"If man did not exist as a world-spanning receptive realm of perception, if he were not engaged in this capacity, nothing at all could exist. 'Being,' in its traditional usage, means 'presence' and 'persistence.' To achieve presence, and thereby being, an entity requires some sort of open realm in which presence and persistence can take place. Thus an open realm of perception like that of human existence is the one being that makes being possible."
                                                                                                                                 - Medard Boss


A psychoanalyst and physician inspired by the existential-phenomenological philosophy of Martin Heidegger, Medard Boss set himself the ambitious task of humanizing medicine and psychology from a new existential foundation. Boss, a student of Freud, did not want to do away with the valuable insights of medicine and psychiatry, but rather felt the call to show how the current, modern theoretical pressupositions of medicine and psychiatry were built on faulty theoretical grounds. Not so much as an application of, but rather from a working out of the ground of Heidegger's ontology, Boss felt that psychology and medicine would allow for a place of theory and practice which does a greater justice to the human.

Boss announces this new "paradigm" for medicine and psychiatry as a Daseinsanalysis to differentiate it from Psychoanalysis. However, it should not be misconstrued that Boss' Daseinsanalysis is antithetical to Freud's practice of psychoanalysis; rather, his criticisms are aimed at Freud's meta-psychology. Boss highlights the inherent tension in Freud between his human-science practice and his natural science theory involving "strenous mental acrobatics" due to an "overstepping" of "what was actually experienced and perceived." Boss' struggle with Freud's meta-psychology led him to explore Heidegger's philosophy and, as Paul J. Stern writes: "Not only did Heidegger's ontology propose a reconstructed image of man that boldly abolished long entrenched antinomies, but this image also proved to be amazingly relevant and applicable directly to psychiatry and psychology."

How so? Heidegger's magnum opus, Being & Time, provides a method and ground by which to explore the ontological structure of the human kind of being, which he called Dasein (translated as 'there-being'). Through a hermeneutic-phenomenological method, Heidegger provides a provisional articulation of the 'essential' structures of human existence, which he called "existentials." That is, for Heidegger, there are certain givens of existence, such as sociality, time, space, others, things, etc. How we understand these givens of existence changes historically, yet this foundational structure (or ontology) of human beings constitutes the basis for the dynamic and unfolding direction of the human being's becoming.

Boss' method is what could be called an 'ontic' articulation of Heidegger's 'ontology.' Boss is using Heidegger's method in order to explore psychology and psychiatry and to lay out a human anthropology, whereas Heidegger is concerned with the question of Being, ontology. Thus, Boss' method is phenomenological: it gives a primacy to perception by allowing things to show themselves from themselves in the very way in which they show themselves. Implied here is that Freud's meta-psychology (and any other theory of human existence) is inevitably a second-order abstraction from our lived engagement in-the-world. Boss then, like Heidegger, aims toward a hermeneutic (interpretive) articulation of this lived engagement in our "average everyday" world as human beings.

Stern writes:
"...Heidegger's so-called existentials provided the basis for a new psychodiagnostic scheme. More importantly, his Daseinanalytik directly challenged and led to a radical redefinition of such fundamental notions as reality and reality-testing, dispensed with whatever philosophical respectibility such concepts as the unconscious or repression might have acquired, and highlighted the sterility with which various chronic preoccupations had previously been framed--such as the body-mind question. Heidegger's trenchant philosophical analysis made explicit by Boss, ended up by leveling, to a large degree, traditional distinctions betwen psychic and organic illness. The leveling of the traditional partitions between psychiatry and general medicine was the inevitable corollary." (xiii)

Boss' first book, Meaning and Content of Sexual Perversions, was published in 1947 and focused on case studies of sexual deviants. In this book, Boss describes the sexual deviant as suffering a constricted existence by which he or she is unable to participate in a genuine loving of another human being--a love that is as much spiritual as sensual--due to self-absorption. In his second book, Boss explored the phenomenon of dreaming. From a Heideggerian place, Boss develops a method of dream analysis which allows the dream to reveal its own meaning and, as such, the method avoids, Boss felt, the kind of interpretive violence that can be done in the name of 'analysis.' Most importantly, Boss apprached dreams with the utmost care and regard, giving the dream-world as much ontological significance as waking life; that is, the dream is viewed by Boss as a being-in-the-world on equal footing with the day-world of waking consciousness.

Perhaps one of the most significant aspects of Boss' work is a re-conception of the role of the physician. As Stern writes: "it was no longer enough for the doctor to be an expert repairman of bodily or psychic dysfunctions. The Daseinanalytic healer is called upon to deal with the existential limitations and deficiencies of which, in the Dasienanalytic canon, individual diseases, both psychic and organic, are--or, at least, may be, symptomatic." (xvi) Boss is particularly relevant today as the framer of an alternative paradigm for medicine apart from the cold and inhuman effiency and means-end rationality of the essembly-line approach to medicine which has become economically (and ideologically?) motivated by the rising power of HMOs.

