarily reviewing its ‘conceptual and philosophical bases’ and its main ‘methods and theories’ (with a prominent role for Binswanger’s Daseinsanalyse), he defined it as a ‘renovating movement of psychiatric thought’ characterised by humanism, holism and the ‘concern for meaning, ethics and freedom’.Footnote 64

A similar panoramic view had been presented by Román Alberca Lorente, Professor of Psychiatry at the University of Valencia (and originally trained as a neuropathologist), in a lecture he gave in Barcelona in May 1951, which was published two years later. Starting from the appreciation of its epistemic ‘humility’ as a ‘phenomenological anthropology’ that does not pretend to ‘solve psychiatric problems’ (but ‘to limit itself to collecting modes of existence’), and continuing with its consideration of the ‘organism and its world’ as a ‘transcendent unity’ (ie. ‘as a whole in which no isolated factual or intimate alteration can occur’), Alberca described existential analysis as an enterprise aimed at ‘obtaining, by circling around his world, news of [the mentally ill man’s] being’.Footnote 65 He then gave a detailed account of the Heideggerian understanding of Dasein as ‘being-in-the-world’ and of other ‘existentials’ such as spatiality, temporality or ‘finding oneself’, as well as of the dissents and nuances introduced by Jaspers, Sartre, Marcel or Binswanger himself (for example, with his redefinition of the dialogical ‘being-with’ as a ‘we’ forged ‘in the light of love’).Footnote 66 And, after referring to anguish as the ‘fundamental state of mind’ and to the (always lurking) possibility of being ruined in ‘impersonalism’ and ‘inauthentic life’, he reviewed Binswanger’s fine analyses of the flight of ideas, the ‘manic–depressive antinomy’ and schizophrenia; he noted the contributions of authors such as Minkowski, Gebsattel and Straus; and, finally, he praised the ‘modesty’ and ‘respectful timidity’ of existential analysis in the face of the psychoanalytic tendency towards determinism and objectification.Footnote 67

Alongside this conference by Alberca, one of the most thorough syntheses of the foundations and contributions of existential analysis among all those made at that time in Spain was delivered by the Galician psychiatrist Manuel Cabaleiro Goás. Endowed with an encyclopaedic mastery of the psychopathological literature of the time despite his peripheral position (geographically and academically),Footnote 68 Cabaleiro presented as early as 1954 a preliminary existential–analytical interpretation of a case of schizophrenia that allowed him to note its ‘emptying or existential impoverishment’, but also ‘the infinite diversity that exists in the schizophrenic way of “being-in-the-world”’.Footnote 69 However, it was above all in the first volume of his Temas psiquiátricos [Psychiatric Themes] (1959) that he dealt most thoroughly with ‘existential anthropology’ (and Binswanger’s work in particular). After the mandatory review of the approaches of the four great names of ‘existentialist philosophy’ as the starting point of Daseinsanalyse, Cabaleiro focused on its ‘application to clinical psychiatry’; thus, he offered an examination of the ‘modes of existence’ in melancholia (highlighting the disorders of ‘lived time’ described by Minkowski), schizophrenia (underlining the different profiles of Binswanger’s cases), anxiety (adding nuances to López Ibor’s phenomenological notes) and mania (referring in detail to Binswanger’s ‘very profound study’ on the ‘flow of ideas’).Footnote 70 In his opinion, this ‘knowledge of the mode of existence of the mentally ill man [had] to be one of the goals of psychiatry’ insofar as it provided very valuable clues from the psychopathological, prognostic and therapeutic points of view, but Cabaleiro did not hide his reservations about the obscurity of some of its philosophical assumptions, its speculative excesses and the impossibility of generalising its findings to all cases of a given disorder (something particularly noticeable in schizophrenia).Footnote 71 Even so, he had no doubt that – as he wrote in the second volume of Temas psiquiátricos (1966) – existential analysis ‘[had] come to sow in the psychiatric environment the seed of an anthropological orientation’, an orientation that he conceived in an ‘integralist, totalist and dynamic’ sense and to which he dedicated his greatest intellectual efforts.Footnote 72 Paraphrasing López Ibor, Cabaleiro conceded that existential analysis might, indeed, be no more than the ‘poetry of psychiatry’, but this should not lead to questioning its value as ‘one more weapon in the hands of the psychiatrist’ which ‘raises us above the materiality of the psychotic […] as poetry does above the prose of everyday life; and everything that leads us to a better knowledge of man, and as psychiatrists, of the sick man, must be accepted without excesses, even if it is only that, poetry’.Footnote 73

Concluding remarks: The crisis of psychopathology

Although some translations of Binswanger’s work were still published and some more or less idiosyncratic reviews were also produced (mainly by university authors),Footnote 74 in the mid-1960s the interest of Spanish psychiatrists in existential analysis and other related approaches began to wane. As in other countries, the attention of many professionals (especially the younger and more restless ones) shifted then to social and community psychiatry; clinical practice became increasingly focused on other (neurotic) patient profiles and took root outside the confines of the old ‘madhouses’; the introduction of psychotropic drugs (led by neuroleptics) mitigated the ‘visibility’ of some of the most prominent symptoms of mental disorders (so that an important stimulus for the cultivation of psychopathological analysis was lost); and the ‘philosophies of existence’ lost much of their cultural prominence and appeal in favour of Marxism, structuralism, critical theory and other currents in social science.Footnote 75 However, in the Spanish case, there were also other factors that, to a large extent, can be explained by the doctrinal, but also ideological, institutional and socio-political particularities that influenced the reception of Binswanger’s work and the ‘appropriation’ of existential analysis in the previous decades.

