Surname:

West

First name:

Ellen

Era:

19th century
20th century

Field of expertise:

Other

Place of birth:

(USA)

† 04.04.1924

Patient of Ludwig Binswanger.

Ellen West (1897–1921) was the pseudonym of a patient of the Swiss psychiatrist Ludwig Binswanger, who later published her case study. Having been in treatment for a severe eating disorder with depressions since 1910, she was admitted to Binswanger’s sanatorium in Kreuzlingen in 1921. She committed suicide shortly after her release in March 1921.

Life

Ellen West was probably born to a wealthy and educated Jewish family in the United States and emigrated to Europe with her parents and two brothers when still a child. Her precise background is unknown as medical files are subject to information privacy protection. According to Binswanger (1944), she attended a school for girls but preferred boys’ games and clothes until she fell in love for the first time at the age of 16. As a young woman, she kept a diary and enjoyed reading and writing poetry. When in her twenties, she increasingly suffered from depressive spells. She was interested in literature and started several study courses but never completed one of them (cf. Akavia 2008; Hirschmüller 2003; Studer 1992).

At the age of 21, she developed an extreme fear of “becoming fat”. Binswanger reports that when friends mocked her for having gained weight during a trip to Sicily, West started taking excessive amounts of emetics, laxatives and thyroid drugs to curb her appetite and stay thin. Nonetheless, she was haunted by a constant craving for food (Binswanger 1944: 269). Over the years, she fell in love with several men of whom her parents did not approve. Finally, at the age of 28, she had her parents’ consent to marry her cousin Karl West, a doctor of law. A pregnancy resulted in a miscarriage since West would not adjust her eating habits. In December 1919, when her loss of weight could no longer be ignored, she was seen by Emil Kraepelin, who diagnosed her with “melancholia” (Binswanger 1944: 270). In February 1920, she started a psychoanalysis with Viktor Emil von Gebsattel, who suggested a case of “hysteria”. West abandoned the treatment after only six months, just like a second psychoanalysis with Hans von Hattingberg, which she started in October 1920. Von Hattingberg diagnosed a severe case of “obsessional neurosis” with “manic-depressive” swings (cf. Hirschmüller 2007; Keifenheim 2011: 57–63). Two suicide attempts failed. A doctor who was called in on the case suggested “psychopathy”. Binswanger (1944: 271) diagnosed a “rather severe case of cyclothymic depression with ... strong feelings of anxiety and temporary ideas of suicide”.

Treatment at Binswanger’s Bellevue Sanatorium

Ellen West was admitted to a clinic of internal medicine on 12 November 1920. The doctors in charge could not agree on a treatment. Her family doctor, an internist, demanded that she not continue the analysis with von Hattingberg and transferred her to Binswanger instead. West arrived at Bellevue Sanatorium on 14 January 1921, weighing only 53 kgs. On 24 March, after two-and-a-half months of unsuccessful treatment, Binswanger (1944: 276) consulted his colleagues Eugen Bleuler and Alfred Hoche. Hoche, who had just published the treatise Die Freigabe der Vernichtung lebensunwerten Lebens (Allowing the Destruction of Life Unworthy of Life) together with Kurt Binding, suggested a “psychasthenic” condition, while Bleuler and Binswanger agreed that West “undoubtedly” suffered from “schizophrenia” (schizophrenia simplex). They ruled out any possibility of successful treatment and prognosed that the patient would commit suicide if released. Faced with choosing between release or permanent hospitalisation, West’s husband decided to take his wife home despite the risk of suicide. She left the sanatorium on 30 March. On the evening of 3 April 1921, in the presence of her husband, Ellen West took a lethal dose of Luminal combined with morphine and died the next morning. Binswanger, Bleuler, Hoche and von Hattingberg extended their condolences.

Interpretation in the perspective of daseinsanalysis

Twenty-three years after Ellen West’s death, Binswanger published his case analysis Der Fall Ellen West, eine anthropologisch-klinische Studie (1944; The Case of Ellen West: An Anthropological-Clinical Study) in which he elaborated on the gradual development of an increasingly reified contradiction between West’s inner world and her environment. He wrote that during puberty, she made a “serious attempt at a thorough self-interpretation” (1944a: 74; our translation) but instead developed a wishful, ideational and “ethereal” mental world. Over the years, West increasingly perceived herself as being stuck in a world of gloom, darkness and hopelessness. She was unable to conceive of her life and identity as biographically coherent and imagined a future in an “ethereal” illusory world. Binswanger (1944a: 82) suggested that West’s “fear of becoming fat” marks the point at which the true disorder became manifest. However, this was not the “beginning but rather the ‘end’ of a process of encircling her entire existence, a definite fixation upon the rigid existential contrast between light and dark, flowering and withering, with thin equalling the intellect and fat equalling the opposite” (our translation). This life in two worlds and the stress of the symptoms confined West to a steadily diminishing and tightly constricted circle of existence where death seemed the only way out. Binswanger saw her suicide as a case of rational suicide as the “inevitable fulfilment of the meaning of this life” (1944a: 97).

