T192. BINSWANGER’S THREE FORMS OF FAILED EXISTENCE AND ITS RELEVANCE FOR CONTEMPORARY PSYCHIATRY

BACKGROUND: Social impairment is a hallmark feature of schizophrenia spectrum disorders and the subject of much research attention. In contemporary psychiatry the principal way of understanding and examining these difficulties is closely linked to the concept of social cognition, but while this approach has yielded valuable results it has still left the bulk of the variance of social functioning unaccounted for. By zooming out from subpersonal constructs and engaging with first hand experiences of lived through sociality, the phenomenological tradition offers a complementary viewpoint. One prominent proponent hereof is Ludwig Binswanger, but unfortunately much of his pivotal work is only accessible in the original German. It is the purpose of this presentation to introduce some of his central but largely overlooked insights to a wider audience and to highlight their relevance for current research and clinical practice. METHODS: A reading of Binswanger’s magnum opus Drei Formen missglückten Daseins of which only a fraction has previously been presented to an Anglophone readership. RESULTS: To Binswanger, schizophrenic existence is, at its very core, marked by a breakdown of natural experience understood as the unreflective and unobtrusive processes which usually afford us a sense of harmony with ourselves, others, and the material world. In its place schizophrenic autism may transpire and be traced in three forms of existential failure: extravagance (“Verstiegenheit”), perverseness (“Verschrobenheit”), and manneristic behavior (“Maniertheit”). These are not mere defects or plain symptoms, but represent modified modes of being in the world, which all testify to a breakdown of the intersubjective dimension. In extravagance a certain disproportion between basic features of human existence eschews the existential “order of preference”, which usually affords us a basic trust in being, a tacit feeling of ontological security, and the possibility of true community with others. Perverseness, then, denotes a replacement of pragmatic prudence and seamless adjustment to the world and others with withdrawal, resistance, and certain private concepts, principles or rules. Finally, manneristic behavior, deeply rooted in a loss of basic trust, represents an inauthentic mode of being in which the self may be defeated in an effort to appropriate some foreign model of existence. DISCUSSION: From Binswanger’s descriptions of these modified modes of existence three key insights emerge, which all challenge fundamental, if often tacitly held, assumptions in current psychiatric research and clinical practice: 1) Intersubjective difficulties are not simple symptoms or add-ons that may or may not be present, but constitutive features of the schizophrenic Gestalt. 2) Intersubjective difficulties in schizophrenia spectrum disorders cannot be reduced to the dysfunction of one or more modular psychological constructs or to mere sequelae of specific symptoms and signs. Rather, they reflect a fundamentally and globally altered structure of subjectivity. 3) Schizophrenic autism and intersubjective difficulties cannot be sufficiently understood in purely behavioral terms as a tendency to withdraw or isolate oneself or as an insufficient stock of knowledge. Autism is neither a neatly demarcated symptom or sign nor a simple defect but transpires through the various clinical manifestations. It is perhaps best understood as a disruption of the basic prereflective attunement with the shared-social world. If taken seriously, these realizations might be helpful in developing novel and complementary ways of understanding and engaging with schizophrenia spectrum patients’ oftentimes altered existential styles.