Firstly, and as González de Pablo has shown, there is no doubt that some Spanish psychiatrists were attracted by an approach that seemed to ‘alleviate some of the more strident limitations’ of the methodology of the Heidelberg School (Jaspers and Schneider), ‘in particular those derived from the narrowness of understanding and the establishment of meaningful connections in the patient’s experiences’Footnote 76; nevertheless, it must be borne in mind that – as the work of López Ibor paradigmatically demonstrates – the strictly organicist conception of mental disorders predominant among the professionals of the time led in many cases (although not always) to a rather ‘poetic’ (and, therefore, not substantial) adoption of the phenomenological–existential perspective. Secondly, it is evident that, at least in part, existential analysis found in Spain a ‘fertile ground’ because of the belligerent animosity of the ‘official culture’ and of some of its psychiatric spokesmen towards Freudian ‘instinctive mechanicism’ and ‘pansexualism’Footnote 77; however, and as we have seen, it is necessary to note the diversity of ideological profiles of the authors who made use of Binswanger’s work, as well as the plurality of their attitudes towards psychoanalysis (from the most dogmatic rejection to ‘anthropological’ or ‘existential’ reformulations). Thirdly, it is undeniable that the ‘incorporation’ of the postulates of phenomenological–anthropological psychopathology into Spanish psychiatry took place to a large extent from the specific environment of university chairs and professional conferencesFootnote 78; but it is also necessary to recognise the genuine interest in its foundations and contributions of authors who cannot simply be ascribed to the ‘academic psychiatry’ of the Franco regime. And, finally, it is equally true that the maximum influence of existential analysis in Spain took place at a time when, in the context of the ‘political immobility’ imposed by the regime, ‘clinical–theoretical speculation’ was favoured by the unfeasibility of ‘any project to transform the reality of psychiatric care provision’Footnote 79; even so – and as the cases of Valenciano and Cabaleiro show – the interest in psychopathological research was then not entirely incompatible with openness to transforming experiences and new models of care.Footnote 80

In any case, and insofar as many of the most conspicuous representatives of the ‘psychiatric power’ promoted or were receptive to existential analysis, it was to some extent logical that, after Franco’s death and in a context marked by the absolute priority of undertaking a profound reform of the mental health care system, the previous interest in it was seen as a mere discursive ‘superstructure’ at the service of solipsism, conservatism and immobility. In a tone very similar to that of Castilla del Pino, for example, progressive psychiatrist Enrique González Duro described in 1978 ‘existential phenomenology’ as a futile exercise of ‘pseudo-philosophical abstraction’ which ‘has only served to enable the most traditional and academicist Spanish psychiatrists to cover their crude and classical conceptions of mental illness with a spiritualist façade’.Footnote 81 Aggravated thus by the rejection aroused in broad sectors by its (inevitable) discursive instrumentalisation during the dictatorship, the general decline of philosophically inspired psychopathology in the last decades of the twentieth century has meant that today Binswanger’s contributions (and those of phenomenological–anthropological psychiatry as a whole) are barely known in Spain and appreciated only by a few specialists.

In this regard, what has happened in Spain is a particularly extreme case of an international phenomenon that has only recently begun to reverse itself with the revitalisation of ‘philosophy of psychiatry’ and phenomenological–anthropological psychopathology brought about by the holding of regular scientific events, the creation of various stable research groups and centres, the appearance of quality academic journals and the publication of monographs and major reference works.Footnote 82 And, for this reason, it can shed some light on the broader epistemological, but also social and cultural factors influencing (and even determining) the crystallisation, the development and the implementation of psychopathological discourses and practices.

Acknowledgements

This study was carried out with the support of a grant from the German Academic Exchange Service (DAAD) and in the framework of the research project ‘The Clinics of Subjectivity: History, Theory and Practice of Structural Psychopathology’ (PID2020-113356GB-I00), funded by the Spanish Ministry of Science and Innovation (Spain).

Competing interest

The authors have no competing interests to declare.

References

1 del Pino, Carlos Castilla, ‘El concepto de “gravedad” en Kierkegaard’, Actas Luso-Españolas de Neurología y Psiquiatría, 9 (1950), 33–37 Google Scholar, 37. In his splendid memoirs, Castilla del Pino acknowledges that at that time he was ‘fascinated by the reading of Sein und Zeit’ (sic) and ‘infected by the tendency of German philosophy to make everything complicated’ (Carlos Castilla del Pino, Pretérito imperfecto, Barcelona: Tusquets, 1997, 485, 492). All translations are my own unless otherwise noted.