Controversies and revisions

Binswanger’s case presentation and his retrospective prognosis of suicide raised controversies and have since been revoked in part. Especially the following aspects drew criticism: the role of family members (Lester 1971), the tendency towards overidentification with the patient as is often found in daseinsanalysis (Holzhey-Kunz 2003), the release from treatment and the diagnosis of schizophrenia. Binswanger was also criticised for giving an incomplete picture of the case and for not acknowledging his own responsibility. Carl Rogers (1961: 164 f.) highlighted Ellen West’s fundamental loneliness and her status as an object in the hands of helpless therapists. Hoche’s (1934: 242) autobiographical writings and later-found documents from the Bellevue archive in Tübingen and from relatives (Akavia 2008; Akavia & Hirschmüller 2007, Hirschmüller 2003) suggest that West’s husband assisted in her suicide.

Ellen West wrote numerous diary entries, poems and other texts, including the autobiographical piece Geschichte einer Neurose [History of a Neurosis] written in November 1920 (Akavia & Hirschmüller 2007). The family therapist Salvador Minuchin (1984) wrote a stage play based on her story.

Literature

Akavia, N. (2008): Writing “The case of Ellen West”: Clinical knowledge and historical representation. In: Science in Context 21, (1), pp. 119–144.

Akavia, N., A. Hirschmüller (2007): Ellen West. Gedichte, Prosatexte, Tagebücher, Krankengeschichte. Heidelberg: Asanger.

Binswanger, L. (1942): Grundformen und Erkenntnis des menschlichen Daseins. Zurich: Niehans.

Binswanger, L. (1944): Der Fall Ellen West. Bericht. In: Schweizer Archiv für Neurologie und Psychiatrie 53, pp. 255–277.

Binswanger, L. (1944a): Der Fall Ellen West. Daseinsanalyse. In: Schweizer Archiv für Neurologie und Psychiatrie 54, pp. 69–117.

Binswanger, L. (1944b): Der Fall Ellen West. Daseinsanalyse und Psychoanalyse. In: Schweizer Archiv für Neurologie und Psychiatrie 54, pp. 330–360.

Binswanger, L. (1945): Der Fall Ellen West. Weitere Beobachtungen über Freßgier. In: Schweizer Archiv für Neurologie und Psychiatrie 55, pp. 16–40.

Binswanger, L. (1945a): Der Fall Ellen West. Eine anthropologisch-klinische Studie. Zurich: Orell Füssli.

Binswanger, L. (1946): Über die daseinsanalytische Forschungsrichtung in der Psychiatrie. In: Schweizer Archiv für Psychiatrie und Neurologie 57, (1), pp. 209–235.

Chernin, K. (1981): The obsession. Reflections on the tyranny of slenderness. New York: Harper & Row.

Furt, L. R. (1999): The elusive patient and her ventriloquist therapist: Ludwig Binswanger’s “The Case of Ellen West”. In: L. R. Furst: Just talk. Narratives of psychotherapy. Kentucky: University of Kentucky Press, pp. 193–209.

Hirschmüller, A. (ed.) (2003): Ellen West: Eine Patientin Ludwig Binswangers zwischen Kreativität und destruktivem Leiden. Vol. 1. Neue Forschungsergebnisse. Heidelberg: Asanger.

Hirschmüller, A. (2003a): Ellen West: Drei Therapien und ihr Versagen. In: A. Hirschmüller (ed.): Ellen West – Eine Patientin Ludwig Binswangers Zwischen Kreativität und destruktivem Leiden. Heidelberg: Asanger, pp. 13–78.

Hoche, A., K. Binding (1920): Die Freigabe der Vernichtung lebensunwerten Lebens: Ihr Maß und ihre Form. Leipzig: Meiner.

Hoche, A. (1934): Jahresringe: Innenansicht eines Menschenlebens. Munich: Lehmann.

Holzhey-Kunz, A. (2007): Ellen West. Binswangers daseinsanalytische Deutung in daseinsanalytischer Kritik. In: N. Akavia, A. Hirschmüller: Ellen West. Gedichte, Prosatexte, Tagebücher, Krankengeschichte. Heidelberg: Asanger, pp. 95–109.

Jackson, C., G. Davidson, J. Russell, W. Vandereycken (1990): Ellen West revisited: The theme of death in eating disorders. In: International Journal of Eating Disorders 9, (5), pp. 529–536.

Keifenheim, K. E. (2011): Hans von Hattingberg (1879-1944). Leben und Werk: Inaugural-Dissertation zur Erlangung des Doktorgrades der Medizin der Medizinischen Fakultät der Eberhard Karls Universität zu Tübingen. Tübingen, pp. 58–63.

Lester, D. (1971): Ellen West’s suicide as a case of psychic homicide. In: Psychoanalytic Review 58, (2), pp. 251–263.

Minuchin, S. (1984): The triumph of Ellen West. In: Minuchin, S.: The family kaleidoscope. Images of violence and healing. Cambridge: Harvard University Press, pp. 195–246.

Maltsberger, J. T. (1996): The case of Ellen West revisited: A permitted suicide. In: Suicide and Life-Threatening Behavior 26, (1), pp. 86–97.

Rogers, C. R. (1961): Ellen West – and loneliness. In: C. R. Rogers: The Carl Rogers reader. Edited by H. Kirschenbaum, V. L. Henderson. New York: Houghton Mifflin 1989, pp. 157–168.

Studer, L. (1992): Ellen West (ca. 1890 - ca. 1924): “Das Leben lastet wie eine Wolke auf mir”. In: S. Duda, F. Pusch (eds): WahnsinnsFrauen, Vol. 1. Frankfurt am Main: Suhrkamp, pp. 226–254.

Julian Schwarz, Burkhart Brückner