New documentation on the famous case of ‘Ellen West’

In 1944, the Swiss psychiatrist Ludwig Binswanger published an elaborate case history of a patient he diagnosed as having a form of schizophrenia.

In fact, it is a poignant example of anorexia nervosa of the bingeing-purging subtype. After it was translated into English, the case became well known and is often quoted as one of the classic case histories of bulimia. I personally have studied the case from a clinical point of view and published a Dutch translation with comments. But at the time we commented on the case, the original files were not available, so we had to rely on Binswanger’s publication. In the meantime, the hospital files and Binswanger’s personal archives are now at the University of Tuebingen in Germany.

A collaborator of the Institute for the History of Medicine, Albrecht Hirschmueller, has studied the original reports as well as Binswanger’s own notes in detail [Ellen West – a pseudonym – was treated at his private hospital in 1921] and has also found new documentation obtained from Ellen West’s family (including correspondence between her husband and Binswanger). Hirschmueller organized a conference in October 2002 on Binswanger’s hospital with aspecial section on the case of Ellen West. The papers will be published soon (others can be found on the website: http://w210.ub.uni-tuebingen.de/portal/binswanger_tagung/).

To those who can read German, I recommend the detailed report by Hirschmueller recently published in a German journal on the history of psychoanalysis. It is a most fascinating story because you will read about the treatment failures (from Ellen’s viewpoint), interwoven with the psychoanalysts’ countertransferences, and also that Binswanger and the husband have “arranged” or “prepared” Ellen’s suicide!! In fact when I was studying the case ten years ago (and published in Dutch about it) I was puzzled that Binswanger had missed a ‘neurotic’ diagnosis (anorexia nervosa) and defended a ‘psychotic’ one (the ‘incurable’ schizophrenia). I hypothesized that he needed this interpretation to get rid of his responsibility (guilt) and feelings about Ellen’s suicide (Binswanger’s own son committed suicide…). The new documentation confirms this assumption in a most dramatic way!