2 Carlos Castilla del Pino, ‘La psiquiatría española (1939–1975)’, in Castellet, Josep M. (ed.), La cultura española bajo el franquismo (Barcelona: Ediciones de Bolsillo, 1977), 79–102 Google Scholar, 100.

3 In fact, Castilla del Pino’s ‘settling of scores’ with the ‘post-Kraepelinian’ psychiatry in which he had been trained began in 1963 with ‘Vieja y nueva psiquiatría’ [‘Old and New Psychiatry’], one of his best-known articles. In it he declared that ‘a better cultivation of phenomenological psychopathology, to limits of precision that today seem admirable to us, more for the intellectual effort involved than for the amount and usefulness of the results, could not be the solution for the clarification of the problems’. del Pino, Carlos Castilla, ‘Vieja y nueva psiquiatría’, Archivos de Neurobiología, 26 (1963), 215–226 Google Scholar, 220.

4 In this regard, see, for instance, Passie, Torsten, Phänomenologisch-anthropologische Psychiatrie und Psychologie. Eine Studie über den ‘Wengener Kreis’: Binswanger, Minkowski, von Gebsattel, Straus (Hürtgenwald: Guido Pressler, 1995)Google Scholar; Lantéri-Laura, Georges, Essai sur les paradigmes de la psychiatrie moderne (Paris: Éditions du Temps, 1998)Google Scholar; and Abettan, Camille, Phénoménologie et psychiatrie. Heidegger, Binswanger, Maldiney (Paris: Vrin, 2018)Google Scholar.

5 Binswanger, Ludwig, Über Ideenflucht (Zurich: Orell Füssli, 1933), 174 Google Scholar. Among the abundant bibliography on Binswanger and existential analysis, the following works deserve to be mentioned: Herzog, Max, Weltentwürfe: Ludwig Binswangers phänomenologische Psychologie (Berlín: DeGruyter, 1994)CrossRefGoogle Scholar; Lanzoni, Susan, Bridging Phenomenology and the Clinic: Ludwig Binswanger’s Science of Subjectivity (Harvard University PhD thesis, 2001)Google Scholar; and Foucault, Michel, Binswanger et l’analyse existentielle (Paris: EHESS/Gallimard/Seuil, 2021)Google Scholar.

6 See in this regard Lazcano, Silvia Lévy, Psicoanálisis y defensa social en España, 1923–1959 (Madrid: Los Libros de la Catarata, 2019), 142–148 Google Scholar.

7 The bibliography on the extraordinary circulation and influence of the works of Kierkegaard and Heidegger, but also of Jaspers, Jean-Paul Sartre and Gabriel Marcel, in the middle decades of the twentieth century is, as one might expect, vast. A good overview, however, is given in Steven Crowell (ed.), The Cambridge Companion to Existentialism (Cambridge: Cambridge University Press, 2012). Regarding its presence in Spain, see Gustavo Bueno, ‘La filosofía en España en un tiempo de silencio’, El Basilisco, 20 (1996), 55–72.

8 Worth noting among them are the essays collected in Fuentenebro, Filiberto, Berrios, Germán E., Romero, Isabel and Huertas, Rafael (eds), Psiquiatría y cultura en España en un Tiempo de Silencio. Luis Martín Santos (Madrid: Necodisne, 1999)Google Scholar; the introductory studies to Martín-Santos, Luis, El análisis existencial. Ensayos (Madrid: Triacastela, 2004)Google Scholar; the excellent biography by Lázaro, José, Vidas y muertes de Luis Martín-Santos (Barcelona: Tusquets, 2004), 144–150 Google Scholar; and the recent study by García, Juan Carlos Sabio, Psiquiatría y psicoanálisis en la obra de Luis Martín-Santos (Madrid: Minerva, 2018)Google Scholar.

9 Of course, the use of the term ‘reception’ in this article is methodologically consistent with the overarching goal of examining how Binswanger’s work was interpreted, adapted, transformed, passed on and (finally) forgotten in mid-twentieth century Spain. For a recent overview of ‘reception theory’ see Ika Willis, Reception (New York: Routledge, 2018).

10 de Pablo, Ángel González, ‘Sobre la génesis del orden psiquiátrico en la posguerra española: la implantación de la psiquiatría de Heidelberg en España’, Revista de la Asociación Española de Neuropsiquiatría, 7 (23) (1987), 633–647 Google Scholar, 643–646.

11 de Pablo, Ángel González, ‘La teoría psiquiátrica durante el primer franquismo’, in Campos, Ricardo and de Pablo, Ángel González (eds), Psiquiatría e higiene mental en el primer franquismo (Madrid: Los Libros de la Catarata, 2016), 46–80 Google Scholar, 69–71.

12 A recent assessment of this emerging historiographical domain can be found in Elisabetta Basso, ‘Quale storia per la psichiatria fenomenologica?’ Mefisto, 2 (2018), 31–50. For an exhaustive review of the historical and philosophical roots of phenomenological psychopathology, see Fernandez, Anthony Vincent and Rosfort, René (eds), ‘History’, in Oxford Handbook of Phenomenological Psychopathology (Oxford: Oxford University Press, 2019), 11–188 Google Scholar.