Boss' prelimary work on sexual deviancy, dreams, and the role of the physician culminated in his first global and systematic attempt to re-work Freudian psychoanalysis from an existential-phenological perspective. Boss' Psychoanalysis and Daseinsanalysis (1957) particularly focused on the problem of "transference" in Freud's meta-psychology. In general, Boss persuasively argued, through concrete descriptions of case studies with his own patients in psychotherapy, that Freud's empirical observations, made thematic in his case studies, are inconsistent and abstracted from in his theory. As always, Boss holds a tension between his reverance and indebtedness to Freud while attempting to overcome the inconsistencies in Freud's meta-psychology. Boss suggests that Freud is, in some sense, a closet 'existentialist' whose practice reveals a profound ability to attend to empirical phenomena, which nevertheless, in the theoretical articulation of these phenomena, become veiled by the metaphysical prejudices of his culture. The theory of "transference" is a case in point.

Freud's meta-psychological theory of transference assumes that feelings are thing-like, isolated and detachable phenomena which can be transferred from one person (object) to another. Boss, however, understands feelings as "attunement" in the Heideggerian sense; that is, as a mooded openness to the world with-others. Thus, Boss is able to talk about transference in a way which makes much more theoretical sense and is more true to the concrete experience of "transference" in psychotherapy. In order to understand feelings in such a concrete, existential sense, it is necessary to begin with a new foundation for understanding human existence as a whole. It is this foundation which Boss fully articulates in his Existential Foundations of Medicine and Psychology.

Boss writes:
"We declare that only man exists. This is not to say that material, inorganic nature and nonhuman beings--animals and plants--are in any sense unreal, insubstantial, or illusory beccause they do not so exist. We merely state that the reality of these nonhuman realms differs from that of human existence, whose primary characteristic is Dasein (literally "being-the-there")...Man as man is a manner wholly different from...inanimate things." (xxix)

Medicine, deriving its foundations from Descartes, begins with an understanding of a split between subject and object and between mind and body. As such, medicine approaches the human body as a thing subject to causal, mechanistic processes like inanimate objects in nature. For Boss, however, the human being is precisely not a thing, and thus the body cannot be understood as a thing. Rather, the body is primarily an existential-body, the means by which we are a being-in-the-world and "body-forth" our possibilities. It is as bodies that we exist in existential space. But this space is not the res extensa of Descartes; it is not mere geometrical space. "Human beings," writes Boss, "are, as an open, clear realm of perception, so essentially spatial that they dwell from the beginning with whatever is accessible to perception, and in a way suited to the meaning they perceive." (90) That is, for human beings, spatiality is part of the ontological structure of the human being, without which our being-in-the-world would not be possible. This is a spatiality which is an openness to significance, to how things matter to us. As such, spatiality is meaningful and consists of the context of significance which is the world.

As Being-there (Dasein), the human being is always with the things of the world, "actually at the place where the thing is present." (92) In this sense, the body is not a thing, but the existential center by which things can presence to us in our world-openness. Yet, in my experience, I am not simply here at my body; rather, it is my body which is the openness to the "there" which is the meaningful world of perception. Things, unlike my body, gather a world of meaning. They gather together the contextual signficance of the world as mattering to me as a human being. Thus, too, the thing is not a representation in my head: "When we visualize something, we establish a relationship to the thing itself, not to some mere subjective representation of it inside us." (92) In my experience, I am at the thing, I am in-the-world as a embodied being.

While the human being is spatial, it is equally and just as importantly temporally structured. But the way we live time must be distinguished from clock time. "A watch," writes Boss, "can only tell us how much time it is, how much time has passed, or how much time must still pass before something will occur. These statements are related not to time itself but only to its measurement or calculation." (93) Like space, time is always significant, meaningful; "time is always time for something." (94) Thus, time is not simply a succession of "now-points" along a straight line. Time is part of the very structure of human existence; it is "the basis of our dwelling in the world." To "have" time is to be open to the past, present and future as the world-spanning opennness of human existence. "Having" time, I have it "in such a way that I am expectant of which is to come, aware of what is present, and retentive of what has been." (101)

Space and time, as such, make possible and yet are equiprimordial with human bodyhood. Yet, while natural science views the human body as some self-contained material thing, by doing so it "disregards everything that is specifically human about human bodyhood." (100) The human body, unlike a thing, is not limited like the material borders of inanimate objects. Rather, as a world-openness, human embodiment is an opening onto things "there" in the world, while things are self-contained and have no experience what-so-ever. The human body does not end at the skin, but existentially opens onto a world of possibilities which are significant. "The borders of my bodyhood coincide with those of my openness to the world," writes Boss. "They are in fact at any given time identical, though they are always changing with the fluid expansion and contraction of my relationships to the world." (103)

It is by virtue of the existentials of space, time and body that Boss reveals the equiprimordial existential of human co-existence in a shared world. As spatial-temporal, embodied being-in-the-world, human beings can be together--with each other--"jointly and inherently dwelling in the same relationship to the common objects of their shared world." (106) Human beings are radically social; always already a being-with. Even loneliness or being alone can only be understood first as a condition of our primordial structure as primarily a being-with-others, without which being alone or lonely would not be possible. The human being, therefore, is not first an individual and then social by means of an additive process; rather, the human being is radically social from the very beginning and individuality is secondary to this primordial sociality.