13 For a biographical sketch of Binswanger, see Dino Larese, Ludwig Binswanger. Versuch einer kleinen Lebensskizze (Amriswil: Amriswiler Bücherei, 1965); and Herzog, op. cit. (note 5), 14–26. Regarding Bellevue see Herzog, Max (ed.), Ludwig Binswanger und die Chronik der Klinik ‘Bellevue’ in Kreuzlingen (Berlín: Quintessenz, 1995)Google Scholar, which includes a brief essay of Binswanger himself (‘Zur Geschichte der Heilanstalt Bellevue’) originally published in 1957 on the occasion of the centenary of the sanatorium.

14 The medical records of the Bellevue Sanatorium, also kept at the Tübingen University Archives (UAT), show a total of 114 admissions of 73 Spanish patients between 1913 and 1948. I owe this information to the kindness of Professor Albrecht Hirschmüller.

15 Binswanger had originally published this case study in ‘Analyse einer hysterischen Phobie’, Jahrbuch für Psychoanalytische und Psychopathologische Forschung, 3 (1911), 229–308. Together with the laudatory presentation by Carlos María Cortezo (President of the Academy), the text of his lecture was published shortly afterwards with the new title ‘Introducción a la psicoanálisis médica’ [‘Introduction to Medical Psychoanalysis’], in Anales de la Real Academia Nacional de Medicina, 43 (1923), 735–761; and in El Siglo Médico, 73 (1924), 388, 417–418, 447–448.

16 Even so, Binswanger maintained a close and friendly relationship with Freud, whom he always regarded as one of his teachers and treated with the utmost respect and admiration. See Gerhard Fichtner, ‘Einleitung’, in Sigmund Freud and Ludwig Binswanger, Briefwechsel 1908–1938 (Frankfurt am Main: S. Fischer: 1992), IX–XXXI.

17 Binswanger, op. cit. (note 15), 750–751.

18 Lafora reportedly invited Binswanger to have dinner at his home on the same day of the lecture and asked him to write a paper ‘on phenomenology’ for Archivos de Neurobiología, a journal founded in 1919 with the support of philosopher José Ortega y Gasset but mostly focused on clinical neuropsychiatry. Based on a lecture given by Binswanger in May 1924 in Rome and translated by Lafora himself, the contribution was eventually published as ‘Psicología moderna y psiquiatría’ [‘Modern Psychology and Psychiatry’], in Archivos de Neurobiología, 5 (1925), 85-100. As for Sanchis Banús, Binwanger remained in contact with him until his early death in August 1932, and translated into German and promoted in 1926 the publication in the Schweizer Archiv für Neurologie und Psychiatrie (18, 141-6) of his pioneering study on the paranoid delusions of the blind (UAT 443/534).

19 The original diploma, issued in Madrid on 24 December 1923, is preserved at UAT 443/163.

20 Binswanger’s correspondence with López-Ballesteros extends from 25 October 1923 to 4 February 1931 (UAT 443/35, 443/37 and 443/39). Although López-Ballesteros announced on a couple of occasions that he had completed the translation, it was never published despite Binswanger’s constant demands. It should be added that, at Silvela’s request, the Spanish Royal Academy of Moral and Political Sciences commissioned a report on Binswanger’s monograph by the philosopher Adolfo Bonilla y San Martín, who described it as ‘the best study that currently exists on the directions of contemporary psychology’ (Francisco Agustín Silvela, Letter to Ludwig Binswanger, 23 April 1923, UAT 443/97).

21 Binswanger’s talk was positively reviewed by Rodríguez Arias in the Revista Médica de Barcelona, 1 (1924), 73–74, which also published shortly afterwards (translated by Mira) another article by Binswanger of a clearly promotional nature: ‘La psicoterapia en el sanatorio psiquiátrico mixto o combinado’ [‘Psychotherapy in the Mixed or Combined Sanatorium’], Revista Médica de Barcelona, 3 (1925), 144–154.

22 Binswanger’s correspondence with Lafora, Mira and Rodríguez Arias can be found, respectively, in UAT 443/870, 443/947 and 443/1044.

23 On Ignacio Bauer, see Jacobo Israel Garzón, ‘Judíos ignorados de la España del siglo XX: Contribución judía a la cultura española de nuestro siglo’, in Kapón, Uriel Macías, Koch, Yolanda Moreno and Benito, Ricardo Izquierdo (eds), Los judíos en la España contemporánea (Cuenca: Ediciones de la Universidad de Castilla-La Mancha, 2000), 237–282 Google Scholar, 249–253.

24 In a booklet he published on Lo que debe ser el Manicomio Provincial [What the Provincial Asylum Must Be] (Madrid: Imprenta de Jesús López, 1925), Bauer included a letter sent by Binswanger on 18 November 1924 in which the latter made a series of bibliographical recommendations and questioned whether the Bellevue model of an ‘open sanatorium’ could be extended to Spain. As for the Doctoral College [‘Colegio de Doctores’], it had been founded in 1922 with the goal of promoting academic culture and the corporative interests of doctors. The original diploma of Binswanger’s appointment, issued in Madrid on 1 March 1928, can be found at UAT 443/164.

25 Thus, and in line with Bauer’s wishes, Binswanger concluded that ‘by acquiring the asylum of Ciempozuelos, the province of Madrid would lose the opportunity to build an institution for the care of the insane that could serve as a model for the whole of Spain’ (Ludwig Binswanger, Letter to Ignacio Bauer, 20 December 1930, UAT 443/120).

26 See Azumendi, Óscar Martínez, ‘De visita al manicomio’, Revista de la Asociación Española de Neuropsiquiatría, 31 (111) (2011), 555–569 CrossRefGoogle Scholar.

27 Ludwig Binswanger, Letter to Emilio Mira y López, 20 June 1936, UAT 443/947. The congress, which had been declared ‘official’ by the Government of the Spanish Republic (Gaceta de Madrid, 29 January 1936, 859), was finally held in the French capital between 25 and 31 July 1937, but there is no record of Binswanger’s participation.

28 Binswanger’s correspondence with Escardó (in German) and with Germain (in French) can be found, respectively, in UAT 443/671 and 443/721.

29 Ludwig Binswanger, ‘La concepción freudiana del hombre a la luz de la antropología’ [‘Freud’s Conception of Man in the Light of Anthropology’], Archivos de Neurobiología, 16 (1936), 471–505. As an additional fact, it should be noted that in 1957, the Revista de Psicología General y Aplicada, directed by Germain, also published (in Escardó’s Spanish translation) Binswanger’s article ‘Mi primera visita a Freud en Viena’ [‘My First Visit to Freud in Vienna’], written on the occasion of the centenary of Freud’s birth the previous year.

30 Psychiatrist and military officer Vallejo Nágera had played a major role in the Civil War as Head of the Psychiatric Services of Franco’s army. Acquainted with the postulates of eugenics and racial hygiene, he depicted political rivals as pathological degenerates prone to the most diverse mental disorders. A catholic conservative and monarchist, very cultivated and extremely ambitious, López Ibor could secure for his part an influential institutional position though this initial defeat and became the leading figure of Spanish academic psychiatry in the central decades of the twentieth century. On both figures and this episode in the history of Spanish psychiatry (which came to be referred to as the ‘Battle of Madrid’), see Juan Casco Solís, ‘Psiquiatría y franquismo. Periodo de institucionalización (1946–1960)’, in Filiberto Fuentenebro, Germán E. Berrios, Isabel Romero and Rafael Huertas (eds), Psiquiatría y cultura en España en un Tiempo de Silencio. Luis Martín Santos (Madrid: Necodisne, 1999), 85–128, 103–104.

31 Ibor, Juan José López, Los problemas de las enfermedades mentales (Barcelona: Labor, 1949), 21–22 Google Scholar.

32 The case of Ellen West, a patient with elusive psychotic symptoms and strongly disturbed eating behaviour who committed suicide after leaving Binswanger’s care at Bellevue, was originally published in the Schweizer Archiv für Neurologie und Psychiatrie between 1944 and 1945 and was translated (from English) into Spanish in Rollo May, Ernest Angel and Henri F. Ellenberger (eds), Existencia (Madrid: Gredos, 1967), 288–434.

33 Juan José López Ibor, op. cit. (note 31), 25.

34 Ludwig Binswanger, Letter to Juan José López Ibor, 31 January 1950, UAT 443/902. López Ibor replied that he planned to publish an article ‘on the influence of Binswanger’s thought on modern psychiatry’ (Juan José López Ibor, Letter to Ludwig Binswanger, 8 April 1950, UAT 443/902), a project he never accomplished.

35 Binswanger, however, regretted that López Ibor regarded Ellen West as a simple case of anorexia nervosa: ‘I do not take it at all amiss that you reject the diagnosis of schizophrenia in Ellen West; in this case I assure you that you had to see the patient, as Bleuler could also do, to be convinced of this diagnosis’ (Ludwig Binswanger, Letter to Juan José López Ibor, 13 November 1950, UAT 443/902).

36 Binswanger, Ludwig, ‘Análisis existencial y psicoterapia’, Actas Luso-Españolas de Neurología y Psiquiatría, 14 (1955), 61–64 Google Scholar; Juan José López Ibor, ‘Ludwig Binswanger, Ausgewählte Vorträge und Aufsätze Band II’, Actas Luso-Españolas de Neurología y Psiquiatría, 15 (1956), 261; Ibor, Juan José López, Lecciones de psicología médica (Madrid: Paz Montalvo, 1963), Vol. 2, 77–90 Google Scholar; and Ludwig Binswanger, Artículos y conferencias escogidas (Madrid: Gredos, 1973).

37 After having enthusiastically met Freud in Vienna in the mid-1920s, Sarró became (together with López Ibor) one of the earliest critics of psychoanalysis in Spain. See Teresa Sánchez Sánchez, ‘Ramón Sarró y el psicoanálisis: Historia del acercamiento y la abjuración’, Revista de Historia de la Psicología, 37(3) (2016), 14–19.