To return to the subject of feelings or moods, Boss shows that the openess of human beingness is always attuned or mooded in one way or another. Boss writes: "The prevailing attunement is at any given time the condition of our openness for perceiving and dealing with what we encounter; the pitch at which our existence is vibrating. What we call moods, feelings, affects, emotions, and states are the concrete modes in which the possibilities for being open are fulfilled. They are at the same time the modes in which this perceptive openness can be narrowed, distorted, or closed off." (110) How one is attuned, then, opens up certain possibilities of relatedness to the world, while closing off others.

As always attuned to the world as a bodying-forth of one's temporal-spatial being-in-the-world, human beings can also be understood as radically historical. "Whether he is aware of it or not," writes Boss, "every human being dwells in tradition and history. Human memory is this constant dwelling in tradition. It constitutes that fundamental human characteristic of historicity." (119) The human being is its history, and that history is there in one's embodied relationship to the world as a particular kind of openness. History opens up possibilities and provides a direction to the becoming of our lives at the same time that it forecloses possibililities and restricts one's possibilities. And this directionality is at any given moment always already an extension from birth to death.

"Death is an unsurpassable limit of human existence," writes Boss (119). Primarily, however, human beings flee from death and the awareness of our mortality. But in our confrontation with death and our morality, we discover the "relationship" which "is the basis for all feelings of reverance, fear, awe, wonder, sorrow, and deference in the face of something greater and more powerful." (120). Boss even suggests that "the most dignified human relationship to death" involves keeping it--as a possibility rather than an actuality--constantly in awareness without fleeing from it. As Boss writes: "Only such a being-unto-death can guarantee the precondition that the Dasein be able to free itself from its absorption in, its submission and surrender of itself to the things and relationships of everyday livingn and to return to itself." (121) Such a recognition brings the human being back to his responsibility for his existence. This is not simply a inward withdrawal from the world--far from it. Rather, this responsible awareness of death as the ultimate possibility for human existence frees the human being to be with others in a genuine way.

From this foundation--based on the existentials described above--Boss is able to articulate an understanding of medicine and psychology which gives priority to the freedom of the human being to be itself. By freedom, Boss does not mean a freedom to have all the possibilites, for we are finite and limited by our factical history and death. Yet within these finite possibilities, we are free to be who we are and to take responsibility for who we are in the world with others and alongside things that matter. Psychotherapy comes into play in cases in which people suffer from "pathological deficiencies of freedom," who, while constricted, still retain a degree of freedom, but a freedom which includes a suffering from constrictedness. The therapist, in this regard, provides the client with a space to free up this constricted existence in order to discover previously foreclosed possibilities of being in the world.

With this existential foundation, Boss is able to describe concretely a more human medicine and psychology which overcomes the mind-body split, the subject-object dichotomy, and physiological reductionism and allows for a freedom within limits--all of which, based on the pressupositions of modern medicine and psychology, were previously impossible.

As Boss said:
"A new vision and understanding of something demands a new way of talking about it, for the old terminology gets in the way of this effort. Stubbornly entrenched behind the words coined by a particular conceptual orientation are its secrete prejudices. Any attempt to open out an adequately human vista onto the phenomena of undisturbed existence must include a critique of the most important idea of traditional biology, physiology, and psychology." (125)


C. George Boeree on Medard Boss
"Ludwig Binswanger, Medard Boss and the Modern World"
"The Psychological in the Neighborhood of Thought and Poetry" by Michael Sipiora
"Emotion, Movement and Psychological Space" by Brent Dean Robbins
"Spirit and Soul in the Therapeutic Relationship" by Brent Dean Robbins
"Reflections on Being a Psychotherapist" by Brent Dean Robbins
"Madness and Liberation: A Journey to Cader Idris" by Brent Dean Robbins
"The Paranoid-Schizoid and Depressive Positions in the Psychogenesis of the Self" by Brent Dean Robbins
"Existential-Phenomenological Psychology" by Brent Dean Robbins
"The Psychotic Dr. Schreber: A Critique of Freud's Theory of Paranoia" by Brent Dean Robbins
"A Phenomenological Social Psychological View of the Contemporary Technological World" by Brent Potter
"Embracing the Body of Culture" by Jeffrey Compton
"Paradoxes in the Therapeutic Relationship" by Magda Denes
"Existential-Phenomenology and Dreams" by Richard Wilkerson
"The Theoretical Foundations of Existential Psychotherapy" by Abdul Hamid Evans
"Communion of Dreams" by Colin Wee
"Horney, Fromm and the Existentialists"
Existential Psychology
"The Existential Megabomb is Still Ticking" by Alvin R. Mahrer
Martin Heidegger page
ReBirth of Wonder


Existential Foundations of Medicine and Psychology
by Medard Boss
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On Dreaming an Encounter With Medard Boss
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Existential-Phenomenological Perspectives in Psychology
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Duquesne Studies in Phenomenological Psychology
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Pathways into the Jungian World: Phenomenology and Analytical Psychology
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