38 Ramón Sarró Burbano, Letter to Ludwig Binswanger, 13 October 1934, UAT 443/1068.

39 Ey, Henri, Marty, Pierre and Dublineau, Jean (eds), Premier Congrès Mondiale de Psychiatrie Paris 1950: I: Psychopatologie générale. Comptes rendus des séances (Paris: Hermann et Cie, 1952), 381–384 Google Scholar.

40 Ramón Sarró Burbano, Letter to Ludwig Binswanger, 26 July 1956, UAT 443/1068. The first bulletin of the congress justified the choice in almost identical terms: ‘Although we owe to psychoanalysis the greatest progress that psychological medicine of all times has made, the need for it to be confronted with other conceptions of man, among which the most important is undoubtedly the one derived from Kierkegaard or existential anthropology, is increasingly felt’ (Primer Boletín del IV Congreso Internacional de Psicoterapia, Barcelona: Emporium, 1957).

41 Ludwig Binswanger, Letter to Ramón Sarró Burbano, 18 April 1958, UAT 443/1068.

42 Ramón Sarró Burbano, Letter to Ludwig Binswanger, 21 April 1958, UAT 443/1068.

43 Sarró, Ramón, ‘Ludwig Binswanger, fundador del análisis existencial psiquiátrico’, Diario Oficial del IV Congreso Internacional de Psicoterapia, 2 (1958), 1–2 Google Scholar.

44 Ludwig Binswanger, ‘Mensaje para el IV Congreso Internacional de Psicoterapia’, Revista de Psiquiatría y Psicología Médica de Europa y América Latina, IV (1959/1960), 17–19, 19. It should be added that the congress (which was attended by figures such as Medard Boss, Henri Ey, Ernst Kretschmer, Rollo May, Eugène Minkowski and Erwin Straus and supported by a total of 75 scientific societies) had more than 1200 participants and witnessed the presentation of 18 lectures and 38 communications (out of a total of approximately 500) devoted to the central theme (many of them by Spanish psychiatrists). The proceedings were published between 1959 and 1962 in several volumes of the Revista de Psiquiatría y Psicología Médica de Europa y América Latina. See, for instance, the review of the event by Ramón Conde Obregón, ‘La psiquiatría existencial. Nota sobre el IV Congreso Internacional de Psicoterapia, celebrado en Barcelona del 1 al 7 de septiembre de 1958’, Convivium, 5/6 (1958), 101–106.

45 Ramón Sarró Burbano, Letter to Ludwig Binswanger, 6 November 1958, UAT 443/1068.

46 Gonzalo, Justo, ‘Contribución al estudio del esquizoide’, Archivos de Neurobiología, 14 (1934), 909–925 Google Scholar, 919.

47 Ibid., 922.

48 Nieto, Dionisio, ‘Antropología existencial y psiquiatría’, Archivos de Neurobiología, 15 (1935), 411–416 Google Scholar.

49 Justo Gonzalo, ‘Contestación al Dr. Nieto’, Archivos de Neurobiología, 15 (1935), 417–421. In Gonzalo’s defence, the Catalan psychiatrist Enrique Irazoqui Villalonga intervened shortly afterwards in a review on the ‘new orientations’ in the understanding of schizophrenia: ‘To ironise about existential studies by saying that by the same logic one would have to speak of a diabetic existence is to ignore the directions of modern psychology and the directions of current psychopathology and to capriciously undervalue such interesting existential analyses as those of Storch and Binswanger’ (Enrique Irazoqui Villalonga, ‘Planteamiento y orientaciones de la psicología de la esquizofrenia’, Archivos de Neurobiología, 16 (1936), 305–318, 318).

50 Luis Valenciano, ‘Valor de las nuevas orientaciones antropológicas para la psicoterapia’, Archivos de Neurobiología, 16 (1936), 435–454, 454; and Ramón Sarró, ‘Valor de las nuevas orientaciones antropológicas para la psicoterapia’, Archivos de Neurobiología, 16 (1936), 405–433, 425. It should be noted that Sarró had already presented a communication on the ‘renovation of psychoanalysis by the new anthropology’ at the 6th Annual Meeting of the Spanish Association of Neuropsychiatrists held in Granada in October 1932.

51 Ramón Sarró, ibid., 431.

52 Luis Valenciano, ibid., 448. On the Binswangerian notion of ‘existential encounter’ in the framework of the psychotherapeutic relationship, see the excellent article by Susan Lanzoni, ‘Existential Encounter in the Asylum: Ludwig Binswanger’s 1935 Case of Hysteria’, History of Psychiatry, 15 (2004), 285–304. See also the lecture by Binswanger, Ludwig, ‘Über Psychotherapie (Möglichkeit und Tatsächlichkeit psychotherapeutischer Wirkung)’, Der Nervenarzt, 8 (1935), 11–21 Google Scholar, 180–189.

53 Ibor, Juan José López, La angustia vital (Madrid: Paz Montalvo, 1950), 99–134 Google Scholar; and Ibor, Juan José López, ‘Psicopatología de la angustia’, Actas Luso-Españolas de Neurología y Psiquiatría, 14 (1955), 65–73 Google Scholar.

54 As, for example, in his detailed analysis of the ‘existential mutation’ resulting from the ‘reversal of the intentional arrow’ in primary delusional ideas. See, for instance, Ibor, Juan José López, ‘Percepción y humor delirante. Análisis fenomenológico y existencial’, Actas Luso-Españolas de Neurología y Psiquiatría, 12 (1953), 89–102 Google Scholar.

55 Baena, José Aumente, ‘Sobre el planteamiento del problema del “verdadero existir”’, Actas Luso-Españolas de Neurología y Psiquiatría, 10 (1951), 138–157 Google Scholar.

56 After frequenting a famous discussion group in the Café Gambrinus of Madrid where Sartre and Heidegger were collectively read (Lázaro, op. cit. (note 8), 73), one of his first publications was ‘El psicoanálisis existencial de Jean-Paul Sartre’, Actas Luso-Españolas de Neurología y Psiquiatría, 9 (1950), 164–178. Having assimilated Freud’s works in the mid-1950s, Martín-Santos returned to this subject in his posthumous essay ‘Libertad, temporalidad y transferencia en el psicoanálisis existencial’ [‘Freedom, Temporality, and Transference in Existential Psychoanalysis’] (published in El análisis existencial. Ensayos, Madrid: Triacastela, 2004, 149–272). His reading notes on Heidegger’s Being and Time (in the Spanish version by José Gaos published in 1951) were also published posthumously in 1970 and later republished under the title ‘La psiquiatría existencial [Heidegger]’ [‘Existential Psychiatry [Heidegger]’] in El análisis existencial. Ensayos (Madrid: Triacastela, 2004), 67–85. In this regard see also the references included in note 8.

57 Martín-Santos, Luis, Dilthey, Jaspers y la comprensión del enfermo mental (Madrid: Paz Montalvo, 1955), 277 Google Scholar.

58 Martín-Santos, Luis, ‘Fundamentos teóricos del conocer psiquiátrico ’, in El análisis existencial. Ensayos (Madrid: Triacastela, 2004), 123–144 Google Scholar, 139.

59 All these expressions are taken from Luis Martín-Santos, ‘Descripción fenomenológica y análisis existencial de algunas psicosis epilépticas agudas’, Revista de Psiquiatría y Psicología Médica de Europa y América Latina, V (1961), 26–49.

60 Ramón Sarró, ‘La medicina ante Heidegger’, in Medard Boss, Psicoanálisis y analítica existencial (Barcelona: Editorial Científico-Médica, 1958), 3–15, 6, 11. In his article to the Barcelona congress in 1958, Sarró once again praised the approach of the ‘phenomenological–existential’ orientation, but regretted that this had been ‘devoted primarily to the study of psychoses or to pure aspects of psychopathology’ (Ramón Sarró, ‘La interpretación del mito de Edipo en Freud y en Heidegger’, Revista de Psiquiatría y Psicología Médica de Europa y América Latina, IV (1959/1960), 125–141, 141).

61 Ortega-Monasterio, Leopoldo, ‘L’anàlisi existencial a la medicina catalana’, Gimbernat, 1 (1984), 216–222 Google Scholar.

62 Juan Obiols Vié, El caso Julia. Un estudio fenomenológico del delirio (Barcelona: Aura, 1969), 199–236. Sarró went so far as to say that this work constituted ‘one of the most important contributions of the Spanish Psychiatric School to World Psychiatry’ (Ramón Sarró, ‘La aportación del profesor Juan Obiols (1919–1980) a la investigación fenomenológica de los delirios endógenos (comentarios al caso Julia)’, Revista de Psiquiatría y Psicología Médica de Europa y América Latina, XV (1981), 119–122, 120).

63 From this point of view, hypochondriasis could be defined as a ‘dramatisation of the thanatic experience and an attempt at a non-transcendent solution oriented towards somatic concreteness and the arrest of temporality […] by a desire for durability’ (Delfí Abella Gibert, Estudio clínico y fenomenológico de la hipocondría: Resumen de la tesis presentada para aspirar al Grado de Doctor en Medicina, Barcelona: Frontis, 1957, 7).

64 Gibert, Delfí Abella, L’orientació antropològica existencial de la psiquiatria (Barcelona: Institut d’Estudis Catalans, 1962), 26 Google Scholar, 37.

65 Román Alberca Lorente, ‘Las bases del análisis existencial’, Revista de Psiquiatría y Psicología Médica de Europa y América Latina, I (1953), 31–41, 107–121, 31–33.

66 Ibid., 38–39.

67 Ibid., 118–119. It should be added that, after meeting personally at the psychiatric conference held in Munich in February 1956 on the occasion of Emil Kraepelin’s centenary (at which Binswanger was decorated together with Ernst Kretschmer with the prestigious ‘Kraepelin’s Gold Medal’), Alberca sent him an offprint of this work with the following note: ‘I wanted to send it to you after its publication, but I was afraid that you might find it contemptible, that it might seem to you that I had not been able to capture all that is good in your thought’ (Román Alberca Lorente, Letter to Ludwig Binswanger, 22 June 1956, UAT 443/61,2).

68 On Cabaleiro, see David Simón and Emilio González, ‘Una visión de la asistencia psiquiátrica gallega en el siglo XX: Manuel Cabaleiro Goás’, Revista de la Asociación Española de Neuropsiquiatría, 17 (62) (1997), 305–309.

69 Goás, Manuel Cabaleiro, Problemas actuales de las psicosis esquizofrénicas (Madrid: Paz Montalvo, 1954), 233–242 Google Scholar.

70 Goás, Manuel Cabaleiro, Temas psiquiátricos. Cuestiones generales y direcciones de investigación (Madrid: Paz Montalvo, 1959), 119–127 Google Scholar.

71 ‘An anthropological psychiatry, although based on the fundamental concepts of Daseinsanalyse, must aim to penetrate more deeply into each individual case, ie., into the biological and psychological factors which, together with the life history of the patient, structure and condition the actual “being-in-the-world” in each case.’ Manuel Cabaleiro Goás, ibid., 1033.

72 Manuel Cabaleiro Goás, Temas psiquiátricos. Algunas cuestiones psicopatológicas generales (Madrid: Paz Montalvo, 1966), XX, 118. Cabaleiro presented the outlines of his ‘anthropological’ understanding of psychiatry (heavily influenced by the thought of Spanish philosopher Xavier Zubiri) in Manuel Cabaleiro Goás, El camino hacia una psiquiatría antropológica (La Coruña: Real Academia de Medicina y Cirugía de Galicia, 1973).

73 Manuel Cabaleiro Goás, ibid., 142.

74 Among them is Miguel Rojo Sierra, who a year before succeeding Alberca at the Chair of Psychiatry of the University of Valencia published an article in which he went so far as to state that, according to Binswanger, psychiatry should be understood as ‘the study of the abnormal forms of love’ while referring to his experiences with LSD and psilocybin as a means of provoking a ‘vital commotion’ and making patients ‘glimpse the Way of the Self’ ( Sierra, Miguel Rojo, ‘Perspectiva filosófico-existencial en la nueva psiquiatría’, Folia Neuropsiquiátrica, 1 (2) (1966), 33–64 Google Scholar, 41, 56).

75 Regarding this process, see Einar Kringlen, ‘A Contemporary History of Psychiatry’, in Filiberto Fuentenebro, Rafael Huertas and Carmen Valiente (eds), Historia de la psiquiatría en Europa: Temas y tendencias (Madrid: Frenia, 2003), 725–734; and Enric J. Novella, ‘Mental Health Care in the Aftermath of Deinstitutionalization: A Retrospective and Prospective View’, Health Care Analysis, 18 (2010), 222–238. Later, the massive and oversimplified use of the successive editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has also contributed to a remarkable impoverishment of ‘psychopathological culture’ among psychiatrists. See Allan, V. Horwitz, , DSM. A History of Psychiatry’s Bible (Baltimore, MD: The Johns Hopkins University Press, 2021).Google Scholar

76 de Pablo, Ángel González, ‘La Escuela de Heidelberg y el proceso de institucionalización de la psiquiatría española’, in Sociedad de Historia y Filosofía de la Psiquiatría (ed.), Un siglo de psiquiatría en España. Dr. Gaëtan Gatian de Clérambault (1872–1934), Maestro de L’Infirmerie. Certificateur (Madrid: Extra Editorial, 1995), 229–249 Google Scholar, 240.

77 Anne-Cécile Druet, ‘Psychoanalysis in Franco’s Spain (1939–1975). Crónica de una “agonía” anunciada’, in Damousi, Joy and Plotkin, Mariano Ben (eds), Psychoanalysis and Politics. Histories of Psychoanalysis under Conditions of Restricted Political Freedom (Oxford: Oxford University Press, 2012), 153–194 Google Scholar.

78 Ángel González de Pablo, op. cit. (note 76), 236–241.

79 Juan Casco Solís, op. cit. (note 30), 125.

80 On Valenciano’s and especially Cabaleiro’s involvement with early projects of community psychiatric care in Spain, see Lorda, David Simón, ‘Atención psiquiátrica, salud mental y salud pública en el tardofranquismo’, in Pérez, José Martínez and Gil, Enrique Perdiguero (eds), Genealogías de la reforma sanitaria en España (Madrid: Los Libros de la Catarata, 2020), 127–154 Google Scholar.

81 Duro, Enrique González, Psiquiatría y sociedad autoritaria: España 1939–1975 (Madrid: Akal, 1978), 222 Google Scholar, 240.

82 See eg. Fuchs, Thomas, ‘Phenomenology and Psychopathology’, in Schmicking, Daniel and Gallagher, Shaun (eds), Handbook of Phenomenology and Cognitive Science (Dordrecht: Springer, 2010), 546–573 CrossRefGoogle Scholar; and Tamelini, Melissa G. and Messas, Guilherme Peres, ‘Phenomenological Psychopathology in Contemporary Psychiatry: Interfaces and Perspectives’, Revista Latinoamericana de Psicopatologia Fundamental, 20 (2017), 165–180CrossRefGoogle Scholar.